From the anti-psychiatry movement of R. D. Laing through Michel Foucault to Thomas Szasz, there’s long been a vigorous debate about the degree to which madness is a reality. I was very struck by one part of an interchange republished in the Fin on Tuesday, originally from Prospect Magazine [pay for view but summaries in this blog post]. Steven Rose makes a very clear argument about causality and parsimony in scientific explanation.
Neurobiologist Steven Rose, in addressing the question of whether science will ever explain mental illness, asks:
What does it mean to explain something? By science, do we mean merely the reductionist techniques of current biological psychiatry, or do we include the wider framing of sociology, politics and economics? And how do we define mental illness.
Rose goes on to discuss the fact that the same patients are often diagnosed with different disorders, and that treatment often involves medications which are targetted at the label for the disease rather than at the symptoms of the individual patient, a point made more acerbically in the LA Times recently. Rose doesn’t want to deny or even minimise the fact that there are biological and genetic aspects to mental illness, but he focusses his attention of the frames in which we interpret it and its epidemiology rather than its aetiology.
Rose writes:
What would constitute an explanation of, for instance, a diagnosis of depression in a working-class woman in Camberwell, or of schizophrenia in an 18 year-old Black British lad in Brixton? Would you want to look for lower serotonin uptakes in the former, or changes in the dopamine metabolism of the latter? Or would you look to deprivation in a profoundly unequal and still and still racist society? As I have said, I take for granted that there will be such biochemical differences, and multiple causal factors, but in science we seek determining causes: those with the greatest explanatory power. The fact that a drug such as Prozac, which affects serotonin reuptake, will alleviate the depression in many patients, is sometimes taken to mean that the depression is caused by a deficit in serotonin metabolism. Yet the flaw of such an argument is clear; aspirin alleviates the pain of toothache, but we don’t conclude that the cause of toothace is too little aspirin in the brain.
I was talking to a clinical psych friend of mine about this recently. She says the problem comes from people looking for physical proof for something that isn’t physical in the same way as a cavity is.
I think it’s similar to photography. We have all this knowlegde about the properties of light are, how it works etc. No-one’s ever seen it behave that way, but photography works when we behave as if this knowledge is correct.
From the anti-psychiatry movement of R. D. Laing through Michel Foucault to Thomas Szasz, there’s long been a vigorous debate about the degree to which madness is a reality…
I’ve been exploring that very concept myself since I had a psychotic break several years ago. What makes my experience different from the mainstream is I didn’t know it was “psychosis”. As a result, I didn’t seek hospitalization but rather, went into the experience and took it through to it’s natural conclusion. I’ve been researching what happened to me ever since then, and perhaps as a result of “taking the road less travelled” have arrived at some different answers for myself. Those who are so inclined are welcome to explore those answers for themselves: Spiritual Emergency
Could be there is sufficient asprin in the brain but still not enough …er, I dunno, conformity device.
At one of the scale I think there are extremes (such as the worst of sociopaths) that are best explained by brain wiring gone wrong. At the other scale, mass movements (such as the Rwandan genocide as an another extreme) show that the individual is subject to all sorts of social and environmental pressures. So my position is that it is a bit of nature and bit of nurture. So I’m with Rose.
Mark, there was an interesting program on Radio National today, wherein Bob Carr “chatted to the Oxford Don, Baroness Professor Susan Greenfield about brains, brilliance and everything” which has relevance here. Greenfield was saying that when we think or experience mentally it is an event in our brain, molecules in motion (my term) as it were. Many scientists have a correspondence theory of mental activity whereby our thoughts are said comprise images etc together with ‘neural correlates’ within our brains. She asked what and where these thoughts might be.
On mental illness she said we can use drugs to change the chemistry, but if through behavioural therapy we change what we habitually think and do then the chemistry will change without the use of intervening drugs. I don’t think she was arguing against the use of drugs btw but rather for a proper understanding of what was actually going on.
I recall hearing of an experiment where a child suffering severe dyslexia was shown to have an abnormal brain scan. After successful remedial activities it was a surprise to the researchers that the brain scans then showed up normal. It shouldn’t have been a surprise imho. If the brain performs differently it seems reasonable that the biochemical patterns should change.
It is a similar problem to the issue of consciousness, which Carr and Greenfield also spoke about, which is taken up very articulately by Susan Blackmore for example here and here.
As to how mental ‘illnesses’ are framed, I don’t have the references to hand but I recall a system developed in Texas whereby the pharmaceutical companies invented illnesses out of divergent behaviour patterns with drugs to match and corrupted every part of the development/trialling/review/evaluation process down to funding groups of prospective ‘patients’, or more particularly their parents in the case of children, who then called for the funding of the drugs under health benefits schemes.
Wow — the stuff about behaviour actually changing the brain physically is mind-blowing. (As it were.) A bloke I know who is a psychologist swears by cognitive behavioural therapy but has never explained that it can make changes at such a basic material level.
He is also very scornful of psychoanalysis, on the general grounds that it has no material or pragmatic dimensions, but I don’t quite see why; surely an intensive and guided program of talking and remembering constitutes ‘behaviour’ as much as any other kind of human endeavour?
I had an interesting exchange with a professor of neuroscience a while ago – he was involved with Jeff Kennett’s beyondblue setup. He gave the address at a graduation I attended and spoke about new understandings about brain chemistry and the resultant strategies for dealing with problems like depression.
He came at it from a resolutely practical angle; this type of chemical reaction causes depression so that type of chemical treatment will reverse or ameliorate it. There wasn’t much space for the possibility of environmental impacts on psychology. The attitude was ‘we had a problem; we’ve solved it’. I was going thru a period of depression at the time and I knew (I didn’t theorise it, I knew) that several interacting factors in my life caused it and that whatever chemistry characterised my brain as a result, it didn’t arise spontaneously on it’s own. It was a RESULT, not a CAUSE.
This bloke is a world class scholar in neurobiology but has co-authored philosophical works as well so didn’t strike me as a scientific logic nazi, but even so he had trouble, when he graciously met me for a coffee, agreeing with my innocuous contention that suffering, often imagined but very often real, causes depression (chemically if you like) and that more grief in the world will cause more depression, even for those only indirectly affected. His stance was ‘well, that might be true (very hard to test scientifically), but if what you end up is a treatable chemical imbalance, you treat it’.
Such a utilitarian approach has it’s uses but to me is fatally unable to address root causes and therefore runs the risk of creating new problems, even while apparently solving old ones. Suffering has always been with us and it takes it’s toll in suicides and wasted lives, but might it not also be an important, even crucial component in many lives of distinction? Might it not play a subtle but integral part in all human progress? Might not it’s banishment eventually bring us more pain in the long term than it relieves us of in the short? Might not the cure preclude any hope of prevention, of healthy self-correction and the spiritual growth it can foster? And anyway, whatever happened to (and what’s wrong with) a bit of good old Stoicism?
That’s when watches were looked at, coffees drained – ‘oh gosh, is that the time?’ etc – it was a bit naïve of me I guess to expect anything more. I was still out of the world, trying to feel my way back in, and the good prof was a vibrant, smiling advert for being in the world, connected vitally to it, appreciating and being appreciated by it. I felt his sympathy but not necessarily his understanding. I wondered if he had ever personally suffered from the ‘disease’ (his nomenclature) he was a leader in treating. I wondered if he ever considered the damage the current medical approach to depression might have in limiting human experience in vital but unseen ways.
And now that a few years have passed and I’ve found a measure of stability, I know that my passing thru that stage without the aid of antidepressants was important for me to have done. I do think it at least possible that had I filled the prescription given me for Xanax that life may have panned out differently; less pain in the short term, less gain in the longer. If the cure cuts off any chance of contact with the roots of the ‘disease’ it can always come back, bigger and better (or worse).
Glen, I think it was Erik Erikson who pointed out that if the psychiatrists had got to Martin Luther and Gandhi and straightened out their kinks the world would have been different but not necessarily better. I think you are spot on in your analysis and your view of suffering. The chemical fix is the quick way home and in some cases may be necessary but in the end you need to understand who you are, how you are placed and get in some kind of control of your destiny.
One problem with drugs is that they affect people in different ways, may have unintended effects and people can become chemically dependent on them. I have heard of people who where not warned about chemical dependence and now have to take the drug for the rest of their lives.
Nevertheless I have heard that psychoanalysis is about as effective statistically as doing nothing. This may be a negative reflection on the skill of many psychoanalists. It is, of course, very expensive to provide. I’ve also heard (via our ABC) that cognitive behavioural therapy can be effectively offered via the net at the cost to the public purse of a few cents an hour.
I think it’s important to differentiate between sadness and clinical depression however – one is certainly a part of life, one is a chemical imbalance, or some sort of malfunction that makes people think and behave unlike themselves. There was a great article on Salon a while back about it:
http://www.salon.com/books/review/2005/05/23/kramer/index.html
Yes, Anna, but I think the distinction is still a contested one. The Texas scam I mentioned above was to medicalise behaviour patterns that may be considered (by whom?) undesirable, especially in children.
I also think that in the case of depression there are gradations. At some point, usually when the behaviour patterns that support daily life break down, clinical intervention may be essential to effect recovery of functional behaviour patterns. This may require drugs or electro-convulsive therapy or whatever.
Where I may quibble with you is where you say “clinical depression however … is a chemical imbalance” (emphasis mine.) Neville Symington for example in A Pattern of Madness claims that all mental illnesses can be treated without drugs, even presumably schizophrenia. He also claims that all mental illness is caused by trauma in early childhood. I tend to think he’s right in emphasising the problems of trauma in early childhood but goes too far in ruling out all genetically-based chemical imbalances which then in interaction with the environment lead to mental illness (I’m staying short of saying cause).
The way Susan Blackmore comes at it is that in mental activity there are a number of streams of neural activity going on simultaneously interacting with the environment and presumably each other. She says you can induce a mental state chemically but not the symbolic content of the state. Yet how you feel about the state and how you remember it is to some degree dependent on the symbolic content.
Also the symbolic content can alter the brain chemistry patterns.
I’m no expert on this stuff, just curious and my mental processes are beginning to break down so I’ll seeya tomorrow.
I didn’t mean to say it was definitely a chemical imbalance – I’m no expert either. Feel free to tell me I don’t know what I’m talking about.
But I have been dealing with people (scientologists) recently who argue that even schizophrenia doesn’t exist. And I have witnessed first hand the wonders of medicating ADHD sufferers.
So yes, in some cases drugs may be offered as a solution before other methods are tried (as in any profession some psychs are better than others), but I think there’s a danger in a. minimising mental illness, and b. portraying drugs as inneffective or dangerous in all cases. There are people who do need them, who are perhaps, because their problems are in the mind, likely to believe the people saying that they’re fine, they’re normal and they don’t need drugs.
As a said in my first comment, I think one of the problems is that people expect the kind of proof that we have of physical illness. I’m just not sure that’s possible. But we have found treatments that work, and even if it perhaps doesn’t prove that there is a chemical imbalance, it doesn’t mean the drugs don’t work.
There is a simple scientific explanation for the cause of mental illness. Look to a little known problem of human physiology that was discovered because it caused mental breaks for knowledge workers. They were using the first prototypes of close-spaced office workstations. The cubicle solved the problem by 1968, and the mental breaks stopped for cubicle users.
Normal features of the physiology of sight contribute to this phenomenon. The effect can be seen in two exercises that also cause mental breaks. In fact the exercises, done in groups, create the same “special circumstances” of those 1960’s early workstation prototypes.
Both Qi Gong and Kundalini Yoga produce a first psychotic episode when too many exercise sessions are performed in a compact time frame. But when the exposure is low level over long time periods a fixed psychotic altered mental state is created with bizarre delusions and thought processing problems like schizophrenia.
The exercises’ effects are so narrowly focused that they do not cause drastic life changing disability like schizophrenia. When schizophrenia is viewed as an altered mental state caused by exposure to visual Subliminal Distraction this explains why so many things can be associated with the disorder. The altered mental state can be imposed on any other mental deficit except full blindness. The fully blind are immune.
The effect of that can be seen in disorders that rarely have a blind victim. Can you cite a case of PTSD or Panic Attacks for a fully blind person? The partially sighted can be exposed if they have enough peripheral vision to subliminally detect movement in peripheral vision.
This vision driven phenomenon explains why schizophrenia onsets in adolescence and why paranoia is often part of the illness. Exposure to SD spikes after puberty causes increased body size in classrooms. The repeating subliminal appreciation of threat from visual Subliminal Distraction eventually colors thought and reason creating paranoia and unattributed fear.
Simple no cost or low cost precautions can create Cubicle Level Protection where it is needed in student work and study areas including computer workstations. Laptops are particularly dangerous for exposure because they can be used anywhere without precautions for CLP.
It was Kierkegaard who said “Life is not a problem to be solved, but a mystery to be lived”.
In a real sense there is more evidence for the existence of Santa Claus and the Easter Bunny than mental illness.
The whole mental health industry would lead us to believe that ‘pathology’ exists in almost all aspects of existence and needs to be treated. So, if you move too much (ADHD) your’re in trouble, move too little (catonia)
The mental health industry and the major pharmaceutical companies have a vested interestin inventing new disorders. DSM2 (Diagnostic and Statistical Manuel of the American Psychiatric aAssociation) voted homoxuality as a sexual disorder, but voted it out as one in DSM3.
New disorders are constantly being invented. One of the more recent is ‘erotomania’ or stalkers disease.
In reality there are no objective tests, slides, viruses or infections that can identify and predict behaviour that would be called ’schizophrenic’, ‘anorexic’ etc.
The mental illness industry is a hoax perpetrated on the unscientific to obtain money, power and prestige.
My very old, pre-Prozac, Goodman and Gillman makes the very sound point that the anti-depressants then available (such as the tricyclics) were completely useless if you were dealing with grief rather than clinical depression.
Beyond that, I don’t want to get into the whole social/community workers vs psychiatrists argy-bargy. I’ll stick with the wise words of my head care specialist who, when I expressed resistance to the idea of going on anti-depressants on the seemingly reasonable grounds that the depression must have some cause – bad living or such – that needed to be confronted and addressed.
“Gummo” he asked, “Why do you want to be so cruel to yourself?”