"There are now plenty of data and evidence that, in the long term, the drugs do not work," the authors write in their commentary, "From neuroleptics to neuroscience and from Pavlov to psychotherapy: more than just the 'emperor's new treatments' for mental illnesses?"
Margraf and Schneider begin by pointing out that the number of people in the industrialized world who are disabled because of mental health issues has been rapidly rising over the past fifty years. At the same time, they note, the common perception is that new antidepressant and anti-anxiety drugs and other new treatments have greatly improved mental health treatment.
If this "epidemic" of mental health issues causing disability is not due to an increase in overall incidence, they ask, "how can this apparent contradiction be explained?"
"Could it be," they continue, "that therapeutic progress is much less than we think or are being told? Could it be that the course of depression, anxiety, schizophrenia, or ADHD has been altered for the worse? Could it be that we cannot make therapeutic progress because the concept of mental illness and its treatment is deeply flawed? There are strong reasons to assume that all three suspicions are in fact true."
The researchers identify three conceptual mistakes that are preventing more successful treatments for mental health issues from being developed.
- The "ill-advised biological notion of mental illnesses" and the "myth of the chemical imbalance"
- The "reification of diagnostic constructs ('depression') as distinct illness categories" rather than as a dimension of human behavior occurring on a spectrum.
- The emphasis on "bottom-up" causal pathways, like genetics, rather than "top down" social and psychological influences.
Margraf and Schneider suggest that psychologists work together to bring a renewed focus to all three levels of analysis, biological, psychological, and sociological, while pushing back against the "marketing power of Big Pharma."
"A realistic assessment of our current treatment options and the close cooperation of clinicians and neuroscientists would help us to overcome the current stagnation and put us back on the track forward," they conclude.