Blaming the Brain ... Another Look at "Mental Illness"

In light of recent efforts by Canada's "national newspaper" the Globe and Mail to promote major psychological difficulties as "mental illness" here is a replay of a short essay from one of the original major critics of psychiatry, the man who 'started it all'. Thomas Szasz MD is widely known as author of The Myth of Mental Illness (1960) and The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (1970). Not very long ago I tried to add a portion of an earlier blog entry to a comment trail on a portion of the Globe's website dedicated to this issue. My item quoted an article published in the Canadian Journal of Psychiatry in 2007. That item denied any biophysical foundation to depression such as reduced hippocampal volume and suggested that such reduction might be the result of drug treatments in the same fashion as "antipsychotics have been shown to do in patients with psychosis". Also the author pointed out that " if I experience an adverse event, I will feel sad, and if this emotion is strong enough, there are likely to be associated biochemical changes - but it is the event that has made me sad, not the chemical fluctuations". Despite these references my comment was not included although scores of anecdotal "first person" contributions passed muster.

MENTAL ILLNESS AS A NAME FOR PROBLEMS IN LIVING

The term "mental illness" is widely used to describe something which is very different than a disease of the brain.Many people today take it· for granted that living is an arduous process. Its hardship for modern man, moreover, derives not so much from a struggle for biological survival as from the stresses and strains inherent in the social intercourse of complex human personalities. In this context, the notion of mental illness is used to identify or describe some feature of an individual's so-called personality. Mental illness -- as a deformity of the personality, so to speak -- is then regarded as the cause of the human disharmony. It is implicit in this view that social intercourse between people is regarded as something inherently harmonious, its disturbance being due solely to the presence of "mental illness" in many people. This is obviously fallacious reasoning, for it makes the abstraction "mental illness" into a cause, even though this abstraction was created in the first place to serve only as a shorthand expression for certain types of human behavior. It now becomes necessary to ask: "What hinds of behavior are regarded as indicative of mental illness, and by whom?"

The concept of illness, whether bodily or mental, implies deviation from some clearly defined norm. In the case of physical illness, the norm is the structural and functional integrity of the human body. Thus, although the desirability of physical health, as such, is an ethical value, what health is can be stated in anatomical and physiological terms. What is the norm deviation from which is regarded as mental illness? This question cannot be easily answered. But whatever this norm might be, we can be certain of only one thing: namely, that it is a norm that must be stated in terms of psycho-social, ethical, and legal concepts. For example, notions such as "excessive repression" or "acting out an unconscious impulse" illustrate the use of psychological concepts for judging (so-called) mental health and illness. The idea that chronic hostility, vengefulness, or divorce are indicative of mental illness would be illustrations of the use of ethical norms (that is, the desirability of love, kindness, and a stable marriage relationship). Finally, the widespread psychiatric opinion that only a mentally ill person would commit homicide illustrates the use of a legal concept as a norm of mental health. The norm from which deviation is measured whenever one speaks of a mental illness is a psycho-social and ethical one. Yet, the remedy is sought in terms of medical measures which -- it is hoped and assumed -- are free from wide differences of ethical value. The definition of the disorder and the terms in which its remedy are sought are therefore at serious odds with one another. The practical significance of this covert conflict between the alleged nature of the defect and the remedy can hardly be exaggerated.

Having identified the norms used to measure deviations in cases of mental illness, we will now turn to the question: "Who defines the norms and hence the deviation?" Two basic answers may be offered: (a) It may be the person himself (that is, the patient) who decides that he deviates from a norm. For example, an artist may believe that he suffers from a work inhibition; and he may implement this conclusion by seeking help for himself from a psychotherapist. (b) It may be someone other than the patient who decides that the latter is deviant (for example, relatives, physicians, legal authorities, society generally, etc.). In such a case a psychiatrist may be hired by others to do something to the patient in order to correct the deviation.

These considerations underscore the importance of asking the question "Whose agent is the psychiatrist?" and of giving a candid answer to it (Szasz, 1956, 1958). The psychiatrist (psychologist or nonmedical psychotherapist), it now develops, may be the agent of the patient, of the relatives, of the school, of the military services, of a business organization, of a court of law, and so forth. In speaking of the psychiatrist as the agent of these persons or organizations, it is not implied that his values concerning norms, or his ideas and aims concerning the proper nature of remedial action, need to coincide exactly with those of his employer. For example, a patient in individual psychotherapy may believe that his salvation lies in a new marriage; his psychotherapist need not share this hypothesis. As the patient's agent, however, he must abstain from bringing social or legal force to bear on the patient which would prevent him from putting his beliefs into action. If his contract is with the patient, the psychiatrist (psychotherapist) may disagree with him or stop his treatment; but he cannot engage others to obstruct the patient's aspirations. Similarly, if a psychiatrist is engaged by a court to determine the sanity of a criminal, he need not fully share the legal authorities' values and intentions in regard to the criminal and the means available for dealing with him. But the psychiatrist is expressly barred from stating, for example, that it is not the criminal who is "insane" but the men who wrote the law on the basis of which the very actions that are being judged are regarded as "criminal." Such an opinion could be voiced, of course, but not in a courtroom, and not by a psychiatrist who makes it his practice to assist the court in performing its daily work.

To recapitulate: In actual contemporary social usage, the finding of a mental illness is made by establishing a deviance in behavior from certain psychosocial, ethical, or legal norms. The judgment may be made, as in medicine, by the patient, the physician (psychiatrist), or others. Remedial action, finally, tends to be sought in a therapeutic -- or covertly medical -- framework, thus creating a situation in which psychosocial, ethical, and/or legal deviations are claimed to be correctible by (so-called) medical action. Since medical action is designed to correct only medical deviations, it seems logically absurd to expect that it will help solve problems whose very existence had been defined and established on nonmedical grounds. I think that these considerations may be fruitfully applied to the present use of tranquilizers and, more generally, to what might be expected of drugs of whatever type in regard to the amelioration or solution of problems in human living.

For a bit more information on "anti-psychiatry" which does NOT require any help from Hollywood dipshits or scientologists check this site from the UK.

One of the myths perpetuated by the Globe and Mail in their oped pages is the idea that the emptying of the mental hospitals was due to the "fortunate" introduction of major tranquilizers like chlorpromazine (marketed as Thorazine). Several commentators like Peter Breggin author of Toxic Psychiatry have disputed this claim saying that de-institutionalization was mainly an issue of economics. From the British Journal of Psychiatry Leon Eisenberg MD, a less severe critic of psychiatry, wrote in 2000

"They (neurolyptics) were credited with emptying the mental hospitals, although the onset of de-institutionalisation had preceded the introduction of the drugs. In catchment areas where ‘open hospital’ and ‘community psychiatry’ policies had been implemented, drugs had relatively little additional effect on length of hospital stay (Shepherd et al, 1961), but they were decisive in hospitals where patients continued to be warehoused (Odegaard, 1964). De-institutionalisation in the USA was driven more powerfully by economic forces (cost-shifting from state to federal budgets) than by theory or data. The decline of the mental hospital census was celebrated without finding out where the former patients were. Elderly patients were ‘trans-institutionalised’ to nursing homes; many long-stay patients were discharged to home addresses that no longer existed, and became street people. Calls to evaluate the community mental health movement (Eisenberg, 1968) were as unavailing as earlier critiques of psychoanalysis."

AND ... from the Manchester Guardian (Feb 27/08):

The creation of the Prozac myth

In the 20 years since its launch, 40 million people worldwide have taken the so-called wonder drug - but research revealed this week shows that Prozac, and similar antidepressants, are no more effective than a sugar pill. So how was the myth created? Psychoanalyst Darian Leader traces the irrepressible rise of the multibillion dollar depression industry, while others explore the clinical and cultural impact of Prozac, its perceived personal benefits- and sometimes terrible costs

Has the depression bubble finally burst? Yesterday's headlines about the inefficacy of Prozac and other bestselling antidepressants must have been an unpleasant shock, not only to the drug manufacturers, but also to the millions of people in the UK taking these drugs. The new research, published in the Public Library of Science Journal, found that a placebo was just as effective as the drugs - excepting in some cases of severe depression, where it was not the drugs that did well, but the placebos that did worse.

What will the impact of this new research be? Is it a case of recognising that the Prozac emperor never had any clothes? Or, on the contrary, of acknowledging the power of placebo and finding new ways of working with it?

For many researchers, the PLoS findings actually reveal nothing new. Several earlier studies comparing placebo with antidepressant drugs had found that there was not much difference, yet these results had little media uptake. The new paper owes its coverage partly to the fact that it includes data from clinical trials that the manufacturers chose not to broadcast. As criticism of the industry's withholding of such results mounted, drug companies were forced to make unflattering results public.

It is only very recently that this has become a legal obligation. In the heyday of antidepressant PR, only about 10% of results about how the drugs affected quality of life were published. More than two-thirds of studies today are industry funded, and such research is four times as likely to find in favour of the drugs than independent inquiry. It is hardly surprising, then, that research has tended to give a positive spin to antidepressants.

The new negative results might seem to promise a change of direction. But they may just be the other side of the industry coin. What remains unchallenged is the diagnosis of depression itself. GPs diagnose it every minute of the day, celebrities reveal they suffer from it and soap opera characters wrestle with it. Yet 40 years ago depression was hardly anywhere. A tiny percentage of the population were deemed to suffer from it. So what happened?

These developments actually followed a surprising course. The story of depression cannot be dissociated from the story of its supposed remedies. And these, like nearly all psychotropic drugs, were not the result of targeted research, but of chance association. The first drugs had in fact been used as antihistamines, yet they seemed to have effects on mood, energy and anxiety.

Although epidemiological studies had found high levels of nervous conditions in the community before these drugs were marketed, this had not been diagnosed as depression. With the marketing of the drugs, this nervous substrata was now labelled as a depression which had gone unrecognised and untreated. Yet this knowledge was not seized on and marketed until the drugs market made this happen in the late 70s.

Where depression had been rated at 50 per million in the early 60s, by the 90s this had jumped to 100,000. These remarkable changes coincided with the crisis in the market for minor tranquilisers such as Librium and Valium, prescribed for anxiety. As these widely used drugs were found to be highly addictive, it looked as if a substantial market was about to collapse. Hundreds of thousands of people took these drugs and the economic gains were enormous. Anxiety had to be remarketed and new agents found to respond to it. And this is where depression started to really take off as a diagnosis. First of all, however, it had to be constructed as a discrete, well-defined clinical entity.

Why couldn't the drugs companies have simply offered their products as tonics or general mood enhancers? After the thalidomide scandal in the early 60s, tough new standards were set in place and drugs had to specify their active ingredients, the outcomes sought and the delivery period for attaining them. This meant a new kind of surface precision. Drugs would have to pass expensive trials proving they were more effective than placebo and do better than other drugs used for this same group of target patients. These new standards brought with them a new technology to evaluate. Randomised controlled trials became the norm, together with a silver bullet model of illness according to which each specific disorder would have a specific cause and a specific treatment.

These changes in the landscape of prescription medicines framed the market for the antidepressants. Since the new diagnosis needed to be publicised, drug companies paid for adverts in medical journals, glossy pullout supplements, conferences and clinical studies to show the prevalence of depression. When Frank Ayd wrote his book Recognising the Depressed Patient, the pharmaceuticals giant Merck bought 50,000 copies and distributed them to GPs. The book argued that depression was going undetected and untreated in the community. This dissemination of knowledge coincided nicely with their marketing of a new treatment for depression in the form of amitriptyline.

The later generation of SSRI drugs had an even more exponential success: by the late 90s Prozac was a household word, with millions of prescriptions and a whole cult of novels, films and memoirs based around it. In 2005, traces of Prozac were even found to be present in British tap water.(more)

Live and learn Grope and Flail!!!!!!