Blaming the Brain: Another Look at Mental Illness

In sections:

In light of recent aggressive efforts by Canada's "national newspaper" the Globe and Mail to promote the concept of 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 http://shagya-blog.blogspot.com/2007/08/fighting-myth-of-men...
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."

Interesting Article, However.......

.......simply because so-called "mental illness" may not be caused solely by "bad brain chemicals" as most bio-determinist Psychiatrists will tell you, it does not logically follow that brain chemicals play no role whatsoever in contributing to an individual's behavior.

The brain is the least understood organ of the human body. I was once told by an MD that not only do we not know why anti-depressants just stop working for some people, we don't even really understand why they work in the first place.

Psychiatry is kind of a fraud; one of the truest things I ever heard was from a Psychiatric system survivor who said "Psychiatrists aren't real Doctors." By that, he simply meant that unlike other Doctors, what many Psychiatrists actually do is manage and control their patients through drugs and threats of involuntary committal, as opposed to actually helping them (a bit of a generalization, but please bear with me). When you visit a Dermatologist for your skin rash or an Oncologist to treat your cancer, you expect them to clear up your skin or cure your cancer. You certainly don't expect them to make your rash worse or accelerate the growth of your cancer.

Yet this is essentially what happens to the Psychiatric system survivors who are prescribed all manner of anti-psychotics, anti-depressants, mood stabilizers, anti-anxiety meds, etc. Horrible side effects such as constant fatigue and tiredness, headaches, upset stomach, sexual dysfunction (including impotence in some men that lasts as long as they are taking the drug), facial ticks, trembling and shaking, even suicidal and homicidal thoughts, are all fairly common in many psychiatric meds. As well, "secured" psychiatric facilities, complete with over-worked and under-paid staff, serve as virtual revolving doors for the many survivors who get "re-admitted" whenever they're not "adjusting" to some new medication or when some shrink who doesn't even have to examine them orders an "involuntary committal".

[Each jurisdiction (province, state, country) has it's own laws, some better than others. In British Columbia, we have the Mental Health Act. Under it's terms, any Medical Doctor (M.D.) can order an "involuntary committal" to a "designated psychiatric facility" (your Family Doctor, your Psychiatrist or the Public Health Psychiatrist who's received some complaints about you from your family or neighbors because they think you've been "acting strange"). Patients are usually given the opportunity to admit themselves voluntarily, but if they refuse, police are empowered to use all "necessary" force to detain them, including tasers. Additionally, any Police Officer or Judge can order a person be taken immediately to a "designated psychiatric facility" for an examination by a hospital psychiatrist. The first Doctor's signature is good for 48 hours, though an examination and signature from a different psychiatrist is required to keep the patient up to 30 days, though most are usually released after 1 or 2 weeks.

Incidentally, mental health survivors committed under "involuntary" orders have essentially no rights: they can be treated against their will, including given drugs against their will. Patients are allowed regular hearings where they may obtain counsel who can argue for their release.]

I would never tell anyone to take meds or not: that is a personal decision. The study from The Lancet of a few months ago, which examined many common anti-depressants such as Prozac, Paxil, and Effexor, concluded that in cases of mild and moderate depression, and even in some cases of severe depression, they didn't even work as well as placebos (sugar pills). This confirmed what I had kind of suspected: that other non-drug methods, such as counselling, cognitive-behaviour therapy, psychotherapy, even changes in exercise and diet, all work better than drugs for mild and moderate forms of depression, even in some cases of severe depression.

Is there a bio-chemical element to so-called "mental illness" (a wider question might be who gets to define what "mental illness" is, as opposed to mere eccentricity or non-conformist behaviour)? I would guess that there is, simply based on my own experiences and the experiences of others. The realtionship between brain bio-chemistry and other factors is more symbiotic than linear.

For starters, being critical and skeptical of theories and arguments that seem too uni-dimensional would be a good start (I said "be skeptical", not "dismissive"). As well, Psychiatry as an institution, a power structure just like any other, needs to be dismantled and replaced with a mental health community that is more holistic and less reactionary, as well as less drug-dependent.

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