TELOSscope: The Telos Press Blog

Is Talk Therapy Dead?

Each Tuesday in the TELOSscope blog, we reach back into the archives and highlight an article whose critical insights continue to illuminate our thinking and challenge our assumptions. Today, Nicole Burgoyne looks at Jonathan Leo’s “The Chemical Theory of Mental Illness,” from Telos 122 (Winter 2002).

Even the first-time reader of Freud recognizes some outdated theory, in part because he or she has already heard Freudian psychology made fun of as part of the pop culture understanding of psychotherapy. But has Freud’s legacy—talk therapy—become obsolete in education as well as in practice? In his 2002 article “The Chemical Theory of Mental Illness,” Jonathan Leo reviews two books that analyze a still dominant trend toward biological psychiatry in modern day academia and the general public. Leo takes a closer look at the idea that mental illnesses are just like other diseases, chemical imbalances that should be rectified by introducing ameliorating substances.

Aside from pointing out that nearly all scientific studies that establish a direct relationship between behavioral problems and chemical treatment have later been called into question, or found unsatisfactory in terms of replication, Leo also hits on a more insidious aspect of the trend toward biological psychiatry, the problem of successful corporate marketing:

In their marketing efforts to promote the biological explanations of mental illness, pharmaceutical companies have stretched their fingers into patient advocacy groups, consensus panels, continuing education for psychiatrists, and even major medical journals. Most problematic is the way funding drives research. Because they hold the purse strings, the pharmaceutical companies dictate what gets studied, resulting in little investigation into the role of psychosocial factors in the etiology of mental illness. Worse yet, doctors in search of information about a drug are much more likely to read a pharmaceutical company brochure than scientific journals.

Leo is particularly concerned that in a health care world ruled by health maintenance organizations (HMOs) driven by profit, patients are more likely to be prescribed a drug in ten minutes than be recommended for extended care. Don’t most psychiatrists agree that a prescription for mental illness should always be taken under close supervision and in conjunction with more traditional methods of therapy? Perhaps, as Leo mentions, the dangers of some medications have been successfully hushed up.

The current health care reform is billed as attacking just such profit-driven oversights, but any change in general opinion and practice must come from more than just the opportunity for a different type of care. It would require integrating new discoveries of the brain chemistry of emotions with psychotherapeutic methods of addressing mental illness. One would have to accept that mental processes familiar to talk therapy, such as explaining oneself and one’s actions, not only affect how we feel, but also impact the same chemical basis of how we feel that biological psychiatrists study. Where are the studies to support such a theory? Perhaps the proponents of talk therapy will just have to take a similar line of defense to that which the president of the American Psychiatric Association deployed for biological psychiatry: point to success in innumerable cases and say, “Until we have a better understanding, we will have to use these tools.”

Will health care reform open the doors to new research that will help us better understand the tools we use against mental illness? Is talk therapy dead?

Read the full version of Jonathan Leo’s “The Chemical Theory of Mental Illness,” at the TELOS Online website. If you are affiliated with an institution that is an online subscriber to Telos, you have free access to our complete online archive. If not, you can purchase 24-hour access to this and other Telos articles at the low rate of $5/article.

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