Saturday, December 15, 2018

All in the Brain? An Open Letter Re: Stephen Fry’s Assumptions About Mental Illness

Richard Bentall, PhD

Stephen_FryStephen Fry’s exploration of manic depression (in the current BBC series on mental health, ‘In the Mind‘) has drawn both praise (because of his attempts to destigmatize mental illness) and criticism (because he appears to have a very narrow biomedical understanding of mental illness).  I have sent an open letter to the actor which challenges some of his assumptions about mental illness, and offers a very different understanding to that promoted in his recent television programme. The letter is reproduced here with permission of the  Discursive at Tunbridge Wells website, where it first appeared.

Dear Stephen,

You and I attended the same public school (Uppingham, in Rutland) at the same time, in the early 1970s, and our unhappy experiences there have undoubtedly helped to shape our different trajectories, which have led us to a shared interest in mental health.

In your case, your premature departure from Uppingham, and your adventures immediately afterwards, were documented in your wonderful book, Moab is my Washpot. Your subsequent openness about your own mental health difficulties, for which I salute you, has been an inspiration to other mental health sufferers.

In my case, despite a lacklustre academic performance which I attribute mainly to spending much of my adolescence feeling depressed and emotionally abused, I managed to make my way to university and eventually pursued a career in clinical psychology. (My brother, unfortunately, was much worse affected by his time at the school; his expulsion was the start of a long downward spiral that culminated in his suicide, an event that haunts me twenty years later, and which reinforces my determination to improve the public understanding of mental ill-health.)

I have now spent more than thirty years researching severe mental illness, focusing especially on patients with psychosis (who, in conventional psychiatry, are typically diagnosed with ‘bipolar disorder’ or ‘schizophrenia’). It is from this perspective that, reluctantly, I must now ask you to rethink the way that you portray these conditions to the general public. I know that you wish to demystify and destigmatise mental illness, which are surely laudable aims, but my worry is that some aspects of your approach may have the opposite effect from that which you intend.

Conventional psychiatry tends to decontextualise psychiatric disorders, seeing them as discrete brain conditions that are largely genetically determined and barely influenced by the slings and arrows of misfortune, and it was this perspective that was uniquely presented in your recent programme The not so secret life of a manic depressive ten years on. According to this ‘brain conditions’ view, psychiatric disorders occur largely out of the blue in individuals who are genetically vulnerable, and the only appropriate response is to find the right medication.  Even then, it is usually assumed that severe mental illnesses are life long conditions that can only be managed by continuous treatment. However, research into severe mental illness conducted over the last twenty years (not only by me, although I have contributed) tells a more complex story.

To begin with, we now know to a level of certainty that diagnoses such as ‘bipolar disorder’ and ‘schizophrenia’ are not separate conditions.1 Furthermore, there is no clear line between severe psychiatric disorders and healthy functioning,2 with the consequence that large numbers of people manage to live productive lives despite experiencing symptoms at some time or another, and without seeking help.3 There is, for example, an international network for people who hear voices, many of whom manage perfectly well without psychiatric care.4 (In my experience, psychiatrists are often troubled by this ‘fuzziness’ at the edges of mental ill health, which I find puzzling as doctors in physical health have no difficulties with handling arbitrary boundaries; there is no sharp dividing line between healthy and unhealthy blood pressure, for example.)

It also appears that the outcomes for severe mental illness are much more variable than was once thought. Longitudinal research suggests that a surprising number of people manage to make full or partial recoveries,5 even when not taking medication. A complication is that recovery means different things for different people; whereas psychiatrists typically think of recovery in terms of recovery from symptoms, patients more often emphasise the importance of self-esteem, hope for the future, and a valued role in society.6

Of course genes play a role in making some people more vulnerable to psychiatric disorder than others, but the latest research in molecular genetics challenges simplistic assumptions about ‘schizophrenia’ and ‘bipolar disorder’ being primarily genetic conditions. The genetic risk appears to be shared across a wide range of diagnostic groupings – the same genes are involved when people are diagnosed with schizophrenia, bipolar disorder, ADHD and even, in some cases, autism.7 More importantly, genetic risk is widely distributed in the population with hundreds, possibly thousands of genes involved, each conferring a tiny increase in risk.8 Hence (to quote American genetic researcher Kenneth Kendler),

‘The genetic risk for schizophrenia is widely distributed in human populations so that we all carry some degree of risk.’9

Of course, some people (possibly yourself) have more of these genes than others, but the fact that so many are involved suggests that it is very unlikely that studying them will lead to therapeutic innovations anytime soon. By contrast, consider Huntington’s Disease, a terrible degenerative neurological condition that is caused by a single dominant gene with a known biological function. Many years after this gene was discovered there is still no sign of a medical therapy for this simplest of all the genetic conditions.

In your programme, you did not attempt to link your own mental health difficulties to circumstances despite the fact that your story suggested that episodes had been triggered by specific events on at least two occasions (after bravely confronting an extreme homophobe in Uganda, and after extensive jet travel). More importantly, perhaps for understandable reasons, you seemed reluctant to explore any possible connections between your difficulties now and your experiences earlier in life. In fact, recent epidemiological studies have pointed to a wide range of social and environmental factors that increase the risk of mental ill health,10 some of which I am guessing you may be familiar with from personal experience.

These include poverty in childhood11 and early exposure to urban environments;12 migration13 and belonging to an ethnic minority14(probably not problems encountered by most public school boys in the early 1970s) but also early separation from parents; childhood sexual, physical and emotional abuse; and bullying in schools.15 In each of these cases, the evidence of link with future psychiatric disorder is very strong indeed – at least as strong as the genetic evidence. Moreover, there is now good evidence that these kinds of experiences can affect brain structure, explaining the abnormal neuroimaging findings that have been reported for psychiatric patients,16 and that they lead to stress sensitivity and extreme mood fluctuations in adulthood.17 And of course, there are a myriad of adult adversities that also contribute to mental ill health (debt,18 unhappy marriages,19 excessively demanding work environments20 and the threat of unemployment,21 to name but a few). Arguably, the biggest cause of human misery is miserable relationships with other people, conducted in miserable circumstances.

Why is all this important? Well, for one thing, many psychiatric patients in Britain feel that services too often ignore their life stories, treating them more like surgical or neurological patients than people whose difficulties have arisen in response to challenging circumstances. In the words of Eleanor Longden, a well-known voice hearer and mental health activist,

‘They almost always ask what is wrong with you and hardly ever ask what happened to you.’22

Patients are routinely offered powerful drugs as shown in your programme (I am not saying they don’t have a place) but very rarely the kinds of psychological therapies that may help them to come to terms with these kinds of experiences, or even practical advice (debt counselling probably has a place in the treatment of depression, for example).

Patients’ dissatisfaction with an exclusively medical approach is well founded, because research has shown that this approach has been extraordinarily unsuccessful, despite what clinicians often assert. Whereas survival and recovery rates for severe physical conditions such as cancer and heart disease have improved dramatically since the end of the Second World War,23 recovery rates for severe mental illness have not shifted at all.24 Even more surprising, you might think, those countries which spend the least on psychiatric services have the best outcomes for severe mental illness25 whereas those that spend the most have the highest suicide rates.26 No doubt, if we understood the psychological mechanisms that lead from childhood misfortune to mental illness, we could do more to help people. However, research funding in mental health is being almost exclusively channelled into genetic and neurobiological studies, which have little realistic prospect of yielding practical interventions.

To make matters worse, research shows that exclusively biological theories of mental illness contribute to the stigma experienced by mental health patients, which I know you want to reduce.27 The more that ordinary people think of mental illness as a genetically-determined brain condition, and the less they recognise it to be a reaction to misfortune, the more they shun mental health patients. The biomedical model of mental illness, which your programme showcased, makes it all too easy to believe that humans belong to two sub-species: the mentally well and the mentally ill.

Finally, the biomedical approach entirely neglects the public health dimension of mental illness. Given the evidence from epidemiological studies, we can almost certainly dramatically reduce the prevalence of mental illness in the population by, for example, addressing childhood poverty and inequality, figuring out which aspects of the urban environment are toxic (you might or might not be surprised to know that living close to a park appears to provide some protection against mental illness28) and by ensuring that all of our children experience more benign childhoods than the ones we experienced. We cannot do any of these things if we spend all of our time peering into test tubes.

Let my finish by saying, Stephen, that I have the highest respect for you, and I thank you for your efforts to reach out to people who are suffering from mental illness. Please continue with this important work. But please, from now on, do so in a more balanced way.


Richard Bentall

Professor of Clinical Psychology at Liverpool University and Former Uppinghamian

* * * * *


  1. The literature on this is complex, but includes studies of patients with symptoms along the schizoaffective dimension (e.g. Tamminga, C.A., Pearlson, G., Keshavan, M., Sweeney, J., Clementz, B., & Thaker, G. (2014). Bipolar and Schizophrenia Network for Intermediate Phenotypes: Outcomes across the psychosis continuum. Schizophrenia Bulletin, 40 suppl 2, S131-S137. doi:10.1093/schbul/sbt179); statistical studies of symptom variation (e.g. Reininghaus, U., Priebe, S., & Bentall, R.P. (2013). Testing the psychopathology of psychosis: Evidence for a general psychosis dimensionSchizophrenia Bulletin, 39, 884-895) and studies showing shared genetic contributions to apparently different psychiatric disorders (e.g. Lichtenstein, P., Yip, B.H., Bjork, C., Pawitan, Y., Cannon, T.D., Sullivan, P.F., & Hultman, C.M. (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based studyLancet, 373, 234-239).
  2. Again, the literature on this is complex, but includes psychological studies of people with psychosis-prone personality traits (Raine, A. (2006). Schizotypal personality: Neurodevelopmental and psychological trajectoriesAnnual Review of Clinical Psychology, 2, 291-326), including sub-clinical bipolar traits (e.g. Bentall, R.P, Myin-Germeys, I., Smith, A., Knowles, R., Jones, S.H., Smith, T., & Tai, S. (2011). Hypomanic personality, stability of self-esteem and response styles to negative moodClinical Psychology and Psychotherapy, 18, 397-410) and also ‘psychometric’ studies which use complex statistical methods (‘taxometrics’) to discover whether there are any natural breaks in the continuum between healthy functioning and psychiatric disorder (e.g. Haslam, N., Holland, E., & Kuppens, P. (2012). Categories versus dimensions in personality and psychopathology: A quantitative review of taxometric researchPsychological Medicine, 42, 903-920).
  3. There are many epidemiological studies which show a surprisingly high prevalence of psychotic-like experiences in the general population. See, for example, Johns, L.C., & van Os, J. (2001). The continuity of psychotic experiences in the general populationsClinical Psychology Review, 21, 1125-1141. This phenomenon has been demonstrated in respect to bipolar symptoms; see for example, Merikangas, K.R., Akiskal, H.S., Angst, J., Greenberg, P.E., Hirschfield, R.M.A., Petukhova, M. and Kessler, R.C. (2007) Lifetime and 12-Month prevalence of bipolar spectrum disorder in the National Comorbidity Survey ReplicationArchives of General Psychiatry, 64, 543-552
  5. See, for example, Harding, C.M., Brooks, G.W., Ashikage, T., & Strauss, J.S. (1987). The Vermont longitudinal study of persons with severe mental illness: II. Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophreniaAmerican Journal of Psychiatry, 144, 727-735, and Harrow, M., & Jobe, T.H. (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: A 15-year multifollow-up studyJournal of Nervous and Mental Disease, 195, 406-414.
  6. Morrison, A. P., Shryane, N., Beck, R., Heffernan, S., Law, H., McCusker, R., & Bentall, R.P. (2013). Psychosocial and neuropsychiatric predictors of subjective recovery from psychosisPsychiatry Research, 208, 203–209.
  7. Psychiatric Genomics Consortium. (2013). Genetic relationship between five psychiatric disorders estimated from genome-wide SNPsNature Genetics, 984-994. Note that this finding, from analyzing DNA, is completely consistent with the results of population genetic studies such as Lichtenstein et al. (2009) ibid.
  8. The International Schizophrenia Consortium. (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorderNature, 460, 748-752.
  9. Kendler, K.S. (2014). A joint history of the nature of genetic variation and the nature of schizophreniaMolecular Psychiatry. doi:10.1038/mp.2014.94
  10. For a recent review, see Bentall, R.P., de Sousa, P., Varese, F., Wickham, S., Sitko, K., Haarmans, M., & Read, J. (2015). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptomsSocial Psychiatry and Psychiatric Epidemiology, 49, 1011-1022.
  11. See, for example, Wicks, S., Hjern, A., & Daman, C. (2010). Social risk or genetic liability for psychosis? A study of children born in Sweden and reared by adoptive parentsAmerican Journal of Psychiatry, 167, 1240-1246.
  12. Vassos, E., Pedersen, C.B., Murray, R.M., Collier, D.A., & Lewis, C.M. (2012). Meta-analysis of the association of urbanicity with schizophreniaSchizophrenia Bulletin, 38, 1118-1123.
  13. Cantor-Graee, E., & Selten, J.P. (2005). Schizophrenia and migration: A meta-analysis and reviewAmerican Journal of Psychiatry, 163, 478-487.
  14. Veling, W., Susser, E., van Os, J., Mackenbach, J.P., Selten, J.P., & Hoek, H.W. (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrantsAmerican Journal of Psychiatry, 165, 66-73.
  15. For a meta-analytic summary of the effects of childhood adversity (separation from parents, bullying, childhood abuse) see Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W, Read, J, van Os, J. and Bentall, R.P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective and cross-sectional cohort studiesSchizophrenia Bulletin, 38, 661-671. doi:10.1093/schbul/sbs050
  16. Sheffield, J.M., Williams, L.F., Woodward, N.D., & Heckers, S. (2013). Reduced gray matter volume in psychotic disorder patients with a history of childhood sexual abuseSchizophrenia Research, 143, 185-191.
  17. Glaser, J.P., Van Os, J, Portegijs, P.J., & Myin-Germey, I. (2006). Childhood trauma and emotional reactivity to daily life stress in adult frequent attenders of general practitionersJournal of Psychosomatic Research, 61, 229-236.
  18. Meltzer, H., Bebbington, P., Brugha, T., Farrell, M., & Jenkins, R. (2013). The relationship between personal debt and specific common mental disordersEuropean Journal of Public Health, 23, 108-113.
  19. Wade, T.J., & Pevalin, D.J. (2006). Marital transitions and mental healthJournal of Health and Social Behavior, 45, 155-170.
  20. Stansfeld, S. & Candy, B. (2006). Psychosocial work environment and mental health: A meta-analytic reviewScandinavian Journal of Work, Environment & Health, 32, 443-462.
  21. Barr, B., Taylor-Robinson, D., Scott-Samuel, A., & McKee, M. Suicides associated with the 2008-10 economic recession in England: Time trend analysisBritish Medical Journal, 345, e5142. doi:10.1136/bmj.e5142
  23. See Chapter 1 of my book Doctoring the mind: Why psychiatric treatments fail (Penguin, 2009) for evidence on historical recovery rates for cancer and heart disease.
  24. This was first pointed out by Richard Warner (1985) in his book Recovery from schizophrenia: Psychiatry and political economy. New York: Routledge & Kegan Paul. For a recent meta-analysis of the historical data, see Jääskeläinen, E., Juola, P., Hirvonen, N., McGrath, J.J., Saha, S., Isohanni, M., & Miettunen, J. (2013). A systematic review and meta-analysis of recovery in schizophreniaSchizophrenia Bulletin, 39, 1296-1306. doi:10.1093/schbul/sbs130
  25. Sartorius, N., Jablensky, A., Ernberg, G., Leff, J., Korten, A., & Gulibant, W. (1987). Course of schizophrenia in different countries: Some results of a WHO comparative 5-year follow-up study. In H. Hafner, W.G. Gattaz, & W. Janzarik (Eds.), Search for the causes of schizophrenia (Vol. 16, pp. 909-928). Berlin: Springer. See, for more recent data, Saha, S., Chant, D., Welham, J., & McGrath, J.A. (2007). A systematic review of the prevalence of schizophreniaPLoS Medicine, 2. e141.
  26. See, for example, Shah, A., Bhandarkar, R., & Bhatia, G. (2010). The relationship between general population suicide rates and mental health funding, service provision and national policy: A cross-national studyInternational Journal of Social Psychiatry, 56, 448-453; and also Rajkumar, A.P., Brinda, E.M., Duba, A.S., Thangadurai, P., & Jacob, K.S. (2013). National suicide rates and mental health system indicators: An eological study of 191 countriesInternational Journal of Law and Psychiatry, 36, 339-342.
  27. See Read, J., Haslam, N., Sayce, L., & Davies, E. (2006). Prejudice and schizophrenia: A review of the ‘mental illness is an illness like any other’ approachActa Psychiatrica Scandinavica, 114, 303-318, and Angermeyer, M.C., Holzinger, A., Carta, M.G., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studiesBritish Journal of Psychiatry, 199, 367-372.
  28. van den Berg, A.E., Maas, J., Verheij, R.A., & Groenewegen, P.P. (2010). Green space as a buffer between stressful life events and healthSocial Science and Medicine, 70, 1203-1210.


    • Me too.

      I have enjoyed Fry for some years now and have read his books which are…interesting indeed…., as he is obviously a highly intelligent human being.

      However, in recent times I have turned off his shows when they have raised “mental illness” as he has been so very badly informed.

      Hopefully he’ll read the letter above, follow up the references, do some of his own research, and then go public clearly refuting the position he has adopted to date.

      He could be a powerful ally.

  1. I didn’t notice the good shrink paying any attention to the biophysical environment. I don’t know if he’s aware you could have a toxic mouth, if you have amalgam fillings, and be plagued by emotional symptoms until they’re gone. Or, you could have the sugar blues, instigated by excesses of sucrose and other refined carbohydrates in your diet, and remain incurable until you went on a diet of unprocessed foods (notice that psychiatric pharmacotherapy is useless for treating either of these maladies). If I had to have some kind of professional treatment, I’d go to a chiropractor familiar with such matters in preference to any of the professionals whose blogs I’ve read on this site so far.

  2. – This audio book unraveled for me some of the mysteries of ‘mental illness’. I also recommend her book – The Molecules of Emotion. The following is from the website:
    Your brain is not in charge. This revelation by Dr. Candace Pert challenges conventional science—and everyone interested in total wellness—to reconsider how our bodies think, feel, and heal.

    As the leading pioneer in a radical new science of life, this bestselling author and world-class neuroscientist has given us an inside look at the molecular drama being staged within every cell of the human body—and a glimpse into the future of medicine. Now, in her own words, Dr. Pert describes her extraordinary search for the grail of the body’s inborn intelligence with Your Body Is Your Subconscious Mind.

    Dr. Pert first came to prominence when she dazzled the scientific community with her discovery of the opiate receptor in 1972. But this breakthrough event was only the beginning of a uniquely productive—and often controversial—career.

    On Your Body Is Your Subconscious Mind, Dr. Pert describes her efforts over the past two decades to actually decode the information molecules, such as peptides and their receptors, that regulate every aspect of human physiology. Her model of how these biochemicals flow and resonate, distributing information to every cell in the body simultaneously, has unlocked the secret of how emotions literally transform our bodies—and create our health.

    Easily shifting from a bench scientist’s view to a spiritual one, she relates her research to past and present mind/body topics, ranging from AIDS and cancer to the chakra system. Dr. Pert’s personal and compelling voice makes this a listening experience that is part detective story, part spiritual odyssey—and entirely irresistible. Your Body Is Your Subconscious Mind takes you on a scientific adventure of the first order, escorted by this pathfinder, iconoclast, and “goddess of neuroscience.”

  3. Thank you.

    Such a relief to have someone clearly state and refute the misinformation still so often being peddled in the name of “de-stigmatising mental illness”.

    Far too much bio-medical propaganda that has already long ago been disproven by the actual scientific data still being peddled as apparent ‘fact’, all in the name of supposedly ‘helping’ those with such lived experiences. In the long term all this causes much more harm than good.

    Thank you again for using your knowledge, experience and access to a forum to be heard to promulgate a more clear and accurate description of the state of knowledge in this field.

  4. Excellent letter, Richard. You hit all the high points needed to refute the bioreductionist viewpoint that Fry is peddling, along with providing strong studies and data to back up your points.

    It is sad to see a presumably initelligent human being like Stephen Fry reduced to acting like a mindless sheep, a pawn who ignorantly confirms the biases of drug companies and psychiatrists who profit from the biological/defect model. Another example of such a pawn would be Elyn Saks; one can assume that when mainstream psychiatrists and drug companies embrace a layperson as a spokesperson for “managing their illness successfully”, it is because that individual takes drugs and more importantly ignorantly embraces a brain disease conceptualization of their problems.

    Regarding this, “Longitudinal research suggests that a surprising number of people manage to make full or partial recoveries,5 even when not taking medication.”

    You should have gone even further Richard. Rather when saying, “even when not taking medication”, it should have been “especially when not taking psychoactive drugs” (because there no psych ‘medications’, and because not using drugs long-term is usually a correlational advantage). The especially could be backed up with the data from the World Health Organization longitudinal studies, the Harrow and Wunderink studies, and Harding’s Vermont project. People do better without long-term drug use. It’s time to be even bolder and put that out there.

    • I read a blog by a woman who stated that anti-depressants had not cured her and many people shamed her for saying this. She was a Christian blogger and other Christians had shamed her–claiming she would discourage others from getting the help they needed!

      Apparently they take blasphemy against Prozac more seriously than blasphemy against the Holy Ghost. Are they truly Christians or believers of Scientism?

      I told the blogger she was not alone in her experience, that she was not evil because she was unhappy. This seemed to make her feel better.

      Few people realize the shaming that occurs when your “meds” do not work. This can be like faith healings that don’t work. Only instead of lacking faith, it’s assumed you are “non-compliant.” Because if you took your “meds exactly as prescribed” everything would be peachy keen.

  5. “The biomedical model of mental illness, which your programme showcased, makes it all too easy to believe that humans belong to two sub-species: the mentally well and the mentally ill”
    We have no evidence that what is referred to as ‘mental illness’ actually exists so should we be talking about being ‘mentally ill’ or ‘mentally well’ in the first place?
    Does discrimination not thrive on this illusion? Many people are oppressed and controlled each day because of this illusion. Many people forcefully lobotomized because the grand illusion becomes stronger each day that passes.
    I believe Stephen Fry is well meaning just like I was when I was misdiagnosed,drugged and seriously misinformed. I think he is doing much more harm than good because he has such a high profile and the public are likely to believe him.
    Drugs might have their place but it looks like most people who prescribe them do not understand them well enough to do less harm than good! Good nutrition on the other hand supports our bodies, minds and spirits. Thanks for writing the letter Richard!

  6. “No doubt, if we understood the psychological mechanisms that lead from childhood misfortune to mental illness, we could do more to help people. However, research funding in mental health is being almost exclusively channelled into genetic and neurobiological studies, which have little realistic prospect of yielding practical interventions.”medicinehorse20001999yahoo”dot”/
    Yes, that IS my personal email. I’m not kidding around here, folks……………………………………………………

    • Yes, I’m “replying” to myself…. If you, too, think my comment above looks a little, well, not right somehow, well, it isn’t. I’m at a loss to explain what happened. First, I cut-n-pasted the relevant quoted paragraph, then wrote a MUCH longer reply than appears here, and ended it with my email address. But, online here, that longer comment seems to have disappeared. But, basically, I’m pointing out the glaring and blatant illogical, and irrational nature of Bentall’s letter to Fry, in THIS PASSAGE, only…. Most of Bentall’s reply is spot on, and I respect Bentall for writing. But YES!, we DO understand the “psychological mechanisms” by which “childhood misfortune” of various kinds leads to what is WRONGLY SEEN, and WRONGLY DIAGNOSED as bogus “mental illnesses”. And, if, as Bentall suggests, we really DO want to “do more to help people”, the first thing we can do is get off the drugs. Most psych drugs, and ALL bogus “mental illness” “diagnoses” do more harm than good. Rather than “de-stigmatize”, as Fry *CLAIMS* he’s trying to do, Fry is in fact helping to perpetuate the very “stigma” which he falsely alleges he’s combating! I still challenge ANYBODY to show how I’m wrong….

  7. It is inconsistent with the research to not include the significance of social-psychological (socio-developmental) factors in the onset, course and outcomes of the heterogeneous group of people we diagnose with bipolar disorder. Expressed emotion, lack of social support, the presence of negative life events, personality factors,forms of interpretation of events, etc., all play a significant role in relapse and course of the disorder. There is a cohort effect not seen in all cultures since the mid-19th century. Even at the level of neurobiological alterations, one could make a reasonable case that hypercortisolemia (increased cortisol which can be neurotoxic) and other stress-related processes play a significant role. As in schizophrenia research, the atrophy of certain neural regions in bipolar disorder, e.g., the prefrontal cortex, insula, cerebellar vermis, corpus callosum, etc., are also observed in developmental traumatology research studies (exposure to traumatic and chronic stress from various events, sources, etc.). Gray and white matter (the information highway of the CNS) are affected. The hyperintensities seen in bipolar disorder are also observed in major depressive disorder. In fact as a stress researcher, I was the first to point out the significant overlap in the neuroscience of schizophrenia and bipolar disorder and the neuroscience of profound and chronic stress, formally at the ISPS London conference in 1997 and prior to that at meetings in the NYC , the states, and to Wayne Fenton, a colleague who was a deputy director at NIMH prior to his tragic death.

    Some of the new biological research in bipolar disorder is centering on mitochondrial dysfunction and the role of oxidative stress in causing it. Again, severe life stress (SLS) invariably induces oxidative stress and thereby can play a significant role in the mitochodrial dysfunction. SLS can induce genomic and epigenomic alterations which may play important roles in the pathophysiology of schizophrenia, bipolar disorder and major depressive disorder. There is so much to say about the new research showing the relevant linkage. SLS shortens telomere length,alters neuronal morphology and gene expression through various epigenetic channels, reduces neurogenesis and synaptogesis, is associated with synaptic pathology, is also associated with the new findings in complementary C4 proteins recently identified in the New York Times as “scientists homing in on the genetic cause of schizophrenia’!

    • Yes, that kind of work is admirable. Since some fully recover without medication I hope the factors related to recovery, including what might be correlated with recovery at the biological level, is looked at. Are improved supports, social and economic circumstances or changed related to developmental processes correlated with changes for the better too?

      • The “arguments” made reflect an immersion of the author in the medical model, and even the biomedical model, even as he purports to challenge them. To suggest that the “answer” lies in coming up with new and different psychiatric “approaches” to non-existent diseases reflects an incomprehension of the problem and is hardly a “better argument.”

          • This is true. But many of the people I’m addressing my comments to have already arrived at Z.

            The kind of frustration I often feel with these sorts of articles is similar to that one would experience while listening to people debating the true nature of unicorns or leprechauns.

          • I’m reminded here of an old Dr. Seuss book – “On Beyond Zebra”, which describes all the letters of the alphabet which lie “on beyond zebra”….
            Many of us, here, Jonathan, DO INDEED live in the much better world which is “on beyond the LIES of the pseudo-science DRUG$ RACKET known as “biopsychiatry”…..

  8. Richard, great letter! The one thing I’d add is that not only have recovery rates for
    “mental illness” not improved, as Bob Whitaker has shown, they have gotten dramatically WORSE as the age of medical intervention has taken over from our earlier focus on communication and experience as the primary interventions, including even shorter and shorter average lifespans for “patients” in the system. If this happened in the field of cancer or heart disease, there would be a huge outcry, but for some reason, worsening outcomes (including early death) among the “mentally ill” disturbs no one particularly much. I think it’s a point worth emphasizing.

    —- Steve

    • Steve,

      The UK spends billions on the mental health system but recovery rates are worse than developing countries that can’t afford to spend ‘anything’ – So what does this tell us?

      According to the ‘London School of Economics’ each Severely Mentally Ill person costs the UK about £60,000 per year – just think what could be done with this money if most people made full recovery

      (The only genuine recovery I know of, has taken place outside of the mental health system).

      • Seriously. Don’t know why that argument is considered radical in any way – if something doesn’t work, why are we spending money on it?

        I remember one woman who was voluntarily signing herself into the psych ward for suicidal feelings, who told me, “For the cost of this, they could probably put me up for a few weeks in a nice hotel on a beach in Hawaii. And it would probably be at least as helpful.”

        — Steve

        • Agreed. Here in Keene, NH, back in Jan., Dr. Marcia Pabo, a psychiatrist, had a “sudden departure.” – That’s literally all the Keene Sentinel article said about her “departure”. But, as a direct result, the local hospital, “Cheshire Medical Center / Dartmouth Hitchcock-Keene”, had to CLOSE their adolescent psych unit. And, due to a shortage of shrinks, the continued operation of their adult psych unit was threatened. Recently, it only had *ONE* out of *12* BEDS FILLED….And, CMC/DHK just spent $1.5MILLION to re-do their ER, to put in 6 HOLDING CELLS…. I’m sick and tired of seeing so-called “mental patients” used as pawns, bargaining chips, and cash cows.
          Can you tell? THANK-YOU, Dr. McCrea, for all YOU do, too!….

    • One important factor for these poor long-term outcomes is that blatant propagandists and apologists such as Mr. Fry are given much more credibility than they truly deserve, and their poisonous message is not countered strongly enough. Remember when “phrenology” gave birth to the pseudo-science of “biopsychiatry”? If it weren’t for the OBSCENE profit$ earned by Pharma, from the misery and suffering of “mental patients”, we might – WOULD – be in a much better place…. Honest, ethical, clear-thinking clinicians, such as we find here on MIA, really need to step up their game, and enlist the help of those victims, such as myself, who have clearly shown the TRUTH…. We do our best to comment here, but we do need help in making our message of hope and recovery beyond the lies of “biopsychiatry”
      more widely, loudly, and clearly HEARD….
      (Yes, SOMETIMES, SOME folks DO do better on SOME “meds”, for SOME short length of time….But that’s not the psychs “party line”, is it….????….)….

  9. I think any of us who experience mental ill health are all in a position where we want to understand why… and I think that leads us all in differing directions. My understanding of Stephen Fry is that he has made a programme about mental ill health, and used his own understanding as a way of helping him better understand his own illness and experience. Although many may disagree with his perspective, it is his right to have a narrative which he uses to understand his and others conditions. I personally manage my mental health largely without medication, and this is hard but I prefer it, and can absolutely root it to many experiences in my past. My husband however, is completely unable to function without medication, with insight and understanding of his condition, and really having nothing in his life to root it to, he is completely reliant on medication to function. Interestingly my ‘type’ of illness appears to run down one side of the family (Grandfather, mother and me) all having been hospitalised, or under close supervision. We have all had very different lives, so it leads me to wonder if we have a ‘vulnerability’… I don’t know. But I am always open to possibilities and arguments. I think that people who experience mental ill health, are repeatedly silenced by society and the health systems. I am unable shout down a fellow human who has experienced mental ill health because they are not as ‘enlightened’ as the psychological community who are fighting to take mental health out of the medical model. It’s his narrative… we all deserve the right to try and understand our own mind. And I’m not sure there are many people who have done as much to enable others to be honest about their illness in such a public way?

    • Let me try, please, “Kits”: I don’t want to argue, or say you’re “wrong”, or I’m “right”, or any of that kind of stuff. And, in a way, I’m talking to BOTH of you, including your husband, who you say “requires medication to function” – something like that, anyway. Don’t let’s get bogged down in details and semantics. Conversationally, OK? First, you don’t have a mind. You have a body, and a brain, and a nervous system, and your own thoughts, and feelings, and emotions, and religion, and spirituality, beliefs, understandings, etc.,etc.,etc.,. But it’s NOT “your mind”. Or “my mind”. It’s OUR MIND. ALL OUR MIND. Not, “all our minds”, because that implies a group of individual minds. I’m saying, “You don’t have a mind, and neither do I, and neither does anybody.” WE ALL SHARE MIND. Therefore, either we ALL have “mental illness”, or else NONE of us do. It can’t be both, so it must be one or the other. Any “mental illness” that you *THINK* you have, is only because you THINK you have it, and that thinking occurs in your BRAIN. It’s your BRAIN which is doing the thinking, not your “mind”. So, exactly *where* is your “mental illness”? It’s NOT. It’s not your mental illness, it’s OUR “mental illness”, or else NONE of us are “mentally ill”. Now, I’m not saying you don’t have troubles, or difficulties, or “issues”, or even “illnesses”. Call them what you will. And, I’m not saying the mind doesn’t exist. But your “mind” is itself the product of your “mind”, and that occurs in your BRAIN, so where’s your “mind”. It isn’t. It isn’t your mind at all. It’s OUR MIND. Trust me, “Kits”, this is harder for me to write, than it looks like! But, let me go further, then try to get back closer to where we started. All so-called “mental illnesses” were & are attempts to describe, categorize, understand, treat, etc., whatever it is, that causes us too much difficulty, or disability, or distress, or call it what you will…. Psychiatrists used to be called “alienists”. We had a great pseudoscience known as “Phrenology”, which was mostly just FRAUD. So maybe what I’m saying, is that in their efforts to “help”, early “alienists” teamed up with the snake oil & patent medicine folks. The snake oil salesman, the “patent medicine” makers & sellers were trying to help people, AND make money. Over time, as phrenology gave way to psychiatry, and snake oil and herbal medicine gave way to the flood of pharmaceuticals, so too were “mental illnesses” INVENTED. Because, if you think about it, ask the question. “Are so-called “mental illnesses” DISCOVERED, or INVENTED? I don’t see how you can say they were “discovered”, because then you need to ask. “WHERE were they discovered, and by WHO?” But, you CAN ask, “When and where were so-called “mental illnesses” *invented*? They were INVENTED long ago, and since, have been used as excuses to $ELL DRUG$. And be a base to build a professional career upon. Just as with ANY pharmaceutical, “mental illnesses” were INVENTED. So, what’s true for you, and me, and ALL of us, is that “mental illnesses” are imaginary “diseases”, which were invented as a means of social control. And to make money. That’s plenty for now, for you to chew on!
      (c)2016, Tom Clancy, Jr., *NON-fiction

    • This could be responded to in several ways. I don’t think anyone is trying to deny Frye his experience, but, although I haven’t watched any of this, I can see people legitimately objecting to an attitude on his part that encourages others to get sucked into the medicalized worldview of the psychiatry industry in which people self-identify as having illnesses, rather than problems in living. It’s one thing to conjecture, another to lecture and I suspect Frye has gone over the line so to speak.

      • I’m going to go further. As far as the truth takes us – and leave superstition behind. So-called “mental illnesses” are modern myths. Superstitions. As Stevie Wonder sings in “Superstition”: “….when you believe in things that you don’t understand, then you suffer, – superstition ain’t the way….”…. So, what Mr. Stephen Fry-brain is doing, is spreading superstitious propaganda. He’s a PROPAGANDIST. He’s pimping for Pharma. He’s telling folks that their *minds* have a *disease*, or “illness”, that NEEDS DRUGS. Who NEEDS DRUGS? NOBODY “needs” DRUGS!
        But, yeah, the drug companies need to $ELL DRUG$…. It’s that simple. The pseudoscience of “biopsychiatry” requires the fabrication of imaginary illnesses, to serve as excuses and justifications to sell drugs, to make money / profit. That’s it. THAT’S ALL. There’s nothing more to it. Um, except for the social control part . Yes, there are controlling and manipulative persons. There are sadistic and evil persons. Fortunately, most people are not sadists, or control freaks, or evil. But too many psychiatrists, (not all!) and drug sellers, and industry types, are greedy, evil, sadistic, control freaks. You think I’m kidding? Look at Nazi Germany, Stalin’s Russia, or Mao’s China. There’s a sickness in people, which allows these kinds of mass abuses to occur. But, saying that all that justifies the fabrication of “mental illnesses” will not fly in MY sky! And, yes, a larger, more compassionate, more rational and sane counter-message to Mr. Fry’s needs to be expressed, even more loudly that Fry’s. “Biopsychiatry” has done – and continues to do – far more harm than good. And Fry is just one opf it’s spokespersons…. Yes, sometimes, some folks do better, on some “meds”, for some short length of time. But that ain’t “polypharmacy”! That’s what I think, anyway…..

  10. Richard,

    Left to his own, he’s high. Then he kills it and gets deplored at the serious side of his luck here on earth. Has he got some neat talk of how to hit the pasture for his way around the lane to the old green slag, maybe, watched on the side roads for the hours it takes against his finders fees? What the gene, what the spinnerette, what the value system. What and who-what-when…: he needs his tram one weather vane each person, in times.
    Socialist table lease on loan man, all the diet you need to jam in that say.

  11. Dear Richard,

    Thanks for drawing attention to the large shortfall in understanding.

    I can’t understand myself why Stephen would be completely bought on the medical model – unless it made good sense to him.

    I refused medication initially, but I was definitely taken in when I tried to stop. My good fortune was that things eventually worked out.

    I hope I’m not wandering off topic here:- on the MIND Website it suggests that depot injection medication withdrawal doesn’t require a tapered approach – this was NOT my experience.

      • Hi Bradford – a “depot injection” is a wonderful way to force people who do not want to take their meds to ‘ake them – it’s an injection of the meds that is slow-release over time, meaning that once given, the person does not need to take meds regularly (daily) to remain under their influence.

        The effects of the injection remain (as if the person was taking the meds as tablets daily or as prescribed) for a month or more and thus only require the prescribing psychiatrist to ‘get their hands on the person’ so much less often, yet still ensure that there can be no so-called ‘non-compliance’ (please – I know the horrible implications of those words and am using established bio-psychiatric terminology deliberately) with the prescribed medication regimen.

        They are often used when restricting people to what here in Australia are called “community treatment orders” – for those who are considered well enough to ‘manage in the community’ – yet not trusted to keep on taking the meds as prescribed by their psychiatrists without regular supervision (incarceration and force).

    • The bio-model made good sense to me for many years, because I knew of no alternatives.

      It was actually Bill Gothard (scandals emerged since) who turned me onto William Glassner’s work and the idea of creative symptoming to explain human suffering called mental illness.

      Till then I had only known 1. You’re crazy because you’re evil, demon possessed, or lack faith in Jesus. Or 2. You’re crazy because you’re genetically inferior and incurably sick.

  12. I’m not on first name terms with Bentall or Fry, but both had some positive influence on my younger life. Fry for his work with Laurie brought many a wild laugh to my youthful dirge of a life, and Bentall for his work with Slade, gifting my freshly schizophrenicised self with the collection of essays in Reconstructing Schizophrenia.

    That said, I agree with Oldhead that this piece is somewhat confused and confusing, appealing for balance where there isn’t any. Perhaps Bentall should re-read the essays from aforementioned collection of essays?

    Pushing against my natural inclinations, I broke out and forced myself to watch the documentary.

    That is also confused and confusing.

    Admittedly I fast-forwarded to the bits with Stephen Fry in, hamming it up with his hamstrung psychiatrist. It was all very mediocre.

    The weird bit is that Fry has been lauding himself as the Lord of the Bipolar Fries for ten or so years and in this doc, that complements the doc from 10 years ago, there are the key scenes wherein the psychiatrist is pretending to do a live upgrade of Fry from the delightfully named cyclothymia, to the full-on bells and whistles of Bipolar 1.

    I think this in itself is a TV first. Never has anyone been so upgraded Live on British television.

    I enjoyed for all the wrong reasons how Lord of the Fry’s psychiatrist artfully and skillfully brushed aside Fry’s use of cocaine, black market Xanax and vodka, and assured the esteemed patron Saint of Bipolar UK (they of the hope that one day geneticists will render them all extinct) that he had fulfilled the requirement to have at least one fully-fledged (and very private) HIGH to make the upgrade bone fide.

    That is the real story of the doc. It’s a shame I don’t get paid to write things like this under the line. I’d try harder.

    Otherwise, this and the appeal to the BBC to be more balanced in their Eastenders scripts and wotnot are, while well-meaning, completely missing the bullseye….

    Hollywood is the real menace when it comes to depicting people of difference as the literal bogeymen.

    Surprises me that our American cousins have not penned a similar open letter of appeal.

    That said, some of my favourite films are gross and grotesque depictions of the mentally troubled. From The Shining to The Cable Guy — the USA is just so good at getting it wrong.

    • And shrinks are always there to encourage this demonization of the “mentally ill.” They justify this by claiming it will “help people get the treatment they need” (gain them more customers voluntary and otherwise.) It will also ensure “treatment compliance” among the “severely mentally ill” (making sure these customers stay regulars.)

    • The original classic is “The Myth of Mental Illness”, by Dr. Thomas Szasz. It’s a bit dense and academic, but still very relevant and cogent. “Asylums”, by Irving Goffman goes a long way towards explaining both the current U.S. “prison-industrial complex” / school-to-for-profit-prison-pipeline”, AND the sociological and market forces which created and drive that.
      Dr. Peter Breggin’s “Toxic Psychiatry” is the modern classic for a comprehensive understanding of where we went wrong, why we went wrong, and what we can do about it.
      Sorry I’m so retarded about posting active links, but you’ll find Dr. Kelly Brogan’s website excellent, for a “woman’s psychiatrist” point-of-view, and Monica Cassini’s “beyondmeds”website.
      My personal view of Mr. Fry-brain is that he’s a truly brainwashed “Manchurian Candidate” personality type. He says whatever he thinks his masters want him to say, and, yes, in political terms, I believe that he’s best described as FASCIST. He has a right to believe in imaginary and arbitrary “mental illnesses”, if that’s what floats his boat, but I do NOT believe that he should be allowed to use his bully pulpit so freely, without a more robust rebuttal. Persons such as Mr. Fry-brain are “useful idiots” for the patriarchal, misogynistic,
      and misanthropic power structure. Thank-you for asking, Jonathan.
      I will be glad to answer any personal questions, if you write me at >medicinehorse”underscore”2000″underscore”1999″at”<
      (c)2016, Tom Clancy, Jr., *NON-fiction

    • I would agree with Bradford’s references. Here’s the original article “The Myth of Mental Illness” which preceded the book and summarizes its essence:
      You can find much more at

      For historical context I believe Peter Breggin’s article on psychiatry’s role in the holocaust would be appropriate:
      Also see other stuff at

      Oh, and check out the 1942 debate on the efficacy of euthanasia for “mental patients” in the American Journal of Psychiatry:

      And if you have an appreciation of info mixed with irony please check out http://www.bonkers

      There’s more where that comes from. 🙂

  13. This seems like a very balanced letter. I have experienced many years of mental health issues. Whilst I think there may be varying levels of genetic disposition, I have no doubt the stuff of life was the trigger of much of my own depression, kookiness, madness, whatever you want to call it. In other words, whilst a sensitive nature makes a person prone to mental health conditions, outside influences – relationship troubles, family problems, money worries, abuse and more widely, societal issues – tip the boat.

    I have long believed one of the greatest expressions of a society in trouble is in those of us afflicted by more extreme mental health issues. We are the markers by which to gauge a troubled place. But whilst some of us are more sensitive than others, very few of us will go through life without experiencing some level of mental health pain. Often we use this to teach us, teach us to slow down, love more, care less, eat better, sleep more, exercise, save money, spend money, holiday and on and on…

    Sometimes we don’t know what to do and reach out for help.

    Sometimes we can reach out to family and friends and it is enough. Sometimes it is not. When counselling is available readily and is affordable (often not the case), we may talk about it with this specialist, beginning a typically very long (and perhaps enlightening) journey of recovery. Or else we may go to the doctor. The doctor, pushed for time and with huge waiting lists to see mental health teams, may give us a pill – often the allure of a magic pill is what takes us to the doctor (it did me). It may work – and for some of us, right now, at this juncture in human history it seems medication is necessary. For me, after trying many different kinds over a number of years, I found it was not the answer. And I am not alone.

    Not knowing what to do, I self-medicated. I drank, amongst other things (many other things). I wanted a quick fix. This is one of the ways I feel I am reflection of my environment. And in the same way a quick fix seems like it’s never the answer – spending money aimlessly, voting in, voting out, declaring war, eradicating enemies – I found it made the war all the more powerful and far reaching. And so began the journey of addiction – a journey I share with millions of people around the world. Millions of people fixing a problem, making a problem, fixing a problem, making a problem, fixing a problem… until the problem needs an answer or the body dies.

    If we begin to recover from the addiction, if we can access the support around us, we then have to contend with life and the stuff of life, just as we had to all those years ago as sensitive souls more prone to mental health issues – gentle markers gauging the sickness of the world around us. Only now, if we are lucky, if we live in a society which readily offers it (often not the case – I am lucky), we have the support around us to try to accept the world and so we begin to see it.

    If there is anything I have learned in these last few years free from self-medication, supported and accessing and trying to give that support in return, it is that addiction, like all mental health issues is on a spectrum. Most of us have an addictive nature, only it varies in degrees. Most of us need it, because often unconsciously it has sprung up in an act of self-medication, a blindfold to a society with problems, to difficult relationships, to money troubles. We eat addictively, drink addictively, obsess over work, hide in the gym, watch our soaps, our shows, gamble and dream. And there is nothing wrong in this. It is a coping strategy and a lot of us struggle to function if we remove it, especially if we do not have or do not access support, the support to accept things for the way they are: being treated badly by family, friends and lovers, bosses, work colleagues; having very little money, being in debt, wanting a better job; being grossly overweight, being ill; the crime around us, having a crime committed against us or else committing a crime; watching people hurt each other, kill each other. Of course it seems to me the only way to overcome this is to see it for how it is, is to try to remove the blindfold, to take the pain of it and learn from it and move on – something I have seen many people do, and I try to do it and aspire to it, even if I slip back into addictive patterns, most often with food or work things – I am lucky to even recognise this, to have the support around me to be able to recognise it.

    In our society we are always looking for bandages to heal the wounds. In the case of mental health sometimes we spend too much time looking for the wound so we can come up with another miraculous bandage – but it is a bandage nevertheless, a temporary solution. We spend too much time killing the pain, rather than getting to the root of it. In my own experience, it doesn’t mean blaming parents for a broken down marriage and a violent household, all my parents were doing is what I spent a lot of time doing: fixing pain… The wound is deeper than my pain and my parents’ pain. The wound is deeper than our pain, be it sadness, depression, addiction, bi-polar illnesses, schizophrenia (and the many schizo- illnesses): the pain is just the marker, we are just the markers of the troubles around us. The solution is in the pain and the understanding of it, but you’ve got to feel it to see it.

    • Wow. I’m not gonna let you tell that much truth, without adding that I can respect what you’ve been through. MOST of what you wrote applies to ME, too…. (I never gambled compulsively,
      or was a gambling addict….) Everything you write here is ME, too. It’s in our SHARING, that our pain is eased. And SHARING, is what WE do…. When WE SHARE, our troubles are lessened, and our pain is eased. When WE SHARE, our hopes are strengthened, and our dreams are realized. When WE SHARE. Thank-you, “lewcoleman”, whoever you are, and where ever you are. (Your use of “whilst” tells me you’re British, correct?)….

    • My lone contribution to this will be that to mention that, in addition to all that has been articulated above, when we recognize that our pain is legitimate, a product of institutional/corporate/governmental oppression and not the result of a personal defect, it is easier to identify, experience outrage, and confront the source of the problem.

  14. Thank you for this well articulated response.

    I have to say that from personal experience, I know the kind of games that occur with the media (marketing) and who gets to have “attention.” It’s awfully nice of you not to mention what might happen to Mr. Fry’s show, or what might even happen to his career would he give explicit notice about what you’ve articulated.

    It’s a big issue (“mental illness”), gets all sorts of media attention, and I have to say that in my little life I’ve been hit on by actors that not only have done roles of “schizophrenics” or other “mentally ill” characters, but also homosexual roles, roles that a “schizophrenic” actor or a homosexual actor couldn’t do given the media attention that these group of actors interested in “nijinsky” are active in. A gay or a “mentally ill” actor wouldn’t work for the marketing agencies that represent these actors I’m loath to mention by name right now. Yes they all have done at least one of such roles, and so and so announces he wants to do a gay role (while ‘happily” married for the second time, the world having heard nothing of his real gay desires and or experiences).

    This kind of environment already being quite unhealthy for someone needing the freedom of expression that an emotional challenge elicits. And a “schizophrenic” who has recovered because he actually did follow the protocol that truly works, and this involves not being medicated, that certainly wouldn’t be something the marketing agencies seem to encourage right now!

    In striving to be someone on screen, they seem to miss that it’s about actual people, and not just the issues that come up creating media attention! And when it’s exciting because of the controversy, to what extent is exploiting the pull of the vacuum in collusion with keeping the vacuum going rather than seeing something is missing?