Opinion: The trouble with psychiatry

POSTED: 09/5/12 10:40 AM

It’s of course a comforting thought that there are psychiatrists in this world to help people cope with their disorders. But psychiatrist Bram Bakker, never shy to vent his opinion wrote in his column in the Volkskrant that psychiatric diagnoses are often short on specifics and that this makes psychiatric treatment look like a game of chance.
Bakker starts with a remarkable statement about the pharmaceutical industry, often seen as the driving force behind diagnose and treatment. Adam Cohen, a professor in pharmacology expressed earlier in the Volkskrant what many psychiatrists had already noticed: the interest of the pharmaceutical industry in developing new medication for people with psychiatric disorders had diminished significantly.
Bakker notes that several explanations for this trend are possible. The common denominators are however clear: investments are uncertain but extremely expensive, they require a lot of time and in most cases they do not result in a profitable registered medicine.
Compared the success rate of antidepressants with those of for instance antibiotics offers a real eye opener, Bakker wrote. Just because a lot of people insufficiently benefit from psycho pharmaca, while the number of people with psychiatric disorders is on the rise one would expect it to be possible to come up with something better than the medication patients have to put up with these days.
Antibiotics work for the large majority of cases; antidepressants work in about fifty percent of the cases. Actually the situation is worse, Bakker notes, because the so-called responders – people who benefit from psycho pharmaca – are not completely free of complaints after a treatment. They get better somewhat, but they do not cure completely.
Bakker mentions as an important explanation for this situation the unreliability of psychiatric diagnoses.
If you were to believe neuro biologists, Bakker wrote, psychiatric problems are in the end disturbed brain functions. And if you know those specific disorders, you are able to attempt to repair them. The truth is more stubborn: in all psychiatric disorders several brain areas and neurotransmitters are involved.
This is where Bakker arrives at his most pronounced and most disturbing conclusion: most psychiatric treatments compare to a shower of shot. If you are lucky you kill the best, but more often than not the damage is limited and the beast lives on. Psychiatric diagnoses are short on specifics and that makes treatment a game of chance, Bakker wrote.
Professor Dick Swaab sold in the meantime 350,000 copies of his bestseller We Are Our Brain, Bakker noted: I grant him that, but the question remains whether psychiatry benefits a lot from the research he describes.
Developments in the pharmaceutical industry suggest that it could take a very long time before significant progress is made with the treatment of psychiatric disorders with medication.
Bakker furthermore referred to a book by the doctor and professor Ivan Wolfers entitled Healthy. His publisher called the book Wolfers’ magnum opus, but Bakker notes with dismay that Wolfers did not sell as many books as Swaab. His texts are at least as gripping, and he is convinced that they are also more relevant for a psychologist or a psychiatrist than those of Swaab.
This is because Wolfers writes about conditions, and about society. About the influence our way of living has on our wellbeing, and about how complicated it is to influence this. The bio-medical model, whereby doctors search on the individual level for a diagnosis is not Wolfers’ favorite approach.
Bakker admitted that he had overlooked Wolfers’ book and that this was unjustified. After you have read his book, Bakker wrote, you understand why the pharmaceutical industry sees insufficient profit options in the treatment of psychiatric problems with pills. The progress psychiatry can make is first and foremost in influencing the conditions under which people develop psychiatric disorders.
To make a good head start, Bakker suggests, all Swaab-readers have to begin by reading Wolfers.

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