Is it time to end our complicity with pharmacocentricity?

Psychotropic medications have traditionally dominated the treatment of mental health problems. The administration of psychotropic medications and monitoring for effects, side effects, and adherence therefore consumes considerable time for mental health nurses (MHN). While there is no doubt many people believe psychotropic medications have helped them, the weight of research evidence questioning their effectiveness and exposing their associated debilitating side effect burden (particularly over the long term) is now too compelling to be ignored. This has prompted the claim that, on balance, psychotropic medications cause more harm than good (Gotzche et al. 2015). The most commonly prescribed psychotropic medications are antidepressants and antipsychotics, yet these names are misleading. They create the impression that psychotropic medications remove a pathogen like an antibiotic removes a bacteria, when this is not the case (Rosenman 2016). Unlike physical conditions such as diabetes, Crohn’s disease or cystic fibrosis, for example, there is no pathophysiology or a single identifiable biomarker associated with any psychiatric diagnosis. Diagnoses such as ‘schizophrenia’ or ‘bipolar disorder’ are based on a consensus model and therefore represent simply one version of the truth, not established scientific facts (Wand 2015). The rationale supporting psychotropic medications is based on the assumption that mental illnesses are predominantly biological and are ameliorated at a neurochemical level, conveying the message to the ‘sufferer’ that they are biologically inferior (Hall 2018). However, there is no evidence that mental illness is due to a chemical imbalance of the brain, and while genetics and biology play a role in all aspects of the human condition, the degree to which genetics and biology influence mental health and well-being remains a matter of speculation. What is known (without question) is that mental health and well-being are predominantly determined by what happens to people after they are born, not what they are born with. Childhood adversity and instability, abuse and neglect, socio-economic disadvantage, discrimination, bullying, rape, incarceration, war, substance misuse, and human rights violations all make far greater contributions to mental ill-health than heredity (World Health Organization, 2013). Indeed, it is disrespectful, and unrealistic, to expect that a medication will mend such harrowing experiences. For example, it is reported that hearing voices in 77% of people diagnosed with ‘schizophrenia’ is related to traumatic experiences. The widely held contemporary view is that voice hearing is a normal human experience that voices have meaning for individuals and are ‘parts of the self’ that should not be ignored. People are encouraged to accept voices and establish a dialogue with them. Conversely, attempting to ‘get rid’ of voices through medication interferes with emotional processing and understanding the meaning of voices (Mosquera & Ross 2017).