Biological Psychiatry: A Practice in Search of a Science
Wyatt, W. Joseph, Midkiff, Donna M., Behavior and Social Issues
The rise of the biological causation model in the past thirty years is traced to psychiatry's efforts to regain lost status and to protect itself from intrusions by non-medical practitioners, as well as to the pharmaceutical industry's drive for profits. Evidence in support of the model, including studies of identical twins and of brain structure and function, are less revealing than was earlier thought, due to problems in methodology and interpretation. Organized psychiatry, when challenged in 2003, was unable to provide compelling evidence for biological causation of most mental and behavioral disorders. A paradigm shift away from biological causation and toward environmental causation is called for.
KEYWORDS: biological causation; pharmaceutical industry; organized psychiatry; efficacy of psychotropic medications; identical twins; brain imaging; paradigm
The term "biological psychiatry" describes a phenomenon of increasing visibility in both the professional and popular cultures in the past thirty years. It reflects growing acceptance of the notion that chemical imbalances, genetic defects and related biological phenomena cause disorders such as schizophrenia, depression, anxiety, substance abuse, and attention deficit hyperactivity disorder (ADHD). As biological causation has gained attention, acceptance of environmental causation has necessarily declined, and psychotropic medications have become the treatment of choice for mental and behavioral disorders (Antonnucio, Danton & DeNelsky, 1995).
However, an examination of the contributing variables, not all of which are empirical, suggests that the research in support of biological causation is weaker than one would expect, given its increased acceptance over the past three decades. Similarly, there are reasons to think that the claims of drug effectiveness are at times overstated (Glenmullen, 2002; Hubbard & WaId, 1997; Valenstein, 1998).
PSYCHIATRY'S ANXIOUS YEARS
To understand the rise of biological psychiatry's influence, it is necessary to examine the changing public face of psychiatry over the past few decades. "Psychiatry's Anxious Years" was the title of an early 1980s New York Times article (Nelson, 1982) that described an evident crisis in psychiatry, and psychiatry's reaction to that crisis. The percentage of medical school graduates opting for careers in psychiatry had dropped by more than half from 1970 to 1980, from 11% to 5%. The Times article listed several reasons why decreasing numbers of young physicians had opted for careers in psychiatry. The reasons included the relatively low pay of psychiatrists and increasing interest in family practice. There were additional reasons that foreshadowed a return to an increased emphasis upon the connection between biology and behavior. First, many medical school graduates had developed the perception that psychiatrists had become "dinosaurs," mired in pits of psychoanalytic confusion. Also, young physicians were not buying into fringe treatments such as primal scream therapy and nude encounter groups that had arisen within the mental health arena during the 1960s. The Times article described the efforts of organized psychiatry to reverse the trend by doing two things. It held recruitment strategy conferences such as one in San Antonio in the late 1970s, and it began to emphasize science, or what passed for science-to advocate a return to biological explanations of mental illness (Nelson, 1982).
As psychiatry was returning to biological causation, another concern emerged. Movement into the treatment field by non-physicians such as clinical psychologists, clinical social workers, psychiatric nurses, counselors and others was escalating. As the 1980s, 1990s and early years of the new century played out, the battles over Medicare reimbursement, hospital privileges and prescription privileges were joined. Those disputes continue today (APA Deplores, 2004). …