Customer Reviews

Blaming the Brain : The Truth About Drugs and Mental Health

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In the 1940's psychiatrists began the effort to convince humankind that mental illness was an epidemic - a "disease" which could strike anyone at any time. This fear mongering has continued unabated for 50 years despite a complete absence of any solid evidence that mental and emotional problems are caused by brain pathology. Valenstein argues convincingly that psychiatric chemical imbalance theories are seriously flawed and reveals the marketing and hype behind the push to convince us that life is essentially a disease. Psychiatric treatment leads invariably and inevitably to diminishing mental and physical health. Read Valenstein's book and you'll gain a great deal of insight into why that is true.

Valenstein does it again! After his insightful book on the history of psychosurgery, the author, a professor of psychology and neuroscience at Michigan University, examines the biochemical theories of mental disorders. In a well-written book, Valenstein (a) describes the history of the major "theories" relating mental disease to brain function, and the history of the main psychotherapeutic drugs; (b) the empirical and logical basis of the claims that mental disorders are caused by chemical inbalances in the brain; and (c) the social, economic, and cultural contexts surrounding the use of psychothrapeutic drugs. Although not a physician, psychiatrist, or clinical psychologist, I admire the book for its extensive review of the scientific literature, for its success at explaining the main ideas about mental disease and brain science to the nonspecialist, and for its thoughtful conclusions. Perhaps the book's greatest virtue is to remind us of how ignorant we still are about the causes of schizophrenia, manic-depressive disorder, and many other mental conditions. In a word, read this excellent book. The writing is also elegant.

Once or twice a month, in many psychiatric hospitals, researchers present data showing the therapeutic efficacy of a new drug (or tweaked older one with a new label). The charts and graphs about these "silver bullets" usually feature percentages of psychiatric patient improvements over six to eight weeks in comparison with those treated by placebo or competing meds. The sample sizes are typically small and, at least in the many of these presentations that I attended, even the simplest descriptive statistics (means, standard deviations, etc), to say nothing of measures of sample overlap (Cohen's d scores) and meta-analyses, are nowhere to be seen. Nor are they readily available from the presenter. The attending psychiatric staff sometimes raise questions about the area of the brain or nerve receptor the drug targets while they enjoy the fine and plentiful free lunch provided by the sponsoring pharmaceutical company. It would be difficult to conclude other than that issues of empirical validity had been comfortably settled long ago. Thus, these concerns were far beyond the mattering maps of the audience. An earlier generation's favored cure was lobotomy before, in the early 1950s, the discovery of Thorazine's (chlorpromazine) quieting effects ushered in this, now dominant, psychiatric treatment paradigm.

Elliot Valenstein's BLAMING THE BRAIN: THE TRUTH ABOUT DRUGS AND MENTAL HEALTH demonstrates why rationales for this paradigm ain't necessarily so. Valenstein, professor emeritus of psychology and neuroscience, University of Michigan, continues the program begun in his GREAT AND DESPERATE CURES: THE RISE AND DECLINE OF PSYCHOSURGERY AND OTHER RADICAL TREATMENTS FOR MENTAL ILLNESS (HarperCollins, 1987) and now followed by his most recent THE WAR OF THE SOUPS AND THE SPARKS: THE DISCOVERY OF NEUROTRANSMITTERS AND THE DISPUTE OVER HOW NERVES COMMUNICATE (Columbia Univ. Press, 2005). He helps his readers look beyond the shiny surfaces of therapeutic regimes and into the empirical heart of these matters. In BLAMING Valenstein draws our attention to the transition in psychiatric treatment ideology from mothers as causes of mental illnesses to the current conventional certainties about chemical imbalances in the brain, which he says, though in other words, rest solidly on a foundation of sand. He describes how neuropsychiatric theory got from there to here, then to now, jettisoning untidy, equivocal empirical data along the way.

In BLAMING, a rich historical context is provided to make sense of the scientific, social and economic forces that led to the now, largely unchallenged, happy and enduring marriage between the pharmaceutical industry and the psychotropic treatments that identify most of present-day psychiatry. [See Peter Breggin's TOXIC PSYCHIATRY, St. Martin's Press, 1991 and C. Ross & A. Pam's (Eds.) PSEUDOSCIENCE IN BIOLOGICAL PSYCHIATRY, Wiley, 1995 for notable exceptions in the psychiatric community]. Included on the theoretical side are the speculations of the 19th century figures like Thidicum, the founder of modern neurochemistry and Freud, both of whom suggested a neurochemical basis for mental illnesses, and the chemical elaboration of LSD accompanied by the English professor of pharmacology, John Gaddum's suggestion that LSD-25's effects might be caused by blocking the neurotransmitter serotonin, a newly discovered brain chemical he thought essential for balanced mental activity.

On the treatment side, Valenstein traces the emerging trials in the early 50s with Thorazine, initially marketed as a surgery anesthetic. This led to it and later generations of drugs becoming the treatments of choice for the schizophrenias. Similar development pathways are described for the anti-depressants and anti-anxiety meds. An anecdote not included, but that gives some idea of the patient's experience with these "tranquilizers," is the story of Dr. Cornelia Quarti, the psychiatric resident who submitted experimentally to a trial with Thorazine in the earliest days of its use. As the drug took effect she tried to shout out, "No! You are bothering me!" and tried to fight off the subsequent feeling of imminent death with all her energy. Later, she listened in amazement as the experiment tape recording revealed, a "weak and monotonous voice..." [cf. D. Cohen in S. Fisher & R.P. Greenberg (Eds.), FROM PLACEBO TO PANACEA, Wiley, 1997].

Professor Valenstein's treatment of the empirical and theoretical developments in neuroscience and psychopharmacology is detailed and exhaustive including issues surrounding electrical versus chemical stimulation of the brain (the Sparks and the Soups camps), relationships between the discoveries of neurotransmitters, brain centers for reward, eating, rage and physiological concomitants of emotion (sweating, changes in heart rate and blood pressure, etc.), and biochemical theories about how these might explain the effects of psychotropic medications and account for mental illnesses. Not the least of these accounts were theories of schizophrenia (excess dopamine) and depression (e.g. serotonin deficiency) that are still favored in the trenches of clinical psychiatry. For reasons that are carefully explored in Chapter 4 (A Closer Look at the Evidence) and Chapter 5 (The Interpretation of the Evidence), these and other biological theories are critiqued on grounds that are logical (cause/effect confusion, reductionism), empirical (brain plasticity in response to experience; complex, often indeterminate, disease pathways) and moral (political/economic forces through which marketing, corporation earnings and bare bones state hospital budgets coalesce in spite of the known limits and iatrogenic effects of sustained treatment with psychotropic meds and proven psychosocial community treatment). See Chapter 6 on the pharmaceutical industry influences and Chapter 7 on special interest groups.

BLAMING provides a thicket of facts woven together clearly, crisply and expertly. Following the evidence, Valenstein comes down hard on current treatment with psychotropics, biological psychiatry and the partnership between Big Pharma and medicine. He makes clear, there is an important place for medication. However, the complex interplay between biological and psychosocial phenomena means that the silver bullet, the wonder drug that can solve the lock and key problem of mental illness, or psychotropic cocktails, are unlikely fixes for problems of living. And, no lunch is free as medical staff surely ought to know.

If the reader wants more from similar terrain there is David Healy's THE ANTIDEPRESSANT ERA (Harvard Univ. Press, 1997), Healy's THE PSYCHOPHARMACOLOGISTS (Chapman & Hall, 1998), Larry Squires THE HISTORY OF NEUROSCIENCE IN AUTOBIOGRAPHY (Society for Neuroscience, 1996), Edward Shorter's A HISTORY OF PSYCHIATRY (John Wiley, 1997), Marcia Angell's THE TRUTH ABOUT DRUG COMPANIES (Random House, 2004), the classic Gordon Paul & Robert Lentz's PSYCHOSOCIAL TREATMENT OF MENTAL PATIENTS (Harvard Univ. Press, 1977) and A. R. Cellura's THE GENOMIC ENVIRONMENT AND NICHE-EXPERIENCE (Cedar Springs Press, 2006).

This book is academically excellent and substantianted well beyond what should have even been necessary. However, it clearly remains "news" that most patients will resist. While the author does a wonderful job of explaining the motivations for medical companies/drug manufacturers, etc. to continue to preach neurobiological causes for most/many emotional disturbances, the patient population is likely the group most resistant to hearing its truth. (...) patients try hard to believe there is a physical cause rather than emotional and to hand our brains over to someone to "fix" rather than risk partnering with a good doctor to mutually share in the work of recovery. I have recommended this book to several "hard sell" patient-friends who comphrehend its WORDS, but fail to accept the reality. Amazingly, the author is not trying to persuade those who don't want to hear, but seems content to provide informative documentation for those of us who already understand his point. And fascinating reading it is. He clearly knows the uphill battle he's undertaken, and doesn't prostelytize or belittle in his efforts to explain. Thanks, doctor, for a mature book about much that many of us simply aren't ready to face yet. Hang in there. Truth lasts longer than denial. - Janine Baker, author of Tales From A Thousand And One Freudian Nights

Vallenstein in his book explores the history and generation of theories and treatments of mental health problems. He does this in order to later demonstrate in his book how the acceptance of biochemical theories of mental illness and the use of drug treatments to the exclusion of other treatments, are NOT a function of either the validity of biochemical theories or effectiveness of drug treatments.

Vallenstein demonstrates how drug companies and HMO's amongst other interest groups have both pushed biochemical theories for economic reasons: sales of drugs, and reduction of costly treatment time for drugs relative to other treatments.

As part of his analysis, Vallenstien also looks in detail and the consistancy of evidence behind biochemical theories and finds many flaws and shortcomings.

Now Vallenstein doesn't refute that drugs help. He does however challenge the PR regarding how effective these drugs are and how these drugs work. By looking at the complexity of the neurology, he demonstrates how dopamine and other neurotansmitter theories are too simplistic and that certain drugs seem to achieve the same goals but have completely different effects on these transmitters. Consequently, Vallenstein suggests that psychiatrists simply admit that they honestly don't know the drugs work for some people.

Vallenstein in challenging effectiveness claims and theory premises also states that the reasons for mental illness are also more complex. Physiological, behavioral and psychosocial factors should also be part of the mental health assessment. The use of other therapeutical treatments shouldn't be discluded due the politics of psychiatrists trying to protect their domains from other non-medical health professionals or limitations imposed on length of treatment by managed care.

Vallentsien tends to be a bit redundant in his book to re-enforce his arguments. But his points are well made and persuasive. From my own experience, I share a lot of his skepticism of biochemical theories and criticism of drug therapies.

Briefly, after having a psychotic episode when I was 18, I was labeled schizophrenic and hospitalized. When I was 25 I was later "downgraded" to manic depressive When I was 32, it was discovered I had sleep disorders: PLMD, RLS and an obstructive sleep apnea. Since I've received treatment for these sleep problems, permax and surgery for a deviated septum plus a UP3, I haven't had any mood cycles for over 3 years.

No psychiatrist looked for these sleep problems. I was young and not overweight, so I didn't fit any sleep problem profile. One actually prescribed klonopin which made my sleep apnea worse, since this benzodiazepine relaxes the throat. A friend suggested I check out a sleep study. Actually when, I suggested this to that psychiatrist who prescribed the klonopin, he told me I was in denial.(As an aside, I couldn't get the sleep study done until I was weened off of the klonopin to which I had become addicted).

So my own experiences reinforce Vallentstein's point that mental health isn't simply a biochemical imbalance and that other factors and treatments need to be considered and utilized. In my case those factors were cognitive, physical, and behavorial.

I recommend this book to anyone dealing with mental illness. It does a rigorous job of making its point: that the CHEMICAL theories you hear espoused most everywhere about the cause and treatment of mental illnesses lack supporting evidence. He makes his point by considering the science, politics and economics that come into play.

I would have given the 5-star rating were it not for the fact that he seems to have stretched out the book. There is unnecessary repetition and sometimes needless detail. The meat is there, but also some fat.

A minor objection: there could have been more said about the ramifications of the difficulties that he identifies from the patients' point of view. He exposes the bad science, but it's the patient that has suffered most as a consequence. I suspect that if he had a close family member with a serious mental illness that his emphasis might have been somewhat different. Also most of us with a loved one suffering from schizophrenia do not like them to be referred to as "a schizophrenic". I realize that it is awkward to avoid that concise usage, but if you don't avoid it, you reduce the person who has many strengths and admirable and enjoyable qualities to a dehumanized label.

Hope the book will create a lot of discussion and expose the current dogma and lead to less constrained thinking among practitioners who are treating our loved ones.

This is the definitive exposure, by a working brain researcher, of the scientific frauds being used to sell psychiatric drugs. Its thoughtful investigation of the absence of relationship between brain science and mental illness is startling.

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 comprehensible 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.

Well documented and sequenced details lead us to questions about current dogmas dealing with mental health. We are not asked to give up what works but rather to ask if it really works as well as the salesmen attest. Perhaps we should be asking for better pharmacological rationale than the old chemical balance/imbalance stories promulgated since the fifties. It seems unwise to give up on psychotherapy and searching for new approaches just because pharmaceuticals currently oil the healthcare machinery. Who knows -- maybe drugs work just because we believe they do.

Elliot Valenstein's book is at the same time informative, provocative and disturbing. He has analyzed a dense literature and distilled from it key ideas that run counter to the current dogma of psychiatry and other "helping professions," the currently fashionable view that so-called mental illnesses of many types are brain disorders. Valenstein prepares the reader with a well-crafted history of biological psychiatry, followed by a knoweldgable and intelligent critical analysis of the literature. This is a book that deserves a wide readership but, alas, will probably not receive it. The juggernaut of the brain psychiatrists and their sympathizers is just too overwhelming to give Valenstein's book the careful reading it deserves. I look forward to his next work, which I hope would examine the related claims for a biological basis of ADHD, homosexuality, alcoholism, and the like.