Currently, mental health medications or psychotropics are placed into five categories: antidepressants, anti-anxiety medications (or anxiolytics), stimulants, antipsychotics (or neuroleptics), and mood stabilizers. Antidepressants treat depression, anti-anxiety medications help reduce the symptoms of anxiety, stimulants treat ADHD and narcolepsy, antipsychotics treat psychosis, and mood stabilizers treat bipolar disorder and mood changes associated with other mental disorders. But they don’t always “stay in their treatment lane,” and are used off label to supplement the treatment of mental disorders in some of the other categories. A helpful way to understand this cross-pollination use of psychotropics is to consider the models of drug action proposed by British psychiatrist, Joanna Moncrieff.
Moncrieff has described two different approaches to psychiatric drug treatment, the disease-centered model and the drug-centered model. She has written several books on the topic, including The Myth of the Chemical Cure, Chemically Imbalanced, and The Bitterest Pills. Respectively, these books critique psychiatric drug treatment, the serotonin myth of depression, and how antipsychotics were transformed from neurological poisons into magical cures. You can also read about her models of drug action on her website and in an article she wrote for Social Science & Medicine, “The creation of the concept of an antidepressant: An historical analysis.” What follows was quoted from her website.
Drugs are frequently prescribed for people with emotional and behavioural problems – problems we currently label as ‘depression,’ ‘schizophrenia,’ ‘bipolar disorder’ and ‘ADHD.’ In trying to understand more fully what these drugs actually do to people, I have formulated two different ‘models’ of drug action: the ‘disease-centred’ model, and the ‘drug-centred’ model. The disease-centred model suggests that psychiatric drugs work because they reverse, or partially reverse, the disease or abnormality that gives rise to the symptoms of a particular psychiatric disorder. Thus ‘antipsychotics’ are thought to help to counteract the biological abnormalities that produce the symptoms of psychosis or schizophrenia, ‘antidepressants’ are thought to act on the biological mechanisms that produce symptoms of depression and ‘anxiolytics’ are believed to act on the biological basis of anxiety. ‘Mood stabilisers’ are thought to correct a pathological process that gives rise to the condition of manic depression (bipolar disorder) or, as is sometimes claimed, to variability of mood more generally.
The disease centred model is borrowed from general medicine and presents drugs through the prism of the disease, disorder or constellation of symptoms the drugs are thought to treat. According to this view, drugs have their effects in a diseased or abnormal nervous system. The important effects of drugs are the ones they exert on the disease process. All other effects are of secondary interest and are referred to as ‘side effects.’ An example from medicine, one that is often cited by psychiatrists in an effort to reinforce the disease centred model, is the use of insulin in diabetes. By replacing the body’s failing supply of the hormone insulin, replacement insulin treatment helps to move the body towards a more normal state. However, even symptomatic treatments like pain killers act in a disease centred way because they produce their effects by counteracting some of the physiological processes that produce pain.
In contrast, the ‘drug-centred’ model suggests that far from correcting an abnormal state, as the disease model suggests, psychiatric drugs induce an abnormal or altered state. Psychiatric drugs are psychoactive substances, like alcohol and heroin. Psychoactive substances modify the way the brain functions and by doing so produce alterations in thinking, feeling and behaviour. Psychoactive drugs exert their effects in anyone who takes them regardless of whether or not they have a mental condition. Different psychoactive substances produce different effects, however. The drug-centred model suggests that the psychoactive effects produced by some drugs can be useful therapeutically in some situations. They don’t do this in the way the disease-centred model suggests by normalising brain function. They do it by creating an abnormal or altered brain state that suppresses or replaces the manifestations of mental and behavioural problems.
She noted that when psychiatric drugs were introduced in the 1950s, they were visualized within a drug-centered model. Antipsychotics were then known then as ‘major tranquilizers,’ a special kind of sedative. By the 1970s, this view had become the disease-centered model, which changed how drugs were named and classified. “Drugs came to be named and classified according to the disease or disorder they are thought to treat; antidepressants, antipsychotics and anxiolytics.”
The ascendance of the disease-centred model of drug action did not occur because of overwhelming evidence of the superiority and truth of the disease-centred model. There was not then, and is not now, convincing evidence that any class of psychiatric drugs has a disease centred or disease-specific action. There was not even any real debate about alternative theories of drug action. The disease-centred model just took over and the drug-centred view simply faded away. People forgot there had ever been another way of understanding how psychiatric drugs might work.
In “The creation of the concept of an antidepressant: An historical analysis,” Moncrieff noted where stimulants were used to treat depression in the 1940s until the anti-tuberculous drugs iproniazid and isoniazid were suggested to be effective with depression. As the disease-centered model became more dominant during the 1950s, certain drugs began to be known as “antidepressants,” and others as “antipsychotics.” But there is little evidence to support the assumption that psychiatric drugs act in a specific, disease centered manner. In a 2005 article, “Rethinking models of psychotropic drug action,” Moncrieff and her coauthor David Cohen said: “The therapeutic value of a drug stems from the usefulness of these effects in clinical situations.”
In “Drug-centred psychopharmacology” a non-diagnostic framework for drug treatment,” Moncrieff and others compared drug-centered practice and disease-centered practice. The disease-centered model suggests prescribing should be driven primarily by diagnosis and etiology. In contrast, a drug-centered model concentrates on making judgments about whether drug-induced mental and behavioral changes are useful, “bearing in mind the particular circumstances of each individual.” A drug-centered approach highlights the harm that drugs can do, without the presumption of benefit inherent in the idea that drugs correct an underlying abnormality. “Many psychiatrists will have used the drug-centred model without explicitly acknowledging it as such, particularly in unlicensed or ‘off-label’ prescribing, where drugs are often used for their emotion- and behaviour-modifying effects.”
Chemical Disruption as Medical Treatment
In “And You Thought They Were Side Effects,” Randy Cima suggested a thought experiment: imagine if Tylenol was marketed as a treatment for “Pain Sensitivity Disorder,” or caffeine pills were labeled “Wakefulness Deficiency Medication.” That marketing would be absurd. Yet, that it is what psychiatry has done—turned drug effects into “cures” for invented disorders. There are four simple categories of psychiatric drugs, according to Cima: tranquilizers, stimulants, painkillers, and hallucinogens. They don’t fix chemical imbalances, regulate mood or stabilize brain function; they merely alter how the body functions. “And when framed just right, those same effects are sold as medicine.”
Big Pharma did this before when they sold amphetamines as a cure for lethargy and said benzodiazepines were “non-habit forming” treatments for anxiety. Psychiatry rebranded stimulation, numbing and distortion as treatment. “The drugs haven’t changed—the marketing just got better.” They aren’t targeted treatments. Rather, they are “broad acting chemicals disguised as diagnoses.”
The same substance might be prescribed for depression, anxiety, ADHD, or PTSD—not because it treats a specific illness, but because it produces a noticeable effect. A tranquilizer becomes a “mood stabilizer,” a stimulant becomes an ADHD solution. The drug stays the same—only the story changes.
So-called “side effects” are the only effects. There isn’t a cure beneath the side effect, just a chemical alteration changing perception or behavior. Drowsiness, agitation, numbness and disorientation aren’t accidents; “they’re the expected results of chemical interference.” These so-called side effects are the treatment. What Moncrieff and Cima are saying is that before accepting the label on the bottle, ask: “What do these drugs actually do—with or without a diagnosis?”
Psychiatry’s influence and power comes from controlling the language surrounding mental disorders and diagnosis. “By shifting the terms, it has turned suppression into stabilization, agitation into focus, numbness into calm, and hallucination into healing.” And then it calls this a cure. Psychiatry rebranded the effects of these drugs and built an industry on the illusion. “It’s marketing—dress in a white coat.”
