“Biological Psychiatry and Labeling Theory”

1. “Biological Psychiatry and Labeling Theory” Scheff, Being Mentally Ill (1984) 1999

2. Key claims of mainstream research on mental illness A. Etiology (causation): the causes of mental illness are mainly biological B. Classification: types of mental illness can be coherently classified (DSM-IV) C. Treatment: mental illness can be treated effectively and safely with psychoactive drugs

3. Claims are not supported by the evidence A. Etiology: Unlike diagnoses of diseases in the rest of medicine, psychiatric diagnoses still have no proven link to causes and cures…no identified causal agents for psychiatric disorders (p. 4) B. Classification: “The classifications of psychiatric disorders that have been organized into the succeeding DSM versions appear to be little more than attempts to confirm current psychiatric practices, rather than empirical studies” (p. 5) C. Treatment: "There are also indications that these drugs may be administered to manage or control certain categories of patients, rather than to help them” (p. 6)

4. Effectiveness of psychoactive drugs? • RCT (randomized clinical trial): a group of patients with similar diagnoses are divided randomly into 2 subgroups: one subgroup, the treatment group, receives the drug, the other, the control group, gets an inert substance disguised as medication, a "placebo" (p. 6) • "Even accepting the validity of the RCTs, most psychoactive drugs are only slightly and briefly more effective than placebos. The decreasing effectiveness over time is suggestive of a placebo effect." (6) • It's not clear that the benefits of psychoactive drugs outweigh the costs, i.e. side effects • There's evidence that psychoactive drugs are being used to control or manage "vulnerable populations" such as children and the elderly, as well as women

5. Reasons for the rule of biopsychiatry • The economics of drug use vs psychotherapy • Therapy has the potential to disrupt the social and emotional status quo of patients and families