Thoughts on the Meaning of Neuroscience

Sandra Steingard, MD
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Judith Shulevitz, the science editor for The New Republic recently wrote an interesting article on loneliness (here).

It caught my eye because it started with a nod to Frieda Fromm-Reichmann, the psychoanalyst who was immortalized in Joanne Greenberg’s fictionalize memoir of her recovery from psychosis, I Never Promised You a Rose Garden.  Ms. Shulevitz goes on to describe the field of loneliness studies from a psychological to a neuroscience perspective.

I have been struggling with the notion of the medical model as it applies to human suffering as well as the ability of basic science research to inform the work we do.  There has been a lively discussion on this website about this (here, here, and here).

For me there are at least four separate questions to be addressed. The first is whether neuroscience is capable of understanding human emotion and higher level cognitive experiences.  The second is the extent to which that understanding – even if it is achievable – is critical to our being able to help people in distress.  The third is whether  it is correct to assume, as many people seem to do, that if we come to some basic understanding of brain function as it pertains to core human emotion and suffering that this will automatically translate into treatments that are commonly thought of as “biological,” such as drug treatment. The fourth relates to the limitations and relevance of studying the brain in isolation when we are constantly in interaction with our environment.

The Shulevitz article provides a good platform from which one can address these questions.  She begins with a discussion of Fromm-Reichmann’s assertion that loneliness – and by this she meant the subjective experience of want of intimacy – was “at the heart of nearly all mental illness”.  She then reviews all of the effects loneliness has not only on the psyche but the body. This is followed by a review of modern research into this field which traces the effects of loneliness in humans from a social perspective to the effects of social isolation and rejection on brain functioning.

I found the article and the studies described to be of interest but inherent in the narrative is the notion that we needed the evidence of brain changes to legitimize Fromm-Riechmanns’s initial observations. The recommended “solutions” are primarily social; the author describes studies that showed the benefits of providing enrichment to young children and their families and she reports on an ongoing study in which researchers are teaching soldiers about social cognition with the hope of reducing post-traumatic stress.  The implication, however, is that the basic science data were necessary to legitimize this area of inquiry.

For those of you who reject the notion that neuroscience research might inform our understanding of human distress, I suggest this thought experiment. I was talking recently to a colleague who studies headache. He explained how researchers in this field worked for years without being able to find biomarkers. They then decided to model a diagnostic system after the DSM. This allowed them to do research that provided preliminary data which they hope will improve their funding.  They propose that understanding the neural substrates of head-ache will yield clues on how to provide more benefit to those who suffer from what for many is a debilitating affliction.   At the same time, he understands how the experience of headache is not based entirely within the person; that the experience can be modified by external experiences.  He is not entirely wedded to finding drugs that will reduce headache; he understands that altered environments might also help. But he nevertheless, believes that this basic research will be informative.

If this seems legitimate, I would ask how in any way this differs from a similar approach to something like anxiety?  Anxiety is an experience that can range from mild and transient to persistent and debilitating. It is experienced in the subjective realm and it has correlates throughout the body.  It can sometimes be reduced dramatically with drugs but it can also be exquisitely impacted by environmental changes.  If basic neuroscience research is legitimate to further our understanding of headache, why is it less important to further our understanding of anxiety?

I find it interesting to learn of the neural correlates of core human experience. In the true spirit of science, we do not know where the research will lead.  I think it is incorrect to assume that neuroscience research will only result in treatments approaches that are “biological”; i.e., contained in a capsule. However, I am not convinced this work is required to legitimize investigation into the value of social connections on our well-being and I do not think we need to wait until we have mapped out the brain before we invest time and money into learning more about this.

That to me is the crux of the issue. I do not dismiss, a priori, that we might someday completely untwist the fundamental workings of the brain.  However, I do not think this is where all of our research dollars should go.  For me, there is ample evidence that social connections matter.  We can invest money into understanding why some of us struggle more and how those of who struggle might learn to make more connections. We can try to understand how our social system maximizes health and well being.  We can invest in understanding treatment approaches that appear to have had good outcomes even if they are not premised on the fundamental biological paradigms of the day.

At the same time, I think it benefits all of us to listen openly to as many perspectives as possible as we join together in re-imagining how best to engage with people who are struggling with extreme states.  I do not want to be privileged in my authority to speak  merely because I am a physician; my experience has taught me the profound limitations of my knowledge.  But we will not know until we know what neuroscience can and can not teach us.  I am hesitant to walk away. I think I write this in the spirit of Robert Whitaker’s work; honest and open inquiry is what should be privileged not an authority or the particular framework from where that inquiry emanates.

99 COMMENTS

  1. Dear Dr. Steingard,

    This is a great post! I also seek an exploration of mental distress on all fronts. I am not afraid of neuroscience; I contend that we can understand human nature with empirical neuroscience and that it proves that mental distress is the normal biology of distressful experiences. Consistently, I support a social science perspective of psychology; we currently have little understanding of others’ unique, personal experiences (distressful experiences cause mental distress).

    Thank you again for your open-minded search for the truth.

    Best regards, Steve Spiegel

  2. Dear Dr. Steingard,

    Thank you for this thoughtful article. We already know much of what hurts and what helps people in emotional distress. I think that we need to be honest about what we know and what we don’t know as we continue to search for answers.

    One of my concerns is that psychiatric research (the medical model) is often very biased by moneyed interests and corporate influence, so we lose scientific objectivity and credibility. In addition, scientific inquiry is based on the assumption that we can derive answers using the scientific method and our senses with the help of technology to examine data and find answers. In the case of psychology and psychiatry we are studying the brain (with all it’s emotions, existential and spiritual dilemmas, pain and biological structures) with our brains…something unique when compared to all other fields of study. Perhaps it’s difficult to be ‘objective’ about something so ‘subjective,’ and close to home.

    When dealing with mental and emotional phenomena, it’s hard to separate the observed from the observer. The way we define and understand psychic experiences and emotional pain depends very much on our varying world views and then leads to what we then prescribe to ease others’ mental anguish. Thus, given the enormous complexity and challenges of our field, I think it’s important that mental health professionals be very careful not to impose their (scientific, spiritual or otherwise) answers on others, but instead keep open and humble minds as they continue to search for what causes and what helps people in distress. I also think we absolutely need to protect the human rights, (including the right to choose what helps and reject what hurts) of those who receive any kind of mental health services.

    Again, I am thankful for your article and perspective.

    Cindy

  3. The problem as I see it is that we are not “working in good faith” as we seek to keep our minds open. Those most loudly championing a medical model as doing so dogmatically, asserting that mental illness is an already-proven neurobiological disease, that it is a chronic condition from which one will never recover (at least in the more “severe” forms) and that the first, best and primary treatment is massive drugging.

    There is a complete lack of honesty from the biggest proponents of this reductionist attitude toward emotional health. Critics are, no matter how well-researched or well-articulated their arguments, punished professionally for telling the truth. Even if that truth is as simple as saying that the picture is not so clear-cut. Researchers are denied funding, often can’t get their findings published. Professionals lose their positions, are shut out of professional opportunities to share their information, and on and on.

    If every single dogmatic belief of neurological reductionists was conclusively proven true, what do I lose? Nothing. I will welcome the scientific clarity and be greatful for how this understanding might help real people in need while doing less harm.

    In contrast, if these beliefs continue to lack evidence or are one day proven completely off base, what does the APA and pharmaceutical companies lose? Everything. Their entire power and dominance is based on diagnosis and a medical model of mental “illness.”

    Over and over again it has been made clear that they will lie, cheat and bully anyone who challenges their power. While intellectually, I concede an openness to new information and personally tend to believe that biological elements are one (small) part of the full picture of lived experiences of extreme emotional states, I’m not particularly interested in focusing on a reconciliatory mindset. Not when I have few good-faith partners to work with, not when the media and culture is dominated by propaganda that is categorically false (chemical imbalance, anyone?) and now while the current power brokers are waging an all out war against people trying to tell the full truth.

    Right now, the voice of those saying, “there is no evidence to support a diagnostic model, many of the claims of medical model adherence are demonstrably false, and when pressed they even acknowledge this, public information about the great harms of neuroleptics, their limited benefits short term, and their huge harms long term are all swept under the rug, minimized or lied about by those currently holding all the power when it comes to “mental health” in the united states.

    One day, a more collaborative attitude may be warranted. But right now, its time to fight. Fight with truth, with a loud voice, and without fear.

  4. Dr. Steingard, Your courage to be conscientiously concerned about doing good by your patients has put you on the right side, the leading edge of this transition for which NIMH is preparing the nation. As for harmonious social interactions, technology can also prove they’re healthy. Brain areas are lonely, or rather isolated from each other, until they all coordinate. Brainwave technology can already enable them to do this. Then one sees the problem and solution as holistic, coordinating the whole brain, rather than segmenting the problem and solution into separate bits. The person and environment then also interact wholly — a coordinated brain interacts more harmoniously with its environment, and seeks and arranges more harmonious situations for itself and others. The harmonizing is done by creating a harmonious environment around the brain which mirrors the brain’s inner harmony. So, the outer and inner become one. Thanks for the good work!

  5. Thanks for a great post as usual.

    It seems important to always be able to consider any mental aspect under both the mind and the body perspective, as well as the social dimension. It is refreshing to read from somebody like you (or many others on MIA) who can hold those different perspectives without dismissing any of them.

  6. Hi Sandra,

    I’ll start by saying that I believe in the identity between mental processes and brain physiology/morphology, so in theory I’m very keen on neuroscience. But as other commentators have pointed out, we do not live in an ideal world and research into this field is not driven by scientific curiosity but by a ruthless industry seeking to increase their profits by any means.

    Rather than speak in generalities I’d ask you to please take the time to look at this study by way of an example:

    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057357

    It is not a particularly substantial study but it is recent and freely available (and I had it handy from a previous comment in MIA)

    In particular I’d draw your attention to this: “Controls who developed a mood disorder were also excluded (n = 4, all MDD)”

    Now, you tell me: in a study that claims to have found a hereditary difference of brain morphology linked to MDD, is it not imperative that the 4 members of the control group who develop MMD are given a second round of fMRIs to see if they also exhibit said brain morphology – thereby showing that it is the result of neuroplasticity and not genetics? Particularly since those members of the study group who did develop MMD and show atypical morphology already had signs of incipient depression at baseline?

    Notice how carefully the authors word their conclusions to divert attention from those 4 controls: “These findings offer the potential of future risk stratification in individuals at risk of mood disorder for FAMILIAL reasons.” (capitals mine). You might also want to pay close attention to the Competing Interests section, and wonder why the study has 10 different authors.

    I’ll tell you what I make of it: this is a dishonest study (one of many), part of a well-orchestrated push to advance an agenda of “preventive interventions”, “early detection” and “screenings of at-risk groups” (see this recent item of news from the UK, for example: http://www.bbc.co.uk/news/health-22478706 ). This is something very dark and very dangerous, and neuroscience – or rather bad neuroscience – plays a big role in this push. You cannot just pretend it isn’t happening or “it’s not as bad as all that”. It’s worse.

    No offence, but if you really think you are playing with nice guys on a level playing field you are very naive. And I don’t think the people you are trying to help can afford that naivete.

  7. I’ll add here something to my last comment above. Perhaps a lot of people will disagree with this, but in a way there’s nothing wrong with DSM categories themselves. The problem is what psychiatry and Big Pharma have done with them. To give a collection of symptoms a name is nothing particularly bad. On the other hand, to carry out a skewed research study which incorrectly claims to show that a particular DSM category has a genetic etiology is very bad. To claim that a research paper shows that a drug is effective in the treatment of a DSM category when in fact the data shows the drug to be completely ineffective and dangerous, is very bad indeed.

    The problem is not in the DSM or its categories but in the scientific studies themselves. And this will not change with RDoC. On the contrary it seems to be getting worse.

    Dropping the DSM is a smoke-screen to try to silence mounting doubts over psychiatry as a profession and its biological model. A scapegoat; a bone thrown to the dogs to quieten them. Like Tomasi di Lampedusa says in The Leopard: “everything needs to change, so everything can stay the same”.

    Don’t get me wrong, it isn’t as though I want to keep the DSM, but to have it replaced with something worse is not good news. The problem is Big Pharma, dishonest research scientists, psychiatrists (honest and dishonest, since the foundations of their profession are just plain wrong).

    Getting rid of the DSM would be a victory, but still a small victory. Only a battle in a much greater war.

    • I disagree.

      The injury *begins* with a diagnosis.

      It takes nothing more than one of these subjective, arbitrary, meaningless labels for a person to lose many of their civil rights.

      Other areas of a person’s life are affected as well – health insurance, life insurance, commercial driving and others.

      All based on a psychiatric label.
      In other words, all based on *nothing*.

      Duane

      • But what I am saying Duane, is that those psychiatric labels are not based on nothing as you say, they are actually based on lies (when I am feeling diplomatic I call them “mistakes”, but to call things by their name, they are lies)

        So if you concentrate only on the label and leave the lies behind the label untouched, you are only replacing one labelling system with another. What we need to challenge is the lies in the science.

        Anyway, I am not defending DSM labels, in a alternative world, without the lies that have gone into them to give them concrete shape, they might not have been a bad thing in themselves, but in this real world we live in of course they are bad. So yes, off with the DSM, but don’t buy into the RDoC or anything along those lines either. It’s just switching one label with another.

        • If we were to leave the lies behind, we would have to start by acknowledging that the DSM categories aren’t illness, disease and/or disorder categories, i.e. that they are not collections of symptoms. They are collections of certain behaviors, emotions, ways of understanding oneself and the world. The moment we judge and define these behaviors, emotions, and ways of understanding oneself and the world as ill, sick and/or disordered, we’re already telling a lie.

          • Good questions, Sandy. What I tend to do is simply describe what I’m seeing, or better yet, have them do it from their viewpoint. Rather than saying, “You have symptoms of borderline personality disorder,” I might say, “You’ve told me you cut on yourself. Can you tell me what it is about cutting on yourself that is appealing to you? What do you think it does for you?” Most “symptoms” have a purpose, and I consider finding that purpose the key to making progress. Sometimes good therapy even makes the “symptoms” worse. I think focusing on the “symptoms” leads down the wrong path. The repeated behaviors of the client tell you something. The DSM/Medical Model approach says that the behavior has no meaning, it’s just brain chemicals. I say that the meaning is way more important than the behavior itself.

            One of the first things I learned in the world of social work was the saying, “All behavior meets a need.” Help the client find the need the behavior meets, and you can start working with them on alternatives. But stopping the behavior stops the need being met and leads to more distress. Psychiatrists need to shift their focus away from the distressing behavior to the distress that is behind it.

            I hope that makes sense!

            — Steve

          • (I hope, this comment ends up in the right place, beneath Steve’s where there’s no reply button.)

            Sandy, I want to add to what Steve has said — and I couldn’t agree more to everything he’s said — that I meet people who tell me they feel sick all the time. But there’s a huge difference, although it may not be that obvious, between feeling sick with sadness, anger, confusion on the one hand, and calling the sadness, anger, confusion a symptom of some alleged illness on the other.

            I can feel sick with sadness (or anger, or confusion, or hearing voices, or or or), and still know that there probably is a good reason why I have this intense experience of sadness. And knowing this, I will focus on the reason, trying to find out what it is, to understand it, and, if possible, act upon it so that it won’t cause me more sickening sadness. At the end of the day, my ability to feel sick with sadness actually has taught me something about myself and my life, helped me to make wiser decisions, and improve my life circumstances. So, basically, it turned out that my sadness was my ally in terms of my survival and wellbeing.

            If I refer to my sadness as a symptom of some alleged illness on the other hand, my quest is over. My sadness will be my declared enemy, which I will fight to the bitter end. Without ever realizing that what I’m fighting against actually is myself, my own vitality and survival capacity. So, whenever I meet people who not only tell me that they feel sick with sadness (or or or), but actually symptomatic with sadness (or or or), it’s pretty clear to me that somebody (a professional, a relative, the media,… ) sadly has managed to turn the person against herself.

          • Marian and Steve,

            I apologize for using the word “symptom” above – I never meant it in a biological or even psychological sense. I’m afraid that because I often use (in my own head) the terms “disease” and “symptoms” to mean the “social disease” and “social symptoms” of groups rather than individuals, I used the word very carelessly.

            I could not agree more with what you both say. For me one of the most important aspects of “mental health” is precisely the recognition that all these behaviours, the “symptoms” of “mental illnesses”, are in fact RATIONAL behaviours – as Steve says “all behaviours meet a need”. Similarly, the “delusions” of “psychotics” are not in any way irrational but convey a rational meaning in symbolic form; they make perfect sense and are always true, even if that truth requires careful interpretation (but then again, all communication is symbolic – the difference is only in that in “psychotic” communication the symbols are not as shared as in other forms of communication).

            To me, classifying a behaviour as “irrational” necessarily denies the humanity of that behaviour. If you then spuriously link that “irrational” behaviour with a person’s genes, with their unchangeable biological “essence”, you are denying their very humanity. This is not to say that there are no genuine irrational behaviours: it is precisely the abusive behaviours which cause amongst other things the distress of “mental illness” that can be described as irrational – that is to say, inhuman behaviours.

            This might sound extreme, but I think it is correct to say that, just like by denying the humanity of the Jews the Nazis became themselves inhuman, psychiatry, by denying the rationality of the “mentally ill” has become itself irrational. There can be no progress until psychiatry recognizes the rationality of the “mentally ill”, but in order to do this psychiatry needs to deny its basic premises – it needs to deny its own validity. Psychiatry, quite simply, needs to disappear.

  8. Sandra, thanks for sharing your perspective on this topic. I am always so appreciative of your honesty, knowing that you are perhaps not as “doctrinaire” as some on this site would prefer. It would be much easier to posture on on side or another of the many issues you address if you were not “in the trenches”, dealing with real people and no easy answers. We would be so much better off, in my opinion, if we had even a small fraction of psychiatrists with your melding of meticulous rationality, honesty, humility and commitment to what is best for each individual.

    Now for a switcheroo…I want you to be aware of a teleconference coming up this Thursday that i plan to “tune in” to. It is hosted by NAMI, as part of their “Ask the Doctor” series, and the special guest this week is Dr. Xavier Amador, who will be speaking on anosognosia. I think your own article on this was the first of yours i read on this site. I am desperately hoping you’ll be able to join the conversation, even though i know that may be impossible due to your work schedule. I have rejoined our local NAMI chapter mainly to be a “different voice” in this organization, since so many people get channeled to NAMI and then get indoctrinated into the very heavily “pro-biopsychiatry” mindset that prevails. On the other hand, it is hopeful and heartening sign to me that Keris Myrick was elected national board president of NAMI, and that Robert Whitaker is speaking at the upcoming convention in Dallas (Amazing…Praise the Lord!)

    At any rate, here’s specific information on the teleconference:

    ***Conference Call with Dr. Xavier Amador on Anosognosia

    Thursday, May 24 at 11:00 am, EST

    To access these calls, dial 1 (888) 858-6021 and enter pass code 309918#.

    Please…I urge any and all MIA readers to tune in and have input in this discussion. The concept of “Anosagnosia” has been used by folks like Dr. Amador and Dr. E. Fuller Torrey to justify forced drugging and other highly coercive measures in psychiatry.

    I would also LOVE to have the host of this website, Robert Whitaker, in on this conversation!

    Russ

  9. Sandra,

    Superficial?

    How did you come up with that term to describe how you *might* be perceived?

    You come across as someone who is anything but superficial. I don’t agree with each and every one of your comments, but you listen and learn from others – seemingly to be in a constant search for answers, facts, truth.

    Superficial?

    Give me a break.
    More importantly, please give yourself a break!

    With gratitude,

    Duane

  10. Thanks for the article Sandra, I think you are very brave, balanced and patient. I’m certain you are a fantastic caregiver. I have so many thoughts and like those here so little time. However, I think I have to say something, at least on this thread.

    I think the headache analogy is apt. In science one has to categorize in order to attempt to reduce a problem of inordinate complexity into units which can be understood. That’s science, it isn’t people. However, neuroscience finds itself in a difficult place because it’s really trying to understand people, or rather human behavior. This same scientific model yielded a detailed understanding of molecular genetics in our lifetimes and has and continues to revolutionize treatment of human cancer. By trying to apply this model to understanding psychiatric disorders, neuroscience finds itself in conflict with people who suffer from the conditions in a way that cancer biologists could never have imagined. Reductionism in the scientific process though should not be mistaken for reducing or labeling people or their suffering. Reductionism is a tool and only one way to understand, but it has been an effective way to gain mechanistic understanding of natural phenomena.

    I think there are several ways in which the issue gets confused here and elsewhere.

    1) Psychiatrists are not neuroscientists, or at least the vast majority are not. Their understanding of neuroscience is often as weak as that of the general public. It is a huge problem for the field because the principles of basic neuroscience which could be used to build an understanding of psychiatric disorders are largely mysterious to them. So, when a psychiatrist tries to explain or justify biologic underpinnings of the disorders they treat or how drugs might work, their explanation is often woefully misguided, inaccurate and even potentially absurd. This has led to often simplistic explanations which have been stated as facts such as ideas of chemical imbalance. It is worth noting that there is a vast field of basic, academic neuroscience which is founded on understanding how the brain works normally. Many, many of these scientists are academics without ties to pharma or other undue sources of influence. Ideas from these neuroscience fields, largely from non-human research, form the true evidence base from which one could argue that neuroscience offers significant potential to understand psychiatric disorders.

    2) Neuroscience or “biological explanations” of psychiatric disorders should not be set up as deterministic. I agree that the profound plasticity of the brain is amongst the most important insights of neuroscience. This cannot be stated too clearly or too often. The issue keeps getting lost in a false nature vs. nurture dichotomy which infuses the way people think about this issue as much as the false concept of mind-brain dualism. These ways of thinking are so deeply ingrained in our psyches that it is difficult to think clearly about them even when one is trying to. The environment is constantly in interaction with the underlying structures of the brain from the moment the first neuron is born until the existential realization that takes place at the moment of death 80 years later. Anyone who talks about this purely from one or the other perspective should likely be mistrusted. However, I don’t think it is really accurate to say that psychiatry as a field has rejected this idea. It is true that pharmacotherapy has come to dominate modern psychiatry, but many psychiatrists lament this fact. The principles of therapeutic relationship, psychotherapy, influence of trauma and impact of psychological and social environment are still central principles.

    3) Current psychiatric medications are not the result of neuroscientific inquiry in psychiatry. They do work via mechanisms that exist in the brain and perhaps neuroscience has been used to justify their use. However, they were discovered by accident. They were not found or designed based on any neuroscience understanding of the biology of psychiatric disorders. Some of them have been modified by organic chemists to develop new versions, but this isn’t neuroscience either really. The search for neurobiological mechanisms is really motivated by the well documented inadequacy of current treatments (including drugs) and founded on the hope that understanding how the condition develops, persists AND RESOLVES in the brain will provide insight for new treatments. The new treatments could be drugs or psychotherapies or environmental manipulations or biofeedback or any number of things. That is the neuroscience approach, that the better we understand the brain, the better positioned we will be influence the course of mental suffering. The full understanding being that this includes both the underlying substrate of the brain and the environmental impacts on it.

    Okay I’m burnt out now. I apologize for using the medicalized terminology of mental suffering, I know that gets people upset. I feel kind of stuck about this, because it is hard to talk without using these terms, at least for me. I think it’s hard for others here too because we are often just using the same words and putting quotes around them which I think speaks to the lack of alternatives. To say “human distress” also seems not right to me though because it seems to put me in a place where I’m saying all human distress is a psychiatric illness which I don’t at all think. Anyway I get distracted on this topic.

    Thank you again Sandra, I support your efforts to explore alternative models from within psychiatry.

    • This was a great comment on “perspective” Scott. I really liked “The environment is constantly in interaction with the underlying structures of the brain from the moment the first neuron is born.”

      Yet I wonder, in terms of human development whether we just “assume” that all neurons are born within the brain? In embryology, I believe there an understanding that the first neurons develop within the heart & nervous systems. Please consider a more holistic view of our pesky neurons, from a body-brain-mind perspective which suggests to me at least, that while the brain may be the “driver” of human motivation, the heart is the engine of our motivation.

      http://www.rcpsych.ac.uk/pdf/Heart,%20Mind%20and%20Spirit%20%20Mohamed%20Salem.pdf

      Sorry about the motorcar analogy, I guess its a mechanically minded “male” perspective? A bit like the patriarch’s of the APA, perhaps?

      Regards,

      David Bates.

  11. Oops! I have to correct the information i gave about that teleconference with Dr. Xavier Amador. It’s this FRIDAY, not Thursday.

    Here’s the info again:

    ***Conference Call with Dr. Xavier Amador on Anosognosia

    Friday, May 24 at 11:00 am, EST

    To access these calls, dial 1 (888) 858-6021 and enter pass code 309918#.

    Please…I urge any and all MIA readers to tune in and have input in this discussion. The concept of “Anosagnosia” has been used by folks like Dr. Amador and Dr. E. Fuller Torrey to justify forced drugging and other highly coercive measures in psychiatry.

    I would also LOVE to have the host of this website, Robert Whitaker, in on this conversation!

    Russ

  12. @Russeford I hope some folks can attend that conference call!

    I appreciate you writing about this, Sandy.

    Did you see this:

    http://www.newscientist.com/article/dn23566-suicidal-behaviour-is-a-disease-psychiatrists-argue.html?full=true
    New Scientist, “Suicidal behaviour is a disease, psychiatrists argue”

    ugh. I share your appreciation for trying to clearly identify the limitations and implications of neuroscience and I hope we’ll keep talking about this topic on MIA.

    I think that, regardless of what we think, it would behoove us all to stay abreast of research directions and to try to mediate some of this rhetoric about aberrations, epigenetic variations, and diseases.

    I wish the NIMH was clearly thinking as much about the ethics of neuroscience as we all seem to be. Of course, they are operating from the worldview that our brains control almost everything and that our brains must surely be diseased.

    Did I already say “Ugh”?

  13. Hi Sandy,

    You may recall that Bob Whitaker wrote an article on the latest eugenics agenda of the NIMH in keeping with psychiatry’s ongoing abuse of so called neuroscience to prove invalidated labels in the DSM.

    I find psychiatry’s long term abuse of so called science such as their horrific eugenics agenda created for and by the power elite that caused the German Holocaust as well as the latest Holocaust that tries to target just about everyone from womb to grave with the constantly expanding DSM appalling. Therefore, given psychiatry’s large amount of junk science created with BIG PHARMA for ongoing disguised eugenics theories to blame the victims of oppression and abuse by the power elite making billions with this scam, like the boy who cried wolf and/or the emperor’s new clothes I could never trust much of what they say ever again. I also think that tacking on the term “neuro” to everything psychiatric in recent times is another scam to give BIG PHARMA KOL’s a false aura of brain or neurological expertise, so I believe that is another cause of grave concern.

    I realize that we may not agree on this and other things, but I thought of you while we were all very demoralized by Jeffrey Lieberman’s latest article at MIA touting the many advances of psychiatry. You noted that you were not pleased with the article either if I understood you correctly.

    I recalled you had posted an article about Dr. Lieberman a while back whereby he indicates that for those who hang in there, many lucrative opportunities await them.

    https://www.madinamerica.com/2012/09/on-drug-development-lucrative-markets-and-the-future-of-psychiatry/

    I give you a great deal of credit for your bravery for posting this article and your astute observations about it and Jeffrey Lieberman, new APA president. The posts under his most recent articles listing his many, many ties to drug companies says it all about his agenda like that of the NIMH, APA and others trying to seduce BIG PHARMA back into the fold to keep the gravy train going at the ongoing expense of so called patients as exposed by 1boringold man and others.

    I would be interested in your thoughts on this. Do you think I could get a paranoia label?

  14. Dr. Steingard, I’m someone who is more ambivalent about some of the ideas that have been expressed on this site than some. I believe that I suffer from a serious mental illness, and while I do not discount the possibility that improper use of anti-depressants and cannibis may have precipitated my first significant symptoms rather than it having been a fully organic process, I still can very confidently say that treatment with psychiatric drugs, including neuroleptics, helped to turn my life around. I have remained high-functioning and achieved many goals while on neuroleptics, for many years, after a series of episodes that resulted in my losing everything, at great cost. I rebuilt my life and accomplished more than I had previously, all while on neuroleptics. But after nearly a decade, I still found myself missing and longing for a self that had been lost, and which I had dismissed as a hypomanic fantasy. Nine years in, and I still could not shake the feeling that something fundamental was not right with me. So, tired of being told in no uncertain terms for years by the psychiatrist who had finally stabilized me that I needed to be on a therapeutic dose of neuroleptics for life, causing me to perpetually live in fear for the loss of my livelihood and my family, I had to try something different. I sought the aid of a very difficult to find psychiatrist with a track record of helping appropriate patients to successfully taper off of neuroleptic drugs, by at least some measure, or do the work necessary to confirm for the patient that it could not be done without unacceptable risk. The result has been transformative. I gained the courage to make this change in no small part by reading things you have written over the past year, as well as the writings of others on this site and elsewhere (e.g. Whitaker and Breggin). I am only 1/3 down from the dose I had been on for several years, and I recognize myself again, in a way that I’ve not for over a decade. I don’t know whether I’ll go down further; I have an open mind but I am committed to remaining vigilant. But even this small reduction in dose has had a soberingly profound effect on my cognitive and emotional functioning. There is little doubt in my mind that the neuroleptic I have been on has been causing me to experience negative symptoms of schizophrenia (I was misdiagnosed as within the schizophrenia spectrum, i.e. schizo-affective/bipolar type). I share the pain and outrage that so many on this site have expressed so eloquently, even if I disagree with conclusions that have been reached by some. My experience is a sample size of one, and cannot serve as a rationale for any other person’s medical decisions. But folks out there should know that you don’t have to disbelieve in neuroscience or dismiss the entirety of the mental health industry in order to recognize that psychiatry and the pharmaceutical industry have a lot more to answer for than most of their spokespeople will ever admit, or even acknowledge. This is for real. But those of us who have fallen victim can’t be the only ones to speak out — we neither have power, nor can afford to lose our anonymity. But thank you Dr. Steingard, for risking your livelihood and reputation and speaking out. It’s shameful that greed and inertia can operate to thwart important clinical work which is based upon scientific evidence and is directed at helping patients live better lives.

  15. N.I. and Anon,

    I think there is a difference between minimizing or denying an individual’s experience and questioning the authority and evidence by which institutions have made certain assertions.

    So for example, when research shows that the long held popular language of “chemical imbalance” used to describe certain experiences is actually false (not just lacking in evidence but having evidence to the contrary) that is not the same thing as denying the real experience of persons experiencing very difficult emotional states that cause immense suffering.

    Challenging the conclusions asserted by certain professionals and institutional bodies, when those groups are claiming that science backs them, should not at all be equated with taking something “away” from a persons direct lived experiences.

    So if you or someone else experienced extreme states of mental or emotional turmoil, and you found that medications, therapy or anything else were part of a healing process which led to a richer life – that’s wonderful, and I don’t think you would find many who would feel anything other than joy at whatever has led to a person finding a way out of suffering.

    But what no one has to do (and should not do) is call things fact when they are not, lay claims to science when no such science exists, or misrepresent what we know and what we don’t know about how the brain works. That is something entirely different than denying another individuals personal experience with suffering and healing.

    I would suggest that one is not required to reject the language of mental illness or diagnosis, especially if that has been somehow part of a positive process of hope and meaning-making for a person. Just as long as we remember that “mental illness” is a metaphor, and diagnosis are labels for a collection of behaviors. That is a very, very different thing then diagnosing biological diseases. As of this moment, there is no known biological marker than can accurately predict or point to any mental “disease” category. That does not mean that neurobiology plays no role in our emotional experiences – it only means we don’t know what that role is, and anyone trying to say more and claim that it is based on conclusive science is lying.

    My attempt to understand the truth of what we do and do not know does not require me to take dogmatic stances about the experiences of others. If you have found medications to be a helpful part of your journey, I would not try to discourage you from that experience. I would only wish to make sure that you are fully informed about all benefits and risks associated with any medication you are given, that you take it with full understanding and informed consent, that you are completely empowered to change or discontinue any medication you are prescribed with the full support and assistance of your prescriber.

    Likewise, I would not try to discourage you from identifying your experience by way of a label such as a psychiatric diagnosis. I would only remind you of the reality that, at present such a label is a metaphor, not a literal concrete thing. It does not represent a clear and known malfunctioning brain part – it represents a collection of behaviors organized under certain categories. Metaphors can be very powerful and helpful things for some. For many, it is not helpful and has in fact been a source of tremendous abuse and pain. So its important for me to try and remain open to all these varied experiences in others.

    When people criticize evidence-absent claims made by the dominant institutions of psychiatry and pharmaceuticals, we are not questioning the reality of your lived experiences. We are question the way reductionist attitudes, power and profit motives and deliberate bastardization of science and research have led to false information dominating the field of mental health.

    • “popular language of “chemical imbalance” used to describe certain experiences is actually false (not just lacking in evidence but having evidence to the contrary) that is not the same thing as denying the real experience of persons experiencing very difficult emotional states that cause immense suffering.”

      I think this is great and I’ve often came up against people who think the alternatives movement is just playing semantics, and when I hear this, I say we are not just using other words for the same things, in fact when a brain disease true believer uses a word, and I talk about life experiences and problems, we are talking about two different things, so I do think you’re right to support as I do, people’s right to seek out whatever solution including drugs that works for them. And I agree we shouldn’t have dogmatic takes on the experiences of others.

      On the issue of legally forced psychiatry though, I simply have to be an abolitionist because my life depends on it. Lives are in mortal danger every day laws exist that allow psychiatry to enter peoples bodies without consent. It’s a political and human rights issue, not equated to any thoughts I may offer on the experiences of others. I believe if NI’s worldview and way of making meaning of his/her life and problems is working for them then why change it? I believe in informed consent not just about drugs, but about models and narratives and where they came from. There’s a lot of focus on the safety of drugs and very little on the safety of telling some distressed person they are as Rufus May says “a passive victim of an active brain disease”.

  16. Heretic and others,

    Thanks for your responses, which I don’t find offensive. In a number of ways I find them thought-provoking and well-reasoned. Still, I believe am able to embrace, all at once, my conclusion that what I have experienced is something that is not desired by me (whatever the causes), my experience that medication, while not a panacea, has assisted me (among other measures) in my efforts to rebuild and succeed in my life, and the fact that, to whatever extent may be the case, science is insufficiently advanced to prove that these experiences are caused by some physiological deviation from healthy biological functioning, even insofar as distress derived from those experiences may be aided with professional or other intervention (using whichever tools may be appropriate, including but not limited to medication). If I had the freedom, given the commitments I have willingly (and in ways unalterably) made in my life to family and career, to choose to live in a stress-free environment, in which I could, for instance, practice meditation, participate in innovative, several month therapeutic retreats, and pursue leisure activities, my level of acceptable risk associated with taking pharma drugs would decrease. I choose to consume processed and non-organic foods (though am more selective with my children), despite awareness of its scientifically *proven* detrimental physiological effects, and despite specious claims by the food industry to the contrary, using a cost-benefit analysis. I must engage in a cost-benefit analysis and arrive at an acceptable level of risk in all of my life decisions, balancing all knowns and unknowns with the aid of reliable resources. I most certainly do include folks referred to here as “survivors” as reliable sources, because I have experienced and experience every day the reality that no medical professional, family member, friend or other person can know what it means to suffer from the ill- (or beneficial or benign) effects of powerful psychotropic drugs unless they have suffered themselves. Equally important are the experiences of individuals who have suffered from experiences similar to those I’ve described — whether referred to as symptoms, manifestations of societal defects or any thing else — and have made decisions of all variations on how to reckon with them in all varieties of life circumstances (most significanlty, my own).

    • “science is insufficiently advanced to prove that these experiences are caused by some physiological deviation”

      Or problems in living may not be a question for science at all.

      I like your post and I sense that you strongly value having the right to weigh the risks and benefits of what you feel works best for you both in terms of how to interpret the problems and what solutions to seek out. We all deserve that freedom.

  17. Dr. Steingard, my question “what resources can I draw upon (other than primary sources, because I’m not a doctor or scientist) in order to determine whom to rely upon for [guidance regarding phrama drug use]” I pose to you. You are a medical professional, expertly trained in psychiatry and well versed in the relevant science. However valuable to me the insights of the sufferers and survivors who make this site such a valuable resource, with all due respect as I suspect some may take offense, I cannot rely upon this group, as such, for the rigorous medical and scientific knowledge that any understanding of the causes and non-causes said suffering and survival requires. Nor for the counsel and treatment provided by a physician to a patient. I speak only for myself, but I am not alone. I had an econ professor once during a time of great economic turmoil and disaffection among many towards economists who distorted flawed economic principles that had been canonized as “classical economic theory,” to aid and abet those who would exploit their work for monetary and political gain. The prof, despairing at the legions of self-styled liberal students who shunned careers as economists pleaded, know thine enemy, and defeat them with the very tools that have been used in the service of greed and corruption. Why leave these tools in the hands of those who’ve misused them, he asked. If psychiatry has lost its way — and I do not contest that it has, its the matter of degree that I might dispute with others here, but even if it has to that degree, indeed especially if it has to that degree — then, I don’t believe medical professionals and scientists should walk away from the study of application of neuroscience to address the emotional suffering of patients. Nor or the actual application, and even before everything is mapped out (which will take an eternity). What I think many in psychiatry may have walked away from — setting aside those (the many) who are corrupt and/or not free thinkers — most of all is the Hippocratic Oath. But when a surgeon amputates the a shrapnel victim on the battlefield the decision to cause that harm is based in part on the fact that technology fails us, as we do not have the tools to save the victim’s life without carrying out the amputation. But the life is saved, and orthopedic surgeons, scientists and engineers work to try to do better for future patients. All science is in its infancy, to a degree, all science is fallible, and we all realize how little we know the more we learn, probably in every context that matters. The suffering that some call symptoms and others call something else is real. No one disputes this, as I understand it. Ultimately the consequences that might result from good people rejecting and declining to pursue the study of psychiatry and neuroscience’s application to emotion in favor of the study of “real [better mapped out]” disease (and those who suffer from it) fall on those who suffer the most from these very serious manifestations of emotional distress, whatever their cause may be. This is true whether the cause of suffering is drug use (be it herion, xanax, or depakote) or something relatively more organic (be it human biology, modern living, or something else).

    • ” as I suspect some may take offense, I cannot rely upon this group, as such, for the rigorous medical and scientific knowledge that any understanding of the causes and non-causes said suffering and survival requires”

      Psychiatry has for hundreds of years tried to prove its pre-judged and dogmatically originated hypotheses on the “causes” of these phenomena. Many confuse tens of thousands of research papers that haven’t discovered a THING, for the impression of a body of science. If you believe psychiatry and economics are real sciences, your preference is going to be for the perceived expertise you see. What extreme states of mind that get labeled “psychosis” teach one, is that people see what they want to see. I could make the argument that ultimately a lot of the suffering of people labeled “mental patients” by psychiatry is caused because these “good people” chose to pursue “the study of psychiatry”. It wasn’t through the “study of psychiatry” that gay people were able to be free from the stigma of being labeled mentally ill. No “mapping”, no scientific discoveries account for the inflation or deflation of the DSM labels.

      No science, or laughable facsimile of science, can tell us how to live. The economists of the world didn’t save us from the crash, and psychiatry, the science of hacking away at, and perturbing the brain function of brains that have never been proven diseased, in the name of numbing, drugging, and kicking the can along the road, essentially offers nothing more than a vending machine full of drugs, something a heroin dealer can offer. What was Michael Jackson’s doctor? Just a drug dealer with a little extra training and knowledge of the human body and what dose of a drug would kill the other person we all ritually name a “patient”.

      Numbness, not insight. Labels that stigmatize and lead to learned helplessness. If you as I do too, feel the need to be anonymous, that’s not because of “stigma against mental illness”, the world doesn’t recoil in alienation from us based upon our behavior and thoughts being weird alone, the world doesn’t even know us, they recoil because being an ex mental patient is seen as an UNunderstandable dangerous mystery, thanks to the mystification of the “good people” who’ve chosen for 200 years to set up a virtual dehumanization system of labeling us out of the human race.

      It’s not our thinking that has stigmatized us for the most part. In the absence of psychiatry’s 200 year reign of error you might have been seen by your work colleagues, family, and neighbors, as just a perfectly equal person who had a crisis at one time or another, became emotionally overwhelmed with life and your thoughts, and strayed from the cultural consensus of “rationality” for a time, a person with no reason to hide, no job or tenure to lose for openly solving your problems. No I don’t believe the stigma originated from your thoughts, it’s psychiatric thinking, the thinking, language, and dehumanization of people who come with moniker “Dr.” that has put your disparate and unique personal crises under the one banner of quackery to draw a direct line between you and James Holmes and Adam Lanza. We have psychiatry to thank for the stigma.

      You seem to respond to things that come with a patina of science. Maybe this paper, speaks your language. This is an economist on the extreme preferences of those labeled “insane”…

      http://econfaculty.gmu.edu/bcaplan/pdfs/szasz.pdf‎

      and

      http://econfaculty.gmu.edu/bcaplan/inecon.htm

      “In sum, while other disciplines regard insanity as a puzzle to be explained, the economic way of thinking inclines me to wonder what the puzzle is.”

      “Absurd beliefs shared by millions are
      ‘healthy’; equally absurd beliefs held by a lone individual are ‘sick’.
      While economists have only begun to study the demand for
      irrational beliefs (Akerlof 1989; Akerlof and Dickens 1982; Caplan
      2001), there is little if any reason to treat ‘popular’ and ‘niche’
      delusions asymmetrically”

      “It is wonderfully revealing of the nature of psychiatry that whereas in natural
      science there is a premium on the expert observer’s ability to understand what he
      observes . . . in psychiatry there is a premium on the expert’s inability to understand
      what he observes (and to understand it less well than the object he observes, which
      is typically another person eager to proffer his own understanding of his own
      behavior).”

      Just some of the wonderful contents of those two papers above.

  18. “the kind of discussion I try to have with the people who come into my office”

    Lets remember that many people who’ve had drugs enter their brains at your behest didn’t just walk past an “office” and see a sign “come into” it. They had no choice. Their brains commandeered by the state, with you as agent of the state, from which there was no escape.

    https://www.madinamerica.com/2012/05/coercion/

    *I read all the 130 comments again. I invested two hours of my time reading all the comments before linking to this above link. I maintain my position that you’re braver than most psychiatrists for writing that piece. I maintain that there is no human behavior can’t be controlled without assaulting the targeted person’s consciousness with forced drugging. I think if this community has evolved in the past 12 months since that piece, we need to be honest not all people just walk into your office. There are human bodies sitting in chairs in your office, that you own. I know you didn’t invent this practice. I have the wherewithal to get the exact same kind of job you have. The reason I wouldn’t be able to do it is because I’d vomit in the nearest toilet if I had do that.

    • Typo. added the word ‘that’: “I maintain that there is no human behavior that can’t be controlled without assaulting the targeted person’s consciousness with forced drugging.”

      https://www.madinamerica.com/2012/05/coercion/

      I don’t think anyone that wound up morally/ethically compromised from getting involved in forced drugging set out to so. I do constantly ponder what kind of socialization goes on, what kind of justifications prevail upon the person involved in carrying out forced drugging to get past what I would have thought would be a natural revulsion to seeing and participating in such extreme violence against strangers. I mean psychiatry is after all, the profession that defines for the world what empathy is.