Top Posts of 2011 #6 – The Epidemic of Mental Illness: Why? summarizes a NYT Book Review review of three recent books that challenge conventional wisdom about mental illness.

All of the authors of the new books agree on two thought-provoking viewpoints:

1. Our understanding of categories of mental illness and their treatments has been influenced by drug companies, through both legal and illegal marketing.
2. Mental illness is not caused by chemical imbalances in the brain.

You can view a talk from the author of Anatomy of an Epidemic here. He does not appear to be the gadfly one might expect. He appears pretty dispassionate and grounded in (ignored) research.

My impression is that it might be unfair to say that he argues  “mental illness is not caused by chemical imbalances in the brain”. This would give the impression that he believes mental illness is entirely exogenous. Rather, he seems to argue three points:

  1. That we have been barking up the wrong trees focusing on dopamine and serotonin regulation for psychiatric symptoms;
  2. that we overestimate the helpfulness of psychiatric drugs and underestimate the long term harms; and
  3. that the assumption that psychiatric symptoms indicate a chronic brain imbalance is wrong and that many people experiencing psychiatric symptoms might be better off if they are not placed on psychotropics on a long-term basis.
He suggests a different path for treatment that does include use of medications:
This does not mean that antipsychotics don’t have a place in psychiatry’s toolbox. But it does mean that psychiatry’s use of these drugs needs to be rethought, and fortunately, a model of care pioneered by a Finnish group in western Lapland provides us with an example of the benefit that can come from doing so. Twenty years ago, they began using antipsychotics in a selective, cautious manner, and today the long-term outcomes of their first-episode psychotic patients are astonishingly good. At the end of five years, 85% of their patients are either working or back in school, and only 20% are taking antipsychotics.
I also just noticed this unrelated paper finding high rates of recovery from borderline personality disorder. This conflicts with the conventional wisdom and raises the question of whether “personality disorder” is the proper way to characterize what’s going on with these patients.