Are “Psychiatric Disorders” Brain Diseases?

Philip Hickey, PhD
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Steven Reidbord MD is a board-certified psychiatrist who practices in San Francisco.  He writes a blog called Reidbord’s Reflections.  On December 12, 2015, he posted an article titled Are psychiatric disorders brain diseases?  It’s an interesting and thought-provoking piece, with many twists and turns.

Here are some quotes, interspersed with my comments and reflections.

“Of the conditions deemed inherently psychiatric, some seem rooted in biological brain dysfunction.  Schizophrenia, autism, bipolar disorder, and severe forms of obsessive compulsive disorder and melancholic depression are often cited.  It’s important to note that their apparently biological nature derives from natural history and clinical presentation, not from diagnostic tests, and not because we know their root causes.  Schizophrenia, for example, runs in families, usually appears at a characteristic age, severely affects a diverse array of mental functions, looks very similar across cultures, and brings with it reliable if non-specific neuroanatomical changes.  Even though schizophrenia cannot be diagnosed under the microscope or on brain imaging, it is plausible that a biological mechanism eventually will be found.  (The same type of reasoning applied to AIDS before the discovery of HIV, and to many other medical diseases.)  A similar argument can be made for other putatively biological psychiatric disorders.”

This is a complex paragraph.  Dr. Reidbord names five psychiatric “diagnoses” and expresses the belief that they seem “rooted in biological brain dysfunction.”  He stresses that their apparently biological nature derives from their appearance (natural history and clinical presentation), and not from diagnostic tests or a knowledge of any pathology involved.

As an example of this, he states that “schizophrenia”

  • runs in families
  • usually appears at a characteristic age
  • severely affects a diverse array of mental functions
  • looks very similar across cultures, and
  • is associated with reliable, though non-specific, neuroanatomical changes

And, it has to be acknowledged, that, at first look, these five factors, if present, might constitute grounds to suspect brain dysfunction. But let’s take a closer look.

RUNS IN FAMILIES

A “diagnosis of schizophrenia” is based on the presence of two or more of the following:

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. disorganized behavior
  5. apathy or avolition

It seems obvious to me that each of these behaviors (or lack of behaviors, in number 5) can be passed on from generation to generation through normal social learning, without any assumption of a genetically-mediated pathology.  If I, for instance, believe that airplane contrails contain toxic substances that are being spread by the government as part of a sinister plan to render the citizens docile and debilitated, and if I had communicated these concerns to my children during their formative years, there is a good chance that one or more of them would have accepted these assertions at face value, and might even pass them along to their children in turn.

Similarly if my growing children had witnessed me responding to stimuli that were clearly internal rather than external, or speaking in a markedly disorganized way, there would be, I think a reasonable expectation that one or more of them might also acquire these habits through social learning.

And so on for the other three “symptoms.”  There is no need to assume genetic transmission in these behaviors.  Indeed, an assumption of genetic transmission of any behavior is always doubtful.  Genes transmit biological structure.  Structure has an impact on behavior, obviously, but there are always multiple intervening factors.

APPEARS AT A CHARACTERISTIC AGE

I have addressed this issue at some length in earlier posts (here, here, and here).  But for the present purposes, it is perhaps sufficient to note that the “characteristic age” for the “onset of schizophrenia” is during the transition from late adolescence to adulthood (i.e. about 17 to 25).  For a majority of the population, this is probably the most difficult period of life, especially because it comes at a time when we are particularly inexperienced in dealing with complex challenges.   It is a period during which many people experience a good deal of failure, disappointment, embarrassment, and discouragement.  All of which can push an individual towards a negative perspective, and in severe cases to a state of belief that would qualify as “delusional,” without any assumption of a “biological brain dysfunction.”

DIVERSE ARRAY OF MENTAL FUNCTIONS

These are not so diverse really.  The APA criteria essentially identify:  false/mistaken beliefs; responding to internal stimuli; lack of organization in speech and behavior; and apathy/joylessness.  But only two of these need to be present in any given individual.

LOOKS SIMILAR ACROSS CULTURES

This issue has become almost impossible to address in any methodical way, because western influences (including the influence of the DSM) have reached virtually every corner of the globe.  The DSM has become the distorting lens through which all problematic behavior is viewed and assessed, and there are enormous formal and informal incentives for psychiatrists everywhere to find “diagnoses.”

But in 1963, these influences were considerably weaker and less widespread.  In that year, Henry Murphy, MD, et al sent questionnaires about “schizophrenia symptoms” to psychiatric centers in various parts of the world, and received responses from 27 countries.  Here’s how they summarized their results:

“The main significance of our findings at this stage is that doubt has been thrown on the picture which Euro-American psychiatry has built up of the schizophrenic process.  For instance, considering the high percentages of the simplex and catatonic sub-types of schizophrenia reported for certain Asian samples (in some instances our respondents kindly sent actual figures) and the low percentages of the paranoid sub-type, it might be questioned whether the delusional systems which are the most familiar feature of chronic schizophrenia in Euro-American hospitals are an essential part of the disease process.  Might they not be culturally conditioned attempts by the personality to ‘make sense’ of that process, attempts which Eastern cultures inspire to a much lesser degree?” (pp. 248-249 Murphy HBM et al, A cross-cultural survey of schizophrenic symptomatology, International Journal of Social Psychiatry, 1963, 9: 237-249)

Dr. Murphy et al are obviously committed to the disease concept, but their finding of such cultural diversity casts doubt on the universality of “schizophrenia.”

And in 1973, E. Fuller Torrey, MD, prior to his conversion to biological reductionism, reviewed the evidence on the universality of schizophrenia, and summarized the matter:

“In fact, however, there is no evidence upon which to base a belief in the universality of schizophrenia.  The studies which have been used to support this belief are found, on careful examination, not necessarily to point in this direction at all.  If anything, they may lead to the opposite conclusions:  Schizophrenia may not be a universal disorder.” (p. 53 Is schizophrenia universal? An open question, Schizophrenia Bulletin, 1973, 7: 53-59)

and

“‘Once an idea becomes part of a textbook, it develops a life of its own and is seldom questioned.  This is what has occurred with the idea that schizophrenia is universal.'” (ibid, p 56)

and

“Finally, within the past few years some preliminary data on schizophrenia in New Guinea have become available. Burton-Bradley, a psychiatrist who has been there for a decade and a half, reported 343 cases of schizophrenia among the first 1,000 cases of mental disease which he examined. Virtually every one of the cases, however, occurred among individuals who had been living in the larger towns (‘the person of limited cultural contact, the so-called bush individual, very rarely presents with the symptoms of schizophrenia [Burton-Bradley 1969]’) or who had just migrated from rural areas to the towns (‘Not uncommon is the acute schizophrenia of sudden onset coming on usually within three months of  the patient’s leaving the village and working for the first time in a large town. Such patients readily recover and are returned to their village, at which level they can function without disturbance [Burton-Bradley 1963]’)” (ibid p 57.  The Burton-Bradley reference is:  Burton-Bradley, B.G. Culture and mental disorder.  Medical Journal of Australia, 15:539-540, 1963)

So, the fact that “schizophrenia” looks similar across cultures is more likely to reflect an artifact of cultural colonialism than any intrinsic property of the so-called illness.  And this is not merely a matter of psychiatrists seeing what they expect to see.  Once the “diagnosis” has been made, psychiatrists and other mental health workers actually begin a process that consists essentially of training the individual in how to “be schizophrenic.”  This process entails “educating” the client on the “symptoms and course of the illness,” and encouraging him to self-identify with the label.

NEUROANATOMICAL CHANGES

Dr. Reidbord doesn’t specify which changes he has in mind.  The main change of this nature that comes to my mind is brain shrinkage, but I think that there is broad consensus at present that this is more a function of extended use of neuroleptic drugs than any putative underlying disease process.

. . . . .

ANALOGY TO AIDS AND HIV

The analogy to AIDS prior to the discovery of HIV is unconvincing.  All the “symptoms” of the various psychiatric disorders that Dr. Reidbord mentions are behaviors, feelings, or thoughts.  And for each, there are plausible and eminently credible explanations from psychology, sociology, and indeed from ordinary experience and common sense.  But the symptoms of AIDS are clearly indicative of biological dysfunction. These symptoms include:

  • Fever
  • Chills
  • Rash
  • Night sweats
  • Muscle aches
  • Sore throat
  • Fatigue
  • Swollen lymph nodes
  • Mouth ulcers

It would be quite a stretch to conceptualize this cluster of symptoms as anything other than a biological malfunction.  But it is entirely plausible to think of “schizophrenia” in this way.  And indeed, Dr. Reidbord himself is restrained in his conclusion:

“Even though schizophrenia cannot be diagnosed under the microscope or on brain imaging, it is plausible that a biological mechanism eventually will be found.  ” [Emphasis added]

In my view, it is considerably more plausible that such a biological mechanism will not be found. This is particularly the case in that more than a hundred years of highly-motivated and generously funded searching for this “holy grail” of psychiatry has to date found nothing.

. . . . . 

But all of this, important as it is, is not the main point of Dr. Reidbord’s paper.  Let’s go on.

“Lately, however, some big names in psychiatry have taken a more ideological stance, declaring that psychiatric disorders in general are brain diseases — right now, no further proof needed.  Dr. Charles Nemeroff, widely published professor and chairman of psychiatry at the University of Miami Miller School of Medicine, writes:

In the past two decades, we have learned much about the causes of depression. We now know from brain imaging studies that depression, like Parkinson’s disease and stroke, is a brain disease.

Dr. Thomas Insel, recent director of the National Institute of Mental Health (NIMH) wrote:

Mental disorders are biological disorders involving brain circuits…

Psychiatrist and Nobel laureate Dr. Eric Kandel says:

All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases.

These claims by prominent psychiatrists agitate critics.  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.  Our best account for most mental disorders remains a complex interaction of innate vulnerability and environmental stress, the ‘diathesis-stress model’.  These psychiatric leaders know the research as well as anyone. How can they call psychiatric disorders brain diseases without scientific proof?”

At this point, readers might be thinking that, despite his earlier comments on biological brain dysfunction, Dr. Reidbord is arguing on our side of the debate.  But wait!  The argument progresses.

“The brain mediates all mental activity, normal or not.  Consequently, any psychiatric intervention — or influential life experience — acts upon the brain.  This is not a new discovery.”

 “It is a philosophical position, monism as opposed to Cartesian dualism, not a scientific finding.”

 “Psychiatric ‘brain disease’ is neither an exaggeration nor a lie.  It does not require scientific proof — and brain imaging has neither strengthened nor weakened the case.  For as long as one is not a philosophical dualist, it is surely true.  In theory, all psychology can be reduced to electrochemical events in brain cells. All psychopathology can be reduced to aberrant electrochemical events, i.e., brain disease.”

Dr. Reidbord is entirely correct in stating that the brain mediates all mental activity.  It also mediates all physical activity.  I cannot lift a finger, shed a tear, recall my mother’s face, hum a tune, feel sad, or even absent-mindedly scratch my ear, without the corresponding neural activity occurring within my brain, and eliciting the thought, feeling, or action in question.

Dr. Reidbord is also correct in stating that, in theory, all psychology can be reduced to electrochemical events within and between brain cells.  In theory, a super-neurologist could identify exactly what happens in a child’s brain when the child learns that two plus two is four; or what happens in a person’s brain when he/she becomes depressed or happy or plays the piano, etc… But the key phrase here is: “in theory.”  This is because, firstly, the complexity and miniaturization of the brain’s circuitry probably precludes the possibility that this kind of detailed super-analysis will ever be feasible. Secondly, and more importantly, a detailed micro-analysis of an event can never capture the kind of qualitative factors that emerge from a macro-analysis.

Take, for instance, the action of a five-year-old boy kicking his teacher in the shin.  Let us pose the question:  Why did he do that?

Our super-neurologist – in theory – could give us a complete account of the entire neurochemical sequence, from the activation of the first sensory neuron to the activation of the last muscle fiber.  In theory, this account, which would run to millions (perhaps billions) of words, would, if accurate, constitute a complete and accurate answer to the question posed above.

A psychological assessment of the incident, however, might conclude that the boy had been raised in a violent home, had never been trained in effective anger control, routinely reacted violently when confronted or given instructions, and that the teacher had told him to stop running around the classroom and to sit down. So he had kicked her.

A sociological perspective might note that the frequency of such attacks in classrooms was increasing generally, and might note associations between this kind of violence and parental conflict, unemployment, cultural background, etc.

The critical point here is that although each account is describing the same incident, there are qualitative differences between them that are critically important.  The neurological account, no matter how complete and thorough it is, could never capture the uniquely human dimensions of the interaction, any more than the psychological account could capture the extraordinary complexity of human biology.  The issue here is not which account is correct, but rather which account is more suited for a given purpose.  If the purpose is to understand human biology, then the neurological account is more helpful.  But if the purpose is to understand the child’s actions and develop corrective measures, then the psychological account is clearly the preferred approach.

And this, of course, takes us straight to the heart of the psychiatric hoax:  that all significant problems of thinking, feeling, and/or behaving constitute brain diseases and are best ameliorated by modulating neurological activity.

Which in turn takes us to Dr. Reidbord’s conclusion in the above quote:

“All psychopathology can be reduced to aberrant electrochemical events, i.e., brain disease.”

And unlike his earlier premises, this conclusion is false.

The best way to illustrate this fallacy is with some examples, but first let’s clarify the language.  “Psychopathology” is a complex term, subject to diverse interpretation.  So rather than try to define this term, let’s use the APA’s Diagnostic and Statistical Manual as a starting point, and accept, for discussion’s sake, that any “diagnosis” or “symptom” listed in the manual constitutes “psychopathology.”

Childhood temper tantrums, for instance, are listed in the DSM as “symptoms” of oppositional defiant disorder, disruptive mood dysregulation disorder, and intermittent explosive disorder.  Therefore, according to Dr. Reidbord, temper tantrums of the severity and frequency specified for these “diagnoses,” “can be reduced” to aberrant electrochemical events.  The phrase “can be reduced to” in this context clearly means “can be conceptualized as,” or “are caused by.”  And the phrase:  “Aberrant electrochemical events, i.e. brain disease,” clearly means:  a malfunction in neurological equipment.

But in fact a child can acquire the habit of throwing temper tantrums without any neurological malfunction.  Generally speaking, there are two principal ways in which a child can acquire this, and other, habits: learning from results; and learning from imitation/coaching.

LEARNING FROM RESULTS

If a child throws a temper tantrum, and the tantrum produces a positive result (e.g. a parent yielding to his demands), then, other things being equal, there is an increased probability that temper tantrums will become habitual, especially if they continue to produce the same kind of outcome.  This is not a function of aberrant electrochemical events in the brain cells.  In fact, it is exactly the opposite:  a perfect example of the normal human learning apparatus operating flawlessly.  It is not an example of something going wrong in the brain, rather it is an example of something going right.  We humans learn from the results of our actions, an obvious fact that has been verified experimentally countless times, and in addition accords perfectly with common sense and general observation.  And we acquire functional, productive habits in exactly the same way and by means of the same cognitive apparatus as counter-productive and problematic habits.  Acquiring the temper tantrum habit is particularly easy, in that babies are born with an anger apparatus which needs little encouragement to express itself in rage and aggression.  In fact, the opposite is the case:  teaching anger control is the challenge.

LEARNING BY IMITATION/COACHING

Imitation is another major component of our normal learning apparatus.  The child acquires skills and habits through imitating, at first his parents and siblings, and later individuals outside the home.

It is self-evident that through imitation and coaching a child can acquire habits that are useful and helpful; but it is equally obvious that he can also acquire habits that are destructive and counter-productive.  Through imitation a child can, for instance, learn to fear objects that are dangerous, but through precisely the same mechanism, he can learn to fear harmless objects such as spiders, closed-in spaces, open spaces, cats, hypodermic needles, air travel, dogs, heights, elevators, social gatherings, etc… All of these fears are “psychopathological” in the sense specified above, but all can be acquired, through imitation, by a person with a perfectly normal-functioning brain, provided the fear in question is being modeled by a significant person in the child’s life.  It is fallacious to assume brain pathology based solely on the fact that the acquired behaviors/feelings are counter-productive or distressful.

Similar observations can be made with regards to every “symptom” listed in the DSM.  Habits of paranoid speech, incessant speech, over-eating, self-deprecating speech, grandiose speech, rule-breaking, cruelty, violence, stealing, suicidal threats, suicidal gestures, apathy, etc., can all be acquired by a person with a normally-functioning learning apparatus, either through learning from results or learning by imitation, or both.  In the absence of specifically identified and credibly causative brain pathology, this is the most reasonable and parsimonious way to conceptualize the acquisition of these kinds of habits.

In his ground-breaking monograph, “The Jack-Roller” (1930), Clifford Shaw provides graphic, first person accounts of how a child can acquire the habit of stealing in this way.  For example:

“On the trips with William, I found him to be a rather chummy companion.  I regarded him, not as a brother, but rather as a boy friend from another home.  He was five years my senior.  He sort of showed it in his obvious superiority.  But I didn’t seem to notice that fault.  He was a ‘mamma’s boy’ at home, but oh, Lord, how he changed on our trips!  He taught me how to be mischievous; how to cheat the rag peddler when he weighed up our rags.  He would distract the peddler’s attention while I would steal a bag of rags off the wagon.  We would sell the rags back to the victimized peddler.  He also took me to the five and ten cent store on Forty-seventh Street, and would direct me to steal from the counter while he waited at the door.  I usually was successful, as I was little and inconspicuous.  How I loved to do these things!  They thrilled me.  I learned to smile and to laugh again.  It was an honor, I thought, to do such things with William. Was he not the leader and I his brother?  Did I not look up to him?  I was ready to do anything William said, not because of fear, but because he was my companion.  We were always together, and between us sprang up a natural understanding, so to speak.

One day my stepmother told William to take me to the railroad yard to break into box-cars.  William always led the way and made the plans.  He would open the cars, and I would crawl in and hand out the merchandise.  In the cars were foodstuffs, exactly the things my stepmother wanted.  We filled our cart, which we had made for this purpose, and proceeded toward home.  After we arrived home with our ill-gotten goods, my stepmother would meet us and pat me on the back and say that I was a good boy and that I would be rewarded”

And stealing is psychopathology:  a “symptom” of “conduct disorder,” “kleptomania,” and “antisocial personality disorder,” but I suggest it is clear that there is nothing wrong with the narrator’s neuro-cognitive apparatus.  He isn’t learning the behaviors approved by the dominant culture.  But he is learning the rules of the smaller group to which he belongs and feels connected.

The habits of thinking, feeling, and behaving mentioned above make perfect sense when viewed from the individual’s perspective, but appear counter-productive and dysfunctional from the perspective of so-called “normality.”  But within the context of psychiatry’s intractable commitment to the medical model, the search for a “diagnosis” precludes any search for meaning or sense in the “patient’s symptoms.”  For psychiatry, the “patient” is “sick.”  His brain is assumed, without evidence, to be broken.  There is no meaning or sense to his “symptoms.”  And in this way, psychiatry has locked itself in a cocoon of comforting but destructive and condescending certainty, which they show no inclination to leave.

. . . . .

At this point, Dr. Reidbord’s paper takes another interesting twist:

“Without elucidating the causative mechanisms, however, this reductionism amounts to little more than political rhetoric.  Calling psychiatric disorders brain diseases serves no clinical or research purpose, it only serves political ends: bringing psychiatry into the fold as a ‘real’ medical specialty, impressing Congress and other funding sources, perhaps allaying stigma.  As a tactic it smacks of insecurity and self-aggrandizement, wholly unbefitting a serious medical specialty.”

To which I would certainly agree, adding only that the reductionism also constitutes an invalid inference, as outlined above.

. . . . .

“Freud’s psychoanalysis acts on brain cells, and ultimately alters chemical bonds in those brain cells.  We could rename psychoanalysis and psychotherapy ‘verbal neuromodulation.’  But to what end?  A reductionistic account of this sort, festooned with pseudoscientific verbiage, has no practical significance.

Brain research is a young field.  It should be vigorously pursued for what will surely be learned.  If history is any guide, many conditions currently considered psychiatric will eventually be explained biologically — and ironically, they will no longer be psychiatric conditions, as was the case with Huntington’s disease, brain tumors, lead poisoning, and many other diseases that now belong to other medical specialties.

Stumping for psychiatry as clinical neurobiology will be justified when basic research in this area affects clinical practice. Until then, ‘brain disease’ is only a philosophical technicality, a spin, to give our clinical work and the institution of psychiatry an air of scientific credibility.  Particularly in light of how diseases leave psychiatry once they are well understood, the field should embrace uncertainty, not preempt it with the premature use of brain disease language.”

So what we’ve got here is an interesting and curious mix of very commendable honesty and professional self-interest coupled with the oft-heard psychiatric assertion that sometime in the future the brain pathologies will be discovered.  In the meantime, Dr. Reidbord contends that promoting clinical neurobiology is not justified, and will not be justified until basic research affects clinical practice.

But, in my view, Dr. Reidbord misses the essential point:  that the “real-illness-just-like-diabetes” assertion has been, and continues to be, widely and avidly promoted by psychiatry, and that clinical practice is already based almost entirely on the false contention that all problems of thinking, feeling, and/or behaving are best conceptualized as neurological illnesses.  It is extremely rare to encounter, or even hear about, a psychiatrist who offers any kind of “treatment” other than drugs or high voltage electric shocks to the brain.  On his website, Dr. Reidbord tells us that his clinical practice “skews towards dynamic psychotherapy” and that he has “a healthy skepticism of commercial influences on medical practice.”  Again, this is commendable but rare.

Dr. Reidbord downplays the practical significance of the “aberrant electrochemical events” falsehood by calling it a philosophical position rather than a scientific finding.  But from either perspective, it is problematic.  From the former it is fallacious (as shown earlier); from the latter it is non-existent (such research does not exist).  Nevertheless, it is widely promoted within psychiatric circles, and is routinely used to medicalize non-medical problems, and to legitimize the use of dangerous drugs to “treat” an ever-increasing range of human problems.

. . . . .

And, incidentally, in another interesting twist in the paper, Dr. Reidbord actually seems to be saying something very similar to this:

“Freud could then have made it a point to declare, as Drs. Insel and Kandel do now, that all mental disorders are biological diseases.  No additional science was required even a century ago.

He didn’t because there was nothing to gain.  The best treatments at the time were psychological, not biological.  There was no grant money at stake, no research agenda to support.  The status and livelihood of early psychoanalysts did not depend on their treatment being biological.”

In other words, if I’m understanding Dr. Reidbord correctly, psychiatry is positing the brain disease concept today because it is good for business.  And in this, of course, he is absolutely correct.  But, ironically, by asserting the falsehood that “all psychopathology can be reduced to aberrant electrochemical events, i.e. brain disease” Dr. Reidbord is himself contributing to, and legitimizing, the hoax.

41 COMMENTS

  1. I find these arguments about schizophrenia to be fairly pointless because none of those most interested in the subject seem aware that schizophrenia is but a syndrome with the various signs the APA thinks are elements of a disease called schizophrenia. It makes more sense to think of schizophrenias, because the syndrome can be produced by a variety of things, such as cortisol, heavy metal poisoning (lead and/or mercury), copper poisoning, food and inhalant sensitivities, zinc deficiency, abuse of stimulants or hallucinogens (amphetamine psychosis being behaviorally identical to acute paranoid schizophrenia). Perhaps the reader will notice there is no single treatment that will be effective for ALL of these maladies.

    • Not to mention, the “gold standard” treatment for “schizophrenia,” the neuroleptic drugs, can also cause both the negative and positive symptoms of “schizophrenia.”

      The negative symptoms can result from neuroleptic induced deficit syndrome, which is frequently misdiagnosed by doctors, resulting in increased neuroleptic levels, rather than reduced.

      https://en.wikipedia.org/wiki/Neuroleptic-Induced_Deficit_Syndrome

      And symptoms like:

      “memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      Symptoms doctors can not distinguish from the positive symptoms of “schizophrenia.” Are what results from too high a dose of neuroleptics, via what’s actually called the ‘central symptoms of neuroleptic induced anticholinergic intoxication syndrome,’ aka anticholinergic toxidrome.

      • Oh, and as to:

        “Once the ‘diagnosis’ has been made, psychiatrists and other mental health workers actually begin a process that consists essentially of training the individual in how to ‘be schizophrenic.’ This process entails ‘educating’ the client on the ‘symptoms and course of the illness,’ and encouraging him to self-identify with the label.”

        I will mention this “training” process is also known as gas lighting a person.

        “Gaslighting or gas-lighting is a form of mental abuse in which information is twisted or spun, selectively omitted to favor the abuser, or false information is presented with the intent of making victims doubt their own memory, perception, and sanity.[1][2] Instances may range simply from the denial by an abuser that previous abusive incidents ever occurred, up to the staging of bizarre events by the abuser with the intention of disorienting the victim.”

        Creating the symptoms of “schizophrenia” with the neuroleptic drugs is merely the, “staging of bizarre events by the abuser with the intention of disorienting the victim,” aspect of the gas lighting process.

        And please note, gas lighting a person is “mental abuse,” not medical care.

        • A friendly suggestion — I think we could do without the term “gaslighting,” which doesn’t really describe much in the first place; not only is it often confusing, but — at least as it has frequently been used on this site — can be used as a brickbat to deflect people’s opinions. I think it would more clear if people would describe specifically what they’re talking about rather than just throwing around another ambiguous and somewhat loaded term.

          Besides it’s sort of boring here tonight and there’s not much new to talk about…

      • This is an excellent observation, too, Dr. Hickey, “within the context of psychiatry’s intractable commitment to the medical model, the search for a ‘diagnosis’ precludes any search for meaning or sense in the ‘patient’s symptoms.’ For psychiatry, the ‘patient’ is ‘sick.’ His brain is assumed, without evidence, to be broken. There is no meaning or sense to his ‘symptoms.’ And in this way, psychiatry has locked itself in a cocoon of comforting but destructive and condescending certainty, which they show no inclination to leave.”

        Although, dealing with lunatics who think in such an illogical and unscientific manner, is quite absurd, and actually insane. Since for one to assume, with no medical evidence whatsoever, that another person’s brain is “broken” is, technically insane, or at a minimum a form of delusional thinking.

        Shame so many psychiatrists don’t want to admit to, and overcome their delusional way of thinking, however. Most of them apparently have, what do they call that disorder? Oh yes, “Anosognosia … is a deficit of self-awareness, a condition in which a person who suffers some disability seems unaware of the existence of his or her disability.”

        Thanks as always, for your words of wisdom, Dr. Hickey.

    • The syndrome can also be produced by Vitamin D deficiency. The example of young people raised on the farm becoming schizophrenic after taking jobs in the city can be easily explained by reduced sun exposure. Psychiatrists have known for years that almost all persons diagnosed with schizophrenia have vitamin D deficiency. They are unwilling however, to test every person presenting with psychosis for this deficiency and prescribe adequate amounts to treat this deficiency. Some people are fast metabolizers and need more of this essential vitamin.

    • Just as there are infinite variations on the nature of god, the meaning of “schizophrenia” is different to almost everyone who uses the term; hence what contributes to “it” depends on one’s personal definition. The question is why we have to entertain the concept at all.

      • Because psychiatry wants to profit from claiming to be in charge of the “scientific” knowledge, thus control, of all people’s minds, over the paternalistic religions.

        But psychiatry’s beliefs, are even more invalid, than that of today’s paternalistic child abuse covering up religions, which is why they are covering up the sins of the religious leaders.

  2. When I stopped taking my medication (long acting depot injection) my problem was anxiety. If you strip out anxiety what’s left in “Schizophrenia”?

    There are effective methods of dealing with ‘anxiety’ (or ‘catastrophisation’) without chemical dependency. These methods are often very simple to understand, but painful to apply, but they DO work.

  3. I think it is pretty clear by now, and it is being recognized by many therapists and even a few psychiatrists, that the psychiatric diagnostic categories, especially since the publication of DSM V, are just descriptions of some behaviors. The label that is put on those behaviors is nothing more than a hypothetical construct; it is not something that exists. The terms such as schizophrenia, bipolar, depression, and even anxiety, refer to many different things. The terms have no relation to etiology.

    Still, questions such as Dr. Hickey poses, while they offer a necessary response to the medical/psychiatric community, also are oversimplifications of the problems.

    I have been a therapist for over forty years. The people who have come to me for help suffer with a combination of psychological, emotional and behavioral difficulties. Do they have a “brain disease?” No. I don’t think “disease” is accurate. Some clearly had brain injuries. Some have toxins, such as lead, that have damaged their brains. But also, some people are clearly wired differently, mostly due to slight variations in their unique genetic codes. They had different placements of a few amino acids along their double helix.

    But, that usually is not the sole cause of their problem. Genetic differences manifest themselves very differently depending upon the environment in which the person lives. This means that family dynamics play a huge role in shaping personalities, in shaping behavior and in forming belief systems.

    Families now come in many shapes and sizes, and they are all ;giving in very different communities. As Dr, Hickey points out, what is acceptable in one culture often seems very weird when that person moves into another culture.

    We can see that with some of the strangeness that goes on in the world today. Are all suicide bombers Crazy?

    My point is that the causes of “mental illness” are very complex, and they are very interactive. Some families are tolerant and accepting of a wide range of behaviors. Other families, or communities, may label those behaviors as “sick.” Once those labels are applied many different experiences begin to befall that person which usually make their lives more difficult.

    Still everyone starts their lives with slightly different brains. Some are more sensitive, some are more active, some are more distractible, some seek more stimulation, some are more active physically. Some people are naturally just happier, while others are just more uncomfortable. These are biological differences. When they interact with their environment, and other people interact with them, it can lead to support, peace, love and understanding, or it can lead to anger, depression or bipolar behaviors.
    It’s complex.

    • “But also, some people are clearly wired differently, mostly due to slight variations in their unique genetic codes. They had different placements of a few amino acids along their double helix.”

      How do you know that they are clearly wired differently? Did you have them tested genetically?

      If so, what did you discover? Which genetic differences did they clearly have?

      What causal role did these genetic differences play? How, exactly, did these genetic factors contribute to their problems? Which exact mechanism are you speaking of?

  4. Steven Reidbord concludes his piece with this sweeping generalization…

    All psychopathology can be reduced to aberrant electrochemical events, i.e., brain disease.

    Change the phrasing a little and you might get something like: All human activity, as far as the brain is concerned, can be reduced to electrochemical events within the brain. Aberrant electrochemical events versus acceptable electrochemical events?

    Odd. I just don’t think you’re going to arrive at a man by calling some people non-normal, and thinking somehow that by studying them you are going to find the key to all people.

    • “Aberrant electrochemical events,” a chilling phrase.

      Not so long ago psychiatry, using this ideology, would have said I was gay because of, “Aberrant electrochemical events.”

      It is a cliam to expertese in human behaviour completely devoid of all social or psyhochological context and there ripe for abuse by the powerful.

  5. Thanks for this article Phil. When reading the comparison between the discovery of the biological cause of AIDS / the HIV virus, and the hope of legitimizing schizophrenia, this idea came up:

    1) The AIDS symptom-complex was first recognized as a potential disease in 1981, with identification of the causal mechanism (HIV virus) and legitimization of the HIV-AIDS disease following by around 1985-1986.

    See – http://www.webmd.com/hiv-aids/ss/slideshow-aids-retrospective

    2) The supposed schizophrenia symptom-complex was first described by Kraepelin in 1887, before being named schizophrenia in 1917 by Bleuler. However, about 130 years of studying this supposed illness have brought no significant advances in understanding its etiology or in legitimizing it as a biologically-caused illness. This timespan includes several decades in which advanced molecular, biological, and genetic techniques have been available.

    See – http://schizophrenia.com/history.htm

    For me, this 130 year time lapse, much of which included a period of advanced technological instruments applied to studying the phenomenon, strongly implies that there is probably no biological illness called schizophrenia.

    In a sense, one could argue that every year, month, week, day that elapses, the chances of legitimizing schizophrenia as a biological illness worsen. Improving technology over time seems to have none nothing to unravel the “mystery.” The prospects of schizophrenia being “revealed” as an illness caused by biological or genetic factors are pretty much doomed.

    On the other hand, it is in a sense incorrect to say that the primary causes of “schizophrenia” (meaning severe psychotic experience) are unknown, because they are known. Clinical reports by therapists of “schizophrenics” and studies like the ACE study and John Read’s work have been showing for a long time that social-psychological stress in terms of abuse, neglect, poverty, trauma, isolation etc. are the primary contributors to becoming psychotic. The processes involved are too complex to nail down any one of these factors as “the cause” of “schizophrenia”, but these data clearly point to social and psychological factors as the primary influences.

    As you correctly identified, most of the fraudulent research of biological psychiatry into “schizophrenia” can be understood as nothing more than an attempt to protect two things:

    1) The income and professional status of psychiatrists and researchers who depend on public belief in supposed medical illnesses like schizophrenia to make high incomes and be perceived as doctors.

    2) The profits and status of pharmaceutical companies that profit from drugging the emotional distress of severely troubled people (“schizophrenics”) by training them to believe they have a brain disease while taking brain damaging pills.

    That’s pretty much it. Schizophrenia’s primary function, and most substantial ontological reality, is therefore as a hallucinated concept serving as a cash cow for psychiatrists and drug companies.

    For me this part of the essay represents present-day psychiatry in a nutshell:

    “For psychiatry, the “patient” is “sick.” His brain is assumed, without evidence, to be broken. There is no meaning or sense to his “symptoms.” And in this way, psychiatry has locked itself in a cocoon of comforting but destructive and condescending certainty, which they show no inclination to leave.”

    • BPDtransformation,

      Thanks for pint out the 130 years of failed research. It contrasts markedly with physicists’ search for the luminiferous aether. Once the Michelson-Morley experiment failed to find the aether, physicists dropped the concept. They followed the evidence. But psychiatry clings to “schizophrenia”, because it is the primary “legitimization” of their existence.

  6. I didn’t say anything about the rotten side effects of antipsychotic drugs, as I wasn’t discussing them, but the perils of diagnosis. They are a stupid idea; medication noncompliance is no surprise. as these drugs deprive you of the opportunity to feel pleasure in anything, the big flaw in medicating in a way true to the dopamine hypothesis.
    Concerning the medical model- it only exists as a fiction in so-called medical psychiatry. Although I suspected as much, my eyes were permanently opened about 40 years ago while watching a late-night talk show on the subject of mental illness.
    The guests were Mark Vonnegut (back when he was a med student) who was quite blase about being a former mental patient, and a young woman from some patients’ liberation organization, who spent the first half of the show railing about the evil medical model in psychiatry. I was ready to turn the show off out of boredom, when Humphry Osmond appeared and began to ask the young lady about her treatment: did the doctor tell you what he diagnosed (no); did he tell you about his treatment protocol and why he was using that one(no); did he give you a prognosis (no); did he tell you about side effects from your medication beforehand(no). Then he told the woman her shrinks weren’t following the medical model at all (psychedelic drugs hadn’t addled his brain).

    • Then Osmond would have been wrong. Maybe he should have stuck to his day job. 🙂

      If the psychiatrist “treated” her he was using the medical model. Psychiatry=medical model. That’s why it’s psychiatry, not psychology — the medical degree, which affirms that one’s specialty is treating “diseases of the mind.” What you seem to be referring to is the biological model, which is only one form of the medical model.

  7. The one thing I appreciate about the author of the article in question is that he actually admits that the psychiatric worldview “requires no proof” IF and only if you are a reductionist philosophically. He calls it a “monism,” and thereby acknowledges (if inadvertently) that psychiatry is, in fact, based on religious or philosophical faith in a particular monism, rather than any actual scientific data. This is the hard truth that most will never admit, so I have to give the guy credit, even though he continues to write afterwards as if his monism were absolute truth.

    • I have a different take on reductionism. Our culture generally considers doctors authorative; psychiatry is a medical science generally based on biological reductionism. Some monism as a physical body that incorporates “spirituality” in contrast to dualism that describes a “spirit” separate from the body. So it is not outlandish to describe doctors as monist even though most are dualists. Nevertheless, I do not understand how the author could say that psychiatry is not required to prove that mental distress is a disorder if one is a biological reductionist. It seems like the opposite is true; psychiatry investigates an abstract philosophy of mind is hardly biological reductionism. Real biological reductionism shows mental distress as emotional distress- the natural, normal neurobiology of painfully distressful experiences.

      • Steve Spiegel,

        Dr. Reidbord’s “logic”, if I understand it correctly, is: All human activity stems from brain activity; therefore problematic human activity must stem from problematic brain activity (i.e., “brain disease”). It’s a logical fallacy, but at a naïve linguistic level, it has some superficial plausibility.

  8. I have also thought of the following:
    We have many organs in our body. In organs like the liver, spleen, etc., what percentage of people have diseases as a direct result of a biological abnormality? I saw sometime back that the number is a very small (something like .03%? – couldn’t locate the exact number right now). So, as soon as people display “mental illness” why is it that a biological problem is assumed to cause it?
    Also, there is so much evidence that mind states actually cause the structure of the brain to change (epigenetics and neuroplasticity). For example, stress adversely changes neural structures and practises such as meditation and mindfulness normalize the brain (there is overwhelming evidence for this).
    In other words, the direction of causation goes the other way around. What these scientists are doing is, as soon as they see an association (mental states associated with different neural structures) they pounce on the conclusion that the brain caused it, and therefore the brain needs to be treated. They forget that association is not causation.

      • And they treat the brain as separate from the nerves in the rest of the body. Emotion, which is a large part of psychiatric diagnosis, is felt and displayed by our bodies. What images in an fMRI might be reactions to the body’s reactions. It is an old debate, of course, but making something of a comeback.

        How many other specializations would get away with treatments the derange and injure the organ of interest? How many would get away with 100% of their drugs causing psychosis, mania, seizures, damaged sexual response, and ruined lives. Odd that headshrinkers do both. The horror is that they get away with by describing (and thinking of) their patients as incompetent and wholly unreliable witnesses. And it isn’t stigma. (Grrr) It’s a studied and intractable prejudice; the Religion. John Read called it iwhen he said something like “psychiatry is the only branch of medicine that locates the problem in the patient.

    • Yes, the medical community definitely knows how to create the “classic symptoms of schizophrenia,” with the psychiatric drugs.

      I’m not certain “schizophrenia” actually would exist, however, without the psychiatric drugs. Although, that’s not to say I do not believe people can experience unusual states of mind due to various other factors, like other prescription and street drugs, abuse, etc.

  9. Actually, we can create schizophrenia(SZ) without any chemical intervention. Prisoners placed in a maximum security solitary confinement facility, can develop symptoms of SZ, when all external stimulus and human contact are withheld from them for long periods of time.

  10. If anyone believes they are immune to experiences like visual and/or audial phenomena , insomnia, up and down moods ,speeding thoughts , feelings of being dead inside , lots of mixing up internal phenomena with external events , and not relating well with others ,etc. just allow your ADA dentist to keep installing enough so called silver amalgams which are really at least 50% mercury into your mouth and you will eventually even if it takes large amalgams in every tooth , yes you will eventually feel the surge . By the way enough mercury will also block other various chemical toxins from various sources from leaving your body. You will also be made more susceptible to other types of trauma then you would be otherwise . And of course you’d be more likely to be captured labeled and engulfed by the government sanctioned pharma psychiatric chemical and electrical torture crimes against humanity cartel.
    Look up the videos of Dr. Chris Shade who himself at one time was poisoned by 17 amalgams containing mercury . He does state of the art testing for mercury poisoning .

  11. Could it be that people diagnosed with SZ, rather than being ‘out of their minds’. are actually ‘too much into their minds’? Could it be that they are getting something out of isolating themselves and wanting to be left alone?

    I believe that we humans, do and say things , because we get something out of it. either consciously or unconsciously.

  12. Hi Dr Hickey,
    have you ever noticed how criminal damage and vandalism becomes an artform (grafitti art) as a result of a few talented individuals?
    Not got a lot of work to display as a result of 130 years of human vandalism have they?
    regards
    boans