Sunday, April 22, 2007

Blaming the Brain, by Elliot S. Valenstein, Ph.D.

If you believe that some mental disorders are caused by a "chemical imbalance" you need to read this book. Blaming the Brain: The Truth About Drugs and Mental Health is perhaps the most definitive, heavily-researched, and thoroughly-detailed book on how mental health professionals and the public came to believe in a biological basis for mental disorders and why this belief is ill-founded.

Valenstein, a professor emeritus of psychology and neuroscience at the University of Michigan, takes us through the history of mental illness treatment from the nineteenth century through the beginning of this one. He explains that his original intent when he began work on the book was to track how views about the basis of mental illness changed over the past fifty years plus. There have been many theories over the years that suggested a biological basis for mental illness, but in the 1940s and 1950s there was a strong belief in the power of psychotherapy alone. Valenstein was curious about how we have come to where we are now, to a commonly-held belief that depression and schizophrenia in particular are caused by chemical imbalances "similar to the imbalance of insulin for those who have diabetes".

The book evolved into more than a history. Valenstein discovered along the way that the basis for this common belief is shaky. What studies there are that seem to support the theory are flawed and can usually not be replicated. Further, too many persons with depression and schizophrenia do not respond to the current drugs. If these drugs actually corrected a problem present in all depressed or schizophrenic patients then we would expect them all to be helped.

Why, then, do so many patients - and doctors - honestly believe such an iffy theory?? Valenstein devotes much of the book to this question and answers it clearly.

Valenstein's research is exhaustive and his caution in interpreting what he learns is admirable. His writing is clear and comprehendible to laypersons but not simplistic. In the end he summarizes his findings and makes clear that he is not saying that nobody should use these drugs. But they should not be used without investigation into alternatives and certainly should not be considered the best option in all cases. His greatest concern - and it should also be ours - is that such a tunnel-visioned view of mental illness is dangerous and will not lead to improvements in care.

No comments: