It's a Mad, Mad World

This is a reproduction of a 16 September 2016 article by Nick Parkins in Kindred Spirit Magazine.
The article no longer appears to exist online but has been reproduced here as it is felt to be very educational.
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It’s a Mad, Mad World

Nick Parkins investigates whether the rise in mental health disorders implies an advance in clinical diagnosis, or could there be more to it.

‘They called me mad, and I called them mad, and damn them, they outvoted me’ Restoration playwright, Nathaniel Lee, on his confinement to Bethlem Hospital

Samuel A. Cartwright was a 19th century American physician who first described the delusional state known as drapetomania. A mental disorder that Cartwright likened to madness, it was inferred in black slaves of the day as the irrational tendency to flee captivity in pursuit of freedom. His diagnosis attracted the perfectly rational response; beating and depriving afflicted slaves of their big toes to prevent future recurrence.

It is comforting to think we have moved on from Cartwright’s day when wilful ignorance and a want to control went hand in hand. Fortunately our modern concept of mental illness is tailored; and somewhat refined. We no longer look on at witches, or those possessed by demons as something to fear. We are enlightened. Today mental illness is viewed as a physical condition, attributed to abnormal biology and chemistry; the cause of which is often tough to pin down. Instead psychiatry often defines it in the context of signs, symptoms and suffering; as emotions, or behaviour thought abnormal enough to cause distress.

In the UK official statistics suggest that one in ten young people aged 5 to 16 suffers from a diagnosable mental health disorder. I might be forgiven for thinking the world has gone mad; that mental illness, whatever that term implies, is on the rise. But what if I’m not thinking straight?

The charge that mental illness is ill-defined was levelled by psychiatry’s eminent critic and author Thomas S. Szasz. In The Myth of Mental Illness, Szasz writes, ‘Psychiatry exists in the company of alchemy and astrology. To define it as a medical specialty concerned with the diagnosis and treatment of mental diseases commits it to the category of pseudo-science. The reason being, there is no such thing as mental illness.’

As a professor emeritus of psychiatry at the State University of New York, Szasz was an advocate of talking therapy as it applied to consensual practice. He did not seek to diminish psychological suffering or deny its condition. In this context, his claim that mental illness is a conceptual error appeals to reason. Any credible diagnosis relies on a demonstrable physical cause. If mental illness, as is thought, results from a brain disorder – such as genetic and neurological markers that are believed to shape the autistic spectrum – why then, do we refer to such illness as mental and not physical in nature?

Certainly diagnosing mental illness by way of behavioural symptoms alone is a subjective practice fraught with prejudice; what Szasz refers to as judgements of some persons about the (bad) behaviours of others. Unlike a diagnosis of brain disease; which must meet strict objective criteria. From an industry perspective, it might be commercially astute to classify normal as abnormal and enshrine such behaviours in unwarranted treatments having bought out the rights to the brain.

‘I’ve been practising psychiatry for 20 years and from my experience antidepressants don’t do any good. I wouldn’t take them under any circumstances,’ states Joanna Moncrieff, a senior lecturer in psychiatry at University College London. ‘Not even if I were suicidal.’ This point is echoed by cell biologist Bruce Lipton, who cites data collected by University of Connecticut psychology professor Irving Kirsch, which show six leading antidepressants failed to outperform a placebo in over 50 per cent of clinical trials. Moncrieff agrees: ‘After all these years of brain scanning, we don’t even have evidence that depression is related to a chemical imbalance in the brain, so the whole idea that we can treat it chemically is questionable.’ A major problem, states Moncrieff, is the pharmaceutical industry, which is heavily involved and actively invests in organising research into psychiatric drugs and the dissemination of research findings: ‘This raises questions about the scientific objectivity of this research and the extent to which the industry is able to shape the research agenda.’

Non-Conformity

Today we accept new diagnoses like oppositional defiant disorder, and DMDD, (disruptive mood dysregulation disorder); a label that seeks to classify severe and prolonged angry outbursts in children aged 6 to 18. But how does medicine measure oppositional conduct? In this context, Szasz can be heard warning against the dangerous overreach of psychiatry into all aspects of modern life. In this world, what is diagnosed is categorised, and what is categorised can be prescribed and owned. Non-conformity can be a stigma and illness; and with a broad stroke of the brush, the way you think and how you behave is no longer yours to decide.

‘Many people diagnosed with anxiety, depression, substance abuse disorders, schizophrenia, and bipolar disorder are essentially anti-authoritarians who fear that their contempt for illegitimate authorities will make it difficult for them to survive,’ according to clinical psychologist Bruce Levine. ‘A potentially large army of these activists are being kept off democracy battlefields by mental health professionals who prevent the development of political consciousness by pathologizing – and thus depoliticising – normal defiant reactions.’

Clearly a label of madness can stick. Fortunately studies do suggest that autism, schizophrenia, depression and other mood disorders might be viewed objectively; as symptoms of modern society. One example, microwave radiation from wireless technologies, has been linked to hippocampus impairment; and is known to result in cognitive dysfunction and mood disorders. Alternatively Martin Blaser prefers to go with his gut.

As the director of the Human Microbiome Project at the NYU School of Medicine, Blaser has 30 years experience studying the role of bacteria in human disease. It is his belief that autism results from abnormal levels of serotonin; a neurotransmitter involved in the regulation of learning, mood and sleep. ‘We think of serotonin as made and trafficked in the brain,’ states Blaser, ‘but the neuroendocrine cells in your gut actually make 80 per cent of it.’

According to Blaser, these cells rely on gut microbes that produce chemicals essential to normal functioning; cells that include gangliosides; molecules that nerve cells use to build their coats. Antibiotic use, particularly in children, has an adverse effect on microbial communities that produce gangliosides and serotonin that in turn has a knock-on effect on the brain. ‘In an adult, this might not make a big difference,’ states Blaser, but in a newborn baby or young child whose brain is developing rapidly it might; a likely concern given that abnormal serotonin levels have been found in the blood of autistic children.

Broad Spectrum Cause

Mental health issues are complex. In fact the broad spectrum nature of symptoms most likely implies a broad spectrum cause. One that might, to varying degrees, encompass us all. Certainly in light of Blaser’s research, synthetic chemicals used as biocides on food and in water treatments pose a particular concern. Sodium aluminium fluoride (cryolite) and dichlorophenols are common examples of toxic substances, indiscriminate as to which microbes they kill.

Fluoride is a proven cause of gut fluorosis and can stress the pineal and glandular system; a point proven to affect intelligence, mood and psychological clarity. Dichlorophenols – a chemical used as a biocide in tap water – may contribute to the escalating incidence of food allergies in westernised societies. This spectre is also emphasised in the typical over application of biocides on GM-strains of, for example, glyphosate resistant crops. All pose a harmful presence to gut microbes and mental health; an imbalance often associated with schizophrenia and depression. In fact, to Dinan et al. published in Molecular Psychiatry, ‘Recent preclinical investigations indicate that these [gut] microbes majorly impact on cognitive function and fundamental behaviour patterns, such as social interaction and stress management.’

Stress fundamentally impacts on how we perceive and react to events around us. Human cognition studies, according to David Ropeik, indicate that subconscious processes are largely responsible for what the brain does that turn into judgements and behaviour. Ropeik lectures internationally on risk perception and risk communication and suggests this process ‘is based as much as or more on emotion and instinct than on cold hard logic.’ Here the subconscious snap judgements that shape us are driven by mental shortcuts about whether something feels risky. This way of thinking, or rather reacting is innate to our survival instincts that are typified in highly stressful western societies.

In fact it is this fast-acting threat-response system, says Paul Gilbert – the signs of which are so often treated as mental illness – that is nurtured in typically harsh, uncaring and ultra-competitive environments; and acts as a source of anxiety, depression and aggression. As a symptom people that feel shame and self-criticism may struggle to feel relieved, reassured or safe, says Gilbert, Professor of Clinical Psychology at the University of Derby.

Compassion-focused therapy is one answer. ‘This integrated approach draws on evolutionary, social, developmental and Buddhist psychology, and neuroscience,’ says Gilbert. Compassion not only helps to release and soothe distressing emotions, it increases feelings of contentment and well-being. In fact by modelling human behaviour on cooperation, and by developing kindness and compassion towards oneself and others we can help to calm this response. In short, by disconnecting from objective world values and re-engaging under our own terms. ‘I believe depression is an extreme reaction to our circumstances, and the best way to recover from it is to work out the cause,’ explains Moncrieff. ‘Sometimes that means talking therapies and sometimes it means changing your circumstances.’

The Japanese film maker Akira Kurosawa once said, ‘In a mad world, only the mad are sane.’ That may be so. Perhaps it is those of us that keep their toes when all around are losing theirs that have greater cause to reflect.

Nick Parkins

Find out more: Nick Parkins holds a masters in philosophy of the mind [Twitter].

[N.B. This is a reproduction of a 16 September 2016 article by Nick Parkins in Kindred Spirit Magazine. Some minor edits have been made.
The article no longer appears to exist online but has been reproduced here as it is felt to be very educational.]

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