Medicalization, and the Importance of Etiological implications on diagnosis and treatment

There is a term in the recovery movement called "the medicalization of mental illness," which is known in disability studies as "the medical model." In this model, the doctor is the omniscient expert, the doctor identifies the pathology, the doctor prescribes medication for the illness, the patient does what the doctor says, and the patient is cured.

The problem here is that with mental illness, no one really knows definitively what its etiology is / what causes mental illness. The prevailing theory of etiology is that somehow the brain's chemistry has gone awry which informs our prevailing treatment these days --  correcting brain pathology chemically with medications.

However, there are 54 identified (so far) neurotransmitters in the brain. Think of the potential permutations and combinations of brain chemistry. Antidpressants supposedly act on neurotransmitters like serotonin or dopamine, yet the most prescribed antidepressants and their manufacturers admit...that the "method of action is unknown."  Even the pharmaceutical industry writes in the fine print "we don't know what these drugs do to the brain."

 Science is in its infancy in terms of our understanding of the brain, yet we proceed  to "cure" with relative certainty. We really have no idea how these medications work, if they will work, or what the long-term impact of medications are on the brain.

Etiology informs treatment. This is why I asked you to articulate what YOU think causes mental illness.

If we can't say for sure what causes mental illness, why are we looking to cure mental illness with medications -- despite not knowing how they act on the brain? If we think MI is caused by genetics, are we researching gene therapy? If it is caused by trauma, why aren't we focusing on love, support, and unconditional regard for people who have trauma in their backgrounds? If etiology is complex and multivariate, why aren't our approaches to diagnosis and treatment?

Questions for replies:

Why is there such certainty within the psychiatric community about medications as treatment? we know first and second generation neuroleptics CAUSE brain damage, and some research indicates that negative effects of newer meds are systematically downplayedn(perhaps due to profit motives). Why are clinicians so SURE of their diagnosis and medications for treatment? Walter Freeman was sure, too....and in hindsight...was his cure what was best for folks?

Research, Its Social Context, and the Impact of Profit on Findings

Whitaker writes "In short, in the 1950s, what American physicians and the general public learned about new drugs was molded, in large part, by the pharmaceutical industry's marketing machine..[which] played a critical role in the recasting of neuroleptics as safe, antischizophrenic drugs for the mentally ill." (p.150, kindle edition). His contention here is that the pursuit of profit by pharmaceutical companies skews their ability to do unbiased research and clinical trials on their products.

In an article published in the New England Journal of Medicine in 2008, researchers studied the clinical trials of 12 different antidepressants that were approved by the FDA (involving 12,564 participants).  Of all these studies conducted, 97% of the studies showing positive results were published, whereas only 12% of the negative studies were published.

Americans consume more prescription medications that all the world combined. Often we demand quick fixes of our "pathologies" -- a pill. It is easier to put a child on medications than to delve into deep family problems and issues and change them. 

The social context here is  twofold 1) Americans want medications to fix their problems, and 2) the pharmaceutical industry and it's marketing machine are driven by profit. It almost seems like the perfect storm, culminating in questionable clinical trials and findings that many feel are suspect.

Questions for consideration / posts / and replies:

1) How does social context impact research in general? what topics get researched and which ones do not?

 (for example, there is very little research on sex and sexuality for people with developmental disabilities, because social mores frown upon people with DD having sex)

2) How much of an impact does the current social context (profit and demand) have on clinical trials of medications for mental illness? what might be the incentive for downplaying negative effects of these new classes of drugs? 

3) The FDA is supposed to protect people from bad drugs coming to market. Is the organization successful in doing this? Why or why not? 

Reference: Turner, E., Matthews, A., Linardatos, E., Tell, R., & Rosenthal, R. (2008). Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy New England Journal of Medicine, 358 (3) 252-260Cited in Bojrab, 2014