In the mental health system, the biomedical model is the dominant paradigm. It depicts mental disorders as chronic diseases requiring lifelong treatment with medication (like diabetes or high blood pressure). This model of mental illness has been under attack in the US, where an estimated 20 percent of the population regularly takes psychiatric medications.
Arguments against the biomedical approach intensified during the past decade as consumer advocates became more vocal, and researchers and journalists challenged the veracity of the disease model of mental disorders. However, given the vast number of people suffering from psychological distress, reliance on medication continues. Furthermore, for persons suffering from mental disorders, the situation is often dire. Around the world, more people die from suicide than homicide.
Some of the most damaging criticisms of the biomedical approach came from researchers in the field. For example, an often-cited review article revealed duplicity surrounded published accounts of the efficacy of selective serotonin reuptake inhibitors, or SSRI antidepressants. The article concluded pharmaceutical companies and psychiatric researchers published studies that confirmed the effectiveness of SSRIs while excluding studies that had negative or questionable results, leading to an overstatement of the efficacy of these drugs by as much as 30 percent. A more recent study showed about a quarter of the people taking SSRIs are potentially made worse by them.
A deluge of lawsuits against pharmaceutical companies also fueled increased skepticism towards the practice of treating mental illness with medications. For example, the pharmaceutical company Eli Lilly came under attack for downplaying health risks caused by the novel antipsychotic Zyprexa, a medication used to treat schizophrenia and bipolar disorder. Eli Lilly was aware of the increased risk of obesity and diabetes occurring with Zyprexa, but consistently denied such correlations existed with long-term use of the drug. Furthermore, Zyprexa use led to deaths in the elderly. Meanwhile, the controversy linking SSRIs use with suicidal and homicidal acts continues.
Some of the most damning evidence against the biomedical paradigm came from investigative reporter Robert Whitaker. Combing through decades of psychiatric research, Whitaker reached the conclusion that the current practice of treating mental illness as chronic disorders is a “failed paradigm of care.” According to Whitaker, psychopharmacology is actually creating chronic illness. Since the debut of psychopharmacology over 50 years ago (initiated by the introduction of Thorazine and Haloperidol), patient outcomes have gotten worse, and more people have become disabled by mental illness. Persons treated continually with psychotropic medications suffer from more physical ailments and are more chronically ill; they are straddled with higher unemployment; and they die as much as 25 years earlier. Furthermore, evidence suggests the medications perturb otherwise normal functioning, including normal mental functioning.
(Note: As the SSRI Stories Website states, “Withdrawal can often be more dangerous than continuing on a medication. It is important to withdraw extremely slowly from these drugs, usually over a period of a year or more, under the supervision of a qualified specialist. Withdrawal is sometimes more severe than the original symptoms or problems.”)
Given the extent of the evidence against the current biomedical approach, there has been a push for reform reminiscent of the anti-psychiatry movement of the 1960s and 1970s. Yet rather than questioning the entire enterprise, many believe the system plays a necessary role in US society, and the goal should not be its demise, but rather a more scientifically rigorous and humane mental healthcare system committed to patients’ needs and not the pharmaceutical industry’s profits or researchers’ professional ambitions.
Increasingly, scientific evidence points to the body’s natural response to stress as the likely culprit leading to mental disorders later in life. Whereas the body’s stress response is a natural defense, research now shows too much activation early in life leads to diseases and mental disorders later on. Recent studies revealed:
• Childhood maltreatment reduces the volume of the hippocampus, a region of the brain responsible for creating long-term memories. Specifically, volume reduction in the subiculum region of the hippocampus, which relays information from the hippocampus to other parts of the brain, reduced signaling to the dopamine system the need to regulate the body’s response to stress. Researchers associate volume reduction in the subiculum with addictions, depression, and schizophrenia.
• Traumatic stress impacts the immune system, causing inflammatory responses in the brain that are linked to mood disorders, autism, and schizophrenia. Early life stressors contribute to an over-active immune system, as well as impacting initial brain development. (On a hopeful note, compassion-focused meditation may reduce inflammation. Conversely, research showed loneliness activates the immune system’s inflammatory response—one more indication that loving attachments contribute to good health.)
Abuse, neglect and other traumatic childhood experiences are so prevalent in the US that trauma specialist and psychiatrist Bessel van der Kolk claimed the most important health problem facing Americans is childhood traumatic stress. Referred to collectively as “adverse childhood experiences,” these traumatic stressors include recurrent physical abuse; recurrent emotional abuse; sexual abuse; an alcohol and/or drug abuser in the household; an incarcerated household member; living with someone who is chronically depressed, mentally ill, institutionalized, or suicidal; domestic violence; one or no parents in the household; and emotional and physical neglect. Based on self-reports of over 17,000 adults in America, a study conducted by Kaiser Permanente and the Center for Disease Control and Prevention (CDC-P) concluded that more than two-thirds of the participants in the study had at least one adverse childhood experience when growing up, while over two-fifths have a history of at least two of these experiences. When extrapolated to the general population, this study suggests a majority of US citizens have histories of childhood traumatic stress, a conclusion other studies support.
In his book, The Truth About Mental Illness, psychiatrist Charles Whitfield gives exhaustive lists of studies that found a relationship between childhood traumatic stress and the later development of mental disorders. He makes this point not only for post traumatic stress disorder—the classic diagnosis given to the trauma survivor—but for many disorders in the Diagnostic and Statistical Manual of Mental Disorders, including anxiety disorders, mood disorders, alcohol and other drug problems, eating disorders, personality disorders, ADHD, schizophrenia, as well as various physical illnesses. Furthermore, persons exposed to multiple adverse childhood experiences are at increased risk for suicide.
Despite mounting scientific evidence, the trauma model faces an uphill battle. Trauma-focused studies tend to underscore the US’s failure to protect its most vulnerable members as well as challenge deeply held beliefs about the family. Furthermore, according to anthropologist Pat Shipman, the genetic essentialism underlying the biomedical model is an attitude that often becomes entrenched when governments are reluctant to support large social programs, which traumatic stress studies imply the US desperately needs.
If the trauma model becomes the dominant paradigm, some of the conditions that allow the US to compete economically should come into question. For example, as the US adapts to a more competitive global marketplace, limited access to health care (including mental health care) has insidiously become the norm for many US workers. However, we have reached a point in our society’s evolution when we must ask ourselves if our well-being is better served by increased competitiveness or by more compassion. I hope we make the right choice.
Shipman, Pat. 1994. The Evolution of Racism. New York: Simon & Schuster.
Whitaker, Robert. 2010. Anatomy of an Epidemic. New York: Crown Publishers.
Whitfield, Charles L. 2004. The Truth About Mental Illness: Choices for Healing. Deerfield Beach, FL: Health Communications, Inc.
© 2012 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).