| 词条 | Biopsychiatry controversy |
| 释义 |
The biopsychiatry controversy is a dispute over which viewpoint should predominate and form a basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics include disparate groups such as the antipsychiatry movement and some academics. Overview of opposition to biopsychiatryBiological psychiatry or biopsychiatry aims to investigate determinants of mental disorders devising remedial measures of a primarily somatic{{clarify|date=April 2017}} nature. This has been criticized by Alvin Pam for being a "stilted, unidimensional, and mechanistic world-view", so that subsequent "research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological factors underlie and cause social deviance".[1] According to Pam the "blame the body" approach, which typically offers medication for mental distress, shifts the focus from disturbed behavior in the family to putative biochemical imbalances. Research issues2003 status in biopsychiatric researchBiopsychiatric research has produced reproducible abnormalities of brain structure and function, and a strong genetic component for a number of psychiatric disorders (although the latter has never been shown to be causative, merely correlative). It has also elucidated some of the mechanisms of action of medications that are effective in treating some of these disorders. Still, by their own admission, this research has not progressed to the stage that they can identify clear biomarkers of these disorders. {{quotation|Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some of the mechanisms of action of medications that are effective for depression, schizophrenia, anxiety, attention deficit, and cognitive disorders such as Alzheimer's disease. These medications clearly exert influence on specific neurotransmitters, naturally occurring brain chemicals that effect, or regulate, communication between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In 1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health, for his discovery of how anti-depressant medications regulate the availability of neurotransmitters such as norepinephrine in the synapses, or gaps, between nerve cells.|American Psychiatric Association|Statement on Diagnosis and Treatment of Mental Disorders[2]}}Focus on genetic factorsResearchers have proposed that most common psychiatric and drug abuse disorders can be traced to a small number of dimensions of genetic risk[3] and reports show significant associations between specific genomic regions and psychiatric disorders.[4][5] Though, to date only a few genetic lesions have been demonstrated to be mechanistically responsible for psychiatric conditions.[6][7] For example, one reported finding suggests that in persons diagnosed as schizophrenic as well as in their relatives with chronic psychiatric illnesses, the gene that encodes phosphodiesterase 4B (PDE4B) is disrupted by a balanced translocation.[8] The reasons for the relative lack of genetic understanding is because the links between genes and mental states defined as abnormal appear highly complex, involve extensive environmental influences and can be mediated in numerous different ways, for example by personality, temperament or life events.[9] Therefore, while twin studies and other research suggests that personality is heritable to some extent, finding the genetic basis for particular personality or temperament traits, and their links to mental health problems, is "at least as hard as the search for genes involved in other complex disorders."[10] Theodore Lidz[11] and The Gene Illusion.[12][13] argue that biopsychiatrists use genetic terminology in an unscientific way to reinforce their approach. Joseph maintains that biopsychiatrists disproportionately focus on understanding the genetics of those individuals with mental health problems at the expense of addressing the problems of the living in the environments of some extremely abusive families or societies.[14] Focus on biochemical factors{{See also|Monoamine Hypothesis}}The chemical imbalance hypothesis states that a chemical imbalance within the brain is the main cause of psychiatric conditions and that these conditions can be improved with medication which corrects this imbalance. In that, emotions within a "normal" spectrum reflect a proper balance of neurotransmitter function, but abnormally extreme emotions which are severe enough to impact the daily functioning of patients (as seen in schizophrenia) reflect a profound imbalance. It is the goal of psychiatric intervention, therefore, to regain the homeostasis (via psychopharmacological approaches) that existed prior to the onset of disease. This conceptual framework has been debated within the scientific community, although no other demonstrably superior hypothesis has emerged. Recently, the biopsychosocial approach to mental illness has been shown to be the most comprehensive and applicable theory in understanding psychiatric disorders. However, there is still much to be discovered in this area of inquiry. As a prime example - while great strides have been made in the field of understanding certain psychiatric disorders (such as schizophrenia)[15] others (such as major depressive disorder) operate via multiple different neurotransmitters and interact in a complex array of systems which are (as yet) not completely understood. ReductionismNiall McLaren emphasizes in his books Humanizing Madness and Humanizing Psychiatry that the major problem with psychiatry is that it lacks a unified model of the mind and has become entrapped in a biological reductionist paradigm. The reasons for this biological shift are intuitive as reductionism has been very effective in other fields of science and medicine. However, despite reductionism's efficacy in explaining the smallest parts of the brain this does not explain the mind, which is where he contends the majority of psychopathology stems from. An example would be that every aspect of a computer can be understood scientifically down to the very last atom, however this does not reveal the program that drives this hardware. He also argues that the widespread acceptance of the reductionist paradigm leads to a lack of openness to self-criticism and therefore halts the very engine of scientific progress.[16] He has proposed his own natural dualist model of the mind, the biocognitive model, which is rooted in the theories of David Chalmers and Alan Turing and does not fall into the dualist's trap of spiritualism.[17]Economic influences on psychiatric practiceAmerican Psychiatric Association president Steven S. Sharfstein, M.D. has stated that when the profit motive of pharmaceutical companies and human good are aligned, the results are mutually beneficial for all. In that, "Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The proven effectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists." However, Sharfstein acknowledged that the goals of individual physicians who deliver direct patient care can be different from the pharmaceutical and medical device industry. Conflicts arising from this disparity raise natural concerns in this regard including:[18]
Nevertheless, Sharfstein acknowledged that without pharmaceutical companies developing and producing modern medicines - virtually every medical specialty would have few (if any) treatments for the patients that they care for.[18] Pharmaceutical industry influences in psychiatryStudies have shown that promotional marketing by pharmaceutical and other companies has the potential to influence physician decision making.[19] Pharmaceutical manufacturers (and other advocates) would argue that in today's modern world - physicians simply do not have the time to continually update their knowledge base on the status of the latest research and that by providing educational materials for both physicians and patients, they are providing an educational perspective[20] and that it is up to the individual physician to decide what treatment is best for their patients. The idea of pure promotion (e.g., lavish dinners) is a remnant of bygone era. It has been replaced by educationally-based activities that became the basis for the legal and industry reforms involving physician gifts, influence in graduate medical education, physician disclosure of conflicts of interest, and other promotional activities.[21] In an essay on the effect of advertisements for marketed anti-depressants there is some evidence that both patients and physicians can be influenced by media advertisements and this has the possibility of increasing the frequency of certain medicines being prescribed over others.[22] See alsoGeneral
Groups critical of the biomedical paradigm
External linksCriticisms from psychologists and the medical profession
Methodological issues
References1. ^{{Cite book | last = Pam | first = Alvin | chapter = Biological psychiatry: science or pseudoscience? | editor = Colin Ross and Alvin Pam | title = Pseudoscience in Biological Psychiatry: Blaming the Body | location = NY | publisher = Wiley & Sons | pages = 7–84 | year = 1995 | isbn = 978-0-471-00776-0 }} {{Anti-psychiatry}}{{DEFAULTSORT:Biopsychiatry Controversy}}2. ^APA statement on Diagnosis and Treatment of Mental Disorders, American Psychiatric Association, September 26, 2003 3. ^Most psychiatric disorders share a small number of genetic risk factors, VCU study shows, Virginia Commonwealth University 4. ^{{cite journal | vauthors = Pickard BS, Malloy MP, Clark L, Lehellard S, Ewald HL, Mors O, Porteous DJ, Blackwood DH, Muir WJ | title = Candidate psychiatric illness genes identified in patients with pericentric inversions of chromosome 18 | journal = Psychiatric Genetics | volume = 15 | issue = 1 | pages = 37–44 | date = March 2005 | pmid = 15722956 | doi = 10.1097/00041444-200503000-00007 | url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0955-8829&volume=15&issue=1&spage=37 }} 5. ^{{cite journal | vauthors = Macgregor S, Visscher PM, Knott SA, Thomson P, Porteous DJ, Millar JK, Devon RS, Blackwood D, Muir WJ | title = A genome scan and follow-up study identify a bipolar disorder susceptibility locus on chromosome 1q42 | journal = Molecular Psychiatry | volume = 9 | issue = 12 | pages = 1083–90 | date = December 2004 | pmid = 15249933 | doi = 10.1038/sj.mp.4001544 }} 6. ^{{cite journal | vauthors = van Belzen MJ, Heutink P | title = Genetic analysis of psychiatric disorders in humans | journal = Genes, Brain, and Behavior | volume = 5 Suppl 2 | issue = Suppl 2 | pages = 25–33 | year = 2006 | pmid = 16681798 | doi = 10.1111/j.1601-183X.2006.00223.x }} 7. ^{{cite journal | vauthors = Meyer-Lindenberg A, Weinberger DR | title = Intermediate phenotypes and genetic mechanisms of psychiatric disorders | journal = Nature Reviews. Neuroscience | volume = 7 | issue = 10 | pages = 818–27 | date = October 2006 | pmid = 16988657 | doi = 10.1038/nrn1993 }} 8. ^{{cite journal | vauthors = Millar JK, Pickard BS, Mackie S, James R, Christie S, Buchanan SR, Malloy MP, Chubb JE, Huston E, Baillie GS, Thomson PA, Hill EV, Brandon NJ, Rain JC, Camargo LM, Whiting PJ, Houslay MD, Blackwood DH, Muir WJ, Porteous DJ | title = DISC1 and PDE4B are interacting genetic factors in schizophrenia that regulate cAMP signaling | journal = Science | volume = 310 | issue = 5751 | pages = 1187–91 | date = November 2005 | pmid = 16293762 | doi = 10.1126/science.1112915 | bibcode = 2005Sci...310.1187M }} 9. ^{{cite journal | vauthors = Kates WR | title = Inroads to mechanisms of disease in child psychiatric disorders | journal = The American Journal of Psychiatry | volume = 164 | issue = 4 | pages = 547–51 | date = April 2007 | pmid = 17403964 | doi = 10.1176/appi.ajp.164.4.547 }} 10. ^{{cite journal | vauthors = Van Gestel S, Van Broeckhoven C | title = Genetics of personality: are we making progress? | journal = Molecular Psychiatry | volume = 8 | issue = 10 | pages = 840–52 | date = October 2003 | pmid = 14515135 | doi = 10.1038/sj.mp.4001367 }} 11. ^{{cite journal | vauthors = Lidz T, Blatt S | title = Critique of the Danish-American studies of the biological and adoptive relatives of adoptees who became schizophrenic | journal = The American Journal of Psychiatry | volume = 140 | issue = 4 | pages = 426–34 | date = April 1983 | pmid = 6837778 | doi = 10.1176/ajp.140.4.426 }} 12. ^{{Cite book | last = Joseph | first = Jay | authorlink = Jay Joseph | title = The Gene Illusion: Genetic Research in Psychiatry and Psychology Under the Microscope | publisher = Algora | year = 2003 | location = New York, NY | url = http://www.algora.com/93/book/details.html | isbn = 978-0-87586-344-3 }}{{Page needed|date=September 2010}} 13. ^{{Cite book | last = Joseph | first = Jay | authorlink = Jay Joseph | title = The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes | publisher = Algora Publishing | year = 2006 | location = NY | isbn = 978-0-87586-410-5 }}{{Page needed|date=September 2010}} 14. ^Jay Joseph The Missing Gene 15. ^{{cite journal | vauthors = McEwen BS, Chattarji S, Diamond DM, Jay TM, Reagan LP, Svenningsson P, Fuchs E | title = The neurobiological properties of tianeptine (Stablon): from monoamine hypothesis to glutamatergic modulation | journal = Molecular Psychiatry | volume = 15 | issue = 3 | pages = 237–49 | date = March 2010 | pmid = 19704408 | pmc = 2902200 | doi = 10.1038/mp.2009.80 }} 16. ^{{Cite book | title = Humanizing Madness | last = McLaren | first = Niall | year = 2007 | isbn = 978-1-932690-39-2 | pages = 3–21 | publisher = Loving Healing Press | location = Ann Arbor, MI }} 17. ^{{Cite book | title = Humanizing Psychiatry | last = McLaren | first = Niall | year = 2009 | isbn = 978-1-61599-011-5 | pages = 17–18 | publisher = Loving Healing Press | location = Ann Arbor, MI }} 18. ^1 {{Cite journal | last = Sharfstein | first = Steven S. | name-list-format = vanc | title = Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly | journal = Psychiatric News | volume = 40 | issue = 16 | pages = 3 | publisher = American Psychiatric Association | location = | date = August 2005 | url = http://pn.psychiatryonline.org/cgi/content/full/40/16/3 | archive-url = http://webarchive.loc.gov/all/20071119004226/http://pn.psychiatryonline.org/cgi/content/full/40/16/3 | dead-url = yes | archive-date = 19 November 2007 }} 19. ^{{cite journal | vauthors = Dana J, Loewenstein G | title = A social science perspective on gifts to physicians from industry | journal = JAMA | volume = 290 | issue = 2 | pages = 252–5 | date = July 2003 | pmid = 12851281 | doi = 10.1001/jama.290.2.252 }} 20. ^{{Cite news|url=https://www.phrma.org/codes-and-guidelines/code-on-interactions-with-health-care-professionals|title=Code on Interactions With Health Care Professionals |work= PhRMA | access-date=11 March 2018 }} 21. ^{{cite journal | vauthors = Zipkin DA, Steinman MA | title = Interactions between pharmaceutical representatives and doctors in training. A thematic review | journal = Journal of General Internal Medicine | volume = 20 | issue = 8 | pages = 777–86 | date = August 2005 | pmid = 16050893 | pmc = 1490177 | doi = 10.1111/j.1525-1497.2005.0134.x }} 22. ^{{cite journal | vauthors = Huskamp HA, Donohue JM, Koss C, Berndt ER, Frank RG | title = Generic entry, reformulations and promotion of SSRIs in the US | journal = PharmacoEconomics | volume = 26 | issue = 7 | pages = 603–16 | date = 2008 | pmid = 18563951 | pmc = 2719790 | doi=10.2165/00019053-200826070-00007}} 4 : Psychiatry controversies|Anti-psychiatry|Medical controversies|Biological psychiatry |
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