Thursday, October 28, 2010
Continuing on from yesterday. As you recall, I began my piece with an American Psychiatry Association annual meeting I attended in San Francisco in 2003. During the meeting, I happened upon a street demonstration of psychiatric survivors brandishing "Psychiatry Kills" and similar signs.
A few months later, six individuals associated with MindFreedom staged a sophistic public display that boiled down to challenging the APA to prove that mental illness existed, with demonstrable biological causes and effects. Robert Whitaker in "Anatomy of an Epidemic" cited the MindFreedom campaign with approval, noting they had "won this battle." In yesterday's piece, I corrected him. In fact, nobody won. Rather, we all lost.
It works this way: When the loudest in our midst are in denial about the reality of mental illness, we simply don't get decent funding for its research and treatment. The funding goes to illnesses whose patient populations have their act together. Thus, for every dollar the NIH spends researching HIV/AIDS per patient, depression and bipolar get one penny. One penny.
In Sept 2006, a friend took me to a function at a drop-in center in Berkeley, CA, organized by antipsychiatry activists. The meeting started with everyone in the circle, myself included, introducing themselves. One guy bragged how he spearheaded a drive to outlaw ECT in Berkeley in the 1980s.
You’re actually proud of that? I wanted to say.
Another happened to reveal how she organized the very demo I had witnessed outside the 2003 APA in San Francisco. I had to use all my self-control to breathe through my nose. Here is what I was thinking, sitting in my chair, polite smile frozen into place:
If you had actually followed me indoors rather than made noise on the streets, you might have actually learned something.
The speakers inside actually addressed the questions the MindFreedom people had posed, in a nuanced way that totally challenged the thinking of everyone in attendance. So much so that three years later in Berkeley my head was still spinning. At the APA, I heard Daniel Weinberger of the NIMH report on a 2002 study I have mentioned many times in this blog and elsewhere.
The study linked a certain gene variation to the fear response in the amygdala in the brain's limbic system. For possibly the first time, we had a connection between a gene and emotion. This is not the same as saying we have a connection between a gene and a DSM mental illness. Critical distinction.
At about the same time, a study on a birth cohort in New Zealand found that those with this exact same gene variation had a much greater tendency to become depressed when exposed to certain stressful situations such as financial difficulties.
Again, this is hardly the biological causal link that MindFreedom was demanding. The brain is way too complex to yield those kind of pat answers. What these and numerous follow-up studies showed in essence was that bad things tend to happen when a biologically vulnerable brain is exposed to stressful situations. It's an old theory, but now the brain science was beginning to validate it.
No one talks about genes and biology in a vacuum anymore. It's all about the how genes and biology and environment interact.
At another session, I heard Robert Freedman of the University of Colorado tell a demonstrably appreciative crowd that "genes do not encode for psychopathology." In other words, forget about finding a depression gene or a bipolar gene or a schizophrenia gene. Dr Freedman is a pioneer in "endophenotype." He wondered why those with schizophrenia craved cigarettes. He discovered a variation in a nicotinic receptor gene that may account for this, that had to do with "auditory gating" that plays a major role in tuning out distracting noises.
Ah, if we could only tune out the distractions.
Again, hardly a direct biological causal link to a specific mental illness, which was Freedman's very point. The brain is not organized according to the DSM. That's one reason "depression," "bipolar," "schizophrenia," "anxiety," and so on are at best rough guides. Two individuals with bipolar, for instance, may not even have the same symptoms in common. But they are both likely to have messed up sleep. So let's investigate the messed up sleep and see if that will give us insights into why we find ourselves too depressed to get out of bed in the morning.
Then, maybe, we can come up with specific treatments that address our real problems rather than stupid one-size-fits all remedies that fit only a lucky few. Assuming we get some decent research funding, that is.
That's why "chemical imbalance" of the brain doesn't begin to tell us what is going on. Whitaker very elegantly debunked that particular myth in his book, along with the fallacy of treatments to correct this chemical imbalance. An antidepressant to treat depression? It's a stupid idea if we persist in thinking a depression is a depression is a depression. So far so good. But then Whitaker mistakenly assumes that because the chemical imbalance myth is wrong then the whole premise of psychiatry is wrong.
Whitaker not so implicitly takes this further: If psychiatry is wrong, then antipsychiatry has to be right. The problem is there is no nuance to antipsychiatry. Its spokespersons deny that mental illness exists in the first place, along with the possibility of finding treatments, which explains why everyone at the meeting I walked into in Berkeley talked about their experiences in making noise rather than helping people.
What is really going on is that the whole premise of psychiatry is changing to a point where it may not be called psychiatry anymore. The smart thinkers in the field know that the biological psychiatry/disease model of behavior is long past its sell-by date, and that a new science of the mind is taking its place, even if this is not readily apparent at street level. That is what I observed inside the APA annual meeting in San Francisco in 2003. I wish some of the protestors outside could have followed me in. I wish Whitaker could have followed me in.
Previous blog pieces:
Thanks to Stupid Advocacy, Your Life is Worth Just One Penny
The Study Psychiatry Wishes Would Just Go Away - Part II
The Study Psychiatry Wishes Would Just Go Away
Is the Cure Worse Than The Illness?
The Whitaker Controversy: An Irony in Search of Nuance
If Meds Work as Well as Our Psychiatrists Tell Us, Why Do We Have MORE Mental Illness Today Rather Than Less?
RIP: Chemical Imbalance in the Brain