"Can I see the test results, please?"
Let’s start with a true story. A colleague of mine in the US heard that her grandson had been admitted to a psychiatric hospital. As a long-standing critic of the psychiatric system she was concerned for his welfare and went to see him. She discovered that in the first few days he had been drugged into a stupor and she insisted on seeing the medical staff. Three psychiatrists told her that, sadly, her grandson had a bipolar disorder caused by a brain bio-chemical imbalance. Quietly, but firmly, she asked what evidence they had there was something wrong with his brain. They said that his mood and behaviour indicated a serious problem. She asked how they knew this problem was caused by brain biochemistry. Slightly uncomfortable, they vaguely referred to studies that indicated that this was the case. Much more confident now, my colleague responded that she knew of no studies that had ever confirmed this idea even though it is a common assumption in the psychiatric world. For good measure she quoted some studies that indicated that there was nothing wrong with the brains of people with all sorts of psychiatric labels. Sensing that they were dealing with someone who might actually have read the literature they asked what she wanted. Her grandson was quickly transferred to a unit offering talking therapies.
My colleague didn’t ask the question that all patients, relatives and advocates should ask when confronted with the claim that a brain biochemical problem lies at the root of someone’s low mood or strange behaviour. She could have said, "Can I see the test results, please?" The truth is that, unlike all other branches of medicine, psychiatrists do not do physical tests on people to confirm their diagnoses. The reason is simple: there is nothing wrong with the brains of people diagnosed schizophrenic, bi-polar, depressed and so on. The organic hypothesis remains just that; an unproven hypothesis.
Claims continue to be made in the scientific literature and popular press. David Cohen, another US activist, has noted that almost all the substances operating within the human body have been investigated as a possible cause of schizophrenia. This research is leaked to the press before it has been accepted in a peer-reviewed journal and "the results are likely to be cited around the world, thought they may never make it to scientific publication". We are also well aware of the massive conflicts of interest involved in the studies that do finally appear in the official literature. Effective Health Care, in reviewing the newest so-called anti-psychotic medication concluded, "Most relevant trials are undertaken by those with clear pecuniary interest in the results"1.
There is no validity in psychiatric diagnosis2,3. Even if there were, after almost two hundred years, we have never found anything at all wrong with the brain biochemistry of people diagnosed with a host of so-called disorders. Some, conditions, for example, Alcohol-induced dementia do indeed show real signs of brain damage. This is rare. The studies on all the main diagnostic categories of psychiatry, however, are plagued by a significant problem: the people being tested have almost always already received psychotropic medication. In other words, if there is a blood, brain or liver disorder, this may well have been caused by the drugs, or ECT. Physical tests on people diagnosed, but not yet treated, by psychiatrists, would be the only way to find out if there really were a difference between these people and the general public. This never happens as most people first encounter a GP who, instead of asking for blood and other tests to demonstrate a psychiatric condition, simply prescribe a psychotropic drug or refer on to a psychiatrist.
Imagine the same situation in oncology. You are told that you look like you have cancer. There are no tests offered to you. You are told you will have two operations, followed by radiotherapy and a course of drugs that makes your hair fall out. The idea is preposterous. You demand proof of your condition. An x-ray, a CT scan and blood and liver tests reveal that the diagnosis was accurate. Reassured, though still very scared you agree to the treatment.
Psychiatrists of course do ask for tests like CT scans on their patients but these are to exclude the possibility of organic damage. In other words, they are checking to see if there is a real brain problem, evidence of illegal drug-use or whatever. Once they have concluded from the test results that there is nothing amiss with the patient’s brain or biochemistry they tell the person that they have a condition that results from a biochemical problem. But they don’t have a test that could prove that a so-called mental illness was actually organic in origin. That’s why psychiatrists tend not to bother with tests of neuro-transmitter levels. Studies have failed to demonstrate that people with the commonest psychiatric diagnoses have a brain-biochemical imbalance. Despite this, all sorts of assumptions are made by psychiatrists and others. These assumptions lead to the use of drugs or ECT to correct imaginary biochemical problems.
So next time you are told that a psychiatric condition is due to a brain bio-chemical imbalance, ask if you can see the test results.
1NHS Centre for Reviews and Dissemination (1999) Drug Treatment for Schizophrenia. Effective Health Care 5, 1-12
2Boyle, M. (1999) Diagnosis. In C. Newnes, G. Holmes, and C.Dunn (eds) This is Madness: A critical look at psychiatry and the future of mental health services. Ross on Wye: PCCS Books
3Kutchens, H. and Kirk, S.A. (1997) Making us Crazy: DSM – the psychiatric bible and the creation of mental disorders. London: Constable
Craig Newnes is Psychological Therapies Director for Shropshire’s Community and Mental Health Services NHS Trust.