Schizophrenia

The dopamine hypothesis of schizophrenia

Our mental health system is currently based under a medical/biological model of mental disorders.  The causes and mechanisms of schizophrenia are currently not known.  It is suggested that it may be due to genetics or through an abnormal imbalance of neurotransmitters within the brain, more specifically involving the dopamine pathway. However, this evidence is based more on wishful thinking rather than on good, sound, and empirical science.

The psychiatric revolution began in the 1930’s with the introduction of lobotomy. Through this idea that changing the brain (in the case of lobotomy, through cutting an actual hole inside the brain) causes change and “fixes” behavior, psychiatry attached itself to neuroscience. The lobotomy itself is a rather quick procedure, considering if would “fix” a potentially long-lasting and permanent “condition”. This is the beginning of a long list of quick fixes that our society has become so attached to. I cannot begin the fathom that we as a nation honestly believe that such drastic changes within our behavior could be attributed so easily, so quickly, and so effortlessly through such crude mechanisms like lobotomy in the 1930’s and later with psychopharmacological revolution of the 1950’s with the introduction of Thorazine – the very first antipsychotic, which was thought of as a chemical substitute to lobotomy. It was the chemical equivalent to lobotomy, and it was through this convenience and alternative that instead of undergoing such an expensive and massive procedure as lobotomy, now we can fix our brains with these tiny capsules.

Especially now, this has become most apparent for my generation – the drugging of America’s children is indeed one of the most important problems and is currently in desperate need for a call for help. Sure, antipsychotics for treatment of schizophrenia has decent short-term efficacy, but there is no long-term efficacy for treating someone suffering from schizophrenia with antipsychotics. Schizophrenics actually have normal levels of dopamine. It is the schizophrenics who have been on antipsychotics for a long period of time who have abnormal levels of dopamine.

So is schizophrenia caused by an abnormal level of dopamine, or is it the treatment for schizophrenia that causes an abnormal level of dopamine? People suffering from schizophrenia do better in developing countries rather than in industrialized countries. There may be several reasons for this. Since they live in developing counties, they do not have the resources to acquire such drugs (which I believe is certainly not a bad thing). Perhaps it is also due to the cultural, societal, and social norms. Schizophrenia is not viewed as an abnormal disorder in Africa.  It wasn’t viewed as atypical or uncommon; in fact it is quite common.

I believe schizophrenia has a much larger societal context to it. I think it is more of a social identity crisis and caused more by strained and fragile interpersonal relationships than anything else especially rather than reducing the causation to chemicals in the brain or to genes.

The following video is a critique of medication use in schizophrenia:

DISCLAIMER: If you or anyone you know is taking a prescriptive psychiatric medication for stress, anxiety, depression, or any other reason deemed appropriate by the prescribing physician, alteration or discontinuation of the drug(s) is NOT recommended. Discontinuation or alteration of prescriptive medications can be life-threatening and can only be done under the authority and supervision of a licensed medical doctor!

Mood Disorders

Antidepressants

Do they really work?

Antidepressants are used to treat Major Depressive Disorder, and can be prescribed for various off-label uses – mostly notably, children are commonly put on antidepressants for bipolar disorder. Antidepressants can be diagnosed to someone who is not clinically depressed. They can be prescribed to treat pain, insomnia, relieve stress, etc. Poverty and unemployment are some of the most common risk factors for depression (along with virtually all mental disorders). 

In the DSM-V, grief and bereavement over the loss of a loved one is going to be pathologized into a “mental disorder”. In the DSM-III, the time-frame needed to be diagnosed with clinical depression over loss of loved one was about 12 months. In the DSM-IV, that number dropped to 2 months. Now in the DSM-V, that number is now 2 weeks. Can you imagine this audacity? I cannot even begin the fathom how the panel could even suggest something as hypocritical as this. I’m sure those people on the panel have children, and through shortening the time-frame from 12 months to 2 months to 2 weeks, they are saying that if they lose their children, they’ll be okay within 2 weeks and if they aren’t then they should be diagnosed with a mental disorder. 

Antidepressants are usually the first line of treatment. When an antidepressant doesn’t work, then the patient is usually switched to another one. If that one doesn’t work, then another one is prescribed. Then another, and another.  There is a wide variety of these “me-too” drugs for this not to be much of a problem. But if all antidepressants act exactly the same, then why have so many different kinds? Antidepressants in fact do act exactly the same. One is not more effective than the other. It doesn’t matter whether an SSRI, SNRI, MAOI, a tricyclic, or even if a placebo is prescribed. The clinical effect is almost the same. If no antidepressant works for you, a combo is usually created of multiple antidepressants – a drug cocktail. It is a common notion that different antidepressants have different effects on different people. A certain person needs their own specific dosage and kind of antidepressant in order for it to be the most effective. This process is called psychiatric drug tailoring. Meta-analysis of data has shown that switching a person from antidepressant to antidepressant is almost just as effective as keeping the person on the same antidepressant. It doesn’t matter which antidepressant you are switched to. How can this be? 

I believe most of the antidepressant effect is actually due to the placebo effect. People experience symptom improvement in depression from placebo almost as much as they do from antidepressants. The difference between the placebo effect and the chemical effect in depression is quite small.  Antidepressants can just be seen as active placebos -- that is, they have little therapeutic effect with powerful and very noticeable side effects.

Here is a clip with Irving Kirsch talking about the placebo effect:

 
If any of the following information stirs any interest for you, please check out Irving Kirsch’s book The Emperor's New Drugs.

DISCLAIMER: If you or anyone you know is taking a prescriptive psychiatric medication for stress, anxiety, depression, or any other reason deemed appropriate by the prescribing physician, alteration or discontinuation of the drug(s) is NOT recommended. Discontinuation or alteration of prescriptive medications can be life-threatening and can only be done under the authority and supervision of a licensed medical doctor!

Stress and Emotions

PTSD

Post-Traumatic Stress Disorder

Mental disorders have a social and cultural aspect that is not very frequently taken into account. Different varieties and forms of mental disorders appear in different cultures at various different times – depending on specifically what the society and culture views as pathological at that particular moment in time. If culture can shape the form of a mental illness, how is it a biological disease of the brain? 

Post-Traumatic Stress Disorder (PTSD) is a severe anxiety and stress disorder.  It is usually caused by experiencing a traumatic experience or event.  Symptoms of PTSD is re-experiencing the event in nightmares or flashbacks and being unable to control the memory recollection.  You can see the transition of stress disorders throughout our history with the way our culture was. Whatever our society viewed as especially pathological at the time was the norm. For example, there was hysteria in the 1700’s and 1800’s, Da Costa’s syndrome in the Civil War, shell shock in World War I, etc.

When the tsunami hit Sri Lanka, the western world attempted to bring PTSD to Sri Lanka. However, Sri Lankans could not relate to it. Their symptoms of trauma and stress are vastly different than ours. Our PTSD Checklist and trauma therapy was not very helpful to their culture.  The way that Sri Lankans experience emotional suffering, trauma, and stress is different from the way that our culture does. Through an attempt to create a Sri Lankan specific checklist, it was revealed that Sri Lankans most notably experienced physical and somatic symptoms. They were more concerned with their social relationships with others.

The following is a clip of Ethan Watters talking about PTSD in other cultures:

If any of the following information stirs any interest for you, please check out Ethan Watters’s book Crazy Like Us: The Globalization of the American Psyche.