Who Do We Leave Behind When We Ignore the Body? Why Critical Neuroscientists and Mad Activists Must Work Together

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2064

A recent Neuroscience News article is titled Bipolar disorder can be detected with blood test.1 This is one of many recent, oversimplified headlines that encourage us to think we are on the brink of discovering the next biomarker that will scientifically validate biomedical psychiatric disorders. The prevailing logic goes: if we can validate biometric tests that are clinically predictive of mental health concerns like in other medical fields, we can more precisely, effectively, and without (solely) subjective clinical observation, treat the malady. This is a lofty goal in psychiatry, and the suggestion that we are just on the verge of the solution is the message we’ve been sold for over three decades, with very little evidence to show for it.

After decades of research yielding little clinical or practical application, many critical clinicians across disciplines believe the biomarker search is fruitless. Some neuroscientists argue that we should rather focus our efforts on the upstream social and structural factors, such as trauma and inequity, that create the conditions for mental health concerns to arise. Psychiatrist Awais Aftab argues that “biomarkers can be approached in a more conceptually robust manner,” skeptical to the idea that biomarkers can be used to validate pre-defined diagnostic categories, but nonetheless advocating for a more integrative approach. Should we give up the search for biomarkers altogether? If we do, who might we be leaving behind?

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The biomarker debate is one of many that opens up many questions about the relationship between the mind and body in mental health. Perhaps one of the most insidious barriers to truly supportive treatment is that psychiatry is stuck in an identity crisis, facing deep philosophical conundrums. On the one hand, the biopsychosocial model is the most proliferated, which in theory acknowledges psychological and societal factors alongside biological ones, but slapping these three domains together within one model does little to elucidate the interplay between them. Meanwhile in research and practice, it operates more often than not as a “bio bio bio model.”

Both traditional and critical psychiatry have long histories of separating people into two camps: those with “organic” disorders or brain diseases (e.g. autoimmune encephalitis or Parkinson’s) that can cause severe psychological impacts typically fall under neurology’s purview, and those with “psychological” or functional origins (e.g. depression and bipolar) are considered psychiatry’s domain. However, the boundaries of organic and psycho genesis are far too blurry for this dichotomy to be a very useful way of categorizing mind-body concerns. For us to be able to move forward in a non-reductive, non-pathological, and holistic way, psychiatry will have to sort out its philosophy on the relationship between the mind and body.

The mind-body problem in psychiatry has very real implications for those who suffer at the intersection of mental health and chronic illness, which is a much larger group than one might expect. Studies show that up to 74% of people who are diagnosed with a psychiatric condition also have a chronic physiological illness, as well as higher rates of mental health conditions in chronic illness populations. The majority of psychiatrized people are also multiply marginalized, and often trauma survivors. Studies show that experiences of trauma and PTSD are associated with developing chronic health issues and other mental health diagnoses.

People often interpret this interaction through a reductionist lens in regards to the mind and body, asserting that one is simply mentally ill because they’re physically sick or disabled, or they’re sick and disabled because they’re mentally ill. This creates an insidious feedback loop that does little to identify underlying causes of suffering. The reality is often far more complex and indicates the importance of elucidating how the body-mind manifests ill health and how these interactions between what we call ‘mind’ and ‘body’ occur. Both mental and physical health conditions arise from a set of multiple factors, many of which can be said to manifest from a sick society and a system that’s designed for ill health.

Anecdotally, in my own practice as a holistic counselor, I have worked with a substantial number of people at this intersection. I have seen those whose chronic Lyme disease manifested predominantly in anxiety, panic, and compulsions, those whose hallucinations seemed to begin at the same time as a major trauma and the onset of a debilitating autoimmune disease, those whose delusions and paranoia and mania stopped when they were treated for celiac disease and addressed food allergies, and those whose depression lessened dramatically after they treated chronic inflammation. My own lived experience reflects a similarly complex interplay between childhood and developmental complex trauma, autoimmunity, and psychosis.

It would be far too reductionist to propose any kind of singular model to explain these overlaps, and yet the health outcomes for those of us who simultaneously suffer mentally and physically depend on our ability to make sense of these experiences. Traditional biomedical psychiatry, intent on finding biomarkers, seems to be uninterested in truly supporting those who find themselves at the intersection of multiple chronic health concerns. Nor does the field seem amenable to seeing mental health conditions as manifestations of broader social and physiological dysfunction, rather than discrete disorders themselves. The survival of psychiatrized people may just depend on it.

This is a crucial time of transition for psychiatry, and current developments are occurring beneath the public’s awareness. New(er) projects in psychiatry have emerged such as the Research Domain Criteria (RDoC) by the NIMH, which seeks to redefine diagnostics from a dimensional approach instead of the statistically unreliable, outdated and invalid DSM categories, and precision psychiatry, which aims to use multiple biomarker tests to individualize treatment protocols. The push to individualize care rather than give everybody the same medication and treatment, and to move beyond the DSM, are productive goals. Both indicate a willingness to learn from past mistakes and shortcomings, but not enough to truly reconsider foundational assumptions about how mental health concerns manifest. Many wonder: is it possible these are simply examples of traditional disease-centered approaches dressed up in new clothes?

Over the last few decades, two related and emergent medical disciplines have advanced useful and practical insights for mental health treatment: functional psychiatry and psychoneuroimmunology. Psychoneuroimmunology is a medical discipline that examines the links between brain health, the immune system, nervous system, endocrine system, and mental health. Prominent researchers in this field such as Edward Bullmore, head of psychiatry at Cambridge University, have found immune dysfunction and inflammation underlying experiences labeled depression and schizophrenia. Additionally, a 2023 study in JAMA found that “poor body health, particularly of the metabolic, hepatic and immune systems, was a more marked manifestation of mental illness than brain changes,” showing the need to look beyond the brain and to other body systems to identify ways to support those with mental health concerns.

Functional psychiatry looks for the multiple underlying roots of mental health issues, as illustrated by the field’s tagline: “one condition, many causes; one cause, many conditions.” For example, a condition like depression can both contribute to, and be caused by, multiple other health conditions. A functional psychiatrist may consider one patient’s depression to be the compounding result of childhood trauma and hypothyroidism, and another’s to be the result of metabolic issues, autoimmunity, and food allergies. While these fields have made astounding advancements in complicating traditional biomedical psychiatry narratives, they remain largely inaccessible to the public for a whole host of systemic reasons. They also tend to rely at times on scientifically invalid tests due to lack of adequate research funding, and treatment remains inaccessible due to lack of coverage from insurance. While these models are steps in the right direction, they don’t resolve systemic issues that contribute to poor whole-body health.

Clinical psychologist Bruce Levine observes that, “once radical critiques of psychiatry are now mainstream.” Although a growing number of people are aware of problems with psychiatric treatment, what remains taboo is challenging fundamental assumptions that equate mental health concerns with biomedical disorders. Contemporary mad movement activists have worked tirelessly to illuminate the influence of social and structural dynamics on ill health, highlighting racism, classism, and colonial capitalism’s role in how we come to conceptualize what’s ‘normal’, and the carceral nature of mental health ‘treatment’ of those who are suffering. As critical lenses in mental health become more popularized across social media and pollinate adjacent movements, it becomes more important than ever that we bring awareness to all the factors that lead to mind-body suffering and chronic disability. It’s crucial that we include the whole body in our analysis of mental health.

Decades of dominant biomedical rhetoric that reduces mental health concerns to mere imbalances in neurotransmitters have led to a polarized environment, where critical resistance can also remain tethered to a narrow framework, even in its opposition to it. The dialogue around biomedical psychiatry all too often presents a false dichotomy: mental health concerns are either rooted in the brain or society. We can and should continue to locate the dysfunction within society, but we can no longer afford to turn a blind eye to biological dysfunction as intricately tied to societal dysfunction. If we are too willing to throw biology and the body out the window, I fear that we’ve left ourselves out of crucial conversations and will exacerbate the harm done to those who suffer at the intersection of mental and physical health concerns and disability. It’s our responsibility to continue to complicate the narrative around root causes of mental health concerns, and ground in a mad and disability justice framework. We currently face an important opportunity to develop more holistic and generative frameworks for understanding the complex interplay between what we consider mental, biological, and societal. What if we can draw on critical neuroscience research to open up new pathways for those suffering?

Modern neuroscientific findings seem to actually bolster some critiques of the mad movement, such as the immense impact of our social environment on our mental health, and the brain’s dynamic ability to heal and recover from neurological and mental health concerns. Rather than validating reductive biomedical science that narrowly considers genetics and neurotransmitters in isolation, broader neuroscience findings suggest a much different story about brains, bodies, and minds. Famous neuroscientist Lisa Feldmann Barrett debunks common myths and suggests better ways to understand our brain grounded in neuroscientific findings in her book Seven and a Half Lessons of the Brain. She explains that our brains are complex networks and there are multiple ways for the brain to realize any specific state of mind, a concept called degeneracy. Our brains have immense capacity to change, learn, and adapt to novel experiences, a popular concept called neuroplasticity.

Additionally, brains don’t produce a single kind of ‘normal’ mind, and there doesn’t seem to be a unifying human nature in regards to our ways of thinking and being; instead, our brains are primed for diversity and heterogeneity. Our emotions are not hardwired, innate features, nor are they located in distinct parts of the brain in opposition to ‘rationality’ or cognitive facets. Our highly complex brains evolved along with, and in direct relationship to, increasingly complex human bodies and organs, making other bodily systems intricately tied to the brain. And perhaps most meaningfully, our brains are formed by our environment, so much so that considering ‘nature’ as separate from ‘nurture’ is senseless, according to Barrett.

While there’s naturally much debate about organizing principles of the brain, or how we should interpret emerging findings, many of the questions that neuroscientists are pondering open up space for questioning prior assumptions about the mind, emotions, and mental health. Ultimately, both traditional and critical psychiatry communities will have to dramatically revise the still-dominant reductive theory of mind and mental ‘illness.’

This process of elucidating the relationship between mind, body, and society, for the sake of evolving and improving treatment for mental and physical health, will require collaboration across fields and interdisciplinarity. We need more philosophers, neuroscientists, and lived experiencers working together to excavate previously held assumptions and propose better care. Cross-disciplinary work is especially crucial to avoid the pitfalls of dressing up old paradigms with new fancy labels.

Naturally, not all facets of mental difference or what gets labeled as “dysfunction” in the eyes of capitalist-driven norms will require medical attention. There’s a way for us to honor neurodiversity, while also not leaving behind those who suffer from chronic illness and who desire support with whole body health. I don’t dare to offer a complete or definitive solution to our problems, but I become increasingly curious how critical neuroscience can help the mad movement, and what a disability-justice centered neuroscience can look like in service of whole health.

Show 1 footnote

  1. This title is highly misleading as researchers found that only combined with self-report measures can certain biomarkers marginally better predict a diagnosis of bipolar compared to major depression. However, it also fails to mention that only one biomarker, a ceramide, had a significant correlation to only one symptom, mania.

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14 COMMENTS

  1. I am so happy to read this article in a bittersweet sort of way. If concepts described in this paper had been included in the care that both of my daughters received, Catherine would still be alive today, and they both would have fared much better. I am not dismissing my own imperfect parenting and communication skills, nor the structural and economic dynamics that limit our choices of care. There are so many factors that could have wonderfully made a positive difference if they were made tangible and available.

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  2. There is a hell of a lot of data that suggests WE, a people do know! Critical Activists and MAD Scientists are already working together! Though to embrace the Whole, then the context of the inquiry is challenged to wonder how and why the separation of the mind with an “and” body. For to just be still a little bit, while receiving the Blessings, perhaps even from this posting or not, should awaken the audience and readership to the brutal reality(s) of lives lost, in service to our country’s medical research if not around the world. Just look at the Senator from Arkansas, Tom Cotton who is mad at the protestors describing them as “lunatics”. Then go and search out Jimmy Warde, his story from experiencing the Arkansas Lunatic Asylum. He published his story and would be buried in Mt. Holly Cemetery, where in being back in Little Rock, this past week, even the Sexton of the Cemetery knew of our families history. Hence, to know the history(s), the migrations and how and then why we are and of the threads of civilization either becoming wiser or only a cotton pickin machine, then how do we call out and speak higher truths to power, when the records are speaking of many bricks made with straw. The truth and learning how to communicate along with empowering others around the globe, seemingly is the “Orders Up” for Today. Thank you for your insights!

    P.S. – What did you do with heart?

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  3. The mind and body are inseparable; each affects the other in ways that are impossible to completely delineate or isolate. And there’s really no need to do so.

    Acupuncture and other somatic practices gently calm and reset the central nervous system NON-TOXICALLY which enables the reduction of bodily inflammation and the release psychic trauma stored in the body.

    Holistic treatments are the way to go because the human system is delicately interconnected.

    Psychiatric drugs are not biologically corrective or emotionally restorative; they are TOXIC AGENTS that harmfully anesthetize the entire human system.

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  4. Um, it seems to me that the researchers who stated “poor body health, particularly of the metabolic, hepatic and immune systems, was a more marked manifestation of mental illness than brain changes” need to routinely distinguish in their research, those who present with psychiatric symptoms and are medication naïve and those who present with psychiatric symptoms and who have been exposed to medication, especially those who have been taking meds for a very long time. In my mind, the medication itself, it not only ineffective for a huge population of folks, it is actually causing some of the very same autoimmune and inflammatory responses you are talking about. I have come to believe that so-called ‘anti-psychotics are ‘aging pills’ based on my daughter’s poor health. This problem goes beyond failure of imagination and failed research, it goes into the legal realm of liability, and reparation for significant, physical, psychological, and mental harm. Who can be held liable for damaging my daughter for six consecutive years of forced drugging and institutionalization now that she has all the symptoms of chronic, physical illness on top of everything else? Many of my parent peers are asking the same questions about their adult children who have been significantly harmed by psychiatry. While I applaud your call for neuroscientists to work with mad activists to prevent harm to future generations, how do we shift the paradigm of research while addressing the impacts of past harm and to provide services tailored for those who were misled by psychiatry’s false promises?

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    • How do we shift the paradigm of research while addressing the impacts of past harm and to provide services tailored for those who were misled by psychiatry’s false promises?

      By suing the pants off the American Psychiatric Association to the point it no longer exists.

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  5. Concerning two family members with lived experience of psychiatric diagnoses and inhumane psychiatric care, over time I began to notice that inflammatory conditions preceded flare ups of mania, that giving those conditions proper medical condition hastened resolution of mania. The delay to treat and resolve inflammatory conditions prolonged the manias and exposed the patient to more toxic drugging. One daughter was repeatedly subjected to torturous titrations of ineffective anti-psychotic. During those times she suffered clearly stressful levels of akathisia over weeks and months, which I believe is the reason she developed symptoms of Cushing Disease; the physical distortions of the body which are produced are irreversible.

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  6. What about how ER stress can be triggered by stress hormones (emotional reaction), chemical stress (medications and pesticides), or physical stress (boxing). I believe bipolar and Parkinson’s are the same underlying vulnerability and the treatments for each (levadopa, antipsychotics) result in an injury that causes the other.

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  7. Amazing work, thank you very much!

    Even when we don’t wish to miss the mark, we do.

    Even when we struggle to become aware of the obvious, we fail.

    Even when we now have at our disposal the works of Eckhart Tolle to elucidate Jung and Jesus, we fliunt!

    Much love.

    Tom.

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  8. Better and more workable models of the human experience were proposed in the 1950s – and ignored by academic medicine. They are still in use by thousands today, much to their benefit. However, their suppression in the academic community has resulted in the almost total oppression of those who cannot afford treatment from private practitioners.

    That these models are not even discussed on this website is a testimonial to the thoroughness of their suppression. Why does the new generation – aware that changes are needed – not refer back to those models and learn something about them? Instead they are enthralled by the “new” (but not really that new) field of “critical psychiatry,” which is basically a social justice movement, not a psychological theory or practice.

    Yes, the field of mental health does need a greater awareness of social justice. Just as with body health, the economically advantaged are still getting the bulk of the benefits from less suppressive practices, and even normal everyday medical services.

    But it has been obvious since way before the 1950s that there was something wrong with psychiatry. Lobotomies had been popularized in the late 1940s, after the various “shock” therapies of the 1930s were proving unworkable. Hubbard stepped into that mess with his research, theories and practices and got a lot of public support, but mostly scorn from academia. Later an academic (Ian Stevenson) demonstrated the reality of reincarnation, a crucial part of Hubbard’s theory.

    A persistent resistance in “modern” academia to the recognition of a spiritual factor has only become more blatant, as its incorrectness becomes more apparent. More in academia need to take up this subject, study it and write and talk about it. Right now we really only have Jim Tucker’s group at the University of Virginia School of Medicine. We need more voices that are supportive of his work.

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  9. Larry, thanks for a most magnificent essay.

    But…

    1. While I, personally, have not as yet read any and MIA blogs or podcasts extolling a Jungian or spiritual approach to human suffering, there have been many, many such comments published here, my own included.

    When it’s occurred to me that the end of coercive psychiatry might mean the end of MIA, too, I have reminded myself that the work of Robert Whitaker has been at least as heroic as that of any human being I am aware of

    2. You mention “a spiritual factor.”

    “Hyperreligiousity” used to be one of the supposed telltale signs/symptoms of the supposed condition known as “bipolar disorder,” at least until it was realized that the term, like “double depression” before it, told a tale on the pseudoscientific religion of contemporary coercive psycho pharmacology

    The term itself, obbiously, was a telltale sign that Judeo-Pauline Psychiatric would not tolerate a whiff of that which it senses spells its own end, and its reason fro rejecting Jung – Spirituality.

    3. There is and can be no spiritual factor, of course, for if anything is spirit, everything can only be, and our every thought, word and deed since we were primordial slime and beyond, must have been leading to our now imment en mass human spiritual awakening.

    4. Looking for true biomarkers for any supposed “mental health conditions,” “psychiatric diseases/disorders” or “personality disorders” (of all the crazy terms, is that not the self-evidently most transparently ludicrous of them all, when still used witha straight face?!) absent true “neurological” conditions – diseases and disorders affecting the brain/nervous system, is obviously like looking for the Emperor’s Invisible Clothes: Anything found can only turn out to be fluff or hair.

    I have viewed/listened to Jill Bolte’ Taylor’s wonderful TED talk scores of times.

    https://www.ted.com/talks/jill_bolte_taylor_my_stroke_of_insight?showsSubtitleTooltip=true&language=en

    But, with the best will and most brilliant and illuminating technology in the world, of course I don’t ever expect her or anyone to stumble on microscopic evidence for a cause of “schizophrenia” or “bipolar disorder.”

    Ironically, by Jill’s own definition of that diagnosis, it seems to me that, insofar she has thus far failed to share her own dream with everyone, and made it a reality, Jill, herself “suffers from schizophrenia.”

    Thanks, again, for your own wonderful essay, Larry.

    Best wishes.

    Tom.

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  10. I am guessing that whole libraries of learned tomes could usefully be discarded once Einstein and others had helped us understand that energy and matter are one.

    I believe something similar may be happening now as we grow to understand that our collective human psyche is one, of which our individual psyche is but one part, that a part of that psyche is our mind, that our mind consists of thoughts and emotion, that emotions occur when the mind interacts with the body, that such interaction can cause disease, and that physical disease, so often a product of stress/imbalance, can only be effectively dealt with by addressing its root causes.

    It’s a long time now since Seneca observed that a healthy mind dwells in a healthy body.

    Once we identify relevant first principles, solutions become obvious, at least.

    The human psyche consists not just of the mind – our thoughts and emotions, an infinitesimally small part of it – but of that vast, limitless and eternal awareness which can now learn to use our minds for good;

    Physical pain consists (initially, at least) of sensation and the emotion of fear (or resistance to that the sensations), but that stress/fear may subsequently reproduce those sensations and others so faithfully as to fool us into believing that ongoing structural issues (sometimes considered to be the effects of chronic Lyme disease, Covid, brucellosis etc.) by engaging brain circuits to simulate the original or other insults, perhaps a little like wheels in an old clock).

    Fear arises with feelings of isolation when we believe that we are our oh-so-vulnerable minds and our oh-so-vulnerable bodies and no more. Oh, and that YOLO, of course: You Only Live Once.

    Freedom arises when we learn to let go of such feelings, having found the source of our fear.

    Perhaps this is the only lesson which all the greatest teachers of humanity have labored to teach us?

    Apart from the likes of Mary Magdalene, Julian of Norwich, Teresa of Avila and Hilda of Bingen, no doubt there were many other wonderful female teachers whom this male-dominated world…well, you know, obliterated from history.

    But lessons in love can never be entirely obliterated, and no doubt “all we do in life echoes in eternity.”

    Distracted as he was by our physical cosmos, Einstein may not have given us all the elucidation he might have about our real virtual world, although he certainly left some pearls for us:

    ‘Besso died in Geneva, aged 81. In a letter of condolence to the Besso family, Albert Einstein wrote “Now he has again preceded me a little in parting from this strange world. This has no importance. For people like us who believe in physics, the separation between past, present and future has only the importance of an admittedly tenacious illusion.” Einstein died one month and 3 days after his friend, on 18 April 1955.’ From https://en.wikipedia.org/wiki/Michele_Besso

    “Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.”
    ― Albert Einstein

    https://www.youtube.com/watch?v=4DXDDf2FRMU – Jiddu Krishnamurti (or is it Yoda?)

    https://mail.google.com/mail/u/0/#inbox/KtbxLvhVdtvnKqhrWKRXJhdzPxPpFmPXpL?projector=1 – Howard Schubiner in conversation with Dr Ranjan Chattwerjee

    Perhaps we are all now rapidly approaching the place where we get it?

    Heartfelt and soulfelt thanks, Jazmine and MIA.

    May the Force be with you all, always: “God” rest ye merry!

    Tom.

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