Neuroscience, Pseudoscience and The Vast Gulf Between

A guest blog and opinion piece at the top of the search pops on the subject of psychiatry at Scientific America is entitled Why Psychiatry Needs Neuroscience. The author is one Daniel Barron. The claim was made in this piece that there was a war between the two fields to which Neuroskeptic blogger at Discovery Magazine replied with a post of his own, The Fake “War Between Neuroscience and Psychiatry”.

Daniel Barron writes:

That the relevance of neuroscience to psychiatry is still questioned is blatantly outlandish: what organ do psychiatrists treat if not the brain? And what framework could possibly be more relevant than neuroscience to understanding brain dysfunction?

Hold on a minute, “what organ do psychiatrists treat if not the brain?” Uh, I’ve got another one for you, what organ do neurologists treat if not the brain?  I suggest we take it to Google and ask for a definition of psychiatry and  then a definition neurology. If we do so, we get this:

Psychiatry: the study and treatment of mental illness, emotional disturbance, and abnormal behavior.

Neurology: the branch of medicine or biology that deals with the anatomy, functions, and organic disorders of nerves and the nervous system.

It is not brains that psychiatrists study, in other words, it is misbehavior. Whether the misbehavior of people can be linked to misbehaving brains, and by extension, nervous systems (misfiring neurons) is another thing altogether.

Psychiatrists, in other words, deal with mental disorders while neurologists deal with brain injury and disease.  Prove you’ve got a bona fide disease affecting the brain, and, as happened with syphilis early in the twentieth century, it is no longer on the turf of psychiatrists, it is then in the territory of neurologists. This is a divide that can’t be breached by wishful thinking.

With the new emphasis on brain research, everything associated with neuro is trendy. Okay, today there are people calling themselves neuropsychiatrists, and that I would characterize as a mystification, pure and simple. Nobody, after all, who has not gotten into trouble with the long arm of the law, is likely to be called a “psycho-neurologist” anymore.

The question becomes, when it comes to behavior, over which people certainly have some measure of control, as conscious decision making must come into play somewhere along the line, should we be placing all the blame for aberrant behaviors on mechanical actions taking place inside the brain, or do they have more to do with other factors–schooling, parenting, etc.–involving a whole constellation of other things.

Again, back to the case of syphilis. Technically speaking, psychiatrists don’t study and treat the brain. Alzheimer’s disease is brain disease. Neurologists handle that. ADHD, distraction among students, is accounted a mental disorder, a matter for psychiatry.  When it comes down to it, we are no closer to reliably attributing distraction in students to dysfunctional brains than we are to attributing it to dull and uninteresting subjects of study.

Although war is an awful strong word to use, I imagine there is plenty of room for disagreement between these two, seemingly similar, disciplines. The present detente worries me much more than any conflict that might arise between them would. I can’t help but imagine bribery, backhanded deals, and suppression of information keeping those lips that should be speaking sealed in the interim..

University of Toronto’s Anti-psychiatry Scholarship In The News

Were you to do a Google news search with anti-psychiatry as the key search term, until recently, you’d get what amounted to, predominately, a lot of anti-anti-psychiatry*  news turning up on your search page. This situation changed dramatically not that long ago when the University of Toronto launched a scholarship in anti-psychiatry. Now if you do the same search you will get a whole lot of anti-anti-psychiatry scholarship news on your search page. Thank you, Bonnie Burstow, for almost single-handedly putting anti-psychiatry back on the map. Now we know, anti-psychiatry is still out there even if the official news services haven’t caught up with it yet.

“Anti-psychiatry” gets official recognition at the U of Toronto

*A note on the terminology: Yes, I know anti-anti-psychiatry is a neologism, and I also know that it is a double negative, and, therefore, perhaps, technically speaking bad grammar, however, this goes to another issue, namely, what is a wolf in sheep’s clothing? In some instances, you know, the walls do have ears. Obviously, anti-anti-psychiatry is going to be, as some psychiatrists themselves have put it, and to distinguish anti-psychiatry from it’s adversaries, pro-psychiatry. Also, I’ve heard some people object to the term anti-psychiatry because they felt it was too negative. I don’t see it that way, especially given the amount of harm and destruction wrought by the profession of psychiatry. Psychiatry is negative, and given that it is negative, that makes anti-psychiatry a very positive matter indeed.

Anti-Psychiatry Is Dead. Long Live Anti-Psychiatry!

The anti-psychiatry movement has already been consigned to the history of psychiatry (Tantum 1991) despite the relatively recent first use of the term in the literature (Cooper 1967).

So goes the first paragraph in a piece, entitled What Was Anti-Psychiatry, on the website put up by Donald Duncan for a Critical Psychiatry Network.

The paragraph goes on.

A key understanding of “anti-psychiatry” is that mental illness is a myth (Szasz 1972).

Okay, I suppose, and the paragraph ends with…

The argument is that illness is a physical concept and therefore cannot be applied to psychological disorder without any physical pathology. As soon as it is accepted that mental illness can refer to psychological abnormality then the “anti-psychiatry” argument fails (Farrell 1979).

Remembering that Dr. Duncan is a psychiatrist, not a psychologist, the question becomes, What the bleep is a psychological pathology?

I personally don’t see how harboring ideas about thought disease would not in itself be a pretty abstract matter. Organs get diseased, thoughts get jumbled, but however jumbled thoughts might get, there is not a disease present in the thinking of the person with the jumbled thoughts.

Many of the most prominent psychiatrists in the world disagree with Dr. Duncan about the demise of anti-psychiatry. According to them, disagreeing with the orthodoxy of bio-medical psychiatry IS anti-psychiatry. A heresy some of them might even accuse Dr. Duncan himself of indulging in.

The fact that ‘antipsychiatry’ has existed in one form or the other for some time, and indeed has sometimes been vehement enough to approach psychiatry as a demon to be exorcised, is noteworthy.

Such a statement, authored by Indian psychiatrist Nimesh G. Desai, was published under the title Anti-Psychiatry: Meeting the Challenge in the 2005 Oct-Dec issue of the Indian Journal of Psychiatry.

Even if the anti-psychiatry movement of  psychiatrists has elapsed, for some of us, its victims, in the psychiatric survivor movement, as long as there is a psychiatry, anti-psychiatry never died. We will fight on. We will fight on until psychiatry ceases to exist at which point anti-psychiatry, having served its purpose, itself will cease to exist, for there is no anti-psychiatry without psychiatry.

Of course, just as NAZIism was replaced by neo-NAZIism, keeping alive the anti-fascist vision, the chances of that happening anytime soon are not so great as we would like for them to be.

Anti-Psychiatry however is a phoenix-bird, and it is reborn from the ashes of its previous existences. So long as psychiatry continues to oppress and abuse, it will meet with resistance. Sure, anti-psychiatry was yesterday. Not only was it yesterday, but it is today, and given the abuse and arrogance of psychiatry, it will be tomorrow.

You can bank on it.

Imaginary Disease Awareness Week

I found out subtly, almost by accident, chancing upon an announcement in the local student newspaper. Once again it is Imaginary Disease Awareness Week. Just in time for Halloween I suppose some of you must be thinking. It is as if the 13th hour had struck, and you don’t know what is going to happen next.

The regional Imaginary Disease Coalition has a series of events going on to mark and celebrate the occasion, logically enough. I imagine a few sighkiatrists, doctors who specialize in imaginary diseases, are going to take part in some capacity. It is important that people realize the seriousness of imaginary diseases, otherwise, one sighkiatrist or another might be forced to go to bed without dinner.

Converts to the imaginary disease religion are evangelical about educating people on the tenacity, veracity, and staying power of imaginary diseases. Sighkiatry, the priest caste of the imaginary disease faith, have come up with a BSM (bullshit manual) which is perhaps best described as a field guide to imaginary diseases. Through this field guide, they keep the real world bustling with imaginary afflictions.

The imaginary disease business is booming, which helps explain the importance of Imaginary Disease Awareness Week. More and more people are stepping forward with a claim to having an imaginary disease and, of course, Sighkiatrists, being imaginary disease salesmen first and foremost, are pleased as punch. Actually, sighkiatrists are imaginary disease treatment salesmen, but disease and treatment are rather like love and marriage in myth and song. It is very difficult to sell treatment to people who haven’t first bought the idea of having a disease.

We’re halfway through Imaginary Disease Awareness Week, and I didn’t know it was even going on. What could be wrong with me? I must be afflicted with a serious imaginary malady, huh? You’ve got to be careful. What did I say? Imaginary diseases are everywhere! The imaginary disease closet is being evacuated, the plague is out of the box, and there isn’t much room for people without some compulsive tic or prosthetic begging gimmick in the world anymore.

The good news is, seven days down, and Imaginary Disease Awareness Week is history. As Tony Soprano might add, “Forget about it.” To which one must reply, “If only imaginary diseases thought the same.” One thing you can be sure of, people will be bellyaching until the cows come home given the nature of imaginary diseases. The bad news? Once Imaginary Disease Awareness Week is over, it is only the beginning of Imaginary Disease Awareness Month that has elapsed. You might just consider it a big festival that climaxes with Halloween night, and continues on through Christmas, and beyond.

Human Rights Or Patient Rights?

The government co-opted the mental patients’ liberation movement by buying it out. Now it’s primarily a mental patients’ movement.

If the mental patients’ liberation movement, also called the psychiatric survivor movement, was once a movement to liberate people from the mental patient role, and by virtue of that fact, from the mental health system itself, government funding has transformed that movement into a movement to promote the mental patient role, and to expand the mental health system. .

The mental patients’ liberation movement has been called anti-medical or anti-psychiatry. It was a movement of what might be called anti-patients, people who wanted out of the mental patient role, people who didn’t think a lifetime of so-called “mental illness” was in their best interests, nor really, in the end, entirely worthwhile. People who, in a nutshell, felt violated and abused by what passed for “mental health treatment”.

The chief difference between then and now can be found in the Brief History and Accomplishments of the Consumer/Survivor/Ex-patient (C/S/X) Movement powerpoint of Sally Zinman and Gayle Bluebird. They have slides for processes then (1970s) and now (1985 onward).

Processes (1970s)

• Autonomous groups; belief in local control
• No money from mental health system
• Separatist
• No major outreach

Processes (1985 onward)

• Mainstreaming
• Centralizing
• Money from mental health system
• Collaborations/beginning reentry

The first category may have been smaller, but it was also not incorporated into the “mental health system” itself. It was also, in theory if not in fact, not a hierarchical movement directed by a leadership elite. The revolutionary Processes have, in other words, been replaced by counterrevolutionary Processes. This change is illustrated most tellingly in the language, in jargon, once it was a mental patients’ liberation movement, now it’s a movement for consumers’ (and/or survivors’), plus some say former patients’, of mental health services.

Let’s not mince words, ‘mental health consumer’ is just another way of saying mental patient. Survivors of psychiatric oppression, by aligning themselves with ‘consumers’ of psychiatric oppression, are doing themselves no great service, or rather, they are doing themselves a great disservice. Liberation is, as it should be, at cross purposes with the marketing of subjugation, and its complementary number, oppression.

The “mental illness” rate has been growing for centuries, this is the way the mental health system expands. The “mental illness” industry is a growth industry. For this rate to decline, you’d have to be getting people out of the mental health system, and not putting more people into the mental health system. This isn’t happening because it doesn’t pay. There is much money, on top of whole careers, in the “mental illness” industry. There is no “mental health” industry. Getting people out of the mental health system, and not putting more people into it, would be more “mentally healthy”, but it doesn’t pay.

The system centers on “mental illness”, not because “mental health” is the objective, but because “mental health treatment” is the objective. “Mental health”, on a mass scale, would throw many, many mental health professionals out of work, and that’s not something a mental health professional would be keen to support.

Zinman and Bluebird also have slides on the difference in Principles between the movement in the 1970s and the movement after the government co-optation and buy out. Then is a little bit fuzzier, to them, and for obvious reasons, than since.

Principles (1970s)

All within the context of a liberation movement for people diagnosed with mental illness, the following examples were some of the principles these groups developed:
• Against forced treatment
• Against inhumane treatment—medications, lobotomy, seclusion and restraints, and ECT
• Sanism
• Anti-medical model, usually described as anti-psychiatry
• Emerging concept of consumer/survivor-run alternatives to mental health system
• Involvement in every aspect of mental health system

I’m imagining that for sanism, the mental health equivalent of racism or sexism, they actually mean opposing sanism. Involvement in every aspect of the mental health system is also somewhat problematic. If there was no forced treatment, for instance, what passes for alternative treatments today would be the rule. Also, a person’s right to reject treatment, and assume a non-compliant or anti-patient status, would be universally recognized as a civil and human right. What you’ve got are out-patient facilities with lists of rights on the wall that include Right To Treatment but absolutely no Right To Refuse Treatment. This is not choice, this is absence of choice, and thus deprivation of liberty.

Principles (1985 onward)

The same principles as the earlier days are expressed in positive rather than negative ways:
• Self determination and choice
• Rights protections
• Stigma and discrimination reduction
• Holistic services
• Self-help/peer-support programs
• Involvement in every aspect of mental health system — “Nothing About Us Without Us”
• Concept of recovery (encompassing all of the above)

The basic problem here is that if you aren’t explicitly against forced and inhumane treatment, you are for it. We could be friendly with despotic governments, too, however that doesn’t make such a positive position the kind of position one should adopt. Rejecting the “mental illness” industry, and with it the “mental illness” pandemic it has engendered, makes much more sense than promoting it. The very reasoning of these so-called advocates indicates the kind of corrupt practices that they personally have become intimately engaged in. Switching sides, from critic to consultant, doesn’t make you a better person. In fact, it can result in the reverse.

A larger and larger mental patient population doesn’t make for a healthier nation. Duh. The “mental illness” industry is its own critique. Were people thrust into the mental patient role, to reject that role, and to opt for a more anti-patient stance instead, we would be making progress. Embracing the mental patient role, on the other hand, and with it, government subsidies, is a way of producing career mental patients. A career mental patient is a person said to have a “chronic mental illness”. Such a career choice may be good for the “mental illness” industry, perhaps, but it is bad for the world as a whole. Certainly there is better work to be found in the world than that of career mental patient. Ditto, career mental patient manufacturer.

R. D. Laing, Thomas S. Szasz, and Mental Patients’ Liberation

Maverick psychiatrist Ronald David Laing once defined madness as follows: “Insanity — a perfectly rational adjustment to an insane world.” This speaks to the theoretical divide between R.D. Laing and his contemporary, fellow psychiatrist Thomas Stephen Szasz. His attitude towards Laing, from the beginning, was that of almost a visceral rejection, but on the grounds that Laing was, in his eyes, dissolute or lacking in moral fiber. This sort of symbolizes the distance between these two figures often falsely associated in the public mind.

Laing was a seminal thinker for the decade that came to be known as “the turbulent sixties”. Thoms Szasz was an emigre from a Hungary that fell under the soviet orbit following WWII, and thus reflected an older and more established world view, although similar claims could be made there, too. Szasz disputed the idea of mental illness, and approved, when it came to treatment, only of a therapist client sort of arrangement, an arrangement that jived with free trade. Laing wanted to throw off the divisions between patient and therapist in his unstructured and freer environment, the experimental therapeutic community, or residence.

What Szasz saw in Laing’s therapeutic setting, in his social experiment, was collectivism, of which, regardless of whether you are looking at communism or monasticism, he violently disapproved. Laing, on the other hand, recognized some of his clients “issues” as situational and social rather than imaginary and isolated. The theory is simple, you put some plants in one environment, and they are going to shrivel and die, however, if you transfer the same plants to another environment, they thrive. Animals, specifically the human animal, must be pretty much the same way.

There were other differences between the two, the stance of Szasz was moral. He was against forced treatment, and being against forced psychiatric treatment, he opposed the insanity defense as well. Laing, despite his social experiment, would never go so far as to oppose psychiatric force across the board. Power was something, for him, a psychiatrist might ruminate about, melodramatically, without relinquishing. He also was not beyond using the insanity defense, of which Szasz disapproved, in testimony before a court of law. Laing was operating under a mandate to live one’s life completely, and in so being, he would not be restricted by such moral constraints.

Another issue Szasz attacked Laing over was his use of psychiatric terminology, disease language, which he rejected. If “mental illness” was a myth, we shouldn’t speak of “problems in living”, as Szasz saw them, as “diseases”. Laing thought the disease theory, merely a theory, and not one that he necessarily subscribed to, but one he was not beyond utilizing in the interests of research and treatment. Basically it boils down to this. Laing served as an inspiration to those in favor of alternatives to forced and conventionally harmful treatments while Szasz served as an inspiration to those who would abolish forced treatment. Szasz’s approach to treatment focused more on accepting personal responsibility for one’s actions rather than evading that responsibility.

Thomas Szasz’s most famous book, in which he first expounded his views, The Myth of Mental Illness, was published in 1961, a year after he had published a landmark essay by the same title. R. D. Laing’s entrance into the published world began with The Divided Self, arguably his most famous book, in 1960. Kingley Hall, the first Laingian experiment, operated in London from 1965 – 1970. The mental patients’ liberation, or psychiatric survivor, movement began in 1969/1970 with the launch of the Lunatic Liberation Front in Portland, Oregon. The mental patients’ liberation movement, in so far as it existed, before becoming almost totally co-opted by federal financing, was against force and for “alternatives”, and thus, could be said to have been influenced and inspired by both figures.

Combating “Stigma” As A Selling Point

If you want more people claiming to be “mentally ill” in the world, there is a sure fired way to get them, and that way is to fight “stigma”, the “stigma” attached, by the way, to making that claim. This, at a time when currently the USA “mental illness” rate is estimated to range from somewhere just under 20 % to 25 % of the US population. We need, in other words, more mental patients like we need more Lyme’s disease to make Swiss cheese of more people’s brains.

What is the highest health care cost in the USA? The cost of mental health care. Why is this so? Because of campaigns to end “stigma”. “Mental illness” is a very popular “illness”. The state is paying for it to be so. What the state is not doing is getting people out of the mental health system (i.e. “mentally well”). This is because it is, in point of fact, not a mental health system at all, it is a “mental illness” system. You don’t push approaching a 1/4 of the population of the USA into treatment, for their “illnesses”, however illusory, if you want people to leave that system. “Mental illness” represents a cash cow to all sorts of people.

There’s a slogan out there that goes, ‘It’s okay not to be okay’, which is kind of like saying, ‘It’s cool not to be cool’. Suddenly all these tinted shades have gone completely transparent. A contradiction is no longer a contradiction. A horse is a goose, a snake is a cow, a duck is a bear, your enemy is your friend, etc., etc., etc. Illogic is no longer illogic. Got it. You get these slogans because there’s money to be made in mental health treatment, and somebody is out to make it. When we talk about mental health treatment here, it is important to note, we are talking about treating people claiming to “have a mental illness”. There is no money to be made in treating people who claim to “have mental health”.

There is also, to provide a corollary, no known “stigma” attached to “mental health”, except in so far as there is a “stigma” attached to “mental illness”, giving the person who makes the claim of having a “mental illness” access to a steady funding stream denied to the person claiming to “have mental health”. We can’t manufacture “disability” payments without at the same time manufacturing “disabled” people to receive them. Manufacturing “able” people, enabling them, would be working in the opposite direction, that is, on getting more people back into the work force, and on lessening the numbers of people claiming to have a “mental illness”. This, unfortunately, is not the direction in which we are headed.

The World Health Organization has, if alarmingly, announced more than warned that depression is rapidly overtaking heart disease as the number one cause of disability throughout the world. A heck of a lot of people are unhappy. If we pay people to be unhappy, of course, that is not going to mean you’ve got less unhappy people in the world. If you keep people from being employed because of their unhappiness that is not going to make for less unhappy people in the world at large either. If you build a business around people’s unhappiness that is not going to make for any fewer unhappy people in the world as well.

Obviously, we are waiting on some kind sea change here that may be a long time indeed in arriving. Could we make a business out of facilitating happiness and contentment, in a material as well as spiritual sense, we might be getting somewhere. “Mental illness”, or rather it’s treatment, may be selling like hotcakes, all the same, were that it could be “mental health”, or non-treatment, that was selling instead; then the little pandemic of “mental disorder” that we are stuck in the middle of at present might show signs of letting up.

Food for thought then, for the decades ahead: how do we get people out of the mental health system and back into their communities rather than expand that system, and, thereby, manufacture more people who see themselves as being “in need” of treatment. I certainly don’t think we are going to get there by pretending to be combating a “stigma” attached to receiving treatment.