Psychiatry has been trying, it seems for 3 decades, to adopt a biological model of treatment. “Depression is a chronic disease, like diabetes,” we are taught to tell our patients. “You wouldn’t skip your blood pressure medicine?” we ask when patient don’t buy into this approach.
What’s wrong with biological psychiatry?
1. Look around. It isn’t working.
Biologic psychiatry took off as the new way of thinking after Prozac. The field of psychiatry was tired of long sessions of psychoanalysis that didn’t produce a cure for many illnesses that were clearly stemming from brain problems. But the health of the population has not improved with the biologic approach. If anything, mental health is a bigger, more expensive, more out of control problem than at any time in history. If pills are the answer, why aren’t patients universally better?
2. We cannot simply ignore environment.
Children who live in poverty, abuse, or neglect cannot just take a pill and feel vibrant. Neither can a recent widow who is steeped in grief, or a lonely elderly man who has no one coming by to check on him. It’s absurd to imagine biology is the magic key for these people, and so many others with financial strain, work stress, unaddressed past traumas, or poor coping skills. If we don’t address the whole person, how can these people be expected to feel better?
3. Intuition tells people there is more.
Sometimes patients come in and ask, “But how is a pill going to make me feel better?” Even non-experts can clearly see that taking a medication might be a tool, but it’s not going to put a broken marriage back together. There will still be stress and pain in the areas that helped fuel a mental health crisis in the first place.
4. Focusing on medication treatments alone is ignoring a large pool of research on psychotherapy, case management, and other psychosocial interventions.
There is a growing body of research showing that patients with a wide array of mental health problems simply improve faster and more completely when they also have psychotherapy and social support. Psychotherapy plus meds performs far better than meds alone in independent trials. Social determinants of health affect outcomes, and when we help address social determinants, patients get better and illness relapse decreases. This research is just as important and useful as the studies showing how drugs outperform compared with placebo, and we (professionals) cannot ignore it.
5. People will not be restored to wellness with only a pill.
Medications are important tools to reduce mental health symptoms, but they won’t get you a job after you were fired during a manic episode. Even for the most highly biologic of the mental health disorders, stabilizing symptoms with medications is only the beginning. Helping people achieve a state of health, wellness, and perhaps even happiness is a bio-psychosocial and spiritual endeavor. Putting a life back together is bigger than a trip to the pharmacy, and that needs to be our goal in mental health.
