The Benefits of Behavioral Health Care and the Need to Reevaluate the Biological Bases of Behavior Perspective

I believe wholeheartedly that the current attempt by some to reduce all mental health issues to neural chains of events in the brain is totally misdirected. There is plenty of evidence that biological changes in the brain are caused by, as well as have an influence upon, psychological factors such as thoughts, feelings and behaviors.  There is no reason to assume that it is a one-way street: Biological and psychological factors both affect the other.

Due to the increased cost of medications and decreases in fees for psychotherapy, it is now a real bargain for the insurance companies to try the psychological methods first, and use medications as a last resort. Perhaps the current Medicaid/Medicare policy that newly diagnosed mental health patients “must” be referred for psychiatric evaluations will eventually be replaced with a new policy stating that all newly diagnosed psychiatric patients “must” be referred for psychological evaluations. Why not require five or ten sessions of psychotherapy, before subjecting patients to the side-effects of medications?  While we are at it, why not require the psychiatry profession to measure pre- and post-serotonin or dopamine levels/markers before and after providing psychiatric medications to patients? Additionally, if the mental health issues are actually related to these types of neurotransmitters, how about psychologists collaborating with M.D.s who would measure these levels before and after psychotherapy?

The medical profession has gained much control over the finances of mental health, both in areas of research and practice. In many ways, it is a very self-serving profession. We need to speak up. By and large, politicians and the general public are extremely naive about these matters. A large section of the population does not even think one should call oneself a doctor unless one prescribes pills. Books such as Anatomy of an Illness provide a sobering look at the failure of the biological approach, especially over the long-term, to treat mental illness in a safe and effective way. There have been some great successes based on the biological approach, such as helping to de-institutionalize individuals, but most of the failures of this approach have been “swept under the rug” so to speak. In my opinion, it is not that biological factors are unimportant. They are very important. It is that psychological factors are equally important. The logical error being made by some is to over-focus on neural circuits simply because they are correlated with psychological factors.

Correlation does not mean causation. In other words, changes in one may cause changes in the other, or vice versa. The reason we need to be included in the research is to establish more empirical evidence as to the cause and effect relationships between the two. These may be different for different types of disorders. To me it seems very simple-minded to believe that “depression is a serotonin imbalance affecting the serotonin neural circuit, and this can be remedied by the magical serotonin reuptake inhibitors.” Why not, “Depression is a complex disorder affecting ones feelings, thoughts, behavior, energy, concentration, motivation, relationships, and a host of other factors, all of which show some correlation with various neurological changes, partially manifested in serotonin and perhaps other neurotransmitter changes.  All of these factors can potentially affect the others in a causative fashion that has not been fully discovered or clarified by the current state of research.”

I think this is why we have to speak up as a group–so that we as professionals are not left out in the cold, and so that our patients can have the best chance of effective diagnosis and treatment.

Stephen J. Antonello, Ph.D., L.P./L.M.F.T., is a Minnesota licensed psychologist who specializes in the psychological assessment and treatment of adults with autism spectrum disorder and developmental disability, and persons with serious and persistent mental illness. He also provides psychological evaluations to determine the mental status, functional capacities and treatment needs of parents in the child-protection system (CPS) and individuals participating in the Minnesota Family Investment Program (MFIP). He has been in private practice in St. Paul and the surrounding area for the past 32 years.

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