The Biological Evidence for “Mental Illness”

On January 2, 2017, I published a short post titled Carrie Fisher Dead at Age 60 on Behaviorism and Mental Health.  The article was published simultaneously on Mad in America.

On January 4, a response from Carolina Partners was entered into the comments string on both sites.

Carolina Partners in Mental Healthcare, PLLC, is a large psychiatric group practice based in North Carolina.  According to their website, they comprise 14 psychiatrists, 7 psychologists, 34 Advanced Practice Nurse Practitioners/Physicians Assistants, and 43 Therapists and Counselors.  They have 27 North Carolina locations.

Partners’ comment consists essentially of unsubstantiated assertions, non sequiturs, and appeals to psychiatric authority.  As such, it is fairly typical of the kind of “rebuttals” that psychiatry’s adherents routinely direct towards those of us on this side of the issue.  For this reason, and also because it comes from, and presumably represents the views of, an extremely large psychiatric practice, it warrants a close look.

I will discuss each paragraph in turn.

“We strongly disagree with this article, which neglects a lot of important information and uses selective hearing to distort what Carrie Fisher was about and also to distort the evidence for mental illness as a real disorder.”

My Carrie Fisher article was brief (566 words), and was intended as a counterpoint to the very widespread obituaries that lionized her as a champion of “bipolar disorder”.  The essential point of my article was that Ms. Fisher had been a victim of psychiatry, and like a great many such victims, died prematurely.  Obviously I neglected a lot of important information.  I could have gone into great length as to the recklessness of psychiatry assigning the bipolar label, with all its implications of helplessness, disempowerment, and “chemical imbalance” to a young woman who by her own account was, at the time, using any drugs she could get her hands on.  But I felt that a brief and respectful statement of the facts was all that was needed.

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“Mental illnesses have a long history of biological evidence. For example, researchers have demonstrated that people with depression have an overactive area of the brain, called Brodmann area 25. Schizophrenia has been linked to specific genes, as PTSD and autism have been linked to specific brain abnormalities. Suicide has been linked to a decreased concentration of serotonin in the brain. OCD has been linked to increased activity in the basal ganglia region of the brain.”

Brodmann area 25 (BA25)
Partners did not provide a specific reference in support of this contention, but my best guess is that the reference is Mayberg, HS, et al (1999) Reciprocal Limbic-Cortical Function and Negative Mood: Converging PET Findings in Depression and Normal Sadness (Am J Psychiatry 1999; 156:675–682).  Here’s the study’s primary conclusion:

“Reciprocal changes involving subgenual cingulate [which includes Brodmann area 25] and right prefrontal cortex occur with both transient and chronic changes in negative mood.”

What this means essentially is that negative mood, whether transient or enduring, is correlated with changes in both the subgenual cingulate (Brodmann area 25) and the right pre-frontal cortex, and that when the depression is relieved, the changes are reversed.

This, of course, is an interesting finding, but provides no evidence that depression, mild or severe, transient or enduring, is caused by a biological pathology.

The reality is that all human activity is triggered by brain activity.  Every thought, every feeling, every action has its origins in the brain.  I cannot lift a finger, blink an eye,  scratch my head, or recall my childhood home without a characteristic brain function initiating and maintaining the action in question.  Without stimuli from the brain, my heart will stop beating, my respiratory apparatus will shut down, and I will die, unless these functions are maintained by machines.

So there is absolutely no surprise in the discovery that sadness and despondency have similar neural triggers and maintainers.  It would be amazing if they didn’t.  But – and this is the critical point – this does not warrant the conclusion that sadness which crosses arbitrary and vaguely-defined thresholds of severity, duration, and frequency is best conceptualized as an illness caused by pathological or excessive activity in BA 25.

Depression is a normal state.  It is the normal human reaction to significant loss and/or living in sub-optimal conditions/circumstances.  It is also an adaptive mechanism, the purpose of which is to encourage us to take action to restore the loss and/or improve the conditions.

All consciously-felt human drives stem from unpleasant feelings.  Thirst drives us to seek water; hunger, food; hypothermia, warmth; hyperthermia, coolness; danger, safety, etc.  Sadness and despondency are no exceptions.  They drive us to seek change, and have been serving the species well since prehistoric times.

But – as is the case with all the above examples – when a drive is not acted upon, for whatever reason, the unpleasant feelings worsen.  Just as unrequited hunger and thirst increase in strength, so the depression drive when not requited deepens.

The reality is that most people deal with depression in appropriate, naturalistic, and time-honored ways.  If the source of the depression is the loss of a job, they start job-hunting.  If the source is an abusive relationship, they seek ways to exit or remediate the situation.  If the source is a shortage of money, they seek ways to budget more sensibly, or increase their earnings; etc.

Depression, either mild or severe, transient or lasting, is not a pathological condition.  It is the natural, appropriate, and adaptive response when a feeling-capable organism confronts an adverse event or circumstance.  And the only sensible and effective way to ameliorate depression is to deal appropriately and constructively with the depressing situation.  Misguided tampering with the person’s feeling apparatus is analogous to deliberately damaging a person’s hearing because he is upset by the noise pollution in his neighborhood, or damaging his eyesight because of complaints about litter in the street.

Our feeling apparatus is as valuable and adaptive as our other senses.  But psychiatry routinely numbs, and in many cases permanently damages, this apparatus to sell drugs and to promote the fiction that they are real doctors.  Their justification for this blatantly destructive activity hinges on the false notion that depression becomes a diagnosable illness when its severity crosses arbitrary and vaguely-defined thresholds.  But deep despondency is no more an illness than mild despondency.  The latter is the appropriate and adaptive response to minor losses and adversity.  The former is the appropriate and natural response to more profound or more enduring adversity.  Though, of course, what constitutes profound adversity will vary enormously from person to person.  An individual, for instance, raised to the expectation of stable and permanent employment may be truly heartbroken at the loss of a job.  Another individual, raised to the notion that there’s always another job “around the corner” will, other things being equal, be less affected.  And so on.

In this regard, it’s noteworthy that Partners’ comment refers to overactivity in BA 25.  The use of the prefix over implies pathology, but in reality there is no yardstick to determine what would be a correct amount of activity for BA 25.  All that can be said, on the basis of Mayberg et al’s findings, and subsequent BA 25 research, is that when a person is sad, there is more activity than when he is happy.  So the use of the term “overactivity” is deceptive – sneaking in the notion of pathology without any genuine or valid reasons to consider it so.  The “reasoning” here is:

–  depression is an illness
–  depression is correlated with high activity in BA 25
–  therefore high activity in BA 25 is pathological

In other words, the contention of pathology rests on the assumption that depression is an illness.  To turn around and use this falsely inferred pathology to prove that depression is an illness is obviously fallacious.  It is also typical of the kind of circular reasoning that permeates psychiatric contentions.  In reality, there is nothing in Mayberg et al or in subsequent research that warrants the conclusion that the increased activity in BA 25 is pathological or excessive.

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Schizophrenia linked to specific genes
This assertion, that schizophrenia is linked to specific genes, is frequently adduced in these debates, as evidence that “schizophrenia” is a real illness with a biological pathology.  Here again, Partners do not provide any references in support of this assertion, but there have been a number of studies in the past fifteen years or so that have found links of this kind.  However, in all cases, the correlations have been small.  In other words, there are always a great many individuals who have been assigned the “schizophrenia” label, but who do not have the gene variant in question; and there are a great many who have the gene variant, but who do not acquire the label “schizophrenia”.  To date, no genetic test has been found helpful in confirming or refuting a “diagnosis of schizophrenia”.

An additional problem arises here, in that the assertion that “schizophrenia has been linked to specific genes” is often interpreted as meaning that “schizophrenia” is a genetic disease, which it emphatically is not.  To illustrate this, let’s look briefly at a real genetic illness:  polycystic kidney disease (PKD).  This is a well established genetic illness caused by cysts in the kidneys.  The cysts progressively block the flow of blood through the kidneys, causing tissue death.

Most cases of PKD are caused by the defective gene (PKD-1).  In polycystic kidney disease, the pathology occurs because the PKD-1 gene causes the nephrons to be made from cyst wall epithelium rather than nephron epithelium.  And cyst wall epithelium produces fluid which accumulates in, and ultimately destroys, the nephrons and the kidney.

So the gene determines the structure of the nephron wall.  This is the primary genetic effect.  This structure causes the wall to produce fluid.  As the nephrons become increasingly blocked, the kidneys produce less urine.  So, reduced urination is a secondary effect of the gene PKD-1.  Symptoms of PKD don’t usually emerge until adulthood, but about 25% of children with PKD1 experience pain and other symptoms.  So a child growing up with polycystic kidney disease may feel sick much of the time.  Such a child, other things being equal, is likely to be fussier and more distressed than other children, and it is entirely possible that one could find a weak correlational link between gene PKD-1 and childhood fussiness, though, of course, any search for such a correlation will be confounded by the obvious fact that children can be habitually fussy for other reasons.  The fussiness would be a tertiary effect of the gene PKD1.

And from there the causal chain could continue in various ever-weakening directions.  For instance, the child might become somewhat sad and despondent.  Or it could be that the child received extra attention and comforting from his parents and was fairly content, and so on.  Ultimately the outcome is impossible to predict with any kind of precision, and the best we can expect from genes vs. subsequent behavior studies are weak, tenuous correlations.

Cleft palate is another example of a pathology that is caused by a gene defect; actually a gene deletion.  This condition results in a characteristically strained and nasal speech quality which can be quite stigmatizing.  The nasal speech is a secondary effect of the gene deletion.

Children with this kind of speech are sometimes mocked and bullied by their peers.  The child might react to this kind of stigmatizing by speaking as little as possible, by withdrawing socially, or in various other ways.  These reactions would be considered tertiary effects of the defect.  And so on.  As with the PKD, each step in the chain takes us further from the genetic defect, and the statistical associations grow proportionally weaker, and it would be stretching the matter to say that the lack of speech was caused by the gene deletion.  Nor would one conclude that the child’s social withdrawal was a symptom of a genetic disease.  And this is true even though the link between the deletion  and the cleft palate is clear-cut and direct.

In the same way, it is simply not tenable to claim that “schizophrenic” behaviors (e.g. disorganized speech) are symptoms of a genetic disease.  This is particularly the case in that correlations between the “diagnosis” and genetic anomalies are typically very small.  The effects of any minor genetic anomalies that might exist have had ample opportunity to be shaped by social and environmental factors, and these are more credible causal constructs.

“Schizophrenia” is not a unified condition.  Rather, it is a loose collection of vaguely defined behaviors.  For this reason, any genetic research done on this condition will inevitably result in conflicting and confusing results.  It’s like looking for genetic similarities in all the people who play bridge, or read romance novels, visit libraries, play football, or whatever.  If the sample sizes are large enough, and in genetic research sample sizes are often enormous, one could probably find small effects in all or most of these areas, but no one would conclude from this that these are genetically determined activities, much less illnesses.

A person’s ability to learn depends on two general factors:  a) the structure of his brain, as determined by his DNA, and b) his experiences since birth.

One can’t learn to play the piano, for instance, unless one has appropriate neural apparatus, and fingers, both of which require appropriate DNA.  But even a person with good genetic endowment in these regards, will never learn to play unless he is exposed to certain environmental factors.  He must, at the very least, encounter a piano.  In the same way, a person whose genetic endowment might be relatively marginal might become an excellent pianist, if he were to receive persistent environmental encouragement and support.

Similar reasoning can be applied to the behavior of not-being-“schizophrenic.”  This behavior involves navigating the pitfalls of late adolescence/early adulthood, and establishing functional habits in interpersonal, occupational, and other important life areas.  Obviously it requires appropriate neural apparatus, hence the weak correlations with genetic material, but equally clearly it calls for a nurturing childhood environment, with opportunities for emotional growth and acquisition of social, occupational, and other skills.

Given all of this, it’s not surprising that researchers are finding correlations between DNA variations and a “diagnosis” of schizophrenia, but given the number of links in the causal chain and the multiplicity of possible pathways at each link, it is also not surprising that the correlations are always found to be weak, and of little or no practical consequence.

Nor is it surprising that the correlations between being labeled “schizophrenic” and various psychosocial factors are by contrast generally strong.  Having a schizophrenia label is correlated with childhood social adversity, childhood abuse and maltreatment, poverty, and a family history of migration.

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Generally similar considerations apply to Partners contentions with regards to “PTSD”, “autism”, suicide, and “OCD”, but space precludes a detailed discussion here.

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“Eric Kandel, MD, a Nobel Prize laureate and professor of brain science at Columbia University, says, ‘All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases…The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?'”

Dr. Kandel (now 87 years old) is an eminent neuroscience researcher at Columbia University.  There’s an extensive biography in Wikipedia.  His early research focused on the neurophysiology of memory.  He has received numerous awards, including the Nobel Prize in Physiology/Medicine (2000), and is widely published.  His record of research achievements is enormous, and his knowledge and expertise are vast, but in the statement quoted by Partners, and, incidentally, by other psychiatry adherents, he is simply wrong.

Let’s take a closer look.  Logically, the Kandel quote can be stated symbolically as:  A is identical to B; therefore malfunctions or aberrations in A are malfunctions or aberrations in B.

On the face of it, this seems sound, and indeed, it is a valid inference in some situations.  For instance, the furnace in a person’s home is the primary heating appliance; therefore, malfunctions in the furnace are malfunctions in the primary heating appliance.  Indeed, in a simple example of this sort, the statement is tautological.  We are simply substituting the synonyms furnace and primary heating appliance, and the inference contains no new information or insights.  But the inference is fallacious in more complex matters.

Let’s concede, for the sake of discussion, that the premise of the Kandel quote is true, i.e., that all mental processes are brain processes.  The term mental processes embraces a wide range of activities, including sensations, perceptions, thoughts, choices, positive feelings, negative feelings, hopes, beliefs, speaking, singing, general behavior, etc.

The term “disorders of mental functioning” is harder to define, but, again for the purposes of discussion, let’s accept the APA’s catalog as definitive in this regard.  Let’s accept that anything listed in the DSM is a “disorder of mental functioning”.

It’s immediately obvious that some of the DSM entries are indeed the result of brain malfunctioning.  In the text these are referred to as disorders due to a general medical condition or to the effects of a substance.  But in the great majority of DSM labels, no such biological cause is identified, and so the conclusion in the Kandel quote would appear to call for some kind of evidence or proof.  However, in the Kandel quote, the conclusion is not presented as something that has been, or even needs to be, proven.  Rather, it is presented as a logical conclusion inherent in, and stemming directly from, the premise.  And it is from this perspective that the Kandel quote needs to be evaluated.

To pursue this, let’s consider the example of “oppositional defiant disorder”.  This is a disorder of mental functioning as defined above, because it is listed in the DSM.  And according to Dr. Kandel’s “logic”, it is also therefore a “biological disease”.  The “symptoms” of oppositional defiant disorder as listed in DSM-5 are:

  1. Often loses temper.
  2. Is often touchy or easily annoyed.
  3. Is often angry and resentful.
  4. Often argues with authority figures or, for children and adolescents, with adults.
  5. Often actively defies or refuses to comply with requests from authority figures or with rules.
  6. Often deliberately annoys others.
  7. Often blames others for his or her mistakes or misbehavior.
  8. Has been spiteful or vindictive at least twice within the past 6 months. (p 462)

Obviously for any of these behaviors to occur, there has to be corresponding neural activity. But there is no necessity that the neural activity is diseased or malfunctioning in any way.  A child learning from his environment, developing his behavioral repertoire in accordance with the ordinary principles or learning, could acquire any or all of these behavioral habits without any malfunctioning in his neural apparatus.  We acquire counterproductive habits as readily, and by essentially the same processes, as we acquire productive ones.  In general, if a child discovers that he can acquire power and control in his environment by throwing temper tantrums, he will, other things being equal, acquire the habit of throwing temper tantrums.  Similarly, if arguing with parents and other authority figures yields positive results, there is a good chance that this also will become habitual.  And this is not because there is anything wrong with the child’s brain.  Rather, it’s because his brain is functioning correctly.  He is internalizing as habits those decisions and actions that pay off.  It is often observed in child-raising practice that if you’re not training your children, they’re training you.

Similar observations can be made about the other seven “symptoms” of oppositional defiant disorder, and indeed all the DSM labels.  A person with a perfectly normal-functioning brain can acquire the habits in question if the circumstances are conducive to this learning.

So to return to the question in the Kandel quote:  “Where else could [mental illness] be if not in the brain?”, the answer is clear:  In the self-serving and unwarranted perception of psychiatrists.  Mental illness is the distorting lens through which psychiatrists view all problems of thinking, feeling, and behaving.  It is the device they use to legitimize their drug-pushing and to maintain the fiction that they are practicing medicine.

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“You’re right that mental illness is also affected by social and environmental conditions–by a person’s disposition, or upbringing, or current environment. It’s also true that mental illness is affected by drug use (both prescribed and not prescribed). So are other medical conditions, such as heart disease and cancer.”

I’m not sure where Partners are coming from here, because I never made any such statement.  In my view, which I have stated clearly on numerous occasions, “mental illness” is a psychiatric invention, self-servingly created to promote the spurious notion that all problematic thoughts, feelings, and/or behaviors are illnesses.  And not just illnesses in some vague allegorical sense, but real illnesses “just like diabetes”, which need to be treated by medically trained psychiatrists with mood-altering drugs and high voltage electric shocks to the brain.

Partners’ vague concessions concerning environment, child-rearing, and drug effects is a fairly standard psychiatric sop, but doesn’t mitigate their earlier contentions on the “long history of biological evidence” and their uncritical endorsement of the logically spurious Kandel quote.

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“And it’s true that mental illness is often difficult to diagnose because of
1) the current limitations of the field of research. Thomas R. Insel, MD, director of the National Institute of Mental Health, for example, talks about how the diagnosis and treatment of mental illness today is where cardiology was 100 years ago, concluding that we need to continue scientific research of mental illnesses.  (There’s a longer quote on this below.)”

And (from later in the comment)

“Longer aforementioned quote:
Take cardiology, Insel says. A century ago, doctors had little knowledge of the biological basis of heart disease. They could merely observe a patient’s physical presentation and listen to the patient’s subjective complaints. Today they can measure cholesterol levels, examine the heart’s electrical impulses with EKG, and take detailed CT images of blood vessels and arteries to deliver a precise diagnosis. As a result, Insel says, mortality from heart attacks has dropped dramatically in recent decades. ‘In most areas of medicine, we now have a whole toolkit to help us know what’s going on, from the behavioral level to the molecular level. That has really led to enormous changes in most areas of medicine,’ he says.

Insel believes the diagnosis and treatment of mental illness is today where cardiology was 100 years ago. And like cardiology of yesteryear, the field is poised for dramatic transformation, he says. ‘We are really at the cusp of a revolution in the way we think about the brain and behavior, partly because of technological breakthroughs. We’re finally able to answer some of the fundamental questions.'”

It is at least forty years since I started hearing about psychiatry’s great biological breakthroughs that were just around the proverbial corner, and the promise, if my readers will pardon the pun, is getting a little old.

What’s noteworthy, however, is that in other disciplines, where there is hope or expectation of breakthroughs, the proponents of these endeavors generally wait until the evidence is in, before implementing practices based on these hopes.  In fact, to the best of my knowledge, psychiatry is the only profession whose entire work, indeed, whose entire conceptual framework, is based on “evidence” and “breakthroughs” that are not yet to hand.

Note also the truly exquisite contrast between Partners’ earlier and confident contention that “mental illnesses have a long history of biological evidence” with the assertion here that the “diagnosis” and “treatment” of “mental illness” today is where cardiology was 100 year ago.

Incidentally, Dr. Insel, former Director of the NIMH, also said:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.” (Transforming Diagnosis, 2013)

And let us be quite clear.  “Lack of validity” in this context means that the “diagnoses” don’t actually correspond to any disease entities in the real world.  Note also that Dr. Insel didn’t say poor validity, or low validity.  He said lack of validity – meaning none.

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Back to the Carolina Partners comment:

“2) mental illness symptoms often overlap with symptoms caused by other illnesses, for example, someone with cancer may also become depressed after diagnosis. Or someone’s fatigue may be caused by a vitamin deficiency, rather than by depression.

While considering all these factors, it is still completely inaccurate to state that there is no biological foundation for mental illnesses. They are not ‘make-believe’ diseases, but rather are caused by a variety of factors, including biological ones. As we understand more about mental illness through research we will (as we have with cardiology, for example) gain more precise vehicles for measuring and understanding the biological implications of these disorders.”

This is a little rambling, but let’s see if we can unravel it.

“… someone with cancer may also become depressed after diagnosis.”

This is true.  In fact, I would say that most people who contract serious illness become somewhat sad and despondent.  But this in no way establishes the notion that the sadness should be considered an additional illness.

“…someone’s fatigue may be caused by a vitamin deficiency, rather than by depression.”

This quote contains one of psychiatry’s core fallacies:  that the various “mental illnesses” are the causes of their respective symptoms (as is the case in real illness).  To illustrate the fallacy, consider the hypothetical conversation:

Client’s wife:  Why is my husband so tired all the time?
Psychiatrist:  Because he has an illness called major depressive disorder.
Client’s wife:  How do you know he has this illness?
Psychiatrist:  Because he is tired all the time.

Psychiatry defines major depression (the so-called illness) by the presence of five “symptoms” from a list of nine, one of which is fatigue, and then routinely adduces the “illness” to explain the symptoms.  In reality, the “symptoms” are entailed in the definition of the “illness”, and the explanation is entirely spurious.  There are many valid reasons why a person might feel fatigued, but none of these is because he “has a mental illness”.  Mental illnesses are merely labels with no explanatory significance.  And because of the inherent vagueness in the criteria, they’re not even good labels.

“…it is still completely inaccurate to state that there is no biological foundation for mental illnesses.”

As stressed above, there is a biological foundation to everything we do – every thought, every feeling, every eye blink, every action.  But – and this is the point that seems to evade psychiatry – there is no good reason to believe that the various problems catalogued in the DSM are underlain by pathological biological processes.  And there are lots of very good reasons to believe that they are not.

“They are not ‘make-believe’ diseases, but rather are caused by a variety of factors, including biological ones.”

I don’t think I’ve ever used the term “make-believe” to describe psychiatric “illnesses”, though I do routinely describe psychiatric labels as invented.  The two terms are not synonymous.  What psychiatry calls mental illnesses are actually nothing more than loose collections of vaguely-defined problems of thinking, feeling, and/or behaving.  In most cases the “diagnosis” is polythetic (five out of nine, four out of six, etc.), so the labels aren’t coherent entities of any sort, let alone illnesses.

But the problems set out in the so-called symptom lists are real problems.  That’s not the issue.  I refer to these labels as inventions, because of psychiatry’s assertion that the loose clusters of problems are real diseases.  In reality, they are not genuine diseases; they are inventions.  They are not discovered in nature, but rather are voted into existence by APA committees.

“As we understand more about mental illness through research we will (as we have with cardiology, for example) gain more precise vehicles for measuring and understanding the biological implications of these disorders.”

But meanwhile psychiatry has made up its mind.  Within psychiatric dogma, all  significant human problems of thinking, feeling, and behaving are illnesses that need to be “treated” with drugs and electric shocks.

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FINALLY

All of this is interesting, and I suppose it’s important to refute the more or less steady stream of unsubstantiated assertions, fallacious reasoning, and spin that flows from the psychiatric strongholds.

But meanwhile the carnage continues.  There is abundant prima facie evidence that psychiatric drugs are causally implicated in the suicide/murders that have become almost daily occurrences here in the US.  My challenge to organized psychiatry is simple:  call publicly for an independent, definitive study to explore this relationship.  And my challenge to rank and file psychiatrists is equally simple:  pressure the APA to call for such a study.  If what you are doing is unqualifiedly wholesome, safe, and effective, then what do you have to fear?

 

  • Chuck Ruby

    This has got to be the best explanation and refutation of the “mental illness” myth I’ve seen! It all comes down to a sleight of hand trick. First claim these problems are illnesses. Then point out the brain “signatures” associated with the problems. Then conclude the brain signatures are evidence that the problems are illnesses. This is exactly what NIMH is going to do with their RDoC initiative. Thanks Phil!

    Chuck Ruby, Ph.D., Executive Director, International Society for Ethical Psychology & Psychiatry.

  • “Client’s wife: Why is my husband so tired all the time?

    Psychiatrist: Because he has an illness called major depressive disorder.

    Client’s wife: How do you know he has this illness?

    Psychiatrist: Because he is tired all the time.”

    This pretty much sums up my three decades of mental health “care.” If I could turn back the clock several decades, I’d cancel the appointments, and try something else. I’d recommend the same to anyone. Please, if you have been given DSM diagnosis, reconsider. Take back your life.

  • Mark

    Bravo!

    The cracks in the profession must be greater than I thought if a large psychiatric group feels compelled to comment here.

  • Al Galves

    This is a terrific refutation of the biopsychiatric ideology. But I take big issue with the following three statements:

    (mental activity) is “triggered by brain activity”
    (mental activity) “has its origins in the brain”
    “brain function initiating” (mental activity)

    This is buying into the notion that the brain has agency, can decide to do anything, can initiate anything. There is no evidence of this and, to say it, plays into psychiatry’s hand. Mental activity is initiated by the mind and the mind is not identical or co-terminous with the brain. I think it is accurate to say that mental activity is mediated by the brain. To say it is initiated or triggered by the brain is a big mistake.

  • Phil_Hickey

    Chuck,

    And thank you for your encouragement.

  • Phil_Hickey

    Julie,

    That’s a nice phrase: “try something else”. How apt. Almost anything would be better than psychiatric “diagnosis” and “treatment”.

  • Phil_Hickey

    Al,

    Thanks for coming in. I think this is a philosophical issue and is usually formulated as: does mental activity cause brain activity, or vice versa? My own position is that they are one and the same event. If my body needs food, certain biological events occur in various parts of my body, including my brain. The mental event that we call “feeling hungry” is my experience of these events from the inside. But it’s very difficult to discuss these matters without using abbreviated phrases such as “triggered” or, as you prefer “mediated”.

    I would never say that the brain decides to do anything. Deciding is an activity, which in my view can be attributed only to the whole person. For instance, I decide to write a post. My brain and other parts of me make this activity possible. Without a brain, I couldn’t write anything.

    Again, thanks for coming in.

  • Phil_Hickey

    Mark,

    Yes. I wondered about that too. After all the anti-psychiatry stuff I’ve written, they come in after a short post about Carrie Fisher! Maybe the sandcastle is crumbing. Happy day!

  • We humans seem to have thick skulls that protect our brains for a good reason. Mother Nature sure is wise! These are much like the fences we build to protect our land. Perhaps for those who need a reminder, here it is: PRIVATE PROPERTY. KEEP OFF.

  • Al Galves

    Thanks for this clarification Phil. I think it is very important to distinguish between the mind and the brain. To impute agency, primacy or autonomy to the brain is a mistake. I realize we are operating in uncharted waters here and that “real scientists” have a problem in dealing with the mind. Robert Uttal wrote a book entitled Mind and Brain: A Critique of Neuroscience” in which he argued that the neuroscientists think they have a theory about how the brain “creates” the mind but they aren’t even close to having such a theory. Sir John Eccles wrote a book speculating about what precisely happens when I decide to move my arm at the count of three and do so. He thinks that agency is fueled by some kind of quantum dynamic but he was admittedly dealing in speculation.

  • Elizabeth Power

    This rocks. It is the best refutation of the subjective, biased work of the DSM–the “Book of Woe” as Allen Francis referred to it in his book by the same name.

    I’ll be sharing this.

  • Glauci Anitta Bernardes

    Oh, nice. So clarifying. OF COURSE my bipolar is fake! Must be an adaptive consequence to the shits happening in my life! Oh wait, my life is kinda perfect, I do what I love for a living, I love my husband, my family is very united, I didn’t suffer any kind of abuse as a child (or grown up), I’ve gone over and over this with my thrrapists, and there’s really no way that having fun in a party with buddies of mine would result in and urge to jump off the balcony (and not drinking, and not on medication). Toooootally.
    And yes, at first, I refused to take meds and went only to therapy. Switched therapists and only kept getting worse. YOU DO NOT KNOW WHAT PSYCHOTIC MANIA FEELS LIKE UNLESS YOU WEAR THE BIPOLAR SHOES.
    The fact that there’s a page called “mental health” that only increases stigma makes me want to vomit.

  • Bradford

    The DSM is in fact nothing more than a CATALOG of BILLING CODES….
    (Obamacare has 70,000 billing codes, but that’s another comment thread!….
    DSM = Designed to SCAM MONEY

  • Bradford

    I clearly remember my parents taking me to my first shrink, in 10th grade…I was given a diagnosis, and prescription, and I was off to the races! (I was also drinking alcohol near daily, w/frequent “black-outs”, smoking weed like it was going out of style, and dabbling w/OTC’s, after a (thankfully not too bad) abusive childhood…. What ensued was the WASTE of the best 20 years of my life, and 3 near-death hospitalizations from psych drugs. I’d be MUCH BETTER off today, if I’d never even heard of the pseudoscience drug racket of psychiatry. Sadly, PhRMA is a multi-BILLION$, global-scale drug racket…. psychiatry is only one of it’s more profitable pushers & dealers…. I’m rarely tired because I don’t over-eat junk food, or drink or drug, and I walk/bicycle/yoga DAILY….
    I only wish I could do more to save the many victims the psychs create every day…. That CMHC scam was pure evil-genius marketing….

  • Rob

    My niece’s dog was diagnosed with depression due to the fact the dog kept peeing on the furniture after her boyfriend moved into the house. The dog was prescribed Prozac, which she got from the local pharmacy. True story.

  • oh god.. it wld be funny if it wer not sad that now poor voiceless creatures(specially dogs because of their proximity to humans) are being made the beneficiaries of psych drugs.. its such a misuse of human power.
    What surprises me is that didnt yr niece think for herself that a dog trainer might be a better option?? why didnt u tell her?
    pray d dog will be taken off Proz. soon. n maybe ur niece may wanna reconsider her relation with that bf !!(dogs can sense emotions of humans and take them on themselves ) ;))

  • Bradford

    Most likely, the dog was marking his territory, not “depressed”. But I’m curious as to what effect Prozac had on the dog. My guess is that Prozac did NOTHING to change the dog’s behavior. And, recently, Carrie Fisher had her ashes put in a giant Prozac-pill urn, by her brother….
    Thanks!, Rob….

  • Rob

    She told me this occurred about a year ago, and that the Prozac “seemed to help the problem”, although the dog still occasionally urinated on the furniture. There are articles that describe dog depression and accompanying Prozac treatment, such as this.
    https://www.vetinfo.com/treating-dog-depression-prozac.html

  • Cled. Anal Health Peer Worker

    Mother nature is wise?

    Old fishy knickers? That old bike? We are talking about the same person aren’t we? About Mother “Bury me in a y-shaped coffin” Nature (to borrow from Edmund Blackadder)?

    If she was wise, she’d keep her legs shut.

    How very convenient that she’s only an allegorical figure! That way we can’t wring her bloody neck, the little hussy.

    And look at the kitschy, mass-produced rubbish our Mother Nature, in her shameless promiscuity, inflicts on the world! (Though, granted, she does every now and then bring into the world a Schubert, an Einstein, the odd George Eliot, a saint here and there, most of whom are either persecuted or left to languish in obscurity (probably for the best, for no fame at all is better than fame amongst fools) whilst the world shoots its figurative load over scoundrels and mediocrities).

    And what about this world into which she brings the unfortunate issue of her humping?

    If it was anyone else, we’d call her a crap mother, powerless as she is to make provisions for all the creatures she with such reckless abandon she produces, who for the most part are cast adrift in this nightmare – though it might seem otherwise to those who won the winning ticket in life’s lottery, insulated against the harsher realities of the brutal struggle for survival by their good fortune, hence the truly sick-making sentimentality about life and the optimism common among the posh and privileged, luxuries the rest can rarely afford – only to tremble with fear for awhile under the gaze of the countless predators converging on their flesh, until their are brutally savaged, and gobbled up.

    Moving on to the article…

    “…proponents of these endeavors generally wait until the evidence is in, before implementing practices on the basis of these hopes.”

    When did evidence ever stop anyone; when did people ever let facts get in the way of their hopes?!

    The problem is when men, unaware of the doom to which they are being led down Hope’s primrose path, take other people with them, like Fred Vincy, one of the principal personages in Eliot’s “Middlemarch”, who, tapping into the “superfluous securities of hopefulness” men always have at their command, borrows money to the eventual detriment of his creditors, on whose purse is visited the punishment for the aforementioned optimist’s rashness in taking out loans on the basis of contingencies, on the hoped for occurrence of which, we are often willing to stake the welfare of others.

    Under the same desire for loot, on the hoped for occurrence of the contingency, nay, the unlikelihood, that one day science will discover a neuropathological basis for the problems of thinking, feeling and behavior with which their “patients” confront them, mental health professionals have staked the welfare and the very existence of other human beings, and it is on their brains and bottoms the punishment for psychiatry’s recklessness is falling.

  • Michael O’Connor

    I disagree with the majority of your assertions on this. Your rebuttal that there are no scientific studies to these cases can be dismissed with a quick google search. There is Mental Illness and the biggest problems with our understanding of it has to do with decades, if not centuries, of social stigmas and denial. So yes the field is very much in flux, currently, and focuses far to highly on treating the symptoms as opposed the cause. The drug culture surrounding mental illness has been crafted by drug companies and while their are, to many, doctors willing to throw drugs at the symptoms there are those trying to actually help people. I don’t see how what you’re doing here is helping us, humanity, achieve better mental health through flat denial of a legitimate issue.
    That said, and I felt it needed to be, I have a question for you.
    In your opinion, what would be the point at which a person would require medication for depression? You cited that this point is not defined and I wonder where you would define it, based on your experience.

  • Francesca Simpson

    Just so you know, some of us actually do believe there’s such a thing as mental illness. Phil Hickey’s insightful, powerful writing has been an enormous help to me in my struggle with bipolar disorder.

  • Phil_Hickey

    Michael,

    Thanks for coming in. Unfortunately you’re missing the whole point. Illness is not a valid or useful way to conceptualize sadness – even profound sadness. You say there are scientific studies that prove these matters. So cite me some actual references that prove, for instance, that all the people who meet the APA’s criteria for major depression or dysthymia have any definable biological pathology.

    Your assignment of blame to the drug companies is also standard psychiatric PR. In reality, not a single psychiatric drug could be sold if psychiatry hadn’t spuriously medicalized every conceivable problem of thinking, feeling, and/or behaving, and progressively liberalized the criteria to the point where virtually everyone can be given a diagnosis, and, of course, a drug.

    With regards to your specific question, there is no “medication” for depression, specifically because depression is not an illness. There are psychiatric drugs that tamper irresponsibly with brain chemistry. These are not as effective as psychiatry claims, often doing no better than placebo, and inevitably entail significant negative consequences when used for long periods of time. And many of psychiatry’s “patients” are told that they have to take these pills for life.

    Most are told the blatant lie that their depression is caused by a chemical imbalance in their brains which the drugs correct! Is this helping humanity?

    So to your question, I don’t think it is ever appropriate to give people drugs to alleviate depression.

  • Olmy Olm

    A quick Google search?

    I’m searching and searching and I can’t find any study that proves there are discrete biological entities causing the so-called mental illnesses defined by the DSM. Can you help me out here?

    What I did find is this, from Steven Reidbord, M.D., who is a psychiatrist himself.

    “No biomarker for any psychiatric disorder has yet been identified.
    Genetic vulnerabilities have been discovered, but nothing resembling a
    smoking gun. Functional brain imaging reveals biological correlates of
    mental impairment, not etiology, and no such imaging can diagnose a
    specific psychiatric condition.”

  • Phil_Hickey

    Glauci,

    There is not a shred of evidence that all, or even most, of the people who meet the APA’s criteria for “bipolar disorder” have any biological pathology. The notion that this loose collection of thoughts, feelings, and behaviors somehow constitutes an illness is spurious and destructive. If you know of some evidence to the contrary, please cite me the references, and I would be glad to take a look.

  • Phil_Hickey

    Elizabeth,

    Thanks for the encouragement.

  • Phil_Hickey

    Bradford,

    Nice!

  • Phil_Hickey

    Bradford,

    Thanks for putting this so clearly. I hope you keep writing. Put comments like this on pro-psychiatry sites.

    Best wishes.

  • Bradford

    We could look at the DSM’s I, & II, & III, & IV, (and IV-R, IV-TR), and the DSM-5, look at the years they came out, and the (growing) number of “diagnoses” in each one, and do some simple mathematical analysis. Will the DSM-6 come out in 2019, and have 600+ “diagnoses”? The DSM-7 come out in 2022, and have 750+ “diagnoses”? The DSM-8 come out in 2027, and have 1,000+ “diagnoses”? You see where I’m going with this?
    The DSM is a CATALOG of BILLING CODES. That’s ALL it is….
    If we’re lucky, and God willing, the DSM-6 will NEVER come out… But the big Wall St. money bets otherwise….
    (I’m ready, willing, able to help, and waiting to be contacted to be of more service and use….

  • Olmy Olm

    Well, here’s a story by a person who lived through psychotic experiences and he would pretty much disagree with most of what you’re saying (and he’s not the only one): https://www.madinamerica.com/2016/09/rejecting-the-medications-for-schizophrenia-narrative-a-survivors-response-to-pies-and-whitaker/

    And here is a description of Open Dialogue, the most successful program for helping people with psychosis in the developed world: https://www.madinamerica.com/2015/04/essay-finnish-open-dialogue-five-year-follow/

  • Bradford

    Due mainly to the poverty of Social Security Disability, I can only access the internet when the Public or local College Library is open. And, again partly due to my IATROGENIC NEUROLEPSIS, I type “2-finger”, which isn’t very fast! Somebody from >madinamerica< DID email me, and ask me, in a general way, about getting my story on there. As I replied to them, I'm doing the best *I* can by myself, and could and would do better, with some help, but I just don't see that happening. The local "community mental health center" has pretty much devastated whatever local recovery/rehabilitation efforts there MIGHT HAVE BEEN…..I'd be glad to respond more fully via direct email….

  • Elizabeth Power

    Thanks–Re the DSM, if you take the most frequently given diagnoses, and overlay the criteria / symptoms that constitute evidence of having them, they are _remarkably_ similar. BTW, ICD-10 is not much better–they at least have an assessment of how well a person functions (the WHODAS) that at least adds context!

  • Cledwyn,
    Love your comments. Reminds me of a classically trained 17th or 18th century orator. What part of the world are you from?

  • Phil_Hickey

    Elizabeth,

    This is interesting, because if you follow the record of someone who has been in the psychiatric system for decades (the so-called chronics!), you usually find that they have accumulated a wide range of “diagnoses”.

    Best wishes.

  • Michael,

    Here’s what a quick Google search of what leading American psychiatrists think about the validity of mental illness diagnoses produced for me recently:

    In 2013, discussing psychiatric diagnosis, the psychiatrist and former National Institute of Mental Health director Steven Hyman stated:

    “The underlying science remains immature…The molecular and cellular underpinnings of psychiatric disorders remain unknown… psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers with which to judge the success of clinical trials.” (emphasis mine)

    Hyman went on to call the DSM model of diagnosis, which includes labels like “schizophrenia,” “Totally wrong… an absolute scientific nightmare.”

    Hyman’s successor at NIMH, psychiatrist Thomas Insel, followed up this criticism by saying:

    “At best, [the DSM is] a dictionary, creating a set of labels and defining each. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.” (emphasis mine)

    David Kupfer, the DSM 5 chair, while trying to defend the new DSM, admitted that the discovery of biomarkers for supposed illnesses like schizophrenia remains “(D)isappointingly distant… unable to serve us in the here and now.”

    And former DSM-IV head Allen Frances went so far as saying, “There is no definition of a mental disorder. It’s bullshit… these concepts are virtually impossible to define precisely.”

    To say the least, these admissions by the leading lights of American psychiatry do not inspire confidence in the validity and usefulness of labels such as “schizophrenia.” And while psychiatrists have promised that new brain research will uncover a biological or genetic basis for the elusive “schizophrenia,” no progress on this elusive goal has been forthcoming.

    Given the fact that leaders of the psychiatric profession have spoken openly about the lack of validity behind labels such as “schizophrenia,” it is fascinating that psychiatrists continue to use the term as if it referred to a valid, reliable illness entity.

  • Olmy, thank you for sharing this; I do appreciate it. Always satisfying to see that one’s musings are starting to get around…

  • Francesca Simpson

    I have much experience with manic psychosis. Believe me, nobody around here is going to tell you your distress is “fake.”

  • Olmy Olm

    Breaking:

    http://blogs.discovermagazine.com/neuroskeptic/2017/01/14/fmri-mental-illness/#.WHt2EFzRMk4

    ‘A
    remarkable and troubling new paper…Sprooten et al.’s analysis
    included 537 studies with a total of 21,427 participants. Five mental
    illnesses were examined: schizophrenia, bipolar disorder, major
    depressive disorder, anxiety disorders, and obsessive compulsive
    disorder (OCD)…

    …The results were rather surprising. It
    turned out that there were very few differences between the different
    disorders in terms of the distribution of the group differences across
    the brain…In other words, there was little or no diagnostic
    specificity in the fMRI results…

    …Sprooten et al. suggest
    that “the disorders examined here arise from largely overlapping neural
    network dysfunction”, in other words that the transdiagnostic trait is a
    neurobiological part of the cause of the various different disorders.
    But it seems to me that there’s no reason to assume this.

    What if the common factor is more straightforward: something like anxiety or stress during the MRI scan?’

  • Phil_Hickey

    Olmy Olm,

    Nice! Psychiatry always assumes that any finding linked to one (or more) of their “diagnoses” must be pathological. But it is just as plausible (or even more so) that the finding is an entirely normal reaction.

    Best wishes.

  • Michael O’Connor

    To Francesca, I’m genuinely glad that you have something that helps with your mental health and wish you the best in finding stability.

    Mr.. Hickey, there is a distinct difference between sadness and depression in my personal experience. I experienced depression. I went beyond “profound sadness” down to the point that I experienced actual pain and serious, and seemingly, logical thoughts of suicide. The catalyst of this was the death of my father and the following suicide of my brother, the next day. Coping with these events was hard and I sought help, which didn’t include medication. Yet it descended to something far worse than “profound sadness,” to the point where something “snapped,” for lack a a better term, in my brain or mind. At this point after the snap, I wasn’t sad, I simply desired to be away from everyone & no longer exist. The thoughts were simple and without any real emotion. Where I was walking down the street looking at headlights trying to judge which vehicle was moving fast enough and had enough mass to end my life painlessly. Fortunately, I did not act on this. However, to move past this pain and desire required medication to assist me in recovering.
    While it took a couple of medications to find the one that worked, all the medication helped, to some degree, in my recovery.
    My experiences and those that I have had with other people close to me which involve mental illness and medication, show me that medication has value. I’ll be the first to admit that medication, in its current forms, may not be the best treatment. However, it does work.
    Next, I find it difficult to believe that you could not think of any form of hypothetical situation that medication would not be useful. Even something wildly unlikely. Say, a family member was “profoundly sad” and literally on the verge of suicide. Where the only thing to help would be psychiatric medication. Even in that extreme a possibility?
    The drug culture that I mentioned, I should have called a pharmaceutical industry culture. What I was refering to is the nigh endless bombardment from pharmaceutical companies in advertisements, direct to doctor sales and so on. These thing to make people terrified that they have something and can only be safe by having the advertised drugs. Drugs which are at least 10 years behind medical science due to the fact that pharmaceutical companies haven’t developed anything new in almost 10 year.
    There is science that supports the changes in the brain between the average person’s brain and someone suffering from mental illness;
    Depression – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2228409/
    Schizophrenia – http://tinyurl.com/zy3e5ex
    Bipolar Disorder – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742607/

  • Phil_Hickey

    Michael,

    Thanks for the links. I look forward to reviewing them, and will get back to you.

  • Phil_Hickey

    Michael,

    Sorry for the delay in getting back. Please see today’s post.

  • K Sean Proudler

    The DSM-5 has been very helpful. For instance, as far as their patent life goes, some drugs had expired, and thus could be replaced with cheap generic drugs instead. However, these old patented drugs were then altered ever so slightly, they were then given brand new names, and through the kindness of the DSM-5, they were assigned to be used for brand new mental illnesses that were invented for these very same modified drugs, new illnesses that did not even exist within the DSM-4.

    And so once again, big big money was falling into the greedy pockets of the pharmaceutical industry. Moving on.

    If a psychiatrist was kidnapped and tortured day after day for 10 years, it is amazing how he will still say that his newly formed deep depression is only the result of a biological abnormal process. Moving on.

    Once a schizophrenic, always a schizophrenic. What do I mean by this? If you have been labeled with the title schizophrenic, no one will ever believe a single word that you have to say from then onward. But these schizophrenic folk do have some fun now and then. What they do, is record events. When encountering an event that does not occur very often, they inform friends, family, etc., about it. Each of the friends, family, etc., immediately shakes their head, expresses anger, and says out loud that no one in their right mind would think that such a ridiculous event is real, “It’s all in your head.”, is what they say. That is when the so called schizophrenic pulls out the physical proof that the event did actually occur.

    The faces of the friends, family, etc., instantly turns deep red with embarrassment.

  • Earth Provides Store

    Unless anyone here is suggesting a religious explanation for life, mental illness, or any other processes and/or disturbances, diseases, or similar issues, then you have ALL failed to realize that your very breathing is a biological function. Unless someone is pulling out the old moralistic notion of a “soul” to explain disease, mental or otherwise, any of you are offering your services as “therapists” should consider a change of career. If you are suggesting some religious, morality-based notion of behavior, go to seminary and show yourselves as religious zealots. Otherwise, if any of you know what an “action potential” is, or are familiar with the motor cortex, or ANY brain structures, you SHOULD KNOW that all thoughts, emotions, along with breathing, have underlying biological processes attached to them. If any of you believe that breathing, fear, walking, sexual impulses, pain, or any other function are outside of the realm of biology, then you ALL are engaged in “magical thinking.” Psychosocial factors play a role in determining biology, such as the role of epigentics disease expression. But, the denial of the role of biology in mental illness is like denying that oxygen has anything to do with respiration. The victimization here is clearly being perpetrated by ignorant and poorly educated individuals expressing unscientific nonsese. Psychiatry has a lot of drawbacks, and the idea of issuing a “pill” to solve all problems is not the better tendency of psychiatry. However, any of you that think you can “‘therapize’ a psychological cure for Cancer,” or “positive think” Schizophrenia away, needs to have your license to practice ANYTHING revoked. With a due respect, look at ALL OF THE RESEARCH before making assertions about what the body of research represents. No wonder people believe in faith healers when this kind of claptrap is posing as “science.”

  • Phil_Hickey

    Earth Provides Store,

    The issue is not that biological functioning underlies all our actions. The issue is psychiatry’s assertion that all human problems are underlain by biological pathology. There is no logical implication here, and no empirical proof either. If you know of any piece of reputable research that proves otherwise please cite me the references. I would be happy to take a look.