‘Mental Illness’ Is Not in Your Head

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Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness
Anne Harrington

Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness
Andrew Scull

From Boston Review: “In 1990 President George Bush announced that ‘a new era of discovery’ was ‘dawning in brain research.’ Over the next several decades the U.S. government poured billions of dollars into science that promised to revolutionize our understanding of psychiatric disorders, from depression and bipolar disorder to schizophrenia . . . The 1990s, Bush declared, would be remembered as ‘The Decade of the Brain’ . . . While it was impossible to predict exactly what the future would bring, there was an overwhelming sense that psychiatric science was going to crack the ‘mystery’ and ‘wonder’ of this ‘incredible organ,’ as Bush called it.

Looking back as a psychiatrist and historian today, I find that these hopes feel quaint. They remind me of other misplaced visions of technological futures from the twentieth century: flying cars, pills for a whole day’s nutrition . . . Thirty years later we still have no biological tests for psychiatric disorders, and none is in the pipeline. Instead our diagnoses are based on criteria in a book . . . We also have not had any significant breakthroughs in treatment . . . People with serious mental illness today are more likely to be homeless or die prematurely than at any point in the last 150 years, with lifespans that are 10 to 20 years less than the general population . . .

In 2015 the former director of the National Institute of Mental Health (NIMH), Thomas Insel, crystallized this disillusionment:

I spent 13 years at [NIMH] pushing on the neuroscience and genetics of mental disorders, and when I look back . . . I realize that while . . . I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.

It does not help that academic psychiatry today feels out of touch. Many people have underscored the profound importance of mental health amid the social isolation of [lockdowns], racial violence in our society, and the increasingly hyper-competitive culture of schools, sports, and the market. But academic psychiatry’s almost singular focus on brain-based research has meant that the profession has been largely absent from these conversations. And for what? All the ‘cool papers’ on neurobiology have won academic grants and helped professors get promoted, but they have not meaningfully impacted the . . . care of the millions of people suffering psychic distress.

How did we end up here? If we have failed to understand psychiatric disorders biologically, what happens when we examine them historically? Two recent books by historians explore the crisis in biological psychiatry, tracing the political, economic, social, and professional factors that led psychiatrists to attempt to pin the reality of ‘mental illness’—and the legitimacy of the profession—on the brain. Written by leading historians in the field, these are big books, in heft and scope, that cover two hundred years of the profession’s failures. They reveal that U.S. psychiatry, across its history, has been dangerously susceptible to hype and ‘cool,’ ranging from enthusiasm for brain dissection in the 1890s to the fanfare surrounding neurotransmitters and genetics a century later.

Understanding the undulating history of psychiatric hype and crisis is crucial today as the profession builds toward its next trend: psychedelics, already heralded as a ‘renaissance’ and psychiatry’s ‘next frontier.’ These two histories demonstrate that the academic and corporate pursuit of such hype has neglected the perspectives of communities most affected by psychiatric research and care, resulting in significant psychological and bodily harm. The strengths and limitations of these important books push . . . us to envision a future world where the billions of dollars invested in biological research are instead redistributed to the communities who need it most—in order to provide the resources necessary for radically reimagined forms of care that center whole humans instead of just brains.”

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10 COMMENTS

  1. I find it ironic that psychiatrists say that “mental illnesses aren’t your fault” but then they proceed to passive-agressivley blame your brain for it without any evidence that can be replicated. So-called “mental illnesses” like “ADHD” and “BPD” are really just a collection of labels based on a scientifically unvalid source- the DSM-IV.
    (Sorry for my spelling errors by the way)

  2. Thomas Insel
    “….I spent 13 years at [NIMH] pushing on the neuroscience and genetics of mental disorders, and when I look back . . I think $20 billion …”

    1. Neuroleptics aka “Antiosychotics” have been around for 60 years BUT have only recently been defined as – (a) having withdrawal syndromes that can actually cause psychosis (b) being most effective at lower doses.

    2. Neuroleptic/”Antipsychotic” Withdrawal Syndrome is a type of Chemically Induced PTSD Condition
    (a) that can completely disable
    (b) …BUT can be successfully accommodated with suitable non drug help.

  3. An important exception that cannot go unmentioned is the biology of childhood trauma. Not only do negative outcomes follow a biological dose-response pattern when plotted against adverse childhood experiences, but there are observable developmental differences in the brain; hypertrophy of the amygdala and deficiency of the prefrontal cortex. These changes lead to lifelong struggles with emotion regulation, impulse control, out of control stress responses, dissociation, and PTSD-related symptoms. And these symptoms are particularly resistant to both medication as well as common therapy modalities such as CBT.

    Unfortunately, as with the other examples, this knowledge has failed to produce a treatment.

    • Actually, the best “treatment” for childhood trauma has been shown to be a healthy relationship with a caring adult or adults. Dr. Bruce Perry has written extensively on this point, as have others. The psychiatric community, as usual, has focused on the ostensible “brain damage” caused by childhood trauma, but have bypassed (or intentionally ignored) the brain-science solution, namely a safe environment with caring parents, which is shown to heal a good part of the damage you describe.

  4. Very interesting articel, with a lot of critical information. But I think a few of the claims are misleading.

    ,,We just don’t know, but we do have evidence that there’s about a 30 percent chance that it will help your mood”
    The Author says that reagarding the effectiveness of antidepressants. But they don’t work better than placebo, as a lot of studies have shown. See for example: Munkholm K, Paludan-Müller AS, Boesen K, Considering the methodological limitations in the evidence base of antidepressants for depression: a reanalysis of a network meta-analysis, BMJ Open 2019;9:e024886. doi: 10.1136/bmjopen-2018-024886

    ,,Current research demonstrates that ECT is safe and effective in the treatment of depression, but like researchers in the 1930s, we still do not know why or how it works.”
    To my knowledge it’s not proven, that ECT works in the treatment of depression, because the scientific evidence is so poor. See for example: Read J. (2022). A response to yet another defence of ECT in the absence of robust efficacy and safety evidence. Epidemiology and psychiatric sciences, 31, e13. https://doi.org/10.1017/S2045796021000846

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