Despite decades of intensive research into various neurotransmitters, genetics and neural networks, a definitive cause of any form of mental distress has yet to be determined. In the light of this uncertainty, two main models for drug action have been proposed. The ‘disease-centred’ model of drug action assumes that psychiatric drugs reverse (or partially reverse) an underlying abnormality or disease process that is presumed to give rise to the symptoms of a disorder. This is closely related to theories that some mental health conditions arise from ‘chemical imbalances’ in neurotransmitters in the brain. Consequently, many people have been told that there is a biological reason for their depression (such as a biochemical change in the brain or a genetic factor). The powerful psychological ‘message’ that they have little control is inconsistent with the thinking that therapy helps people gain more control over their feelings and how they behave.
As there is little dependable evidence to support the above model, the ‘drug-centred’ model has more recently been proposed. This highlights that psychiatric drugs produce an altered global state that involves physiological, psychological and behavioural changes. These changes are superimposed on, and interact with, symptoms of mental ‘disorders’ in ways a person may experience as either helpful or unhelpful. An example of this is the effects of a benzodiazepine on anxiety. Benzodiazepines reduce arousal and induce a state of calmness and relaxation. This may be experienced as a relief for someone suffering from anxiety, but it does not mean that the person returns to their ‘normal’ or pre-symptomatic state. Moreover, it is accompanied by sedation and mental clouding which may be problematic. Because they alter normal bodily functions, all drugs have adverse effects and may do more harm than good especially if prescribed long term. Psychiatric drugs are likely (to varying degrees) to impair and suppress aspects of a person’s mental and emotional functioning. Individuals have to decide and periodically re-evaluate whether the overall effects of a drug are preferable to the original distress or difficulties they experienced.
Understandably, some clients do not wish to experience strong feelings of distress and might assume that drugs will quickly and with little effort bring them relief. Therapists will need to consider not only the implicit and explicit messages received by clients regarding psychiatric drugs, but the beliefs and meanings associated with these, as they could prevent them from accepting an alternative view of what could help.
The British Psychological Society (BPS) takes the view that ‘clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses … which do not reflect illnesses so much as normal individual variation … This misses the relational context of problems and the undeniable social causation of many such problems.’2