Our priorities for studying and improving “mental health” are way out of whack.1 They have been for a long time. For the past 30 years, the National Institute for Mental Health has been spending most of its gigantic budget ($1.3 billion in 2015) on studying the brain and looking for the genes that cause “mental illness.” That’s been a tremendous waste of money, time and effort.
What do we have to show for it? Since psychotropic drugs became the primary modality of treatment there has been a dramatic increase in the number of Americans on Social Security Disability due to “mental illnesses.”2 Patients who don’t use the drugs recover at a higher rate than ones who do.3 Patients who use neuroleptic drugs die significantly earlier than other people.4
The history of psychosurgery is just as bad. We thought lobotomies were the answer but that has proven not to be the case. Electroshock improves the symptoms of severely depressed persons to some degree. But the relapse rate is extremely high and patients suffer the loss of significant parts of their memories. It’s hard to see how inducing grand mal seizures can be of help to many people.
In spite of billions of dollars and countless hours spent looking for genes that cause “mental illness,” a specific gene has never been found. Decades of research have confirmed that the influence of genetics on “mental illness” is very minimal at best.5
You would think that this failure would raise some eyebrows and cause some soul searching. But no, the NIMH announced recently that it is doubling down on its effort to find the biological bases of “mental illnesses.” NIMH’s Research Domain Criteria Initiative (RDoC) will be asking the following questions:
- What are the neural bases of perception, cognition, motivation and social behavior?
- How do there aspects of mental function – which represent how we perceive, interpret, react to and interact with the world – become altered in mental illness?
The strategic plan goes on to say “the answers will come from discovery-based and hypothesis-testing studies examining the biological mechanisms underlying the regulation and dysregulation of mental processes.” Strategy 1.1 is: Describe the Molecules, Cells and Neural Circuits Associated With Complex Behaviors.6
And President Obama recently launched the Precision Medicine Initiative, a major goal of which is to identify the genetic underpinnings of disease, leading one scientist-critic to say: “In other words, we are spending a lot of money on something with questionable utility, and even when we do find genetic variants that contribute to risk, their predictive power is based on environment, culture and behavior.”7
So it looks like we’re going to continue to waste billions of dollars on the quixotic search for the roots of “mental illness” in the brain and genetic dynamics.
How should we be using this money, time and effort? I think we should be using it to study the mind and how to help people use their minds more effectively. I am defining the mind here as the part of ourselves which thinks, feels, intends, understands and perceives. The mind is the faculty we use to do everything we do – to build civilizations, create technology, produce art, learn about the cosmos, raise our children, fall in love, help our fellows, make decisions and plans about our future, plan vacations, study the Earth and the plants and animals that live on it.
It is tempting to think of the brain and the mind as the same thing. But they are quite different. We know very little about the relationship between the brain and the mind. We know something about how neurons operate in the brain. We know something about the function and dynamics of neurotransmitters. We have some idea of the location of different functions in different parts of the brain. But we have no idea of the difference between what is going on in the brain when we are painting a picture and planning a vacation, for example. We have little understanding of how memory works, where it operates or how to improve it through intervention in the brain. We have no idea about what happens when I say I am going to move my arm at the count of three and proceed to do it – precisely at the count of three.
As William Uttal has argued in his book Mind and Brain: A Critical Appraisal of Cognitive Neuroscience, we have no idea of how the brain creates the mind. Neuroscientists think they have such a theory but they aren’t even close. The mind is so vast and powerful and we know so little about the relationship between the mind and the brain that we are a long way from having such a theory.
Here are a couple of questions that may help us understand the difference between the mind and the brain: When a woman learns through a long course of psychotherapy that she has been prematurely breaking off love relationships out of fear that she will ultimately be abandoned, is that insight being performed by the mind or the brain? When a young man decides that he is going to study cognitive neuroscience rather than music therapy, is that being done by the mind or the brain?
Here’s another way of putting it. The brain isn’t capable of performing human agency, of using intention, of making decisions about what to do and when. Only the mind is capable of doing that. In the words of David Jacobs, “the brain is a necessary but not sufficient component of mental life. The alphabet is a necessary substrate of a novel, but it would be foolish to say the alphabet is the novel or that the novel can be reduced to or found in the alphabet.” In the same sense, it is foolish to say that the brain is the mind or that the mind can be reduced to or found in the brain.
How do we study the mind? We can’t do it through the techniques of laboratory science. We can’t do brain scans or blood assays of the mind. But we can study the mind by studying the experience that humans have in using their minds. We can study the mind through the methods of phenomenology. We can put people through various kinds of learning and therapy experiences and see how that impacts their ability to use their minds. We can compare such experiences to see which are most effective. We can study people who use their minds in different ways and study the associations between their life experiences and the way in which they use their minds.
What makes me think we would benefit from spending at least as much money and effort on studying the mind as we do on studying the brain? I think that because the weight of evidence tells me that, if we want to help people who are struggling in their lives, people, for example, who are diagnosed with “mental illnesses,” we are going to be more successful through intervening at the level of the mind than through intervening at the level of the brain.
Here is the benefit-risk profile for intervening at the level of the brain through psychotropic drugs or psychosurgery:
- You may feel somewhat more energetic and alive if you take an upper like Prozac, Paxil, Adderall or Ritalin or somewhat less anxious and agitated if you take a downer like Atavan, Xanax, Zyprexa or Risperdal.
- In the case of antidepressants the research says that the feeling better is largely due to the placebo effect but, nevertheless you may be feeling better.
- Electroshock may help you feel less depressed but that effect won’t last for more than a month or two.
- Taking an antipsychotic drug may dampen hallucinations but it won’t make them go away.
- You won’t be addressing the causes of the symptoms which have led you to seek treatment.
- Although you have probably heard or read that your symptoms are caused by chemical imbalances, genetic dynamics or brain anomalies, there is no scientific evidence of that being the case.
- Scientific evidence would tell you that any physiological changes associated with your symptoms are the result, not the cause of what is going on in your life and how you are reacting to it.
- That is certainly the case with the stress response, the most widely and deeply studied of the mind-body dynamics.
- The scientific evidence says that your symptoms are the result of situations you are facing in your life and of concerns that you have about your life and yourself.
- The drugs won’t help you develop any of the skills and knowledge you need to deal with those concerns.
- You’ll suffer from serious “side effects” of the drugs including increased incidence and risk of:
- Sexual dysfunction
- Akathisia – extremely uncomfortable and dangerous restlessness
- Emotional blunting – loss of conscience and caring
- Depersonalization – a sense of loss of contact with yourself
- In the case of antipsychotics like Zyprexa, Abilify, Geodon and Risperdal, you’ll suffer from:
- Tardive diskinesia – a Parkinson-like loss of control over muscles and gait.
- Cognitive impairment
- Brain shrinkage
- Early death – persons who take antipsychotics die on average 25 years younger than people who don’t take them
- In the case of electroshock, you will suffer significant memory loss and cognitive impairment.
If and when you stop taking the drug you will suffer difficult withdrawal effects. In the case of anti-anxiety drugs such as Atavan and Xanax, that can involve years of debilitating recovery. This is because the drugs have caused your brain to compensate for its changed condition so when you stop taking the drugs, your brain will be in a dysfunctional state. Since the drugs you are taking act on the brain in the same way that cocaine, heroin and meta-amphetamines act on the brain, you will suffer the same kind of withdrawal effects as do persons who use illegal drugs.
If and when you stop taking the drug you are likely to experience a relapse of the symptoms that led you to seek treatment.
You will have bought into and complied with a very cynical and unhealthy message. When you are feeling bad, take a drug.
Here is the benefit-risk profile for intervening at the level of the mind through various kinds of psychotherapy.
- You will be addressing the causes of the symptoms that have led you to seek treatment.
- You will gain self-management skills and knowledge that you will be able to use for the rest of your life to stay healthy and happy
- Learn valuable lessons about yourself, what makes you tick, what you want and don’t want
- Develop compassion for yourself
- Learn how to deal with the difficult dilemmas we all face from time to time
- Become able to connect with others in satisfying ways
- Become more able to use your talents and faculties in satisfying and contributing ways.
As you learn how to manage your thoughts, feelings, intentions and perceptions in healthier ways, your brain will change in beneficial ways.
- You might waste some time and money.
- You might receive some advice or messages that will get in the way of you becoming healthier and which might send you down the wrong path for a while.
The mind is what all the great psychologists have studied: Freud, Jung, Adler, Perls, Sullivan, the Ericksons, Horney, the Fromms, Alice Miller, Hillman, Satir, Haley, Beck, Ellis. What they learned has been of great help to people. They built the foundation of today’s psychotherapy which, according to research, is beneficial to 80 percent of the people who receive it.
If we want to help people who are going through the troubling, debilitating, painful and hopeful states of being we call “mental illness” we will do well to study the mind, not the brain.
* * * * *
- I put quotations around “mental health” because that term assumes there is such a thing as “mental illness” and that term is misleading and problematic. It is problematic because, with the ascendance of biopsychiatry, Americans have come to believe that the states of being associated with diagnoses of “mental illnesses” are essentially physiological in nature, i.e. caused by biochemical imbalances, genetic anomalies and brain disorders. That is a problematic belief for the following reasons. First, it is not supported by adequate scientific evidence. So no “mental illnesses” are diagnosed with laboratory findings, brain scans or physiological markers of any kind. Second it leads to “treatment” with psychotropic drugs and psychosurgery which is more harmful than helpful to people. Third, it regards those states of being as alien, useless and worthy of being extinguished with no regard for their meaning, function and usefulness. A more useful and beneficial belief is to regard those states of beings as understandable and “normal” reactions to life situations and to concerns that people have about their lives and themselves. So, instead of mental illness, I prefer terms such as emotional distress, life crisis, numinous experience, difficult dilemma, spiritual emergency, existential emptiness, deep-seated grief or overwhelm. Since those states of being are debilitating and impede healthy functioning, they can be regarded as illnesses but they are much more than illnesses. They are also wake-up calls, signals of distress and opportunities for growth and life-enhancing learning.
- Whitaker, R (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs and the astonishing rise of mental illness in America. New York: Crown Publishers
- Harrow, M, et al. (2007). Factors involved in outcome and recovery in schizophrenic patients not on antipsychotic medication. Journal of Nervous and Mental Disease,195:406-414
- Joukamaa, M et al. (2006). Schizophrenia, neuroleptic medication and mortality. British Journal of Psychiatry,188:122-127
- Leo, J. (2016). The search for schizophrenic genes. Issues in Science and Technology (Winter, 2016):68-71
- National Institute of Mental Health (2015). Strategic plan for research. Washington DC: National Institutes of Health
- Leo, op. cit.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.