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Behavior Analysis in the Era of Medicalization: The State of the Science and Recommendations for Practitioners

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  • Treating Psychological Problems with Medications
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Abstract

Recent decades have witnessed an increase in biological explanations of common disorders such as depression and anxiety, a phenonmenon termed “medicalization” (Conrad, 2007). Behavior analysts may find it difficult to implement non-drug treatment with a populace that has become inundated with biological explanations and a preference for medication as the treatment of choice. Research frequently cited in support of medicalization includes studies of drug effectiveness, as well as family studies and studies of brain structure and function. Methodological and interpretation difficulties within those bodies of research are described and recommendations are made so that behavioral practitioners may function optimally within the culture of biological causation.

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References

  • Andreason, N. C., & Black, D. W. (2001). Introductory textbook of psychiatry (3rd Ed). Washington DC: American Psychiatric Publishing.

    Google Scholar 

  • Angell, M. (2000). Is academic medicine for sale? New England Journal of Medicine, 342, 1516–1518.

    Article  PubMed  Google Scholar 

  • Angell, M. (2005). The truth about drug companies: How they deceive us and what to do about it. New York: Random House.

    Google Scholar 

  • Angell, M. (2008). Industry sponsored clinical research: A broken system. Journal of the American Medical Association, 300, 1069–1071.

    Article  PubMed  Google Scholar 

  • Antonuccio, D. O., Danton, W.G., DeNelsky, G.Y., Greenberg, R. G., & Gordon, J.S., (1999). Raising questions about antidepressants. Psychotherapy and Psychosomatics, 68, 3–14.

    Article  PubMed  Google Scholar 

  • Antonuccio, D.O., Danton, W.G., & DeNelsky, G.Y. (1995). Psychotherapy versus medication for depression: Challenging the conventional wisdom with data. Professional Psychology Research and Practice, 26, 574–585.

    Article  Google Scholar 

  • Barlow, D. H., & Durand, V. M. (2009). Abnormal psychology: An integrative approach (5th ed.). Belmont, CA: Thompson-Wadsworth.

    Google Scholar 

  • Barnette, A. (2003, December 12). Revealed: How drug firms hoodwink medical journals. The Observer/UK News. Retrieved December 10, 2003, from http://observer.guardian.co.uk.uk_news/story/0.6903.1101680.00.html.

  • Brooks-Gunn, J. (1988). The impact of puberty and sexual activity upon the health and education of adolescent girls and boys. Peabody Journal of Education, 64, 88–113.

    Article  Google Scholar 

  • Byrne, D., Ervin, C. R., & Lamberth, J. (1970). Continuity between the experimental study of attraction and real-life computer dating. Journal of Personality and Social Psychology, 16, 157–165.

    Article  Google Scholar 

  • Caruso, D. B. (2006, November 3). Med students taught to resist drug pitches. The Charleston Gazette, pp. 3A.

  • Caspi, A., Lynam, D., Moffitt, T. E., & Silva, P. A. (1993). Unraveling girls’ delinquency: Biological, dispositional and contextual contributions to adolescent misbehavior. Developmental Psychology, 29, 19–30.

    Article  Google Scholar 

  • Chance, P. (2009). Personal communication.

  • Clausen, J. A. (1975). The social meaning of differential physical and sexual maturation. In S. E. Dragastin & G. H. Elder (Eds.), Adolescence in the life cycle: Psychological change and the social context (pp. 25–47). New York: Halstead.

    Google Scholar 

  • Comer, R. J. (2007). Abnormal psychology (6th ed.). New York: Worth.

    Google Scholar 

  • Conrad, P. (2007). The medicalization of society. Baltimore: The Johns Hopkins University Press.

    Google Scholar 

  • Cooper, W. O., Arbogast, P. G., Ding, H., Hickson, G. B., Fuchs, C., & Ray, W. A. (2006). Trends in prescribing of antipsychotic medications for US children. Ambulatory Pediatrics, 6, 79–83.

    Article  PubMed  Google Scholar 

  • Delgado, P., & Moreno, F. (2000). Role of norepinephrine in depression. Journal of Clinical Psychiatry, 61, 5–11.

    PubMed  Google Scholar 

  • Dick, D. M., Rose, R. J., Viken, R. J., & Caprio, J. (2000). Pubertal timing and substance use: Associations between and within families across late adolescence. Developmental Psychology, 36, 180–189.

    Article  PubMed  Google Scholar 

  • Farber, S. L. (1981). Identical twins reared apart. New York: Basic Books.

    Google Scholar 

  • Faux, S. F. (2002). Cognitive neuroscience from a behavioral perspective: A critique of chasing ghosts with Geiger counters. The Behavior Analyst, 25, 161–173.

    PubMed  PubMed Central  Google Scholar 

  • Flora, S. R. (2007). Taking america off drugs: Why behavioral therapy is more effective for treating ADHD, OCD, depression and other psychological problem. Albany, N.Y.: State University of New York Press.

    Google Scholar 

  • Ge, X., Conger, R. D., & Elder, G. H., Jr. (1996). Coming of age too early: Pubertal influences on girls’ vulnerability to psychological distress. Child Development, 67, 3386–3400.

    Article  PubMed  Google Scholar 

  • Glenmullen, J. (2000). Prozac backlash: Overcoming the dangers of Prozac, Zoloft, Paxil and other antidepressants with safe, effective alternatives. New York: Simon & Schuster.

    Google Scholar 

  • Gottesman, I. I. (1991). Schizophrenia genesis: The origins of madness. New York: Freeman.

    Google Scholar 

  • Graber, J. A., Lewinsohn, P. M., Seeley, J. R., & Brooks-Gunn, J. (1997). Is psychopathology associated with the timing of pubertal development? Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1768–1776.

    Article  PubMed  Google Scholar 

  • Hales, R. E., & Yudofsky, S. C. (2003). Textbook of clinical psychiatry (3rd Ed.). Washington DC: American Psychiatric Publishing.

    Google Scholar 

  • Haslam, J. R., Sayce, L., & Davies, E. (2006). Prejudice and schizophrenia: A review of the ‘mental illness is an illness like any other’ approach. Acta Psychiatrica Scandinavica, 114, 303–318.

    Article  PubMed  Google Scholar 

  • Healy, D. (2004). Let them eat Prozac: The unhealthy relationship between the pharmaceutical industry and depression. New York: New York University Press.

    Google Scholar 

  • Henderson, D. (February 26, 2007). Counter-detailers help doctors wade through drug company marketing. Retrieved August 29, 2009 from http://www.boston.com/business/healthcare/articles/2007/02/26/independent_lens?mode=PF

  • Hopper, J. A., Speece, M. W., & Musia, J. L., (1997). Effects of an educational intervention on residents’ knowledge and attitudes toward interactions with pharmaceutical representatives. Journal of General Internal Medicine, 12, 639.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, L. A. (2004, May 17). Spending soars for children’s attention deficit, behavior drugs. Charleston Gazette, pp. 2D.

  • Jones, M. C. (1965). Psychological correlates of somatic development. Child Development, 36, 899–911.

    Article  PubMed  Google Scholar 

  • Jones, M. C., & Mussen, P. H. (1958). Self-conceptions, motivation and interpersonal attitudes of early and late-maturing girls. Child Development, 29, 491–501.

    PubMed  Google Scholar 

  • Joseph, J. (2003). The gene illusion: Genetic research in psychiatry and psychology under the microscope. Ross-on-Wye, U.K: PCCS Books.

    Google Scholar 

  • Joseph, J., & Leo, J. (2006). Genetic relatedness and the lifetime risk for being diagnosed with schizophrenia: Gottesman’s 1991 figure 10 reconsidered. The Journal of Mind and Behavior, 27, 73–90.

    Google Scholar 

  • Kendler, K. S. (2005). Toward a philosophical structure for psychiatry. American Journal of Psychiatry, 162, 433–440.

    Article  PubMed  Google Scholar 

  • Khan, A., Leventhal, R., Khan, S., & Brown, W. (2002). Severity of depression and response to antidepressants and placebo: An analysis of the food and drug administration database. Journal of Clinical Psychopharmacology, 22, 40–45.

    Article  PubMed  Google Scholar 

  • Kirsch, I., Moore, T. J., Scoboria, A., & Nicholls. (2002). The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment, 5, Article 23. Retrieved July 26, 2004, from journals.apa.org/prevention/volume5toc-jull5-02.html.

  • Kirsch, I., & Sapirstein, G. (1998). Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention & Treatment, 1, Article 0002A. Available on the World Wide Web: http://journals.apa.org/prevention/volume1/pre0010002a.html.

  • Lacasse, J.R., & Gomory, T. (2003). Is graduate social work education promoting a critical approach to mental health practice? Journal of Social Work Education, 39, 383–408.

    Google Scholar 

  • Lacasse, J. R., & Leo, J. (2005). Serotonin and depression: A disconnect between the advertisements and the scientific literature. PloS Medicine, 2, 1–6.

    Article  Google Scholar 

  • Landy, D., & Sigall, H. (1974). Beauty is talent: Task evaluation as a function of the performer’s physical attractiveness. Journal of Personality and Social Psychology, 29, 299–304.

    Article  Google Scholar 

  • Lane, C. (2007). Shyness: How normal behavior became a sickness. New Haven, CT: Yale University Press.

    Google Scholar 

  • Lieberman, J. A., Stroup, T. S., McEvoy, J., Swartz, M., Rosenheck, R. A., Perkins, D. O., et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209–1223.

    Article  PubMed  Google Scholar 

  • Link, B. G., Struening, E. L., Rhav, M., Phelan, J. C., & Nuttbrock, L. (1997). On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior, 38(2), 177–190.

    Article  PubMed  Google Scholar 

  • Lundberg, G. D. (2008, April 3). Placebo as good as Paroxetine for treating acute moderate-to-severe depression. The Medscape Journal of Medicine, Article 79. Retrieved July 1, 2008, from http://www.pubmedcentral.nih.gov/articlerender.fegi?artid=2390688.

  • Mattaini, M. A. (Ed.). (2006). Mental illness, mental health, and cultural analytic science (Special issue). Behavior and Social Issues, 15, 129–131.

  • Millenson, M. L., & Shalowitz, M. (2005). Getting doctors to say yes to drugs: The cost and quality impact of drug company marketing to physicians. Blue Cross Blue Shield Assocation. Retrieved December 20, 2005 from http://www.bcbs.com/coststudies/reports/Drug_Co_Marketing_Report.pdf

  • Mojtabai, R., & Olfson, M. (2008). National trends in psychotherapy by office-based psychiatrists. Archives of General Psychiatry, 65, 962–970.

    Article  PubMed  Google Scholar 

  • Mussen, P. H. & Jones, M. C. (1957). Self-conceptions, motivations and interpersonal attitudes of late- and early-maturing boys. Child Development, 28, 243–256.

    PubMed  Google Scholar 

  • Pharmaceutical federal lobbying spending flourishes (April 2, 2007). Center for Public Integrity. Washington DC. Retrieved April 2, 2007 from http://www.publicintegrity.org/news/entry/216.

  • Phelan, J. C. (2002). Genetic bases of mental illness—cure for stigma? Trends in Neurosciences, 25, 430–431.

    Article  PubMed  Google Scholar 

  • Pincus, H. A., Tanielian, T. L., Marcus, S. C., Olfson, M., Zarin, D. A., & Thompson, J. (1998). Prescribing trends in psychotropic medications: Primary care, psychiatry and other medical specialties. Journal of American Medical Association, 279, 526–531.

    Article  Google Scholar 

  • Ross, C. M. W. (2008). SSRI ads questioned. Canadian Medical Association Journal NEWS. Retrieved July 1, 2008, from http://www.cmaj.ca/cgi/content/full.174/6/754-a.

  • Sarason, I. G., & Sarason, B. R. (2002). Abnormal psychology: The problem of maladaptive behavior (10th Ed.). New York: Prentice-Hall.

    Google Scholar 

  • Skinner, B. F. (1971). Beyond freedom and dignity. New York: Alfred A. Knopf.

    Google Scholar 

  • Skinner, B. F. (1974). Cumulative record: A selection of papers: Some relations between behavior modification and basic research (3rd ed.) New York: Appleton-Century-Crofts.

    Google Scholar 

  • Smith, R. (2005). Medical journals are an extension of the marketing arm of pharmaceutical companies. Health Letter: Public Citizen Health Research Group, 21(7) 1–3.

    Google Scholar 

  • Ten-year retrospective study shows progress in American attitudes about depression and other mental health issues. Presentation at the Bringing Wellness Home conference, Washington, DC, June, 2007.

  • Terry, C., & Kohlenberg, R. J. (2006, May). The implications of the medical model of mental health on mental health and social policies. Poster session presented at the annual meeting of the Association for Behavior Analysis, Atlanta, GA.

  • Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. The New England Journal of Medicine, 358, 252–260.

    Article  PubMed  Google Scholar 

  • U. S. Department of Health and Human Services (1999). Mental health: A Report of the Surgeon General — executive summary. Report. Rockville, MD: U.S. Department of Health and Human Services, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

    Google Scholar 

  • Valenstein, E. (1998). Blaming the brain. New York: McGraw-Hill.

    Google Scholar 

  • Wakefield, J. C. (2006). Is behaviorism becoming a pseudo-science?: Power versus scientific rationality in the eclipse of token economies by biological psychiatry in the treatment of schizophrenia. Behavior and Social Issues, 15, 202–221.

    Article  Google Scholar 

  • Walster, E., Aronson, V., Abrahams, D., & Rottman, L. (1966). The importance of physical attractiveness in dating behavior. Journal of Personality and Social Psychology, 4, 508–516.

    Article  PubMed  Google Scholar 

  • Watson, P. (1981). Twins: An uncanny relationship? New York: Viking.

    Google Scholar 

  • Winston, M. (2006, May). A behavioral analytic look at mental disorders, the DSM-IV, and functional effects of psychotropic medications. Paper presented at the meeting of the Association for Behavior Analysis, Atlanta, GA.

  • Wong, S. E. (2006a, May). Behavioral versus biomedical treatments for schizophrenia and depression. Paper presented at the meeting of the Association for Behavior Analysis, Atlanta, GA.

  • Wong, S. E. (2006b). Behavior analysis of psychotic disorders: Scientific dead end or casualty of the mental health political economy? Behavior and Social Issues, 15, 152–177.

    Article  Google Scholar 

  • Wong, S. E. (2007). Scientific discovery, social change and individual behavior change. Behavior and Social Issues, 16, 190–196.

    Article  Google Scholar 

  • Wyatt, W. J. (1993). Identical twins, emergenesis, and environments. American Psychologist, 48, 1294–1295.

    Article  Google Scholar 

  • Wyatt, W. J. (2001). B. F. Skinner from A to Z. Hurricane, WV: Third Millennium Press.

    Google Scholar 

  • Wyatt, W. J., (2003, May). Biological causation in the professional and popular cultures: Tactics for dealing with an oversold model. Workshop presented at the Association for Behavior Analysis, San Francisco.

  • Wyatt, W. J. (2006, May). Psychiatry’s flight from science: A profession’s headlong, non-empirical rush to biological explanations. Paper presented at the meeting of the Association for Behavior Analysis, Atlanta, GA.

  • Wyatt, W. J. (2009, May). Medication mania: A look at our national love affair with psychotropic medications. Implications for behavioral practice. Paper presented at the Association for Behavior Analysis International, Phoenix, AZ.

  • Wyatt, W. J., & Midkiff, D. M. (2006a). Biological psychiatry: A practice in search of a science. Behavior and Social Issues, 15, 132–151.

    Article  Google Scholar 

  • Wyatt, W. J., & Midkiff, D. M. (2006b). Six-to-one gets the job done: Comments on the reviews. Behavior and Social Issues, 15, 222–231.

    Article  Google Scholar 

  • Wyatt, W. J., & Midkiff, D. M. (2007). Psychiatry’s thirty-five-year, non-empirical reach for biological explanations. Behavior and Social Issues, 16, 197–213.

    Article  Google Scholar 

  • Wyatt, W. J., Posey, A., Welker, W., & Seamons, C. (1984). Base rates of similarities and differences between identical twins and between unrelated people. The Skeptical Inquirer, 9, 62–66.

    Google Scholar 

  • Zimmerman, M., Chelminski, I., & Posternak, M.A. (2004) Exclusion criteria used in antidepressant efficacy trials: Consistency across studies and representativeness of samples included. Journal of Nervous and Mental Disease, 192, 87–94.

    Article  PubMed  Google Scholar 

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  1. Department of Psychology, Marshall University, 1 John Marshall Dr., Huntington, WV, 25755, USA

    W. Joseph Wyatt Ph.D.

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Wyatt, W.J. Behavior Analysis in the Era of Medicalization: The State of the Science and Recommendations for Practitioners. Behav Analysis Practice 2, 49–57 (2009). https://doi.org/10.1007/BF03391748

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