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Book Review 

Toxic Psychiatry
Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock,and Biochemical Theories of the "New Psychiatry"

By Peter R. Breggin, M.D., St. Martin's Press ($17.95)Dr. Carol Maxym

A Book Review by Carol Maxym, 


The title eloquently summarizes the two main themes of this important book, that is, the new "biopsychiatry" is toxic, and talk therapy, empathy, and love are better than medication to help people deal with the problems and crises of their lives. As a result of his careful review of the research literature, Peter Breggin, whose background is as mainstream as possible (Harvard, Case Western, and Harvard again), is able to build a strong case for his extreme and extraordinary viewpoint.

Though easy to read, this book, due to its controversial content, is hard to digest. It is likely to evoke either passionate agreement or disagreement in its readers. Written for the layperson, it contains clear explanations of terms and concepts that while unnecessary for the professional, are not distracting. Psychiatry, pharmaceutical firms, the FDA, the NIMH, and the media are all taken to task. Breggin makes a strong and compelling case for his accusations that they are only telling a partial, simplified story, perhaps even colluding to make good headlines and profits, creating needs for products and services, while minimizing the side effects and maximizing the effectiveness of psychiatric medications.

Perhaps the greatest strength of the book is in the questions he raises- and the fact that he raises them. Do psychiatric medications actually do what they claim? What are their side effects and their duration? What are the possible long-term side effects, and are those who ingest them able to determine the seriousness of such effects? Are they even able to discern any side effects, due the nature of the problems that led them to seek professional help in the first place? Are professionals willing and able to evaluate the effectiveness of the medications in the context of any side effects? Who funds the research on these medications? Is there evidence that politics has played a role in the FDA approval of Prozac and other medications? Are these drugs addictive? Are these medications as selective as they are touted to be in targeting specific brain function? Is there really evidence of a biological or genetic basis to depression and mania, concepts Breggin categorizes as "biomythology?" Even if readers do not accept Breggin's answers to these and other questions, the fact that he has raised these issues at least makes the book worthwhile.

Breggin does not align with the increasingly accepted viewpoint that depression is a physiological illness or a chemical imbalance. He asserts that psychiatry and the pharmaceutical firms have "market[ed] depression as a 'real disease' in need of medical treatment (p. 122) for their own purposes. More than skeptical of biopsychiatry approaches, Breggin asserts that there is almost always a life context that causes depression, and that instead of treating the emotional distress, medication mainly blunts the emotions, even the brain function itself. Breggin advocates the careful attention of a professional who can use talk therapy to discover and work through the life context underlying one's depression. Further, using a simple, logical proposition, he questions the theory that these medications target only one type of receptor site or neurotransmitter that has been declared to be the cause of the problem. He points out that the brain is an integrated organ with integrated functions that in turn affect the balance of other neurotransmitters and receptors. This contradicts both the theory of biopsychiatry and the specificity of a medication's affect on brain function-the so-called "magic bullet" concept. Breggin writes:

  [T]he antidepressants probably have no specific antidepressant effect. Their clinical impact derives from any one of, or a com- bination of, at least four factors: (1) enhanced placebo effect, (2) emotional blunting, (3) an energizing or stimulant effect, and (4) the artificial euphoria or apathy associated with an organic brain syndrome. (p. 170)

By seeking always to place emotions and psychological responses in the context of one's life, Breggin demedicalizes the symptoms and underlying causes which send people into the offices of psychiatrists, therapists, and general practitioners. One of my favorite of his re-categorizations is: "Anxiety is a reaction of emotional stupidity in the face of inner stress." (p. 224).

Breggin's descriptions of the side-effects of psychiatric medications are truly frightening. "Lithium," for example, "suppresses thyroid function, causing hypothyroidism and goiter in up to 10 percent of patients" (p. 180). The side effects of the major tranquilizers are now widely known, but Breggin ponders whether the side effects of the now increasingly popular medications, such as Prozac and Xanax may not also prove to have similarly disasterous side-effects. At any rate, his discussion of the difficulties many people have when trying to go off their psychiatric medications justifies his concern that the medications may help to create the very problems they were meant to correct and that these substances may be addictive.

The book suffers somewhat from being outdated. For example, since the book is more than five years old, certain statistics are no longer as current, and the critique of the tricyclic antidepressants is not necessarily germane, as they are now seldom prescribed in light of the "new generation" of antidepressants; yet the concepts remain the same, though some of the newest medications are obviously not discussed. Some readers may quibble with Breggin's tendency towards conspiracy theories, yet he does present solid evidence to back up his claims.

Dr. Breggin writes with passion, conviction, knowledge, and experience, producing a "must-read" book for anyone whose work either relates even remotely to psychology, psychiatry, and education. It is especially relevant for parents who are considering allowing their child to be prescribed psychiatric medications-or anyone who might be taking such medications. Surely not everyone will agree with Breggin's complete disavowal of psychiatric medications. As Healy in The Anti-Depressant Era, 1997, Harvard University Press, points out, both the population in general and clinicians tend to rely mainly upon the media and the manufacturing pharmaceutical firms for their information on these potent psychiatric medications. For this reason, it is especially vital for the other side of the argument to be presented with intelligence and vigor.