Foreign Correspondents

There are very few things considered more taboo in the world of mental health than the suggestion that problematic family dynamics can lead to a child developing a psychotic disorder. And yet, when we look honestly at the history and research of psychosis and the broader concept of “mental illness,” it becomes apparent that there are few subjects in the mental health field that are more important. I’d like to invite you, then, to join me on a journey into this taboo territory, dividing our trip into three legs. In the first leg (Part One), we’ll go back in time to explore how such a crucial topic has become so vilified, and then embark upon a flight for an aerial view of some of the most essential findings of the last 60 plus years of research that look at the links between problematic family dynamics and psychosis.

In the New York Times’ recent autobiographical account of a “bipolar” woman’s struggle the main message is that the current mental health care system has some real problems but that the general paradigm from which this treatment model has emerged is not to be questioned. Anyone who knows my work knows that I have a real problem with this paradigm, believing that it generally causes much more harm than benefit. So, what is it then about this story that grabbed me? I recognized that if we read Linda’s story while holding a different paradigm, then this story reveals what I believe are some of the most fundamental issues at the heart of this epidemic of “mental illness” that so pervades our society.

Large numbers of studies are being conducted with many claiming internet use causes structural changes in the brain similar to those found in the brains of drug addicts. No snorting, smoking or injecting required. You just have to look at this drug for long enough and your brain is damaged. Is it possible your laptop and mobile phone are the crack cocaine of gadgets?

This column is partly a report on the marketing of Abilify, the atypical antipsychotic that has become America’s best-selling drug.   It’s also an appeal for advice and feedback from the RxISK and Mad in America communities, and a call for some brainstorming about strategy.  The plans laid out by drugmakers Otsuka and Lundbeck for Abilify’s future, and the cooperation they’re getting from leading universities, are alarming enough to me that reporting on them seems inadequate.  We need action, although I’m not sure exactly what kind.

Based on any data from any country it is clear that we have a problem. Mental illness is on the rise. Researchers in the emerging field of nutritional psychiatry have documented the benefits of micronutrients to treat mental illness, showing that micronutrients help treat depression, stress, anxiety and autism and ADHD. Not a single study shows that the Western diet is good for our mental health. Many questions remain to be answered, but we can make some recommendations.

We find ourselves in very interesting times with regard to our understanding of mental health. We find ever more heated, passionate and polarized discussions taking place with regard to the so-called mental disorders — how or even whether to try to classify them, which factors are generally helpful in recovery vs. which factors are generally harmful, what does “mental disorder” or “mental illness” even mean, and what does “recovery” even mean. Given the way my own mind works, I find it helpful, when such conundrums appear, to try to take the issues all the way down to the most fundamental assumptions and experiences that give rise to them, and then try to reconstruct an understanding that is more conducive to meeting our needs. This discussion, then, is an attempt to do just that.

There was a heart-breaking and disturbing story in yesterday’s Guardian newspaper entitled, My Daughter, the Schizophrenic’, which featured edited extracts from a book written by the father of a child called Jani. He describes how Jani is admitted into a psychiatric hospital when she is 5, diagnosed with schizophrenia when she is 6 and by the time she is 7, she has been put on a potent cocktail of psychotropic medications.

I want to follow up my first post by outlining the principles of possible alternatives to psychiatric diagnosis – that is, alternatives in addition to the most obvious one, which is simply to stop diagnosing people.

In the 1950s, when the drugs we now call ‘antipsychotics’ first came along, psychiatrists recognised that they were toxic substances that happened to have the ability to suppress thoughts and emotions without simply putting people to sleep in the way the old sedatives did. The mental restriction the drugs produced was noted to be part of a general state of physical and mental inhibition that at extremes resembled Parkinson’s disease. Early psychiatrists didn’t doubt that this state of neurological suppression was potentially damaging to the brain.

In 2007 I returned to school to pursue a bachelor’s degree in psychology. I remember being confused by the over-emphasis on biological treatments for suffering which seemed to me much more spiritual and relational in nature. A few years earlier, my misgivings had been stirred as I sat on a California beach listening to a friend tell me about what it was like to be on Prozac. She told me that she couldn’t really cry anymore, or connect to her deeper feelings. She couldn’t orgasm. I recall my throat closing up, my thoughts running panicky and confused. I was so disturbed by the power of this drug to rob her of her tears and climaxes, experiences I associated with the more private, sacred parts of being human.

Being the parent of a dead child is hard. Being the parent of a child who died from suicide may be even harder. I love my son and am proud of him and work to make sure that his having lived makes the world a better place.

We have just celebrated the anniversary of the rapidly expanding global Hearing Voices Movement which was founded more than twenty-five years ago following the ground-breaking research of Professor Marius Romme and Dr Sandra Escher. Romme and Escher have advocated for a radical shift in the way we understand the phenomenon of Hearing Voices; in contrast to traditional, biomedical psychiatry which views voices as an aberrant by-product of genetic, brain and cognitive faults, their research has firmly established that voices make sense when taking into account the traumatic circumstances that frequently provoke them.

We are profoundly social beings living not as isolated individuals but as integral members of interdependent social systems—our nuclear family system, and the broader social systems of extended family, peers, our community and the broader society. Therefore, psychosis and other forms of human distress often deemed “mental illness” are best seen not so much as something intrinsically “wrong” or “diseased” within the particular individual who is most exhibiting that distress, but rather as systemic problems that are merely being channeled through this individual.

In the light of the much trumpeted claims that recent research has identified genes for schizophrenia, it is important to review the track record of this type of endeavor. Despite thousands of studies costing millions of dollars, and endless predictions that the genetics of schizophrenia would shortly be revealed, the field has so far failed to identify any genes that substantially increase the risk of developing schizophrenia.

I know that this might sound odd coming from a critical psychiatrist, but I believe that psychiatry has a future. Furthermore, I maintain that a good deal of psychiatry as practised now is helpful and that many psychiatrists manage to play a positive and therapeutic role in the lives of their patients. However, I also believe that we are at our most helpful when we depart from the current biomedical ideology that has come to dominate in our profession. As a first step, we need to get beyond the reductionism that currently guides most psychiatric research and education.

Stephen Fry’s exploration of manic depression (in the current BBC series on mental health, ‘In the Mind‘) has drawn both praise (because of his attempts to destigmatize mental illness) and criticism (because he appears to have a very narrow biomedical understanding of mental illness).  I have sent an open letter to the actor which challenges some of his assumptions about mental illness, and offers a very different understanding to that promoted in his recent television programme.

Just this week, a report written by a task force advising on new dietary guidelines commissioned by the US departments of Health and Human Service and Agriculture recognized the importance of nutrition in mental health outcomes for the first time. Is the public ready to accept the importance of nutrition for mental health?

The Movement for Global Mental Health's objective is to ensure that people living in low- and middle-income countries have access to the best and most effective modern psychiatric drugs and therapies. In pursuing these objectives it assumes that to do so is a neutral project beyond political concerns. China Mills’ book Decolonizing Global Mental Health challenges this view.

Until recently the history of psychiatry was a neglected backwater whose murky depths were explored largely by psychiatrist. The impression conveyed by books such as Tuke’s Chapters in the History of the Insane in the British Isles, Macalpine and Hunter's Three Hundred Years of Psychiatry: 1535 - 1860, Berrios and Freemen's 150 Years of British Psychiatry 1841 - 1991, or Fuller Torrey and Miller's The Invisible Plague, is one that sees psychiatry and modern systems of mental health care as the inevitable outcome of progress through scientific thought, a (white European male-led) narrative from darkness and ignorance to enlightenment and knowledge.

Over the years of my explorations into psychosis and human evolution a very interesting irony became increasingly apparent. It is well-known that people who fall into those deeply transformative and chaotic states typically referred to as “psychosis” often feel, at different points throughout their journeys, that they have received a special calling to save the world, or at least the human race. Indeed, this experience played a particularly prominent role in my own extreme states, as well as within those of at least two of my own family members. From a pathological perspective, this is often referred to as a kind of “delusion of grandeur,” though in my own research and writing, I have come to feel that the term “heroic (or messianic) striving” is generally more accurate and helpful.

Over the last decade, people have commonly made statements to me of the ilk — “What bugs me about antipsychiatry people is they only care about tearing down; there is no commitment to actually helping people” — Which suggests that there is a serious dearth of awareness about antipsychiatry.

I thought I would make a small contribution to the discussion about how coverage of the recent airline tragedy focuses so much on the supposed ‘mental illness’ of the pilot and not so much on the possible role of antidepressants. Of course we will never know the answer to these questions but it is important, I think, to combat the simplistic nonsense wheeled out after most such tragedies, the nonsense that says the person had an illness that made them do awful things. So, just to confirm what many recipients of antidepressants, clinicians and researchers have been saying for a long time, here are some findings from our recent New Zealand survey of over 1,800 people taking anti-depressants, which we think is the largest survey to date.

The serotonin reuptake inhibiting (SSRI) group of drugs came on stream in the late 1980s, nearly two decades after first being mooted. The delay centred on finding an indication. They did not have hoped-for lucrative antihypertensive or antiobesity profiles. Even though a 1960s idea that serotonin concentrations might be lowered in depression had been rejected, drug companies marketed SSRIs for depression even though they were weaker than older tricyclic antidepressants. They sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety. The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance.

For years, people in Germany who act like they are radical antipsychiatry activists have said that in this country psychiatric violent (forced) treatment has been forbidden. Unfortunately, this is not true.

Is "co-production" public service citizen involvement? Is it individual, ‘responsibilised’ health and social care consumerism? Is it power shifting to communities through participatory governance? Perhaps it’s the ultimate post-modern policy concept. But can it work for mental health?