A Neuroscientist Says No to Drugs
The Chronicle of Higher Education http://chronicle.com Section: Research & Publishing Page: A10 Letters to the Editor: firstname.lastname@example.org From the issue dated December 4, 1998 TREATING MENTAL DISORDERS A Neuroscientist Says No to Drugs By JOSHUA ROLNICK
Elliot S. Valenstein has spent most of his career searching for biological explanations for behavior. Now, after more than 40 years, he is attacking the prevailing biochemical explanations for mental illness.
"We have almost reached the point where there will be no limits to what people will believe brain chemistry can explain," he writes in the introduction to his new book, Blaming the Brain: The Truth About Drugs and Mental Health (The Free Press). It's time to stop blaming mental disorders on brain chemistry, he argues.
In simple terms, the biochemical theory holds that clinical depression, schizophrenia, and other disorders result mainly from chemical imbalances in the brain. Drugs like Prozac and lithium are supposed to work because they correct such imbalances.
In his book, however, Mr. Valenstein, an emeritus professor of psychology and neuroscience at the University of Michigan, argues that scientifically, the biochemical explanation of mental illness rests on shaky ground. Environmental and cognitive variables are as important as biology, he writes, and psychotherapy is often just as effective as drug treatments, which pharmaceutical companies, psychiatrists, and others have successfully promoted.
Mr. Valenstein, a former chairman of Michigan's biopsychology program, seems an unlikely crusader. In his years of research on rats and other laboratory animals, and in more than 140 scholarly articles, he studied how the brain and other biological factors, such as hormones, influence behavior.
In the latter part of his career, the psychologist grew more interested in the history of his field -- a history he has not always praised. In Great And Desperate Cures (Basic Books, 1986), he argued that scant scientific evidence supported the use of lobotomy to treat certain mental disorders, even though doctors and the public embraced the procedure in the 1940s.
When Mr. Valenstein began his new book three years ago, he planned to write a history of brain-chemistry theory, not a critique.
"I used to lecture to students and put together a reasonably coherent story," he says. "I knew there were gaps, but this was an emerging science." By the time he was halfway through writing the book, however, his skepticism had become unshakable. "I began to feel that the evidence that didn't fit was becoming overwhelming."
A combination of factors gave rise to the acceptance of drug treatments for schizophrenia and other mental disorders, he argues.
Researchers sometimes stumbled upon the drugs inadvertently, he writes. For example, one drug that is rarely used now, chlorpromazine, originally a synthetic dye, was one of the first antipsychotic medications, after scientists concluded that it might help treat post-surgical shock. "With no effective treatment of mental illness," he writes, "almost anything that held out any hope was worth trying."
As scientists learned more about the brain and its interaction with certain drugs, theories emerged to explain several major illnesses.
Schizophrenia, for example, was believed to result from too much activity of dopamine, a neurotransmitter. The theory evolved when scientists discovered that, on the whole, the more an antipsychotic drug blocked the action of dopamine in the brain, the more the symptoms of schizophrenia were eased, Mr. Valenstein explains. But researchers have failed to find direct evidence that dopamine is, in fact, too active in the brains of schizophrenics, he says. And although most antipsychotic drugs did restrict dopamine activity after a few hours, he writes, they had no therapeutic benefit for the first few weeks of treatment.
As a result, Mr. Valenstein writes, one study found that the drugs helped only about 60 per cent of schizophrenics. Similarly, he says, antidepressants appear to help only 30 to 40 per cent of patients. Mr. Valenstein argues not that drugs never work, but that they do not attack the real cause of a disorder. Biochemical theories, he argues, are an "unproven hypothesis" -- and probably a false one.
The pre-eminence of drug treatments is no accident, he goes on. Pharmaceutical companies have a financial stake in their popularity, and promote them heavily among doctors and patients. Mr. Valenstein cites studies that examined some of the literature distributed by the companies and found that much of it contained misleading or unbalanced information.
Drug companies are also the largest sponsor of medical research in the United States and Canada, Mr. Valenstein says. In some cases, they give complete freedom to researchers. In other cases, the contracts they require give them the right to exclude information from published reports, or to delay publication of the report itself.
A spokesman for one company Mr. Valenstein criticizes, Eli Lilly and Company, declined to comment. Another, Pfizer Inc., did not respond to requests for comment.
Psychiatrists, too, have supported the use of the drugs, he argues. For one thing, he says, an emphasis on medication allows psychiatrists to fend off competition from psychologists and social workers, who usually charge less for their services, but who cannot prescribe drugs. While that may not be the reason for their support, he writes, "there is little doubt that since the 1960s, psychiatry has increasingly emphasized biochemical factors as the cause of mental disorders."
Paul H. Wender, a professor of psychiatry at the University of Utah, denies that psychiatrists favor drug treatments as a way to limit competition. "There have been 2,000 studies of the efficacy of psychotropic drugs in schizophrenia," says Dr. Wender, co-author of Understanding Depression, a book Mr. Valenstein criticizes.
"To argue that psychiatry has a medical passion is untrue," agrees Donald F. Klein, Dr. Wender's co-author. Theories aside, he says, psychiatrists prescribe drugs because they work.
Mr. Valenstein emphasizes that he does not intend to discourage patients from trying medication as one option. But he hopes that Blaming the Brain will open up a dialogue about the biochemical theory of mental illness, even as physicians feel increasing pressure to ignore other treatments, like psychotherapy, in favor of costly drugs that may have serious side effects and little benefit.
Right now, he writes, "the theory is being pursued relentlessly on a path filled with many dangers."
Copyright ) 1998 by The Chronicle of Higher Education
Posted by Jeffrey A. Schaler, Ph.D.
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