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You're at the frontlines of the battle to retrieve an overmedicated America.

The idea that biochemical imbalances are at the root of mental illnesses is now very popular, perceived as objective fact by many in the mental health profession, and many in the public as well. Ye t, amazingly, there is no scientific support for this notion!

Indeed, there is quite compelling evidence against it. For example, in people diagnosed with depression and schizophrenia, the only biochemical imbalances are those created by the drugs designed to treat them. Worse yet, the meager support that appears in the literature found its way there by methods worse than bad science, i.e., corrupt science.

The whistle has been blown, however, and, unethical practices--such as running a study multiple times until a significant difference is found, and running articles in journals purportedly written by professors but actually written by drug company representatives--are now vigilantly monitored.

So, how did the notion that biochemical imbalance causes mental illness catch on? Was this just good science gone bad, or was science used in a brilliant but sinister effort to promote not only the sale of drugs but also the underlying mechanism by which the drugs were claimed to work? Indeed, without the biochemical imbalance theory, the marketing of these drugs would have been a very hard sell.

Yet, interestingly, today most mental health practitioners are either unaware of this dark history or dismiss it. What we still have today is a treatment approach to mental health problems that is often drugs first, and "supportive" psychotherapy as an ancillary option. In the absence of resources, however, referral to psychotherapy all too often becomes little more than lip service.

There Is a Light at the End of This Dark Tunnel

The battle to retrieve an overmedicated America is heating up. A growing number of scientists and healthcare professionals are expressing increasing concern about the uses and abuses of psychotropic medications in the treatment of life's problems ... problems that have been dramatically oversimplified as neurotransmitter dysfunction.

Even within the medical and psychiatric professions, scathing attacks on the status quo have been led by the likes of physician and former Harvard chancellor Marcia Angell, MD; two accomplished psychopharmacologists, Joanna Moncrieff (University of London College) and David Healy (Cardiff University School of Medicine, Wales); and even one of the more conservative members of the psychiatric practicing community itself, Daniel Carlatt, MD (Tufts Medical School). Refreshingly, one pioneering psychiatrist, Peter Breggin, MD, has been an outspoken activist for more than 50 years. Breggin's just-released book--"Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients, and their Families"--could not be more timely!

These courageous scientists and practitioners have raised serious questions about whether the pharmaceutical dominance in the mental health treatment enterprise might well have resulted in more harm than good. Science journalist Robert Whitaker raises very disturbing questions about long-term use of antipsychotic medications, connecting it to a tripling of psychiatric-based Social Security Disability over the past 20 years. Among his many compelling observations is the dismal recovery rate of schizophrenia in the United States compared to underdeveloped countries where antipsychotics are unaffordable.

Harvard's Irving Kirsch, PhD, has spent his career studying the power of the placebo. In the most comprehensive examination ever of antidepressant outcome studies, he presents a compelling argument that antidepressants are indeed effective, but no more so than placebo. His conclusions raise serious clinical questions--as well as moral, ethical, and perhaps legal ones.

Change Is on the Horizon

Thanks to the courageous work of many people, the pendulum's movement is beginning to slow in biological space, preparing to return to the domain mental health counselors were trained to treat ... experience. Experience is the primary cause of life's problems, and experience is the vehicle through which problems are effectively managed. Within this domain lies the psychological essence of happiness generally, and mental health specifically. And, this is your domain!

All methods of counseling respect the experiential history of the client and use his or her current experience to help find more effective solutions to life's challenges. As you are so well aware, your clients have come to you because of experiences that render them incapable of coping effectively. Whether acute or chronic, traumatic or common, their stress lives in the environment they attempt to manage.

As I reflect back on the population of people I treated in my "practice days," it is hard for me to find clients whose symptoms were not directly connected to their experiences of life, especially interpersonal experiences. Endogenous (melancholic) depression truly exists, but it is the vast minority of cases.

No Scalpel or Drug Will Improve Coping Skills

So, are the brain and its neurotransmitter systems to be discarded as we look for clarification of what we have come to call mental illness? Of course not! Without legs, we cannot walk. Without brain, we cannot behave. But brain is not you. Like legs, brain enables; it mediates, but it is not your brain that goes to church on Sunday or out on Saturday night--it's you!

So, continue your work knowing that you are on exactly the right course. Help your clients create a life in which the decisions they make create a destiny in which they have a chance of happiness and meaning. As you already know, mental health will follow.

No scalpel or drug will improve coping skills, ever. And don't let anyone bedazzle you with biochemistry to make you think otherwise. You and your approach are the future; you are Mental Health Tomorrow!

By F. A. Ernst, PhD, Professor, Department of Psychology, University of Texas-Pan American

Fred Ernst, PhD, a clinical psychologist, is a tenured, full professor in the Psychology Department at the University of Texas-Pan American. He has been on the clinical staffs of community mental health centers, a private hospital, and a VA hospital. He has also worked on research staffs of different organizations and was on the faculties of two medical schools. He is currently passionately immersed in hosting a conference on the issues in this article that will be held Dec. 1-2, 2012, on South Padre Island. Ernst welcomes feedback by email:, or cell phone: 615.243.7783. Information about the conference is at
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Title Annotation:The Last Word
Author:Ernst, F.A.
Publication:The Advocate (American Mental Health Counselors Association)
Geographic Code:1USA
Date:Sep 1, 2012
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