Saul Marcus, ND - Naturopathic Doctor

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Psychiatry: Treatment & Diagnosis

Psychiatry primarily does two things:

  • Gives patients a DSM diagnosis.
  • Treats patients according to the DSM diagnosis. Typically this means medications (or other therapies such as "electroconvulsive therapy").

I will first review some problems specific to psychiatric diagnosis and treatment. Then I will show how these problems come from conventional medicine itself.

Psychiatric Diagnosis

Published by the American Psychiatric Association, the DSM is used in the United States as the authoritative guide to diagnosing mental disorders. Nonetheless, DSM diagnoses describe no underlining physiology, biochemical, psychological, or structural cause of mental illness.

Cartoon of depression diagnosis. Patients lists symtoms (fatigue, depression, suicide, insomnia, weight loss) and psychiatrist replies that patient has depression>

Psychiatry perpetrates a myth, that DSM diagnoses somehow indicate a "chemical imbalance," in the brain which can be treated with medications.

"Psychiatric medications can help correct imbalances in brain chemistry that are thought to be involved in some mental disorders." From

psych pump

Psychiatry wants people to believe that medications for mental illness are similar to those in other areas of medicine:

"Medications are used by psychiatrists in much the same way that medications are used to treat high blood pressure or diabetes." From http://psychiatry.org

This is not true as high blood pressure and diabetes are diagnosed through objective labs tests. DSM diagnoses are not.

The "chemical imbalance" theory of mental illness

The theory that a "chemical imbalance" in the brain causes mental illness is a sale pitch for psychiatric drugs. It has nothing to do with science. The following are excerpts from just a few research articles that highlight this misconception.

Medical research and the "chemical imbalance" theory of mental illness

From the 2009 article: On Chemical Imbalances, Antidepressants, and the Diagnosis of Depression

Research results testing the chemical imbalance theories for depression have been contradictory to the theories. Analyses of data from studies and meta-analyses of the efficacy of antidepressants indicate selective publication fostering an inflated impression of effectiveness and that antidepressants offer little more than placebos. [...] A biopsychosocial model may be more useful than a disease model for conceptualizing and treating depression. [1]

From the paper: The "Chemical Imbalance" Explanation for Depression: Origins, Lay Endorsement, and Clinical Implications

Considering the research and practice recommendations given regarding the chemical imbalance theory of depression:

  • At present such [chemical imbalance] hypotheses remain unproven, and at least as presented in many television ads, are likely overly simplistic adn oversold
  • There are potentionaly many different causes of depression. We do not know with certainly how or to what degree biology ... might cause depression.
  • If depression did result primarily from a known chemical imbalance, such tests would likely be available and in widespread use, and depression would be easily and quickly resolved for most patients.[2]

Selling the "Chemical Imbalance" myth

The media has often promoted the "chemical imbalance" theory as fact, without supporting evidence.

From the article,The Media and the Chemical Imbalance Theory of Depression

The cause of mental disorders such as depression remains unknown. However, the idea that neurotransmitter imbalances cause depression is vigorously promoted by pharmaceutical companies and the psychiatric profession at large.

The study asked sources for evidence to support the "chemical imbalance" theory. It concluded:

The evidence offered was not compelling, and several of the cited sources flatly stated that the proposed theory of serotonin imbalance was known to be incorrect. [3]

From the article, The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research

[...] the use of psychiatric medications has sharply increased and mental disorders have become commonly regarded as brain diseases caused by chemical imbalances that are corrected with disease-specific drugs. However, [...], the biomedical model era has been characterized by a broad lack of clinical innovation and poor mental health outcomes. [...] The neglected biopsychosocial model represents an appealing alternative to the biomedical approach, and an honest and public dialog about the validity and utility of the biomedical paradigm is urgently needed. [4]

Philosophy of Conventional Medicine

This section will show how the real problems in psychiatry actually come from conventional medicine.

Conventional medicine typically works off of the following assumptions:

  • Symptoms are the problem in and of themselves.
  • The goal of treatment is to reduce symptoms.
  • Symptoms can be classified into distinct diseases, which represent specific pathologies.
  • Distinct tissue pathology can be matched up with a specific treatment (usually medication or surgery) to reduce symptoms.

This model often works well in certain situations such as:

  • Specific infectious disease (ie. Cholera, Tuberculosis).
  • Specific poisons (ie. lead poisoning, abstestos).
  • Nutritional deficiency (ie. scurvy from lack of vitamin C, goiter from lack of iodine).
  • Certain emergency medical procedures.

The conventional model applied to complex, chronic illness

Consider the example of high blood pressure and its various causes:

Most cases of high blood pressure are called "essential hypertension." Officially this has no known cause. But we do know what causes hypertension. It's a combination of different factors, which demand that each case is treated on an individual level. List of the many possible causes of essential hypertension

Since essential hypertension is not a distinct disease entity the quest to find the one, single cause is doomed from the start as it does not exist.

What is allopathy?

Allopathy refers to treating people with therapies that counter symptoms. It is the philosophy of conventional medicine.

The following table compares the difference between Allopathy and Naturopathy. Notice how allopathic treatments merely suppress surface symptoms, but the naturopathic treatment actually helps the body in overcoming illness.

Symptom Allopathic Treatment Naturopathic Treatment
Fever Aspirin - lowers fever Hydrotherapy - to facilitate action of fever
Acid Reflux Drug to block production of acid Herbs to stimulate digestion
High cholesterol Drug to block production of cholesterol Dietary changes, antiinflammatory supplements
Inflammatory bowel disease Steroids to block inflammation Probiotics to regulate gut flora
note: examples are to point out differences in philosophy, these do not represent full treatment plans

Allopathy views the body as a machine which occasionally malfunctions. Symptoms are thus the problem in and of themselves. They have no deeper significance.

Naturopathy views the body as an intelligent, self-organizing system. Symptoms represent the body's attempt to heal itself.

For example, fever represents the body's attempt to heal itself from infection. From a naturopathic perspective it should never be suppressed unless absolutely necessary. In fact it may often be best to help the body produce a stronger fever, to more quickly get over the infection.

The "gold standard" double blind placebo controlled trial

In health care the "gold standard randomized controlled study" is considered the "scientific" way to test treatments.

Flowchart Phases of Randomized Controlled Study

Clinical trials are not worthless. However they do have limitations.

Lets take the example of hyperthyroidism cause by autoimmunity (Grave's disease).

Imagine two patients. Both have the same diagnosis, and symptoms improve with the identical treatment:

: picture of person with graves disease picture of another person with graves disease
Diagnosis Grave's Disease Graves Disease
Response to Drug treatment: Symptoms Improve Symptoms Improve
Response to Supplements: Symptoms Improve Symptoms Improve
Trigger of symptoms: Gluten sensitivity Heavy metal toxicity

There are many potential triggers for a complex autoimmune condition such as Graves. This is a partial list:

  • Emotional stress
  • Food allergies including gluten sensitivity
  • Physical trauma around neck area
  • Toxicity
  • Specific gut pathogens (most notably Yersinia)

Do both patients really have the same condition?

In some ways yes, and in some ways no.

Classifying disease into discrete diagnoses helps to organize medical text books, and gives insurance companies diagnosis codes used to regulate medical care.

However, the concept of discrete diagnoses is an abstraction. In the real world every patients is different. Their symptoms do not fall neatly into a system of discrete diagnoses. When doctors attempt to treat the disease instead of the patient unique individual factors become invisible.

The endocrinologist treating Graves disease is not going to accidently stumble upon causal factors like Gluten Sensitivity because it's outside the narrow frame of reference of direct thyroid pathology.

Yet the continued message we get from conventional medicine and the media, is that we need more research in order to fight and find "the cure" for complex disease.

For example, finding "the cure" for breast cancer implies that somewhere, waiting to be discovered is the one single cure for all breast cancer.

In fact, the very concept of cancer of treating the individual with cancer (instead of the cancer itself) has been swept aside. Cancer is now the external enemy that randomly attacks people.

Researches do write about the multi-factorial nature of chronic disease. It is understood that complex chronic disease can not be reduced down to just one thing. However, the medical system as a whole is geared towards the production of drugs targeted at the treatment of disease. Not at treating the individual.

Allopathy and Homotoxicology

Suppressive drugs don't cure illness, they move it around.

For example, consider the person who takes antibiotics for a sore throat, only to develop a urinary tract infection later on.

What happened?

Bacteria can not proliferate in the upper respiratory system unless the environment allows it. A sore throat is not the problem. It is the body's attempt to heal itself of the problem.

Antibiotics are a suppressive therapy. They shut down the body's superficial attempt at detoxification. This causes disease to move "deeper" into the body, (ie. from the tonsil to the urinary tract in this example).

In the system of homotoxicology this is called progressive vicariation.

When taking detailed patient histories it is often seen how suppressive drug therapies for superficial symptoms proceed the onset of more severe illness. However the different illnesses are considered unrelated in conventional medicine.

True healing does not suppress symptoms, forcing disease deeper into the body. It actually opens up pathways of elimination, so disease can leave the body. This is why there are often detoxification responses such as skin rashes, increased mucous production, more frequent bowel movements, etc... In homotoxicology this is called regressive vicariation.

Progressive Vicariation, and Regressive Vicariation

When we take drugs, herbs, supplements or any other medicinal agent, they can trigger one of two possible reactions:

  • A toxic reaction. Toxicity may suppress symptoms, giving the superficial appearance of better health, or there may be a clear toxic response. Either way, disease is moving deeper into the body (progressive vicariation).

  • A healing/detoxification effect. There may be immediate symptoms relief, or provocation of symptoms as a detoxification response (regressive vicariation). Either way, disease is moving out of the body.

Change of symptoms must be interpreted in terms of progressive or regressive vicariation!

simple diagram of homotoxicology

How do drug trials contextualize symptoms?

They don't!

Drug are assigned an "intended effect," and unwanted actions are called "side effects."

How do researchers tell if a reduction in symptoms is a true healing response, or toxic suppression of symptoms?

Answer - they don't.

How do researchers tell if unwanted symptoms (so called "side effects") are caused by a direct toxic effect, or some provoked detoxification reaction?

Answer - they don't.

Simply counting the seemingly good and bad results of a drug or supplement gives no framework to understand its actions. Detoxification reactions must be differentiated from direct toxic effects. True healing must be differentiated from symptoms suppression.

flow chart

Clinical trials as toxicology studies

Clinical trials use something called a "benefit / risk" assessment.

But when drug poison are used both the "benefit" and the "side-effects" are toxic responses. So in effect, researches judge if the perceived "benefit" of symptom suppression, out weighs the "side effects."

In certain extreme cases there may be validity in using such poisons. For example, hypertension medication to bring down out of control blood pressure.

However, the whole system is built off of the belief that poisoning the body with toxic chemicals, so it is less capable of producing symptoms lead to greater health.

It is the union of allopathy, with a bizarre pharmacological fetish (faith based belief that synthetic drug poisons are inherently better, or more "scientific" then natural substances the human body evolved to recognize) which has created the "gold standard double blind placebo controlled trial," as currently used.

Psychiatry - an extension of conventional medicine

Holistic systems of health care, do not force the same diagnosis and treatment on patients because they have the same superficial symptoms. For this reason two people may go into see a Naturopathic Doctor for the same "disease," yet get very different treatments.

Holistic systems are patient focused, whereas conventional medicine is disease focused.

In terms of being diseased focused, psychiatry is no different than other branch of medicine.

Dermatology Gastroenterology Cardiology Psychiatry
Eczema is suppressed with steroids. Acid reflux is suppressed with ant-acids. Elevated cholesterol is suppressed with statin drugs. Anxiety is suppressed with drugs that numb mind.

Where psychiatry differs is that it's diagnoses are largely subjective. There are no lab tests for psychiatric diagnosis.

Where psychiatry is the same, is the belief that health can be produced suppressing symptoms with all manner of drug chemicals (and other suppressive treatments).

So just as the cardiologist will poison the liver to prevent it from making too much cholesterol, the psychiatrist will poison the brain to prevent it from making someone feel anxious.

Psychiatry and allopathy

Even though the DSM is totally useless at identifying the cause of illness, as far as psychiatry is concerned this doesn't matter. Psychiatry simply wants to match up symptoms, with corresponding suppressive drugs. The actual cause of symptoms (which can be related to psychology, nutrition, toxicity, or structure/physical trauma) is irrelevant.

Psychiatric drugs are not therapeutic agents. They do not correct an underlining "chemical imbalance." That would produce an overall effect consistent with regressive vicariation. We would see improvement with regards to the deep mental symptoms (including better mental function), and various signs of detoxification as the body worked out the disease from more deep to more superficial.

Instead psychiatric drugs produce numerous "side effects." This reveals their true nature; poison.

Psychiatric drugs and clinical trials

Running clinical trials on things such as "depression" is completely removed from what a truly holistic and "scientific" approach should be.

The underlining assumption is that all people who are diagnosed with "depression" are alike. That they must all have the same condition. This foundation assumption has is based upon nothing.

One person may feel "depressed" due to psychological abuse and another due to chronic viral infection and poor immunity. What is to be proved by lumping them together with people who feel depressed due to any number of other reasons and seeing how well they respond to some neurological drug poison?

Yet somehow this pseudo-science farce passes as "scientific" research.

Trials need to utilize more narrow criteria. For example, if a group of depressed people was screened for signs of viral infection. Then a trial could be made on that group. Perhaps a natural substance like monolaurin which is good for chronic viral infections could be given.

Ultimately, clinical trials are limited because everyone is different. It is up to the practitioner to take abstract data, and apply it to the individual. This is part of the art of being a physic an. No two people have the exact same condition. But using more narrow (and rational) criteria can make studies more useful.

Image of 3 concepts, all linked together, allopathy, pharmaceutical drugs and double blind randomized studies

Allopathy dictates that symptoms are treated by suppressing them (instead of actually treating the cause). Thus allopathy will rely more on poisonous drugs because they are most suppressive. From this philosophy of better health through poisoning the patient, medicine has turned the clinical trial into a toxicity study, masquerading as health research.

The fact that treatments are considered "scientific" and "evidence-based" based upon how well they suppress symptoms just goes to reinforce this whole system.

History of psychiatry

Through its history psychiatry has believed in improving mental health by physically harming the patient.

There are many examples of this; electroshock therapy (renamed electroconvulsive therapy to sound humane), lobotomy, and going further things which would be considered tortured today (ie. Benjamin Rush's tranquilizer chair).

The thesis seems to be that the body and brain of the mentally ill patient is inherently defective. Health enhancing therapies (stress free environment, proper nutrition, herbal medicine, detoxification, etc...) are thus pointless. Instead the physician must somehow physically destroy the inherit defect.

In a reductionistic leap psychiatry assumes mental illness must lie within the brain (never mind that the brain is connected to the rest of the body, and health of the whole person affects how we feel). Therefore correcting the inherit defect means doing something to the brain itself.

Certainly Prozac is more selective then electroshock, or frontal lobotomy. Nonetheless, the philosophy of damaging the body in order to render it less capable of of producing symptoms remains the same. This is allopathy. This is conventional medicine. Psychiatry is not some unscientific aberration (as many people who are against psychiatry claim). It is simply an extension of conventional medicine.

In some ways psychiatry is worse. Other physicians treat objectively verifiable illnesses. Psychiatrists make up their illnesses in conference rooms and the print them in the latest version of the DSM.

Nonetheless, the psychiatrist is trying to do the exact same thing as his/her counterpart in physical medicine. That is throwing all manner of suppressive treatments at a symptoms in order to eradicate it. Health care in name, but disease care in practice.

The one treatment supported by psychiatry which is an exception is talk therapy. While this can help people, this does not excuse the numerous dangerous treatments psychiatry has promoted in the name of mental health.

 

References

[1] Leventhal, Allan, and David O. Antonuccio. "Chemical Imbalances, Antidepressants, and the Diagnosis of Depression." Ethical Human Psychology and Psychiatry 11.3 (2009): 199-214. Print. Link to abstract

[2] France, Christopher M., Paul H. Lysaker, and Ryan P. Robinson. "The "Chemical Imbalance" Explanation for Depression: Origins, Lay Endorsement, and Clinical Implications." Professional Psychology: Research Adn Practice 38.4 (2007): 411-20. Print. link to article

[3] Leo, Jonathan, Lacasse, Jeffrey. "The Media and the Chemical Imbalance Theory of Depression." Society© Springer Science + Business Media, LLC 200710.1007/s12115-007-9047-3 link to full article

[4] Brett J. Deacon, The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research, Clinical Psychology Review, Volume 33, Issue 7, November 2013, Pages 846-861, ISSN 0272-7358, http://dx.doi.org/10.1016/j.cpr.2012.09.007. (http://www.sciencedirect.com/science/article/pii/S0272735813000482) Link to full article

 

 

 

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