Anthropologists Question the Legitimacy of Mental Disorders

Anthropologists call for a move away from biological approaches to psychiatry citing failure to deliver discoveries or improved treatments.

Micah Ingle, MA
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A recent article published in the American Journal of Physical Anthropology examines the state of the evidence for viewing mental health struggles as purely biological disorders. Biological anthropologists Edward Hagen and Kristen Syme argue that the evidence for pharmacological interventions is weak and that the prevalence of “mental disorders” has not decreased over time. Citing widespread problems with contemporary psychiatry, they propose a “re-thinking” of psychiatry grounded in biological anthropology and evolutionary theory.

“The brain is the most complex organ in the human body. Advocates contend that mental disorders should be regarded as biological diseases like any other, invoking the effectiveness of psychopharmaceutical drugs and the associations of mental disorders with hormonal, imaging, genetic, and epigenetic biomarkers, as evidence for this view,” Syme and Hagen write.
“It is inarguable that mental health phenomena have a basis in biology, and that most (but not all) should be classified as biological dysfunctions. The track record of biological psychiatry, however, a field that investigates the neurophysiological and genetic bases of mental disorders, is poor.”

Anthropology has been one of the primary academic disciplines to question the dominance of a brain-based medical model for understanding human beings. For example, anthropologists have criticized the effects of psychiatry’s ethnocentrism, as well as thrown a wrench into quick “neuro” explanations that disconnect the brain from culture.

The current article extends this critical tradition by offering a broad overview of the scientific evidence for the existence of psychiatry’s “biological disorders.” The authors look at pharmacology, genetics,  neuroimaging and biomarkers, financial conflicts of interest, and psychiatry’s theoretical roots, ultimately concluding that the field has not delivered on its promise and that professionals should entertain the notion of a more anthropologically informed psychiatry.

According to Hagen and Syme, although the biomedical sciences have drastically increased life expectancy during the 20th century, mental health has seen little progress. Between 1990 and 2010, for example, the rate of “mental, neurological, and substance abuse disorders” remained steady.

“Most studies find that the prevalence of mood and anxiety disorders have remained constant over time,” they explain. “There is little evidence that increased treatment rates reduce suicide rates, and there has been no appreciable decline in cross-national suicide rates, which vary dramatically across countries and regions.”

Critiquing biological psychiatry, the authors focus on the limited efficacy of pharmaceutical drugs, corrupt marketing practices by pharmaceutical companies, the failure to find biomarkers for mental disorders, genetic/epigenetic findings, and psychiatry’s theoretical roots.

The authors argue that the “chemical imbalance” explanation for depression was successfully disseminated through direct-to-consumer corporate marketing, despite it not being aligned with the available evidence. For example, the “chemical imbalance” hypothesis states that antidepressants work by increasing monoamines (serotonin, dopamine, noradrenaline) in the brain, but certain antidepressants like tianeptine actually decrease monoamines.

Evidence for the efficacy of commonly prescribed antidepressants has been recognized as barely superior to placebo for over two decades, while strong bias in favor of positive drug trials has been detected in the scientific literature.

“After adjusting for unreported studies, [researchers] found effect sizes Cohen’s d = .31 to .32, indicating a modest advantage of treatment over placebo. This corresponds to less than 2 points on the Hamilton Depression Scale (HAM-D), which ranges from 0 to 52.”

As the authors note, this limited efficacy is also married to common side effects such as “insomnia, sexual side effects (e.g., decreased libido, erectile dysfunction), and weight changes.”

Related to the strong bias for positive drug trials, a review of 397 clinical drug trials found that 47% of the articles reported at least one financial conflict of interest. This type of research led Marcia Angell, former editor-in-chief of The New England Journal of Medicine, to reluctantly claim:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”

Drug companies are also known to pay physicians to advocate for specific pharmaceutical treatments and to sign off on articles ghostwritten by industry insiders.

Turning to the question of neuroimaging and biomarkers, the authors acknowledge that Functional MRI and PET scans sometimes show statistically significant differences between patient and control groups, but they state that these differences are not sensitive enough to be of clinical use. There are no currently available biological tests for diagnosing mental disorders, they add.

As far as genetics and epigenetics are concerned, while acknowledging that some “mental disorders” appear to be heritable—such as schizophrenia, bipolar disorder, autism spectrum disorders, and obsessive-compulsive disorder—the exact mechanisms are far from clear.

Genetic research has primarily moved from a focus on “candidate genes” to “gene-mapping” after unsuccessful efforts at discovering candidate genes associated with particular disorders. Complicating the matter is the fact that:

“[…] the genetics of mental disorders evidences equifinality, in which different variants lead to a single disorder, and multifinality, in which a single variant or the same variants are risk factors for several different disorders.”

In other words, we still know very little about how genetic and epigenetic factors contribute to psychological suffering in concrete terms.

Regarding psychiatry’s theoretical roots, the authors explain that many professionals are questioning the validity of the DSM, which is failing to align with the forward edges of “genetics, systems neuroscience, and behavioral science.” Additionally, co-morbidity or overlap between disorders leads many to question the scientific status of the manual.

There are practical issues as well; for instance, individuals may lose insurance coverage for their conditions if the DSM removes certain diagnoses.

Still, the DSM has been called an “impediment to progress” by the 2013 director of the National Institute of Mental Health, leading some critics to wonder about the scientific value of psychiatry as it is practiced clinically, even if it does provide a “common language” for clinicians.

Related to this, the authors discuss different philosophical understandings of what makes up “mental illness.” They point out that, in contrast to a “naturalistic” perspective, which assumes that mental disorders are examples of biological dysfunction, a “constructivist” perspective acknowledges that different traits and behaviors function differently in different contexts.

An obvious example here is the fact that homosexuality was considered a psychiatric mental disorder prior to changes in how it was perceived socially. Other examples of now discarded “disorders” include “moral insanity, childhood masturbation disorder, and hysteria.”

In contrast to the position of mainstream psychiatrists, the authors propose an approach to mental health grounded in biological anthropology and evolutionary biology. They believe that “mental health disorders” can be grouped into several subsets:

  • Disorders which are genetic-based developmental dysfunctions
  • Disorders associated with senescence/aging
  • Disorders caused by a mismatch between modern and ancestral environments
  • Disorders which are adaptive responses to adversity, however undesirable

Among “developmental disorders,” they list autism spectrum disorders, Tourette’s, obsessive-compulsive, schizophrenia, bipolar disorder, and eating disorders.

All of these are believed to be cross-cultural phenomena and to have significant genetic/heritability factors in their genesis.

The second group, senescence, contains disorders such as dementia, which they describe as “organism deterioration with age” associated with different possible evolutionary pressures, such as “lack of selective pressure during the post-reproductive phase” compared to the necessity of fitness during reproductive phases of life.

Disorders viewed as potentially resulting from a “mismatch” between modern and ancestral environments are, for example, ADHD. ADHD is possibly far less of a problem in “less structured environments” without the behavioral restrictions that modern society pushes on people—sitting at a desk for extended periods, for example.

Several large studies have found that younger children belonging to the same educational cohort (i.e., a year younger than their peers) are more likely to be diagnosed as ADHD because teachers’ expectations for behavior are biased toward the slightly older developmental group.

Finally, the authors believe that certain disorders are simply responses to adversity, however undesirable and unpleasant. These include depression, anxiety disorders, and post-traumatic stress disorder.

All three “disorders” may, from an evolutionary perspective, help to mitigate future adversities because of an individuals’ tendency to focus or “ruminate” on possible negative outcomes.

The authors believe that psychiatry’s resistance to viewing these conditions as adaptations to adversity may be an example of psychiatry serving “the interests of the powerful over the powerless.” Work-related depression, for example, is a significant drain to employers’ financial profits. As the authors note: “the illness label for work-related depression alleviates employers from the responsibility to improve working conditions for depressed employees.”

Hagen and Syme conclude:

“Understanding the complex, multi-level mechanisms that underlie mental disorders, and cognition and behavior more generally, cannot be achieved by focusing only on the lowest mechanistic levels (e.g., molecules, neurotransmitters). Nor can we rely solely on the descriptive symptom-based approach to mental disorders epitomized by the DSM.”

 

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Syme, K. L., & Hagen, E. H. (2019). Mental health is biological health: Why tackling “diseases of the mind” is an imperative for biological anthropology in the 21st century. American Journal of Physical Anthropology, 171, 87-117. (Link)

20 COMMENTS

  1. “Human suffering arises because of an embodied interaction with a world whose nature we cannot know but which we cannot escape.” I don’t know why we need to keep debating this. The DSM mindset outlived it’s usefulness long ago if it ever had anything to commend it. But it seems to proliferate like an out of control epidemic capturing more and more in its poisonous grasp – poisionous words followed by poisonous drugs. Not all are harmed or recognise the harm, maybe even some are helped to heal as they claim – who am I to argue with them. But many are left dissapointed if not destroyed by these treatments which profit the few at the expense of the many. Resting as it does on no firm intellectual basis but more so on a profound denial of the dangers inherent in life, the damage done by adverse experiences, events or circumstances how does it survive and continue to thrive?

  2. “Among ‘developmental disorders,’ they list autism spectrum disorders, Tourette’s, obsessive-compulsive, schizophrenia, bipolar disorder, and eating disorders.

    “All of these are believed to be cross-cultural phenomena and to have significant genetic/heritability factors in their genesis.”

    “we still know very little about how genetic and epigenetic factors contribute to psychological suffering in concrete terms.”

    In other words, it is UNTRUE that disorders like “schizophrenia” and “bipolar” “have significant genetic/heritability factors in their genesis.”

    But since we know that the ADHD drugs and antidepressants can create the “bipolar” symptoms. And since we know that the antipsychotics can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and antipsychotic induced anticholinergic toxidrome.

    It’s highly likely that the majority of “bipolar” and “schizophrenia” has an iatrogenic – not genetic – etiology/’genesis.’

    But I do agree, continued reliance “on the descriptive symptom-based approach to mental disorders epitomized by the DSM” is a dumb idea. The DSM should be flushed. And the psychiatrists should stop creating the “serious mental illnesses,” in innocent humans, with their psychiatric drugs, for profit.

  3. There are some poignant arguments here, but why argue the biological evidence of severe mental disorders? Have antropologists worked in psychiatric care? Have they found the evidence of white matter deterioration in MRI scans? No, says they just read some research articles.
    Many psychiatrists don’t believe in the DSM either, but you cannot hit delete on a biological cause and generic etiologies of mental illness because you found that the studies you read were false. If you have seen several families with the same or similar disorders then genetic predisposition is highly likely, if you find that a man with psychosis begins to lose higher processing functions then you may realize that their neurons are on overdrive and there are functional mri scans that can show the difference.
    I’m not simply glorifying psychiatry, it has become a corrupt practice because of the medical industry. To deny the existence of thousands of journal articles of evidence and medications that have worked to curb mental illnesses is simply ludicrous. Anthropologists and psychiatry/neurology needs to work together rather than attempt to disassemble each other, many mental diseases are solely human disorders and anthropological studies can help disseminate how the hominid brain evolved and formed complex pathways that could deteriorate.

    • Actually, it is the job of the researcher to prove that genetic/biological causes exist and are causative, not the job of detractors to disprove it. Scentifically speaking, lack of proof of genetic causation means it is assumed to be scentifically untrue, at least for the moment. And the fact that something “runs in families” is certainly no proof of a genetic origin! Speaking Chinese or using silverware to eat with both run in families, but are not in the least genetically related. Culture is passed on through families, and explains a great deal of similarity between parents’ and children’s behavior.

      If we want to be scentific, we have to be VERY careful about what we assume to be true. 50+ years of research have failed to demonstrate a specific biological cause of ANY of the “mental health” diagnoses in the DSM. Scientifically speaking, this suggests that such causes are very unlikely to exist, at least in a general sense. Specific instances of these “diagnoses” may have biological origins, but unless ALL or almost all cases of “depression” are shown to be biologically caused, we can not say that “depression” is biologically-caused condition.

      • The problem with today thinking is that people can’t imagine talking about identity/psyche or illness, without using medical empiricism.
        Medicine is not the owner of the psyche or even illness or pathology.

        Depression, psychosis even headaches does not belong to medicine. This is psyche, psyche creates pathology, and psyche is not medical empiricism. Monotheistic science talks about psyche and illnesses, using medical language, and we should remember that this is a medical usurpation. The proper language of psyche/pathology was destroyed by science and its pretensions to mythical reality and also to the psychological reality of illness. Psyche was destroyed by science.Imagination was destroyed by science, the psychological meaning of illness was destroyed by materialism. Mythical reality is not science. Psyche is not medical empiricism or materialism, and never will be.

        Psychological meaning of illness does not belong to medical empiricism. Every kind of pathology is an identity trait, at first. Not medicine. The nature of every illness is psychological , not medical.

        We are being treated by medical empiricism like a soulless meat. We are being treated that way, because we live in barbaric reality of materialistic fascism.
        People think that this is progress, to talk about psyche using medical empiricism. No, this is f. tragedy.
        ——————————————————————————–
        James Hillman “Re-visioning psychology.”

        • Danzig – an earlier name for a city in Poland that the Nazis wanted to take back into Germany. WW2 started after the Nazis invaded Poland in 1939.

          Yes, the psyche should not belong to medicine. They have indeed destroyed the language of the psyche, a real and actual element of human existence.

      • “50+ years of research have failed to demonstrate a specific biological cause of ANY of the ‘mental health’ diagnoses in the DSM. Scientifically speaking, this suggests that such causes are very unlikely to exist, at least in a general sense.”

        “There are some poignant arguments here, but why argue the biological evidence of severe mental disorders?”

        Because we’ve already medically proven the iatrogenic – not “biological” or “genetic” – etiology of the “severe mental disorders.”

  4. Good article, but doesn’t go far enough. “Schizophrenia” and eating disorders are not genetic. The book Crazy Like Us shows how eating disorders are extremely culturally dependent, going up dramatically when the concept of “eating disorders” is introduced into a culture. They are also to some degree of product of adversity, whether that adversity is malnutrition, stress, or cultural pressure to be thin. As for “schizophrenia”, the “paranoid” part is a pretty obvious reaction to childhood trauma, for instance thinking others are talking about you behind your back because you used to be a target of racist bullying (my best friend’s issue). And the visions/voices that get diagnosed as “schizophrenia” by psychiatry are treated as signs of a spiritual path by cultures with shamanic traditions, so, like “ADHD”, it is more a problem of our restrictive environment.

    • Yes, this is the primary problem with their reasoning. Bless them for noticing that “psychiatry’s resistance to viewing these conditions as adaptations to adversity may be an example of psychiatry serving ‘the interests of the powerful over the powerless.'” But this smacks, frankly, of the new “critical theory” viewpoint of life and living, which overall has proven to be quite mindless.

      How much longer must we wait for broken academics to figure out a “problem” that has largely already been solved? I know that my belief that is has been solved is not widely shared, but this does remain my belief. And at the core of the academic problem is its fixation on biology and evolution. That is like giving an artist a palette with yellow and red paint on it and then asking him to make a realistic image of a tree. “Where is my blue?” he should complain. Instead he insists there must be a way to arrive at the color green starting only with the colors red and yellow. Good luck with that!

      Oddly, another article posted here just a few days ago, “Do We All Need Tinfoil Hats?…” was picked up by someone in a Facebook group that I am a member of. It’s the same problem there. They are like those cave dwellers in that story by Plato, who refused to go outside to see what was there, as they had become so accustomed to living in a cave that they no longer wished for anything different.

      Walk out of the cave and look around! The air is fresh! (Unless you live down wind from a forest fire). The flowers are full of bright colors! And the basic questions of the mind and spirit have been confronted and answered!

  5. I agree and disagree and suspend judgment on much in the article and in comments to it. I’ll just say a couple things:
    To rehash what other commenters have highlighted or framed, speaking from my own experience, I find it odd they both didn’t include schizophrenia as a disorder of adversity (& iatrogenesis) and emphasized it’s genetic & developmental aspect after appearing to negate those earlier in the article. Did I misunderstand something? I tend to believe there can be aspects of all of the above & sometimes none, including schiz as a social construct and loose, if not completely misapplied, label, with its stigma, illusions, etc.
    Unlike many, I am interested in the biogenesis of schizophrenia a la Hoffer & Osmond’s aminochrome hypothesis (which apparently accounts for the dopamine & trans-methylation hypotheses). Also, their urine ‘mauve’, kryptopyrrole, or pyrrole disorder test for some, but not all, people labeled with schiz. Also it’s relevance for other ailments like cancer. It was said to be a marker for oxidative stress. It is an example, and there are others in their work, that there can be biological markers for mental illness though they may not always be only specific to the diagnosis, and also may not be proven. Because we have been so over-immersed in pharmaceutics and their related research & diagnosis standards, we tend to overlook the biochemistry of nutrients and how they directly or indirectly provide insight into health & sickness. Though I’ve made many mistakes, especially doing it mostly all on my own, I‘ve noticed how nutrients—diet & supplements—can have profound effects on mental & physical status and their interrelationships.
    Other commenters, please don’t make this a long debate on what I say. While I welcome comments, & will try to respond to some, I don’t want to get into the thicket and go down the rabbit hole. Of course, I’m still exploring and fleshing all this out, and I think we all know how damn complicated all this is. Thank you.

    • I think the first mistake of psychiatry is to assume that everyone who acts or feels a particular way should be grouped together and “treated” as if they have the same “disorder.” The evidence you report supports this. There most definitely could be biological factors that cause any sort of “psychiatric symptom.” But then we need to detect and treat the REAL problem instead of just suppressing the overt manifestations with drugs. I know I’m preaching to the choir here, but biochemistry can easily be addressed without resorting to the subjective and largely nonsensical DSM. Real science looks for causes and relationships, which I’m hearing you call for. I have no problem with that, as long as we don’t assume that “schizophrenia” is a legitimate category that groups together people who have some causal factor in common.

      • Yes. And yes, rock on. While I don’t pretend to know the ultimate answers, I would like to highlight one of Hoffer’s notions that I find appealing, even though it is materialistic etc. I should add that another favorite psychiatrist of mine, Carl Jung, also used the label schizophrenia and had an enormous amount to say about ‘it’ and had a psychogenic theory that is well worth examining. He also theorized a metabolic toxin ‘X’. He himself had ‘psychotic’-like symptoms which played a role in his self development. Hoffer considered schizophrenia a syndrome whose common final pathway is the by-products of oxidized adrenaline. He said many different causes can lead to the final pathway, but perhaps a majority had to do with chronic pellagra and vitamin b3 dependency; dealing with too little NAD/NADH from normal amounts of vitamin B3 in the diet and a high turnover rate to oxidized adrenaline and it’s by products. He named a whole consortium of psychological AND physical symptoms that can come from this. Having simply summarized his hypothesis, he had a very limited perspective on the function and meaning of hallucinations (and dreams?) and tended to medicalize people who experienced these, and I completely understand if this type of thinking is a turn off; I’m labeled, have used nutrients, & find it all rather maddening. It is not proven and would be hard to get the funding, consensus, etc. But I find it stimulating. His hypothesis was developed in the psychedelic pre-illegal era and before the use of vitamins, which came as a response, not a cause. It is the first oxidative stress disease theory and led to treatment with antioxidants etc. If you’ve bothered reading this, thank you for your patience. I try to make psychology & the body complimentary, and these types of ideas help me with that. Now to the….Peace.

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