Are Mental Disorders Brain Diseases ‘In Waiting’?

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The sixth in a series of blogs presenting a philosophical analysis of the modern mental health system.

In the last blog I referred to how Szasz argued that mental disorders are not rightly thought of as illnesses or diseases because these terms refer to conditions of the human body, and mental disorders consist of patterns of human behaviour.

Some people have tried to maintain the idea that mental disorders can be thought of as illnesses or diseases by detaching these terms from their link to the body. However, we saw how this approach just empties the terms of any distinctive meaning, and leaves us unable to differentiate between situations that have distinctive implications and call for radically different reactions. In fact, because we have muddied the concept of illness so much, we have had to invent new concepts to refer to a bodily disorder — we talk of organic illness or physical illness or medical illness, for example, and the concept of ‘disease’ also sometimes works to indicate a specifically bodily condition, as opposed to ‘illness’ which is used more widely.

The other way in which people have tried to enfold mental disorders within the category of disease is by claiming that they are diseases of the body, particularly of the brain. We are all familiar with this rhetoric, which often presents the idea as if it has been conclusively demonstrated.

The website MentalHelp.net tells us, for example, that “Data from modern scientific research proves that schizophrenia is unequivocally a biological disease of the brain, just like Alzheimer’s Disease and Bipolar Disorder.”

Similarly, “ADHD is a neurological disorder that develops during childhood and can persist into adulthood.”

On another website, psychiatrist E. Fuller Torrey claims that “Since the early 1980s, with the availability of brain imaging techniques and other developments in neuroscience, the evidence has become overwhelming that schizophrenia and manic-depressive disorder are disorders of the brain.”

Despite such statements, we are a long way from finding a specific pathology that aligns with what we call schizophrenia, psychosis, depression, anxiety, ADHD, OCD or any other mental disorder you care to name. The fact that there are some subtle group differences between people with some diagnoses and ‘normal controls’ in aspects of brain structure or function does not demonstrate the presence of a neurological disease. None of the findings are specific or capable of differentiating between a person who is thought to have a particular mental disorder and one who is not. Diagnosis is still made on the basis of behaviour, thoughts and feelings that are reported by the individual or those around them, and which depend, of course, on judgements about what is ‘normal’ and what is not.

Moreover, the variations detected are most likely attributable to other differences between people who get labelled with psychiatric disorders and those who end up in the control group for studies like this, which include differences in life experiences, social class, IQ and of course the use of psychiatric medication. The most consistently demonstrated differences between people diagnosed with schizophrenia and a control group, for example, are the smaller brain volumes and larger brain cavities that show up with brain imaging technology. This research was cited for decades as demonstrating the biological nature of schizophrenia. Recent studies involving the administration of antipsychotics to animals, however, show conclusively that these differences are caused in large part, at least, by antipsychotic medication.12 No research has shown that the subtle reduction in brain size observed in people diagnosed with schizophrenia on MRI scans has anything to do with the so-called schizophrenia.

Arguing that mental disorders are not brain diseases is not to deny that biology is involved at some level, as it is in all behaviour. Many people suggest that mental disorders are a ‘bit’ biological, as well as being a bit psychological and a bit social — sometimes referred to as the ‘biopsychosocial model’. But if we think of situations that are unequivocally brain diseases, we see that where a specific abnormality of brain structure or function is causally associated with psychological or behavioural symptoms, it trumps other possibilities. If someone has multiple sclerosis (MS), their erratic behaviour is caused by the pathology of MS. If someone has hypothyroidism, their sluggishness, apathy and low mood are caused by the depletion of thyroid hormone. No other explanation is needed, although there will be social and psychological consequences, of course.

Proponents of the idea that mental disorders are brain diseases are right to point out, however, that brain diseases like multiple sclerosis, Parkinson’s disease and neurological syphilis can, and do, affect behaviour. So, it is argued, even though we may not have discovered the underlying pathology of mental disorders like schizophrenia or depression yet, surely we eventually will? Mental disorders, on this view, can be thought of as brain diseases ‘in waiting’.

For Szasz, the only criteria capable of defining a condition as a disease or illness are detectable physical signs — that is objective, material evidence of specific bodily changes. Unless these are present, a situation cannot be considered to be a disease.

However, there are some situations that we universally think of as brain diseases that do not have characteristic and distinguishing bodily features. Dementia or Alzheimer’s disease is one of these. In the early stages, there are rarely any physical symptoms, and even by the later stages there are no specific characteristics that mark out the brain of a person who is suffering from dementia from anyone else. As a group, people who have dementia show more of the pathology that naturally develops with aging (plaques, tangles and vascular changes) than your average person of the same age, but you cannot distinguish the brain of a single individual with dementia from one without.

So does this not confirm that the situations we refer to as mental disorders can be thought of as brain diseases, even if they are not linked with any particular, observable brain pathology, as yet? I do not think this is the case, because there is something special about the ‘symptom’ of cognitive deterioration or deficiency, which is a hallmark of brain disease, that points toward a brain-based origin.

Again Wittgenstein’s insights are useful here (see Blog 2 of this series). Like pain, we identify dementia first and foremost as a characteristic pattern of behaviour that demonstrates the deterioration of mental abilities. Something about this situation strongly suggests to us that it originates with changes in the brain. No one argues that dementia is really a meaningful response to environmental trauma or alienation — a sane response to an insane world — as R.D. Laing is purported to have said of schizophrenia.

Back in 1913, the German psychiatrist and philosopher Karl Jaspers observed the difference between an organic condition like neurosyphilis (also known as General Paralysis of the Insane), which involves dementia, and what was already denoted as schizophrenia. He writes: “in the one case it is as if an axe had destroyed a piece of clockwork, and crude destructions are of little interest. In the other it is as if the clockwork keeps going wrong, stops and then runs again.” This appears to suggest simply that schizophrenia involves a more superficial and temporary brain dysfunction, but he went on to say: “but there is more than that. The schizophrenic life is peculiarly productive. In certain cases, the very manner of it, its contents and all that it represents can in itself create another kind of interest. We find ourselves astounded and shaken in the presence of alien secrets, which in this sense cannot possibly happen when we are faced with the crude destructions, irritations and excitements of General Paralysis.”3 (3) (P 576).

Jaspers is pointing to the different quality of behavioural disturbance that occurs in brain disease compared with the condition we call schizophrenia.

This discussion suggests that there is a line to be drawn between states where ‘behaviour’ is driven by brain processes that occur independent of the individual’s agency (rightly referred to as a disease), and other situations. In fact, there is some common ground between Szasz and those biological psychiatrists and others who argue that some mental disorders are brain diseases, in that both recognise that a disease is a bodily state with particular implications.

The difference lies in where to draw the line. Like Szasz, I think that brain disease demarcates the territory of neurology, not of psychiatry, bearing in mind that some ‘neurological conditions’ like dementia and intellectual disability have ended up within psychiatry for historical reasons. We should acknowledge, however, that neurological conditions cannot always be detected in the brain, and may only be identified through the characteristic way in which they are manifested in publicly observable behaviour. This does make judging what is and is not a brain disease a complex and imprecise matter in some cases.

Taking a cue from Jaspers, the behaviour we associate with brain disease is characterised by depletion and narrowing of our intellectual capacities and especially by a loss of the productivity and inventiveness of normal human behaviour. In contrast, the individual in the grip of a paranoid psychosis demonstrates a level of originality in constructing a delusional system or interpreting their own thoughts as alien occurrences. Depression too can involve a productive state of self-blaming, catastrophizing and pessimistic interpretations of the world. However unhelpful these forms of thinking may be, they demonstrate a level of mental sophistication and creativity that, by contrast, is destroyed by brain disease.

There are situations, however, such as very severe depression or what is sometimes referred to as ‘negative-state’ schizophrenia, where there appears to be a loss of intellectual and creative capacity. It is possible that some of these situations are associated with underlying brain dysfunction or damage. In some cases depression in the elderly appears to be the herald of dementia, for example, although in most it is not. In people diagnosed with schizophrenia with severe negative symptoms, often there are some inklings of creative thought that provide evidence that mental abilities remain intact. I recall a young man who barely spoke, and spent almost all of his time slumped in a chair with his hood drawn down, apparently doing nothing. Yet, he could rouse himself to levels of considerable ingenuity from time to time in order to obtain a supply of cannabis!

To summarise the last two blogs, the terms illness and disease only make sense if they refer to the body. Outward behaviour can sometimes be disturbed by a bodily process, such as a brain disease, but when it is, there is a loss or depletion of mental capacities which is not characteristic of mental disorders. In the latter, creative mental abilities remain intact, even if their products are self-defeating or socially problematic.

Next: So what are mental disorders?

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57 COMMENTS

  1. I contend that this article is biological, medical science until it switches to philosophy: “However, there are some situations that we universally think of as brain diseases that do not have characteristic and distinguishing bodily features. Dementia or Alzheimer’s disease is one of these.” This statement describes our cultural ageism and a universal lack of empathy for the emotional suffering of the elderly. I agree with Szasz and do not understand how “Alzheimer’s disease” can prove him wrong.

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  2. Great article. I don’t find myself disagreeing with you at any point on this one, although I do have qualms about the direction in which you seem to be heading.

    People react strongly when any suggestion is made that racial difference equals racial inferiority or superiority, however, when dealing with people in the mental health system this visceral heartfelt reaction mysteriously vanishes. One thing is certain, claiming that we’re dealing with a diseased brain does not make it so, and showing that we’re dealing with a diseased brain would place the object of our study in the neurology rather than the psychiatry department.

    Are mental disorders diseased brains? Are mental disorders? I think we’ve got issues in defining the problems that have not been dealt with adequately. If it’s a matter of the “mentally ordered” ones identifying the “mentally disordered” ones, etc., we’re almost back to square one. This would make it a social matter, surely, but at the same time highly prejudicial. Almost as highly prejudicial as claiming that the “mentally disordered”, in relation to the “mentally ordered”, are genetically defective.

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    • Thanks Frank. I always thought we would agree on the ‘diagnosis’ of what is wrong with the current approach, but as you say, we may not agree on what is to be done. I really value your comments though, because I certainly do not have the answers- only more questions. I think you hit the nail on the head by pointing out that if we ditch the pretence of science and objectivity (i.e. the idea that ‘mental disorders’ are diseases), we are left with a highly contentious political issue, where one group of people are making judgements about another. I am looking forward to your thoughts about the next couple of blogs.

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      • “I think you hit the nail on the head by pointing out that if we ditch the pretence of science and objectivity (i.e. the idea that ‘mental disorders’ are diseases), we are left with a highly contentious political issue, where one group of people are making judgements about another.” I agree, this is the problem. Today’s psychiatrists are willy nilly judging, defaming, and poisoning people, who they do not even know.

        As to “Are Mental Disorders Brain Diseases ‘In Waiting’?” I don’t think so, since Whitaker pretty well established the fact that the antidepressants and ADHD drugs can create the “bipolar” symptoms, thus making “bipolar” an iatrogenic “disorder.” And the “schizophrenia” drugs can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and antipsychotic induced anticholinergic toxidrome, thus making “schizophrenia” primarily an iatrogenic “disorder” as well.

        So it seems pretty clear to me that today’s “mental disorders” are iatrogenic illnesses that can be created with the psychiatric drugs, as opposed to being real brain diseases. Thus the psychiatric judgement of others, is really nothing but psychiatrists unjustifiably defaming the character of another, and then poisoning that person. And in a civilized society defamation of character and poisoning people are illegal.

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    • Frank – In this comment, I like your statement “It’s a matter of the ‘mentally ordered’ ones identifying the ‘mentally disordered’ ones”! To this, I thought of adding that according to Buddhist teachings, everyone is mentally ill – until they become enlightened!

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  3. Thank you for the intetesting article:-

    Catastrophisation is a good word because it is a normal way for describing what anyone can be doing inside in their heads.

    The technique in the link below works for Catastrophisation – but it takes patience.

    https://youtu.be/EtRaBEhNWgE

    I don’t support the idea of “negative schizophrenia” but I do accept that terrible
    boredom does exist.

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  4. The takeaway line for me was:

    “However, there are some situations that we universally think of as brain diseases that do not have characteristic and distinguishing bodily features. Dementia or Alzheimer’s disease is one of these. In the early stages, there are rarely any physical symptoms, and even by the later stages there are no specific characteristics that mark out the brain of a person who is suffering from dementia from anyone else.”

    I didn’t know this. I’d been merrily running along under the assumption that the opposite was true. Probably in similar ways that people think that schizophrenia is an established brain disease.

    It’s going to take me a while to work through this revelation. Lots of jokes already, almost all of them entirely inappropriate. Which is great.

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  5. I don’t think we know very much about mind/emotional/behavioral problems…we are working on it….treatments are there but are not workng out too well….there is a lot of talk here but I don’t see much
    success…at least not enough…it seems we are arguing about what words to use…

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    • Hi, Littleturtle,

      Have you picked up on the thread that the psychiatric leadership is not really “working on it” due to corruption? That they are dedicated to biological “explanations” regardless of what the research shows? I think there’s a lot bigger issue here than understanding the mind or behavior. The problem is that the profession has stopped honestly looking at the data. Sure, there are undoubtedly physiological issues that cause SOME of the manifestations of “mental illness” in some cases. But psychiatry is not interested in making these distinctions. They appear to be interested in selling their “services” and the drugs that go with them. That’s a very different problem than figuring out what a particular person needs to assist them with their mental/emotional distress.

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      • Sorry Francesca, but I do not go along with you. Sometimes facing the ways in which we have been used, exploited, and abused, and facing how unfair and unjust our world is, and the ways that most of the society is in a trance, is just too painful to bear, and so it is easier to believe that we ourselves suffer from some sort of medical and moral defect.

        The mental health system attacks at your own life affirmation, and the desire to fight and fuck. And it makes you believe that you yourself are the problem.

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      • If by “mental disorder” you mean bizarre, counter-productive thoughts and behaviors I heartily agree. I have been so tormented by my own mental processes I could barely leave my own room. That still does not mean my brain or genes were responsible. I now have a real brain disease (TBI) from decades of “safe and effective treatments.”

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  7. “There are situations, however, such as very severe depression or what is sometimes referred to as ‘negative-state’ schizophrenia, where there appears to be a loss of intellectual and creative capacity. It is possible that some of these situations are associated with underlying brain dysfunction or damage….. In people diagnosed with schizophrenia with severe negative symptoms, often there are some inklings of creative thought that provide evidence that mental abilities remain intact. ”

    Are you able to speak in more detail about this either here or in future articles? Do you believe that in these cases of severe depression or severe negative symptoms that there is likely also brain dysfunction or damage, and more importantly, do you think that it is usually or sometimes something that is irreversible?

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    • I read this comment in the Mental Elf written by Paul Morrison and he seems to be describing a similar condition as you have described in the quote I listed above. He writes “….The inexperienced sometimes label it as autism, and yes, it can be hard to define. That’s because it involves a loss – a loss of the former personality. The loss encompasses; motivation, ambition, emotion, conversation, interests, family-life, friendships, romantic relationships and intellectual-life. In terms of brain science, it is an impoverished ability to embody (select and initiate) psychomotor and emotional programmes. Lived out in back bedrooms, easy for services to ignore. No voice. No complaints. No risk. No narrative. Usually no striking life event or trauma, certainly not always, although sometimes a catastrophic decline in high school or college.”

      In terms of chances for recovery Paur Morrison goes on to write: “Here, talking is painfully difficult; expect long silences. Unless one is an RD Laing type, therapy can’t even get off the ground. Of course we all try and keep trying. And the dopamine blockers don’t really work that well here either. Only one therapy has a chance to bring the personality back, clozapine. And when it works, it is astonishing – a penicillin-like effect. It doesn’t block dopamine, to any great extent. Indeed, nobody knows how it works – which is a bit embarrassing for the field. But the parents are so thankful to see the spark return, they don’t care how it works. And at last, my psychology pals can do their thing, and gently guide the person back to their former self”

      ***I am really wondering about your take on all of this. Any thoughts or ideas (or a future blog if it is beyond the scope of this blog) would be so very appreciated. ***

      [One thing that strikes me is that psychiatrists like Paul Morrison may only ever see how medicated people progress. Would Catherine Penney’s previous condition be considered similar to this? Are there other case studies from the pre -med past that gives information about how these people progress if they haven’t been medicated? If some people are ‘brought back’ by clozapine, is that also evidence that their cognition is all ‘in there’. Are there stories of people coming back from these states after years (with or without medication). Also do you see other types of ‘cognitive shut downs’ (for want of a better term) such as seen in PTSD , severe dissociation or trauma, as having similar presentations, or as being very different to what some people refer to as ‘negative schizophrenia’ (Here I am thinking of the points made in Noel Hunter’s article on this site entitled something like “Trauma or psychosis..the Ultimate Political battle) ……..I have so many questions…..]

      (By the way I am not trying to offend anyone here by language used in the quotes or mentions of medication and blocking dopamine etc…just wanting to find out more information of a very specific type of presentation that seems different than a lot of peoples’ experiences. )

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    • Hi Sa,
      I am not saying that what is diagnosed as severe depression or negative schizophrenia are caused by brain dysfunction/damage. I am saying that in some people with these presentations, brain dysfunction may turn out to be the cause.
      I recognise the situation that Paul Morrison describes. Sometimes it is accompanied by some more familiar psychotic ‘symptoms’, sometimes not. I agree with him that helping someone who is in this state is really difficult. I don’t recognise the miraculous effects of clozapine that Paul describes, but I have seen it help some people who have been very troubled by persistent psychotic experinces to care less about them.

      I don’t think we know what happens without drug treatment any more. We can look back and see that some people who presented in an apparently psychotic state recovered (e.g. John Perceval, a 19th century English gentleman who had a severe psychotic breakdown, and spent a couple of years in various asylums, before making a full recovery, and going on to lead a ‘normal’ life, while campaigning for asylum reform- you can access his incredible personal narrative here: https://archive.org/stream/percevalsnarrati007726mbp/percevalsnarrati007726mbp_djvu.txt)
      However, from my exploration of early 20th century asylum records, there were also those who remained psychotic for years. The problem is mental health problems change profoundly with history and it is always difficult to know whether the problems people had then are the same sort of thing as those people have now.

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    • I don’t see any way these ‘neurological disorders’ will ever be found. It’s just more voodoo. The nervous system is very plastic. Even if you could find something different about the so called ‘Mentally Ill”, or about the so called ‘neurological differences’ of ADHD, Aspergers, and Autism. what does that prove?

      It proves nothing, except maybe for the fact that there are huge numbers of people who have been broken by the system and who have stopped politically organizing and defending themselves.

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  9. Why do these articles on “manic-depression and the brain blah blah” never talk about antidepressant induced mania? That you guys are labelling people as manic-depressives/bipolars because of the effects of your own drugs?

    More importantly, why do they not tell the truth? Nobody in clinical psychiatry is checking anybody’s brain. Those articles are nothing more than useless mental masturbation.

    What psychiatry definitely is doing is labelling people with defamatory tautological labels, obfuscating an individual’s truth and providing no concrete biological evidence in any specific individual in real life (when I say real life, I mean everyday people, not research and journal papers).

    Also, when I say “biological evidence”, I don’t mean simple brain correlations. We all know that pretty much everything we do will be associated with something in our brains. That is meaningless.

    All pro-biopsychiatry related articles on the internet hide the truth about real life occurrences in psychiatry. All you do is talk to people and give them drugs. Nobody needs psychiatrists to consume drugs. Talking to you guys is dangerous too.

    False biological arguments are used to ruin people’s lives (even if unintentionally). Criminal justice issues are turned into medical problems. Problems in living are biologised. Hell, argumentation with psychiatrists is dangerous. All it does is get you deeper into the brothel of psychiatry.

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    • Ironically, the antidepressant induced mania you mention is one of the most convincing evidence of the biological model. It is also biological evidence in specific individual in real life: if someone developed psychiatric symptoms after ingesting neurotoxins there is a strong evidence that he suffer from a neurological condition.
      I think some psychiatric disorders are brain diseases, especially psychotic episodes (these are often related to legal or illegal drugs use). The problem is that psychiatrists don’t treat them properly, and they treat even things that are likely not biological as biological.

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  10. If Szasz were alive today, he would completely ransack these distortions of his views and the sophistry that is employed to justify the coercive and abusive practices of psychiatry. The only thing that these articles can possibly accomplish is to bring psychiatry one step closer to fully embracing the falsehoods that are perpetuated by E. Fuller Torrey and his ilk. Even worse, these articles attempt to provide philosophical justification for a pseudo-scientific system of oppression. Moncrieff is a great person, and her book “The Bitterest Pills” is a great contribution to the ever growing library of works that expose the truth about psychiatry. However, these dangerous ideas cannot go unchallenged.

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  11. Thanks for this article. I was following along and nodding my head in an emphatic YES until I got to the part about Alzheimers. I believe the Alzheimer’s Foundation (or whatever the major charity may be called) states that to properly diagnose Alz, the patient has to go to a NEURO, not to a psych. The Alz Foundation has articles on “Preparing for your neuro exam” and talks about how grueling this three-hour exam is. There are also instructions for caregivers of the elder, telling about the exam and how tiring it could be for the elder.

    A neuro exam tests reflexes, EEG, balance, tests for stroke, seizure disorder, head trauma, etc. These would reflect physical changes in the brain. Am I right?

    A recent article came out written by a man dxed with Alzheimer’s. What happened was that he was diagnosed and then, he prepared for gradual decline and death. This was life-changing for him. (Yes it does change your life!)

    Oddly, as time went on, he found he wasn’t deteriorating. Then, he spent a huge fortune, (as he was wealthy) on a complex test that proved he never had Alz at all. The dx confirmed his suspicions, but he expressed in the article that knowing he had lived with a false death-sentence type dx was certainly almost like years had been stolen from him. Does this sound familiar to us?

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    • Hi Julie,
      most of the physical tests done when assessing a possible case of Alzheimers disease are to rule out other possible causes. The diagnosis is a clinical one, made on the basis of the memory loss and cognitive problems, not on the results of physical tests. As I said, there are differences between the brains of people with Alzheimers disease and people without as a group on MRI scans, but the scans are not diagnostic. You can have a normal scan and still have Alzheimers, or an abnormal one and not have it. I don’t know what test the man you described had, but there are no diagnostic tests for Alzheimers.
      I can see how the confusion arises though. I just looked at a few sites and they do not make this clear at all. However, the NHS Choices website does state that: ‘There’s no simple and reliable test for diagnosing Alzheimer’s disease’ https://www.nhs.uk/conditions/alzheimers-disease/diagnosis/
      I think this is interesting. It suggests that even where questions of biological aetiology are not really in doubt, there is an inclination to give an impression of more certainty than really exists.

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      • Thanks for clarifying, Joanna. So that three-hour test rules out the possibility of, say, stroke being the culprit. This DOES make sense.

        My friend’s mother was misdiagnosed and that killed her. She has Lewy Body and the great McLean Hospital said it was Alz. Sadly, they gave my friend’s mother Risperdal. That did her in. I believe my friend was able to hire an attorney, but that will not bring her mother back, sadly.

        The test that the wealthy writer had was $10,000 out of his own pocket, he said. It did not diagnose Alz. Rather, it told him he didn’t have it. He ended the article saying the test showed he actually had something else, something that was less of a death sentence as far as he was concerned. He said very few can afford the test and it’s brand new, but you’re right, it’s not a positive, but negative indicator.

        If I recall correctly this was in something like The Atlantic, not in a scientific journal. It was an interesting read.

        I could relate as a person coerced onto disability and unemployment for over three decades and then, slowly realizing it was fraud. I have to correct people. I didn’t recover from schizoaffective. I never had it, never had the signs nor symptoms. I have to say this over and over because very few believe me. It is hard looking back knowing that for three decades, you were duped.

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    • “Mental health problems”!?

      Psychiatry is “too extreme”. All it’s physical answers to the “problems” it describes as “mental”, but views as “physical”, are damaging. Language is a big issue here. “Mental health problems”, “mental health issues”, etc. Biological psychiatrists certainly aren’t so fain to call what they specialize in “disease” or “illness”.

      You want “extreme”. Non-consensual coercive psychiatry is extreme. Psychiatry abducts people, locks them up in prisons it calls hospitals, and then tortures them until they “confess” to having an “illness” before letting them go. No “confession”, no release (i.e. discharge). Of course, given torture or the threat of torture, people will say anything. Once they’ve got their “confession”– hop, skip, and jump–it’s only a matter of calling “torture” “treatment”, and convincing their captives that it, “torture”, is good for them.

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    • Why would being “antipsychiatry” mean being “anti-biology?” Psychiatry’s problem isn’t that it CONSIDERS biological causality – it’s that it postulates biological causality without any evidence or understanding of what causes anything, and invents “diseases” without knowing the first thing about what causes them or whether they are “diseases” at all. Psychiatry’s other problem is that it’s totally corrupt. It denies facts and data in favor of what is profitable. There are certainly biological issues that inform how people behave, but those are the province of neurology, nutrition, pain management, endocrinology, etc. Psychiatry itself is a sham – it has become the pretense of knowing something that they don’t know so they can make money and control people’s behavior. Very, very different than working towards understanding the causes and possible interventions for mental and emotional distress.l

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      • Very, very different than working towards understanding the causes and possible interventions for mental and emotional distress.

        You think? This is the crux of much of this debate, the naïve belief that psychiatry is given all this system support out of a desire to help people with “mental and emotional distress,” rather than control them and hold any disruption they might represent to “business as usual” to a minimum.

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  13. I wish this article were written using straightforward language using simple sentences! 🙂 I had to read each sentence more than three times in order to understand what exactly is being said here!

    As I see it, whether it is a physical illness or a mental problem (i.e., “problems in living”), the reason one would seek help from a professional is ultimately due to an individual’s subjective experience. If this subjective experience of pain (mental or physical) reaches a certain threshold level (this threshold can be different for different people), and interferes with one’s day-to-day activities, then they seek help. For physical illnesses, we have established systems of treating patients – no one questions that. With mental issues psychiatrists assume there has to be a physical cause (they assume this although there is no evidence for it).

    Regarding all this, what I don’t understand is why everyone ignores neuroplasticity (a key discovery of neuroscience). Neuroplasticity is a situation where neurons and neurochemicals continuously change with human experience (just like physical activities change our muscles). For example, when someone experiences psychological stresses, these stresses result in changes in the brain but when these stresses are addressed, the brain becomes normal again (I gave many references for this in comments to Joanna’s previous blog). As I see it, this is how ‘mental pain’ issues should be addressed. This can be addressed either by targeting the stressor itself (e.g. finding a job for someone who lost their job), or by changing the way people deal with stresses (e.g. providing hope and support to the patient, as well as with other interventions such as training in meditation/mindfulness practices). The current practice of giving fancy psychiatric labels to patents (and being told that these are long-term conditions) only aggravates their stress level and the medicines that are given interfere with the normal functioning of the brain.

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    • Some people don’t “seek help”, but that doesn’t stop “help” from being forced upon them. So when a person is being “helped” who doesn’t want to be “helped”, whose subjective experience are we talking about?

      “Neuroplasticity” is a little over played in the sense that it may, in many circumstances, be a matter of how the brain deals with damage, and damage would imply that harm has already been done to the brain. Sure, maybe the brain has a way to repair itself, however, preferable is not needing repairs, and then there’s what changes occur in “neuroplasticity” (i.e. the extent to which the brain is not “neuroplastic”.) I would imagine there is some loss involved as well. (There’s little doubt, for instance, that, “neuroplasticity” or no “neuroplasticity”, neuroleptic drugs destroy some brain cells in animals. There is little reason to believe they don’t do the same to humans.)

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      • Hi Frank – In my comment, I am referring to normal people who expect help from any health system. So, I do not understand what you mean by “help being forced upon people.” In any case, everyone has subjective experience all the time.

        Regarding neuroplasticity – you cannot deny research evidence. Even animal research has shown changes that happen in the brain. For example, mice that are subjected to various psychological stresses (such as being restrained) show dendritic atrophy and loss of dendritic spines, and these changes are reversible through psychological means (when these restrained animals are released). Check out the following article: Popoli M, et al. (2012). The stressed synapse: the impact of stress and glucocorticoids on glutamate transmission. Nature Reviews Neuroscience. 2011;13(1):22-37).

        As I see it, the words you use “repair” and “damage” are not appropriate to describe neuroplasticity. What happens in neuroplasticity is “change” – and these changes are reversible.

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        • “Normal” people? Sorry, I haven’t met any.

          Whose denying the brain changes? I’m just saying that not all those changes are necessarily for the better.

          Appropriate or not, my view is that much of this evidence regarding neuroplasticity involves people’s recovery from brain damage, and I would add, there’s no “recovery” like prevention.

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  14. Regarding Alzheimer’s – the ‘Einstein Aging Study’ (a longitudinal study) demonstrated that psychological stress predicts cognitive impairment. So, various stress reduction techniques could go a long way in preventing and in stopping the progression of this condition as well.
    Reference for the study: Katz, M. J., et al. (2016), Influence of Perceived Stress on Incident Amnestic Mild Cognitive Impairment: Results From the Einstein Aging Study. Alzheimer disease and associated disorders, 30(2), 93-98.

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    • From what I have heard stress contributes to most diseases out there, certainly to one’s susceptibility to infection.

      Of course, how one reduces stress, or whether one does, is a choice. And for some of us, stopping psychiatric “care” has been a great way to reduce stress. Sadly, people with Alzheimer’s are often sent to psychiatrists, and even worse, locked units. Many of them spend their final days locked up.

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      • Thanks. Yes, stress contributes in a big way. Being stressed results in physiological changes in the body in addition to neural changes. I think receiving the diagnostic label of Alzheimer’s can also be quite debilitating for anyone, and the label itself could lead to further progression of the disease through nocebo effects (i.e., negative expectations leading to negative outcomes: opposite of placebo effects).

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  15. Hi Nancy and others,
    I think neuroplasticity is interesting. I agree with Frank that sometimes it probably reflects compensatory mechanisms in response to drug induced damage. However, I think it also shows us how our brains reflect our lives and activities. If we do more of certain things, parts of our brains grow in response (the famous study of taxi drivers in London, for example).

    On the issue of subjective experience, of course, some people go to psychiatrists voluntarily because they feel unhappy, worried or confused, but others are taken to psychiatrists by others- family members, the police etc. In these cases the individual’s behaviour is bothering other people in some way, but they may not be distressed or want help themselves. So I don’t think it is the subjective state that is the key factor in these situations. Even when someone is asking for help for themselves, often it is social factors, such as not being able to go to work or fullfil other duties, that precipitate help-seeking, rather than just the way someone is feeling.

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    • Thank you Joanna. I noticed that you are willing to “grow” from people’s comments to your blogs, which I think is wonderful. So, thank you!

      Regarding neuroplasticity – although many people probably think of neuroplasticity simply as “compensatory mechanisms for drug induced damage,” there is much more to it than that. As you say, the organization of brain circuitry is constantly changing as a function of experience or learning. When we consider learning, most training benefits are stimulus or content specific – such as brain changes in taxi drivers, piano players, jugglers, etc., where specific areas of the brain change in response to training.

      Interestingly, other research has shown that systematic mental training, as cultivated by meditation, can induce learning that is not stimulus or task specific, but process specific. “Process-specific learning” denote learning effects that do not only improve performance on the trained task or tasks, but also transfer to new tasks and domains.
      This is described in the following article:
      Slagter HA, Davidson RJ, Lutz A. (2011). Mental training as a tool in the neuroscientific study of brain and cognitive plasticity. Front Hum Neurosci, 10;5:17.

      Regarding subjective experience – I think here we are talking about typical instances where a person decides to access mental health care. Of course other factors like different people encouraging/forcing the person to see a psychiatrist (i.e., based upon their beliefs on how mental issues need to be handled, etc.), can play a role for some cases. However, I think if we solve the problem regarding how mental issues need to be addressed (an evidence based method that everyone can agree on – just like how we currently have a good system in place for physical illnesses), then others may not force an individual simply based on their own belief systems.

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    • Or, how about this? You ask for help with X but they help you with Y, which you may, or may not have. Example: You go to the college health center saying you were raped. You get pills for depression..You go to them with a career question, you get diagnosed with a phobia. And me…I went to them with an eating disorder, asked for rhelp with it, they declared me schizophrenic. looks like I MIGHT be able to get hold of the records precisely when this was done….

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  16. As Peter Breggin has pointed out, even experts of the brain are pretty ignorant of it’s chemical makeup and what–if any–chemical makeup composes a healthy brain.

    Assume, for the sake of argument, that brain chemistry does cause extreme behaviors or “mental illness.” They still have no idea what parts of the brain are at fault or how to correct them. Perhaps they’re suppressing dopamine when it could be some brain chemical no one has even discovered. Maybe they are causing the brain to put out more of the very chemicals at fault to begin with?

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