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Brain Disease Or Mental Illness?

A lot of bogus pseudo-science is being bandied about in the media, folks, like in the following interview from Sarasota Florida with the current director of the National Institute of Mental Health (NIMH), Dr. Thomas Insel.

Q: What would you say has been the most significant recent breakthrough in mental health research?

A: Part of it is a conceptual breakthrough that is recognizing that mental disorders are brain disorders. That has shifted the conversation about how we diagnose them, how we treat them, and how we train people to help with mental illness.

Dr. Thomas Szasz, Columbia University Psychiatry Professor Emeritus, ends an essay Mental Health As Brain Disease: A Brief History with a quote from a famed neurologist as follows.

Neither the American Psychiatric Association nor American presidents remind people of the caveat of the great nineteenth-century English neurologist, John Hughlings Jackson (1835-1911): “Our concern as medical men is with the body. If there be such a thing as disease of the mind, we can do nothing for it.”

Although there is no mind without a brain, mind is not synonymous with brain.

Back to Dr. Thomas Insel’s interview…

Q: What is an example of a mental disorder we now realize is a brain disorder?

A: Depression. If you asked people 20 years ago what depression was, they would say it was a chemical imbalance. We often treated it with medication to increase serotonin in the brain because we thought depression was an absence of something, a lack of serotonin. We know now that it’s a change in how the brain in functioning in certain circuits. Just like we think of Parkinson’s and other disorders, we can treat it by altering brain circuits, such as through deep brain stimulation. That’s not a common treatment, but it helps us rethink this disorder in terms of the underlying basis in the brain and new treatments will have to do with that.

(Strangely enough, the questions directed to Dr. Insel immediately following the above questions have to do with the effect of environmental factors–the economic recession and hurricane Katrina–on mental health, er, brain disorders.)

Sadness, unshaken sadness then, what used to be referred to during the Middle Ages as Melancholia, is a “brain disease”.

I don’t see any proof here. I just see leading presumptions. “We know now…” “We” do? Where’s your proof?

The thing about the serotonin levels theory was that it was always ass backwards. Doctors presumed depression had something to do with serotonin levels because the drugs they used to treat it extended the life of serotonin in the brain. Yes, but that doesn’t mean doing so will alleviate despair.

If a man were in a very depressing situation, his situation didn’t change overnight, and he was said to be sad or symptomatic about it, he would be called chronic or clinically depressed. You are expected to change him despite his situation, but if he were happy in a sad situation, that is “inappropriate affect”, and a symptom of mental illness.

Hey, maybe he’s bipolar!?

Let me point out, there is no proof, and so this is all a matter of conjecture, of theory.

The same mistake is often made about the label of schizophrenia, that it’s a “brain disease”. If you go to schizophrenia.com you can get lost in such a theory posing as fact. Don’t be fooled. You are reading disinformation spread by people who, if they aren’t comforted by pathos, are more or less tools of the pharmaceutical industry.

Brain disease is the field of study for the neurologist; mental illness is the field of study for the psychiatrist.

If you don’t believe me, go to a search engine on your computer, such as Google, Yahoo!, or what have you, and type into the search box “brain disease”, and hit the search button. You will find a number of undisputable neurological conditions turning up in the links to pages listed from your search. Explore them. Next use “mental illness” as your key search term, and it’s likely to be mostly depression, schizophrenia, bipolar disorder, and lesser problems often referred to as behavioral that are turned up in the links. If you want to verify that we’re dealing with theory, and not with fact, use “mental illness as brain disease” as your key search term, and review the debate.

So we don’t know mental illness is a brain disease, but some people would like you to think we did. Curious, isn’t it?

11 Responses

  1. Partly a conceptual breakthrough that has shifted the conversation.
    Methinks he speaks with forked tongue. I think the man is shifty.

    Unfortunately is seems that neurologists who we may have once thought might be our allies have been subverted. They have recently been using the term neuroplasticity. This will be taken over by the shrinks who will be able to use the metaphor to mean whatever they want it to mean if they have to give up on their old tired chemical imbalance claims.

    • Very true. This notion of neuroplasticity, derived from neurology, is being used by psychiatry to serve its own purposes. Some neurologists may be encouraging this trend as well. What once was a matter of over-active neural transmitters is coming to be seen by some as a matter of changing synapses and brain circuitry. Also, brain shrinkage, undoubtably due to psychiatric drugs, researchers are trying to credit neuroplasticity with causing. I think this tendency is likely to become more pervasive in the future, and so I’d look out for it.

      I would have preferred to give my post another title, too. Something along the lines of Brain Disease Or Mental Illness Or Problems In Living?. I felt I was perhaps giving a little too much to the medical model of treatment by not doing so. Mental illness is a myth, and its all about turning problems that all people face into the ideosyncracies of a few space aliens. Back up a bit, the antennae retract, and you’re looking at another human being. Oh, well. Perhaps I can elaborate in some future post.

  2. Hi mfv, I don’t think I was aware that you were the blogger.

    You’ve mentioned “brain shrinkage, undoubtedly due to psychiatric drugs”.

    I might be out of line here but could I just humbly suggest something. Sometimes I get a little bit worried that by attempting to refute some of the dubious claims made by the psychtroopers that even the best intentioned person can fall into the trap of buying into the psychtroopers arguments and worse be wrong or else just present them with an “unfalsifiabe” theory.

    See what I’m getting at? If the shrinks say that the brains of schizophrenics are smaller, you say, “What… the smallest healthy brain is larger than the largest schizophrenic brain?” It’s best to ridicule some of their arguments rather than try to come up with an explanation for something that might not be true anyway.

    I think I know what you mean in the last para of your comment. Its tedious when you are deconstructing the psychtroopers arguments but feel like you have to constantly remind the listener that you maintain that there is no organic condition. A bit like the use of quotes which can become complex and even nested and give too much of a sarcastic tone to a piece of writing.

    You could consider a short statement near the title or on the sidebar of the blog.

    • It depends on which psychotroopers, as you put it, we are talking about. Here’s the argument we get from MindFreedom International:

      “Brain Damage Caused by Neuroleptic Psychiatric Drugs

      In the past two decades, countless medical studies have shown that use of neuroleptic psychiatric drugs (also known as antipsychotics) is associated with structural brain changes, especially when taking high dosages for a long time. These brain changes can include actual shrinkage of the higher level parts of the brain. The shrinkage can be seen in brain scans and autopsy studies. In response to industry defenders who claim that this shrinkage is from the “mental illness,” studies show neuroleptics lead to similar brain changes in animals. While the medical side of large libraries has this information, the public media side of the library does not. In other words, the public, patients and their families are not being informed about what medicine has long known. ”

      Now read some of the evidense cited in this section of the website, and see if you don’t wind up in agreement.

      Neuroleptic Brain Damage

      • I’m thinking in terms of an argument I would coach my clients to use or I use use on their behalf. That neuroleptics cause brain damage will never sway the shrinks (psychtroopers). They just say that the risk of the untreated “condition” outweighs the risk of brain damage.

        Like if I want to get a client of a compulsory outpatient drug order I’m not gonna argue that the pharmaceutical companies are corrupt or that some psychiatrists molest little boys.

  3. Just quickly. Neuroplasticity, like it’s an exciting discovery. Haven’t we known forever that if you practice at something you get better.

    • I want to write this while I think of it. It might be off topic but it’s 115 F in Melbourne and I’ve had about 6 beers. I can barely hear myself type over the noise of the fans in the computer.

      The shrinks will even spin the fact that prolonged use of neuroleptics will cause either permanent damage or damage irreversible given that the patient has a finite lifespan. They spin it in their favour. They’ll say that they have to continue to trank the person because the person is now well and truly brain damaged even if he wasn’t before and now needs to be further tranked. They appeal to the current “reality” of the situation.

      There’s a kind of a precedent comparable dilemma in the criminal justice system. It’s often accepted that a person was NEVER dangerous until the moment AFTER he committed the crime. That the crime itself must have so irrevocably traumatized the perpetrator that in states that have the death penalty death is the kindest sentence.

      In states that don’t have the death penalty whats happening now is that people serve 20 years expecting to get out and then current public opinion is that they stay locked up for natural life. If that’s the case the prisoner should have the option of suicide with morphine and have a few recreational shots of morphine before making a decision. That way the death penalty could be abolished for capital crimes but voluntary suicide could be allowed after a certain sentence had elapsed.

      • I’m working under the assumption that persuation works, and that even psychiatrists are willing to give some weight to the facts. It may be an erroneous assumption, but I’m working under it nonetheless.

        I’m against physically harmful practices. I don’t think trading off years of a person’s life for what basically amounts to a lie is a good trade. I know there are some psychiatrists who think they are doing what’s best for their patients. I want to convince them that harming the physical health of a patient is not going to be good for the mental health of that patient.

        I wouldn’t encourage suicide.

  4. I am one such psychiatrist, who has looked at the facts that we look at only
    at the risk of loosing our source of income. The tradeoff, however, is that I
    have regained my freedom of thought. I’m please to find an icreasing number of forums like this where we are not tied down dogma. We must, though, be careful that we don’t develop a dogma ourselves. I’d love to share where I’m going with this with as many people as I can. VIsit my new blog if you dare.
    Stephen Hale http://www.bettermindset.com

    • Good to have you joining the discussion, Doctor. I think it’s good to keep an open mind, and it’s good to refrain from being dogmatic. The question then becomes though who is being dogmatic. Read almost anything written today on mental health issues, and you get the same sort of nonsense. Some people are just chemically unbalanced. Really? Nobody has ever even found any sort of chemical balance among people who don’t have ‘issues’. The whole chemical imbalance theory falls on its face when you think that it grew out of the drugs that were used to treat emotional disturbances. A person is crazy, give that person a drug, and the person will act less crazy. The drug therefor must have supplied a chemical the body was deficient in. Not so fast. You get an imbalance alright, but after the pills are swallowed, not before. You’ve altered a person’s natural chemistry with this additional chemical. You haven’t corrected any imbalance. Stimulants used to ‘treat’ ADHD may also stunt an adolescent’s growth, but this is not because those chemicals are correcting a chemical deficiency, this is because the kids chemistry has been changed from that which mother nature provided.

      • I’m pleased that you are thinking and writing about this issue.
        So, I’m motivated to add a few more comments.

        “Chemical Imbalance” implies that there are several chemicals that act in opposition to each other to keep the mind working normally. It works normally when the right amount of these chemicals is present. Presumably various biochemical feedback mechanisms control this balance.

        There are neurotransmitters and enzymes that naturally destroy neurotransmitters. It is known that various medications can effect the production as well as the destruction of neurotransmitters. So, the idea is
        that the level of the drug modifies the effective life of the neurotransmitters. Maybe it does.

        The proof of the pudding though is does this result in an improvement in the patients health, well-being, overall happiness and ability to function. That is quite another thing. Who judges the outcome? Of course both the patient and the physicians judge it, but by quite different criteria.

        For the patient, felling better, being more productive, being able to think and then act on thoughts are among the most important. To the physician, these matter, too… but, the emphasis is on control of behaviors that annoy other members of the community, reduction in indicators that support the diagnosis as described in the DSM-IV . So, improvement can be documented by the physician even when the pt. has no sense of improvement. Typically, psychotropic medications have side effects that cause the pt to choos not to take them. Most common are drownsiness, loss of interest in life, anxiety, body tremors, dry mouth, to mention a few.

        So, the management of the “chemical balance” in synapses does have effects, but we are operating on the workings of these synapses with a very blunt tool, and with very poor idea of which synapses we are effecting and of what they do. Research goes on about this, but the challenge is huge. Douglas Hofstadter points out that the very low level system that is a synapse is probably not the level at which issues important to their owners resides. In this case, We are still fumbling around, with good intentions, at some level between molecules and systems at a much higher level that each of us experiences as well-being or distress.

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