Why Are So Many Psychiatric Drugs Prescribed if We Don’t Really Understand How the Brain Works?

Reader’s Question

There seem to be so many medications prescribed these days that alter brain chemistry. I often wonder why these drugs are prescribed when we don’t yet fully understand how the brain really works. I also wonder how safe the medications really are. They do alter brain chemistry, but they also have powerful side effects. I don’t think the brain was meant to be tampered with so much and not enough is really known about its operation to throw so many drugs at us. There seem to be far too many unknowns for them to be considered genuinely safe. Sometimes I wonder if the “science” of psychiatry isn’t really a self-perpetuating myth. I also wonder if tampering with the brain isn’t an action that might not come back to haunt us.

Psychologist’s Reply

It’s understandable to have concerns about the rapid proliferation of drugs that alter brain chemistry. Although we still don’t know a lot about how the brain works, we certainly know infinitely more than we did just thirty or forty years ago. And in many cases, some of the discoveries we’ve made have dramatically changed people’s lives for the better. For example, it was not too long ago that individuals with the brain chemistry disorder we call schizophrenia were often doomed to a lifetime in an institution, subjected to therapies that were both ineffective and sometimes easily regarded as inhumane. With the advent of effective anti-psychotic drugs, such individuals were able to leave the confines of the institution and live near normal lives, provided they got the continuing supportive therapies they needed. Further, the histories of individuals with biologically-based severe mood disorders were much more likely to include serious life disruptions or even death before the advent of mood elevating and stabilizing drugs.

As with any other medical intervention, care that is not comprehensive and that does not include other vital therapies can be problematic. Prescribing powerful mind or mood altering drugs without addressing the lifestyle and other factors that might be contributing to a person’s difficulties can certainly be problematic. That’s why most good psychiatric care includes regular psychotherapy or other adjunctive or supportive therapies as part of the treatment regimen. Also, although sometimes long-term treatment with medication is indicated, in many instances the objective is to help a person achieve a level of coping ability in which medication is no longer necessary.

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Every day we also learn a lot more about how the brain works. Every new discovery challenges the way we’ve always thought about ourselves, our behavior, and what makes us the way we are. As for why treatment is even attempted when we still don’t understand everything, the same issue could be raised about just about every area of human knowledge. Besides, some of our best scientific discoveries have come about serendipitously. That’s what makes science an “evolving” body of knowledge. So, we try things and build on the knowledge that we steadily acquire, collecting data (both the good and bad) about how our interventions fare and then refining our techniques.

Science is not perfect. And, for a variety of reasons (mostly economic), these days it’s not very pure, either. But the quality of human life owes a lot to science’s preeminence as the vehicle for acquiring knowledge.