Time has come in mental health services – humanistic approaches are possible

On 1^st of September I was invited to have a speech in a seminar in Helsinki. The subject was Mental health and Medicalization.  Out of us three having the speech the main lecture was given by Peter Goetsche, a Danish doctor, who is the director of the Nordic Cochrane center. Last year he published the book “Deadline medicine and  organized crime”.  His message in his speech was clear, even if a bit scary:  The Evidence Based recommendations for treatment of depression are based on research that is done by fraud. Pharmaceutical industry has strongly affected the research by financing it and by selecting only those studies to be published that show favorable results for antidepressive medication. But even worse: In many studies the design has been manipulated and if this is not enough, the results of the studies could have been changed.  Myself being a researcher also, all this information was awkward and disgusting.

I have had critical comments on the research design in randomized clinical trials, because e.g. in medication research there are many basic problems in the studies: The follow-up period is usually very short, between 6 to 8 weeks if compared medication to non-medication.  During this period some rapid changes will occur, but it does not tell of the long term outcome that actually in many studies has been shown to change in the way that the advantage of the medicine treatment is no longer visible at 1 year follow-up. The second basic problem in the design is that comparing group means actually do not tell anything about the single clients and their response to the studied method. Statistically significant difference may occur already even if only less than 30% of the participants in the treatment group go over the variation of the results within the control group. So actually 70 % of participants in both groups may have the same results and still because of the statistical difference the conclusion is made that all patients should have the treatment, e.g. antidepressive medication. This is use of power that is manipulated by the research design.

Peter Goetsche’s message has caused a lot of discussion.  His comments come out at the same time when convincing evidence has emerged that both neuroleptic medication in psychosis and antidepressive medication are related to brain changes. Neuroleptic medication has been shown to be related with shrinking of the brain.  More openness has emerged to come back to more humanistic and psychotherapeutically orientated treatment in most severe mental health problems. We are living a momentum, an important period of time, in which the field is open to receive good practices. But this does not happen by itself, but all of us who have the interest of more human services should be active in our context to introduce new ideas of dialogical practice, to organize education of the new practices and also to by research document the advantages of the new practice.

Jaakko Seikkula