A Pill is Not Enough

Psychologist Michael Browne on the failures of antidepressants

It doesn't get talked about very much, but there's so much research that shows that the most valued part of psychotherapy is the relationship. It's the quality of the relationship between the patient and the psychotherapist that determines the success of the therapy. It's so easy to focus on technique, but so much of it comes down to the relationship.

Whether it's a child's mental health problems or an adult's, no mental health problem grows out of a vacuum. They grow out of the context of the relationships that they exist in. The way I understand it, bears spend a lot of time alone in the woods. That's just how the biology of bears is. Their biology suits them to spend months at a time in the woods eating nuts and berries. That's not true for human beings. For the millions of years of our biological history, we are beings that can only live in relationships. That's a fundamental fact of human nature, that we have to have relationships. And whatever the mental health problem is--whether it's depression, or anxiety, or schizophrenia--you have to look at the network of relationships within which that person has lived their life. And if you ignore that, you've missed the boat.

CP:In your paper you posit that the therapeutic relationship can actually be discredited by the introduction of drugs.

Browne: See, there are a couple problems here. If you treat somebody with psychotherapy you are saying to the person, "Okay, you've been quite depressed, and we can understand that in terms of what's been going on in your life for the last five years. We can understand that in terms of what happened in your childhood." So you start to create a story--a true story, not a fictional story--you start to create a true story of that person's life and how that's lead them to be depressed and that story also begins to show what the person must do to solve these problems. That's very important.

Now, if you then say to the person, "You need medication, too, because there's also some biological part of your depression," then it becomes confusing to that person. "Geez, am I depressed because of what's going on in my life or am I depressed because the chemicals are screwed up in my brain?" It detracts from the credibility of the therapy.

Especially when someone is seriously depressed, and they're talking about suicide, they're talking about quitting their job, but especially about suicide, that is very frightening. It's frightening to family members, to friends, to coworkers, and it's frightening to psychologists and psychiatrists. When a person says suicide, it scares us. And it should, we should take it very seriously. Suicide is a major problem. It's easy then to say, "Boy we can turn to this pill, medication will help us."

CP:You make a convincing case for the drug companies being behind a slow but subtle shift from the public perception of psych drugs as a means of controlling certain symptoms to chemical agents that actually get to the root of any mental illness.

Browne: When the drugs that we now call antipsychotics were first introduced, they were termed major tranquilizers, which indicates that the function of the drug was to sedate the person. So you have an unruly, difficult-to-handle patient, and you give them this drug and it makes the person lethargic. It's very much a symptomatic treatment; we're gonna reduce these troublesome symptoms so these people are less trouble. That was the idea. But *when the name was changed, and we now call these drugs antipsychotics.

When we call something antibacterial, or antiviral, the name implies that you're not treating a symptom, it implies that you're treating the cause of the problem. It's antibacterial, so you're killing the bacteria that causes the disease. Antipsychotic implies that you are getting to the source of the problem and treating it, rather than the fact that you are applying a symptomatic treatment, that you are slowing these people down.

In the same way, if you have a person suffering from Tourette's syndrome and you give them medication that eliminates the tic, that's helpful. Especially for children, these tics can make the child the object of ridicule and so to give them a medication that eliminates the tic is very helpful. But the tendency is then to think that we've cured the problem. That if we've given this drug to a psychotic person, that we've cured him. That if we've given a different drug to a person with Tourette's syndrome, that we've cured that person. And then we don't look any further to what we really need to do to cure this problem.

CP:Your colleagues swallowed this. Why?

Browne: If you take a really hard-nosed scientific approach and look at this research and find there's little there to support the use of psychiatric drugs, then why did these drugs become so popular? Why has that become perhaps the dominant treatment for mental illness in the United States today? I think there are several reasons.

First of all, the pharmaceutical companies just have enormous power, both financial and political. Second, psychiatrists have used an emphasis on drugs to make themselves a home in the medical profession: "We're just like you, we prescribe drugs, too." Because psychiatry has always been the stepchild in the medical community. The other people in the medical community have never known what to do with psychiatry. Everybody else is treating something that's tangible, that's concrete, and there you have the psychiatrist dealing with feelings and emotions. And often in medical communities, psychiatry has little prestige. So medication has been a way to shore up their credentials: "We're doctors."

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