This guy goes to a psychiatrist and says,
"Doc, uh, my brother's crazy; he thinks he's a chicken."
And, uh, the doctor says, "Well, why don't you turn him in?"
The guy says, "I would, but I need the eggs."
Woody Allen in Annie Hall.
What if our concept of depression, anxiety, schizophrenia, bi-polar, personality disorder and so on as types of mental illness was all wrong?
An influential group of thinkers in the 1960s and 70s, roundly described as the Anti-psychiatry school thought this was the case. Were they completely mad?
I once commented on a below the line section of an article in the Guardian that mental illness, as we know it, does not exist. I added caveats explaining my position but I was bombarded with people telling me I was full of crap, didn't understand depression, how they certainly experienced mental illness so how can it not exist? To suggest mental illness doesn't exist makes people mad (in the American idiomatic sense). We're completely steeped in the idea that mental illness is an illness akin to biological illness. Yet this is based on faith, you know like
because there is not one jot of evidence that depression, or indeed mental illness per se, is biological, or dare I say it, dare, dare...that it even exists at all.
My position was fairly straightforward. All the things we consider to be mental illnesses; depression, etc. are not actually illnesses. The common Anti-psychiatry position is that if it doesn't show up on an autopsy how can it be a sickness? In the biological sense, depression, as an example of mental illness, doesn't have any physical signs. A depressed person feels melancholia, probably insomnia, lethargy, hopelessness, and so on. But these aren't biological symptoms. Just as neurological scanning of depressed brains so often show different chemical make-ups, different synapses firing or not, the depressed person's signs of depression are 'after the fact.' That is, you go to the doctor because you can't sleep and feel hopeless and the doctor diagnosis depression. But while hopelessness and insomnia make one depressed, the doctor is diagnosing depression as the cause of these symptoms. Yet no one can define what depression is. It's these symptoms, after the fact.
Contrarily, for many years the psychological fraternity pushed an idiotic idea that chemical imbalance (most notably low serotonin) was the cause of most mental illness. This has begun to lose favour because it's so obviously ridiculous and some have woken up to the idea that a neuro scan of a depressed brain with low serotonin doesn't necessarily follow that the low serotonin caused the depression but is perhaps rather a sign, symptom or marker of feeling depression.
So it's equally simplistic to say these sets of symptoms (insomnia, hopelessness, etc.) cause depression as, of course, if you're depressed then you'll probably have difficulty sleeping, begin to feel hopeless, and so on. It's the classic paradox, of chicken and egg.
It's far more sensible to see depression, hopelessness, insomnia, and so on as the same thing rather than a cause and effect.
But how does that not make it a mental illness? Well, the first part, mental, is only half the story, and the second part, illness, implies both that it's organic and that it's curable.
Depression isn't organic. It's not like a physical disease, like a cancer or kidney failure. Apart from symptoms being vague and often contradictory (insomnia and needing to sleep a lot more are both considered symptoms) there has never been any evidence that depression, or indeed mental illness per se, has a physical, organic cause. Even twin studies of schizophrenia, the king or queen of organic mental illnesses, have repeatedly failed to show a genetic cause.
If we were to accept that, say, depression had both a physical and mental appearance, say, actual physical exhaustion, insomnia, aching muscles, alongside the more nebulous melancholia then is it both a physical and mental illness?
And, as I suggest, if it is an illness then it's perfectly feasible to assume that it could be cured. How would one cure depression? We don't even know what it is. It's almost certainly always existed around humans (and perhaps other animals). So in an age where we know everything (from what the universe is made of to where humans came from to how to build Ikea wardrobes) why don't we know the first thing about mental illness?
At present, mental illness in most forms, is treated biologically. If you feel melancholic and see your doctor then they will almost certainly prescribe a course of anti-depressants. The ubiquitous form at the moment is Mirtazapine (Remeron). It's marketed as a "Tetracyclic Anti-Depressant."
Quite recently (February 2018), a major study of drug trials for depression was carried out by Andrea Cipriani et al The Lancet and found " In terms of efficacy, all antidepressants were more effective than placebo." Mirtazapine was the second most effective after Amytriptyline (an old school SSRI).
The study was hailed as proof to doubters thatGod exists anti-depressants do work in some vague way at very slightly ameliorating symptoms of depression.
The drugs do work: antidepressants are effective, study shows
It's official: antidepressants are not snake oil or a conspiracy – they work
Just two such headers from The Guardian.
Of course, if you read the study it actually just reinforces received wisdom that anti-depressants, in studies, tend to affect participants more than placebos. Ignoring the fact that only positive results for drug trials tend to be published ("409 (78%) of 522 studies were funded by pharmaceutical companies") and that results rely on personal testimony of participants rather than some solid measurable criteria ("The great majority of patients had moderate-to-severe major depressive disorder, with a mean reported baseline severity score on the Hamilton Depression Rating Scale"), this just reinforces the obvious that if you give someone a mind altering chemical then it will effect them in some way more than if you don't.
Obviously, the sight of someone in a white coat giving you 'medicine' tends to have a placebo effect anyway. Advertizers know this, of course.
They even do studies themselves.
What the Cipriani study does show is that placebos work quite well too. And that the drugs themselves are only marginally better than placebos. But they do have more of an effect than placebos across most studies ergo they are effective. Effective at what?
"Our primary outcomes were efficacy (response rate measured by the total number of patients who had a reduction of ≥50% of the total score on a standardised observer-rating scale for depression) and acceptability (treatment discontinuation measured by the proportion of patients who withdrew for any reason)... Secondary outcomes were endpoint depression score, remission rate, and the proportion of patients who dropped out early because of adverse events. When depressive symptoms had been measured with more than one standardised rating scale, we used a predefined hierarchy, based on psychometric properties and consistency of use across included trials. In the absence of information or supplemental data from the authors, response rate was calculated according to a validated imputation method..."
It's typical of scientism associated with psychiatry. The study is a meta analysis of other studies so it's simply gathering data and averaging out. The data refers to people taking anti-depressants in studies over 8 weeks so very short term responses. "In total, 87 052 participants were randomly assigned to an active drug and 29 425 were randomly assigned to placebo."
You might think, why wasn't it a 50/50 split between drugs and placebos? Well, the study looked at Double Blind trials (where neither researchers or participants know who is getting what), Parallel (two groups) and Randomized Control Trial where participants are randomly chosen for the drug or control (placebo) group. The study doesn't show how many are Double Blind (which I find the most reliable). But the study does suggest:
"46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low."
Does that fill you with confidence?
The trials were mostly North American and European (75%) and a median age of 44 for both males and females.
They found, intriguingly, that head to head (as in, measuring efficacy of Mirtazapine to say, Sertraline, to second generation anti-depressants) there were large differences in efficacy yet when measured against placebos:
"...there was more diversity in the range of efficacy and dropout patterns seen across the head-to-head comparisons than the meta-analysis of antidepressants versus placebo."
Yep, when groups took drugs they experienced similar responses but when they took different drugs they experienced different responses. I sat last night and took no drugs. I've just lined a quarter gram of coke and feel much better. I'm off in a minute to mainline me some horse. I shall addendum the results later. I intend to ask a lot of other drug users and a small handful of non-drug users their experiences in the short term after taking or not taking drugs and their responses on the Arkady Hughes Mood Altering Substance Scale before and after and cross reference matrices of median results.
When you take any drug (I just ate some chocolate) you experience changes to your mood, thoughts, feelings, motivations, etc. If you're given a drug or placebo and don't know which it is but experience physical or mental alterations this would naturally result in you assuming you are not on the placebo. The anti-depressant thus boosts the placebo effect.
In articles from the Guardian, above, claims were made, on the basis of this incredibly fragile evidence. Unravel this...
"The debate over antidepressants has unfortunately often been ideological, said Cipriani. Some doctors and patients have doubts over whether they work at all and point to the big placebo effect – in trials, those given dummy pills also improve to some degree. Some people suspect drug companies of fiddling trial results. Some patients simply do not want to take pills for a mental health condition."
"Antidepressants and psychological therapies – of which the most frequently used is CBT (cognitive behaviour therapy) – have similar success rates. Around 60% of people respond by about two months to the drugs with about a 50% reduction in their symptoms - an improvement in mood, better sleep and so on. But, he said, “about 80% of people stop antidepressants within a month”."
My maths is bad but...only 20% continue anti depressants after one month? Of that 20% just over half respond after two months? And those experience a 50% reduction in symptoms? So of those put on anti-depressants only 10% experience a half reduction in their symptoms?
Wow. Effective.
"Professor Carmine Pariante, spokesperson for the Royal College of Psychiatrists, said the analysis “finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression. Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin.”"
You can go on believing that pharmaceutical companies gave access to studies showing their drugs were useless. Keep on believing that.
Carmine Pariante has claimed that depression could be caused by brain inflammation.
And argues here that bio-medicine and psychiatry are the same thing and goes further:
"Because there is no difference between medicine and psychiatry. And nothing has changed since the beginning of times, when our ancestors first used latex from the opium poppy and leaves from the salix tree. We have a body (which includes a brain) that feels changes in functions or sensations or emotions (symptoms), which sometime other people can see (signs), and that can be induced, or modified, by external agents: the poison of a snake; the deadly effect of a bacterium; the extract of a leave; the assault of a predator; the ruthlessness of discrimination; or the chemical product of a pharmaceutical plant. Nothing more, nothing less...We and others are testing anti-inflammatory drugs to treat depression: this is targeting a biochemical system in the body, to induce downstream effects in the brain, to eventually affect processes relevant to depression. How is this different from the rest of medicine?"
Because, Carmine Pariante, depression is almost certainly not organic (and it's just ridiculous to suggest inflammation of an organ causes mental illness, what century is this?) so the analogy is completely false and depression, oh God do I have to say this again, is NOT a brain disease. So yeah, take everything this man says with a pinch of salt. It's worth reading his whole piece to see how wrong headed his argument is (and yes, he does liken using anti-depressants to using biomedical interventions for cancer...sigh). But other than that, can you trust him?
"Dr Carmine Pariante has received Funds for a member of staff and funds for research. Professor Pariante’s research on depression and inflammation is supported by: the grants ‘Persistent Fatigue Induced by Interferon-alpha: A New Immunological Model for Chronic Fatigue Syndrome' (MR/J002739/1) and ‘Immuno-psychiatry: a consortium to test the opportunity for immunotherapeutics in psychiatry’ (MR/L014815/1; together with GSK), from the Medical Research Council (UK); the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre in Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London; by Johnson &Johnson as part of a programme of research on depression and inflammation; and by a Wellcome Trust-led consortium that also include Johnson & Johnson, GSK and Lundbeck."
Probably not.
In the Guardian piece:
"Dr James Warner, reader in psychiatry at Imperial College London, said: “This rigorous study confirms that antidepressants have an important place in the treatment of depression. Depression causes misery to countless thousands every year and this study adds to the existing evidence that effective treatments are available.”"
According to the study leader, Andrea Cipriani, the treatment is marginal at best.
The most bizarre argument is put forward by Mark Rice-Oxley in the Guardian, above.
"It’s official: antidepressants work.
They are not a multibillion-dollar conspiracy dreamed up by Big Pharma Bond villains. They are not a snake oil distilled in secret laboratories, designed to stupefy us all. They are not a futile cop-out from overextended family doctors.
They are an effective treatment to alleviate symptoms of depression, a global scourge that affects as many as one in 20 people on the planet. Even the least effective antidepressants are better than placebos, the sugar pills dished out in trials. And placebos are better than nothing. [my italics]"
How about that? Anti-depressants work. So do sugar pills. So it isn't some pharma conspiracy, you could just eat some sugar and that'll do the trick too. Listen to the soothing screech of Brian Molko. Just don't do nothing*.
* Except there are studies suggesting that long term use, habituation (relying on the drug if not actual addiction) and withdrawal are actually less effective for some than simply trying to cope without.
Rice-Oxley's piece brings me back to my initial argument. Mental Illness. His muddled thinking is typical of discussion around the subject:
"The upshot of this, the most intensive piece of meta-analysis ever conducted into antidepressants, is that the millions of people (including me) who take them – reluctantly, sceptically, hopefully – can continue to do so without feeling guilt, shame or doubt about the course of treatment."
Guilt? Shame? Doubt? This sounds like some bizarre religious experience (psychiatry anyone?) rather than anything like science. Rice-Oxley has cashed in on (or reached out with) his depression by writing a memoir on how he recovered from depression. Sort of. Many famous people find it cathartic and financially conducive to write about their own misery. For Rice-Oxley the way forward is thus:
"Moreover, doctors should feel no compunction about prescribing these drugs, though really they should be reserved for serious cases, and should be offered as part of a mix of interventions such as CBT, group therapy, work sabbaticals, mindfulness-based cognitive therapy, exercise, education and local support networks."
What is a serious case? How does one measure that other than asking the individual (usually using an index, do you feel suicidal? a) Sometimes b) Quite a lot c) All the time d) how do you tie this damned knot?) CBT is about as effective as anti-depressants (or sugar pills) and is not usually reliable in suicidal cases, which are surely serious cases. Most of this is either obvious or sticky plasters. Where is the cure? Far more importantly, what is the cause? No one's mentioning this. Isn't that weird? Imagining treating cancer without having any idea how to not get cancer in the first place.
If anti-depressants don't cure mental illness but merely ameliorate symptoms then what is their function beyond making you, the mentally ill, function?
Imagine some doctor going on TV and saying we need to cure cancer now.
Why? asks the presenter innocently.
Because cancer patients are a burden on the state and its finances.
Imagine that. We'd all be shocked, right. Yet this illness, mental illness, is talked about in exactly those terms.
"“Antidepressants are an effective tool for depression. Untreated depression is a huge problem because of the burden to society,” said Andrea Cipriani of the NIHR Oxford Health Biomedical Research Centre, who led the study."
And in his study, Cipriani helpfully opens by pointing out once more what a burden the mentally ill are, the huge cost of keeping them upright and stopping them throwing themselves off cliffs en masse and best of all, explains why so many people are depressed...
"Psychiatric disorders account for 22·8% of the global burden of diseases. The leading cause of this disability is depression, which has substantially increased since 1990, largely driven by population growth and ageing. With an estimated 350 million people affected globally, the economic burden of depressive disorders in the USA alone has been estimated to be more than US$210 billion, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs.3 This trend poses a substantial challenge for health systems in both developed and developing countries, with the need to treat patients, optimise resources, and improve overall health care in mental health."
Yep, the depression rate is rising because we're getting older and there's more of us. Again, using an actual illness, cancer, as a kind of control subject here, imagine some doctor going on TV and saying, no no no, we're not seeing more cancers because of higher UVs, poorer diet, lack of exercise, smoking, drinking blah blah it's just that we're getting older. And there's more of us.
And this is the crux. All illnesses have a cause. Even shingles, but I don't even know what that is so how could I know the cause.
Cancer is caused by environmental effects and a helpful dose of genetics and random happenstance.
It's a biological illness that you can actually look at under a microscope.
Mental illness unfortunately, as mentioned above, cannot be seen under a microscope, in a telescope or kaleidoscope (though sometimes the latter might be a good metaphor for how one feels with depression). It can't be measured (except by self reporting and, of course, the mentally ill are highly unreliable, it's part of the diagnosis of schizophrenia, bi-polar, personality disorders and so on). There's no treatment, no sign of a treatment, because, see above, we don't know what it is, how to measure it, why it exists and so on.
So why isn't it an illness then? Because it is treated as an illness. And see where that gets us. It means we take mind altering drugs that have a marginal effect on this supposed illness. We have CBT which teaches us that this illness is in our mind and it's our fault in some way because we aren't thinking correctly. If we think correctly then the illness might go away, it might not but, at least, you'll be able to appear more normal. Like those who aren't mentally ill (or are they? and they just don't know it, as that's a symptom, of course). We can do mindfulness, a kind of bargain shop Buddhism where you distract yourself by thinking about nice things and thus your misery can take a back seat for a while. As Rice-Oxley argues, you can take time off work. Except, of course, you can't. Not if you're poor and mental illness affects the poor in far greater numbers. Why could that be? You could exercise, except our whole society is built around not exercising from the micro (TV remote, take out food(except those making said take-out...and that's a depressing job)) to the macro (the ubiquitous car). You could use education, though, see above again, the poor are greatly disproportionately affected by both mental illness and lack of opportunity in all forms of education. You can use local support networks, except our current society has drastically cut public spending, funding to such organizations, and our society is geared to atomization and increased aloneness and isolation. See what I'm doing here? I'm suggesting, and I know this is crazy talk (can I say that?), that perhaps, just perhaps, so called mental illness is actually a response to our environment.
There's a lot of evidence that animals in zoos simply go mental. Tigers walking back and forth in a repetitive pattern. Gorillas listlessly staring at nothing in the distance. Dolphins and Killer whales simply dying with no apparent physical cause. David Attenborough doesn't hike about Africa saying look at those dolphins and tigers there, you know 20% of tigers and dolphins suffer from mental illness. Hopefully Attenborough would sigh and say in that upper class less likely to experience mental illness voice, you know, killer whales, out in the Serengeti, are social animals who galivant about happily. It's caging them up that makes them go plumb crazy.
A common critique of mental illness is that it's a "western disease." But, of course, this is nonsense as, strangely enough, there are hardly any studies of garment workers in Dhaka in Bangladesh. Working seven days a week, fourteen hours a day for $25 a month. They don't get time to get depressed, some argue. Fucking idiots. Of course they're depressed. How could you not be?
It's nothing to do with intelligence (or is it?) as working class people are more likely to be depressed (assuming working class/intelligence thing there). Even a squirrel would be depressed in these conditions. Actually all animals would be because it's completely against their nature. Strange then that we assume that such conditions aren't against our nature. Humans. Human animals.
And it's not just garment workers in Dhaka. It's just about all grinding meaningless hopeless work.
It's about money, housing, relationships, families, sex, love, opportunity, actual illness, life, death, especially life and death. What if...what if depression is actually our default setting but with modernity we've fooled ourselves into believing that happiness is the default, or the pursuit of happiness? Historically, most of us lived in grim, grinding poverty. A tiny handful lived in splendour. Royal types and whatnot. But since the Second World War those dreams of wealth are in the hands of most in the west. Even the poorest are materially wealthy. Yet, strangely we appear to experience more mental illness. In a sense, paradoxically, if depression is our default then all this splendour (ready meals, smartphones, hot water, sex aids, etc.) takes us away from our default. It makes us depressed not being depressed. Or rather, all these things are mere temporary distractions from our default depression and we occasionally get glimpses of our real raw selves. You know, like the Hobbesian argument that really underneath our fine clothes we're just savages, given the right conditions we would gestate back to our savage selves at the flip of a hat.
And we get glimpses of our default depression and we think, Christ that's awful, it's making me feel depressed. And as we get older all these shiny objects begin to lose their shiny appeal and the glimpses of our default selves get greater. The default self becomes more often than the shiny object distraction. So we go to the doctor and say, we've been feeling a bit down lately. The doctor says, ah, I see you've been getting reacquainted with your default depressed humanity. It's perfectly normal. Life is a struggle for life but we in our splendour have done away with that struggle with showers and TV and jelly and tea towels and whatnot but like all splendour it begins to get tarnished, stained, and you begin to see beneath the shiny gold leaf to the cold grey steel beneath. It's life, my friend. Here's some anti-depressants.
But what of young people then? Depression is rife among the young. Well, they've grown up immersed in the splendour more than anyone before. Thus they see through the splendour so much quicker than the old. They know this is just shiny stuff to distract us. It's sometimes considered a low boredom threshold. Like that experiment where students were found to prefer an electric shock to just being left alone with their own thoughts. With their own default depressed selves.
They know.
But even if depression were not a mental illness but just life, what of schizophrenia? I mean, that's hardcore mental illness. It's not just insomnia, hopelessness, melancholia, hopelessness, impotence, hopelessness. It's voices and different personas and all manner of things that are downright strange to the average non mentally ill person. Yet voices, personas, hallucinations are a key symptom of dissociation. Dissociation was first outlined by Pierre Janet who believed it was just the weak willed giving into hysteria. It was Sigmund Fraud who suggested that it was a mental defence mechanism. A contemporary of Fraud, Victor Tausk worked on schizophrenic patients and wrote a paper about the Origin of the Influencing Machine. It was based on one of his cases, Natalija A, who believed a machine influenced her thoughts from afar. It was operated by her tutor at university who had almost certainly sexually assaulted her. Natalija claimed the influencing machine had got to her family too, as her mother was very keen on Natalija marrying her suitor, the aforementioned sexual predator tutor. It was Fraud who explicitly linked 19th century hysteria (a precursor term for dissociation) to repressed memories of sexual abuse. An idea he later recanted because of the sheer number of hysterical women he was seeing in consultation. Dissociation now has clear links to PTSD.
Alongside the rising numbers of dissociated has been a drastic fall in the number of diagnosed schizophrenics. There's some interesting data on schizophrenia in the US here.
Onset is most often post puberty. That seems odd to me. You become schizophrenic. Also there are disparities in diagnosis between races. There is a common assumption, backed up by diagnostic data, of higher prevalence among African Americans (Study).
Looking through the literature on diagnosis rates of around 5 times more among Black Americans something interesting jumps out. All the studies do not reinforce the notion that schizophrenia thus must be a genetic disposition in those of African descent, after all, the argument goes that schizophrenia is genetic (though evidence is very patchy indeed, twin studies, at best suggest around a 50% link, but that seems strange in twins sharing the same DNA if it were genetic, after all if it were environmental then the link would be just as strong, or weak, in twins brought up in the same households). They all focus on diagnosis, suggesting that diagnosis is skewed towards diagnosing 'deviant' African Americans with a mental illness.
As with other life circumstances (I'm thinking here of domestic abuse and sexual assault/child abuse*) mental illness diagnosis might be skewed towards diagnosing poorer people and placing them on anti-depressants. *I'm not suggesting you diagnose these but that similarly, figures are skewed towards working class numbers because, in the former, middle class women are more likely to have financial/emotional support systems and thus less likely to report DV and with the latter, working class perpetrators are more likely to get caught and sentenced and working class victims/survivors more likely to be caught up in the care system.
Working class people can't just take some time out of work like Mark Rice-Oxley. They are, thus, more likely to seek medical intervention, more likely to be diagnosed. Judging from what I could find of Rice-Oxley's memoir, for instance, he had a strong support network as well as being financially wealthy and educated. That isn't meant as a criticism of him. I criticize his views not him.
So if working class people, black people, women (see DV, abuse) are more likely to be diagnosed mentally ill are they actually mentally ill? Are upper middle class white males just less likely to be diagnosed or less likely to be mentally ill?
As I mentioned above, cancer, for instance, while it has its measure of ill luck and genetics also relies on the individual's life habits to foster its carcinogenic self (can cancer be carcinogenic?). If depression isn't our default setting, if it isn't biological (it isn't in the sense of a disease), then it seems reasonable to believe it's caused by our life habits. As there's no link between smoking and depression or drinking and depression (as in drinking alcohol causing depression) etc. then it's reasonable to assume depression, if not all mental illnesses are environmental. Look it's in the name, environ mental.
A recent poll by Mind, the 'mental health' charity, found that poor housing severely affected those with 'mental illness.' Benefit cuts and unemployment also had great effects. Mind
So you're homeless because you lost your job and your partner left you and your beloved mother just died and your dog too and her puppies and you have no money and you're ugly and people have always said you smell of gammon and so avoided you and recently you've been lying in the gutter looking up at the stars, at the infinite universe, wondering what on earth could be the purpose of existence and your own impending death and you feel terrible because you're not even hitting the most basic of Maslow's Hierarchy of Needs, though the seeing no purpose in existence is a kind of self actualization...so you go to the doctor. They turn you away because you don't have an address. So you go to A&E and you can guess the rest. A stupid example of how environment affects your 'well being' but it is so blindingly obvious that our environment not only affects us physically, with my own callused hands from the grinding work I do here at the keyboard, but also mentally. It does make us ill. But if you call it an illness without any kind of medical or biological cure or even effective treatment then it denigrates the sense of what it is and you simply end up spouting nonsense like Andrea Cipriani about the cost and loss to the workforce of this 'illness.'
Personally, I prefer to be called mad than mentally ill or depressed. There's a truth in Michel Foucault's argument that the more benign the mad industry became the more restrictive it became and rather than ceding power the mad doctor, alienist or psychiatrist became ever more powerful.
Rather than believing in some pharma conspiracy I'm well aware how corporations work. They work for one motive, profit. And they'll do anything for profit. Enslave workers in suicide netted factories, blow exhaust fumes in the faces of monkeys, etc. Anyone who believes a single thing a corporation PR arm tells them is an idiot and deserves the horrific mess our planet is in because of it.
So when I argue that mental illness does not exist I'm in no way suggesting many of us do not feel distressed, psychotic, mad, if you like. I'm not suggesting that anti-depressants do not ameliorate symptoms for some people. I'm not suggesting it isn't real or doesn't exist in the sense of people who suffer any form of mad feelings, from so called mild depression through to psychosis. I am saying that it isn't an illness (in the bio-medical sense), that it isn't curable by medical intervention and that its root causes are not bio-medical.
Relatively recently, Autism has undergone a radical change in classification from being marked against 'normal' behaviour (Neurotypical) to high functioning (Asperger's) to low functioning (Autism) and is now seen as a spectrum condition. I don't actually agree with this definition but the idea would be useful for 'mental illness.' What we consider mental illness is actually just varying extremities of normal behaviour. Depression may be seen as prolonged and heightened sadness, for instance, we all feel sad sometimes, depressed people feel sad just about all the time and their weight of sadness is greater. Psychosis (which I'll explore in another post) is a response to unlivable conditions. Dissociation, a rational 'splitting away from' the self in extreme traumatic events. And so on. None of these are illnesses. They are responses to life events. We then, however, have actual biological illnesses as a response to these forms of 'madness,' heart disease from stress and anxiety, insomnia and its various physical difficulties, and so on.
The psychiatric model wishes to define madness as an illness in order to appear to be a science. And quack psychiatrists like Carmine Pariante, often aided by pharmaceutical or psychiatric college funding, look for biological markers of this disease in order to maintain this illusion of madness being an illness, one you can treat, as a psychiatrist and by a pharmaceutical industry. It's no conspiracy to see that both psychiatrists and the drug industry have a vested interest in the medical model of mental illness, their lives depend on this.
Again, this is not to say that all psychiatrists are out for their own ends and do not care for their patients. Psychiatry itself is the problem. The so called anti-psychiatry movement did not intend to do away with psychiatry but change its parameters and explicitly engage with the inherent power relationship between the psychiatrist and the patient.
Though RD Laing did drift into spiritual mumbo jumbo, his famous epigram that "insanity" was "a perfectly rational adjustment to an insane world" does hold true. I shall explore that within the nature of consent.
"Doc, uh, my brother's crazy; he thinks he's a chicken."
And, uh, the doctor says, "Well, why don't you turn him in?"
The guy says, "I would, but I need the eggs."
Woody Allen in Annie Hall.
What if our concept of depression, anxiety, schizophrenia, bi-polar, personality disorder and so on as types of mental illness was all wrong?
An influential group of thinkers in the 1960s and 70s, roundly described as the Anti-psychiatry school thought this was the case. Were they completely mad?
I once commented on a below the line section of an article in the Guardian that mental illness, as we know it, does not exist. I added caveats explaining my position but I was bombarded with people telling me I was full of crap, didn't understand depression, how they certainly experienced mental illness so how can it not exist? To suggest mental illness doesn't exist makes people mad (in the American idiomatic sense). We're completely steeped in the idea that mental illness is an illness akin to biological illness. Yet this is based on faith, you know like
My position was fairly straightforward. All the things we consider to be mental illnesses; depression, etc. are not actually illnesses. The common Anti-psychiatry position is that if it doesn't show up on an autopsy how can it be a sickness? In the biological sense, depression, as an example of mental illness, doesn't have any physical signs. A depressed person feels melancholia, probably insomnia, lethargy, hopelessness, and so on. But these aren't biological symptoms. Just as neurological scanning of depressed brains so often show different chemical make-ups, different synapses firing or not, the depressed person's signs of depression are 'after the fact.' That is, you go to the doctor because you can't sleep and feel hopeless and the doctor diagnosis depression. But while hopelessness and insomnia make one depressed, the doctor is diagnosing depression as the cause of these symptoms. Yet no one can define what depression is. It's these symptoms, after the fact.
Contrarily, for many years the psychological fraternity pushed an idiotic idea that chemical imbalance (most notably low serotonin) was the cause of most mental illness. This has begun to lose favour because it's so obviously ridiculous and some have woken up to the idea that a neuro scan of a depressed brain with low serotonin doesn't necessarily follow that the low serotonin caused the depression but is perhaps rather a sign, symptom or marker of feeling depression.
You don't have to believe that the mind and brain are separate things to believe that depression is not a brain disease but something manifesting in the brain
It's far more sensible to see depression, hopelessness, insomnia, and so on as the same thing rather than a cause and effect.
But how does that not make it a mental illness? Well, the first part, mental, is only half the story, and the second part, illness, implies both that it's organic and that it's curable.
Depression isn't organic. It's not like a physical disease, like a cancer or kidney failure. Apart from symptoms being vague and often contradictory (insomnia and needing to sleep a lot more are both considered symptoms) there has never been any evidence that depression, or indeed mental illness per se, has a physical, organic cause. Even twin studies of schizophrenia, the king or queen of organic mental illnesses, have repeatedly failed to show a genetic cause.
What does depression even look like? If you're a health professional fortunately you can google "Depression" and you'll notice straight away
that depression is characterized by a strange hunched appearance as if you're trying to do that thing that Prince (the depressed dead musician) allegedly tried to do by having ribs removed
I mean, it's weird that people even have to go to their doctor when their depression is so bloody obvious in their physical demeanour
Sometimes people with depression handily have a strange linguistic manifestation of their illness following them around as they crawl from one hunched attitude to another
Even in the bathroom after a hot shower that unmistakable mien is there
Some have no shame and make a living out of their illness by doing conceptual art. Imagine the tastelessness if this were cancer "bloody stools, hair loss, death, morphine..."
Christ, if even Jesus is depressed what hope is there for the rest of us? Why hast thou forsaken me?
If we were to accept that, say, depression had both a physical and mental appearance, say, actual physical exhaustion, insomnia, aching muscles, alongside the more nebulous melancholia then is it both a physical and mental illness?
And, as I suggest, if it is an illness then it's perfectly feasible to assume that it could be cured. How would one cure depression? We don't even know what it is. It's almost certainly always existed around humans (and perhaps other animals). So in an age where we know everything (from what the universe is made of to where humans came from to how to build Ikea wardrobes) why don't we know the first thing about mental illness?
At present, mental illness in most forms, is treated biologically. If you feel melancholic and see your doctor then they will almost certainly prescribe a course of anti-depressants. The ubiquitous form at the moment is Mirtazapine (Remeron). It's marketed as a "Tetracyclic Anti-Depressant."
Quite recently (February 2018), a major study of drug trials for depression was carried out by Andrea Cipriani et al The Lancet and found " In terms of efficacy, all antidepressants were more effective than placebo." Mirtazapine was the second most effective after Amytriptyline (an old school SSRI).
The study was hailed as proof to doubters that
The drugs do work: antidepressants are effective, study shows
It's official: antidepressants are not snake oil or a conspiracy – they work
Just two such headers from The Guardian.
Of course, if you read the study it actually just reinforces received wisdom that anti-depressants, in studies, tend to affect participants more than placebos. Ignoring the fact that only positive results for drug trials tend to be published ("409 (78%) of 522 studies were funded by pharmaceutical companies") and that results rely on personal testimony of participants rather than some solid measurable criteria ("The great majority of patients had moderate-to-severe major depressive disorder, with a mean reported baseline severity score on the Hamilton Depression Rating Scale"), this just reinforces the obvious that if you give someone a mind altering chemical then it will effect them in some way more than if you don't.
Obviously, the sight of someone in a white coat giving you 'medicine' tends to have a placebo effect anyway. Advertizers know this, of course.
"Our primary outcomes were efficacy (response rate measured by the total number of patients who had a reduction of ≥50% of the total score on a standardised observer-rating scale for depression) and acceptability (treatment discontinuation measured by the proportion of patients who withdrew for any reason)... Secondary outcomes were endpoint depression score, remission rate, and the proportion of patients who dropped out early because of adverse events. When depressive symptoms had been measured with more than one standardised rating scale, we used a predefined hierarchy, based on psychometric properties and consistency of use across included trials. In the absence of information or supplemental data from the authors, response rate was calculated according to a validated imputation method..."
It's typical of scientism associated with psychiatry. The study is a meta analysis of other studies so it's simply gathering data and averaging out. The data refers to people taking anti-depressants in studies over 8 weeks so very short term responses. "In total, 87 052 participants were randomly assigned to an active drug and 29 425 were randomly assigned to placebo."
You might think, why wasn't it a 50/50 split between drugs and placebos? Well, the study looked at Double Blind trials (where neither researchers or participants know who is getting what), Parallel (two groups) and Randomized Control Trial where participants are randomly chosen for the drug or control (placebo) group. The study doesn't show how many are Double Blind (which I find the most reliable). But the study does suggest:
"46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low."
Does that fill you with confidence?
The trials were mostly North American and European (75%) and a median age of 44 for both males and females.
They found, intriguingly, that head to head (as in, measuring efficacy of Mirtazapine to say, Sertraline, to second generation anti-depressants) there were large differences in efficacy yet when measured against placebos:
"...there was more diversity in the range of efficacy and dropout patterns seen across the head-to-head comparisons than the meta-analysis of antidepressants versus placebo."
Yep, when groups took drugs they experienced similar responses but when they took different drugs they experienced different responses. I sat last night and took no drugs. I've just lined a quarter gram of coke and feel much better. I'm off in a minute to mainline me some horse. I shall addendum the results later. I intend to ask a lot of other drug users and a small handful of non-drug users their experiences in the short term after taking or not taking drugs and their responses on the Arkady Hughes Mood Altering Substance Scale before and after and cross reference matrices of median results.
It's one of those contradictory things about biomedical intervention with mental illness that the anti-depressant's side effects are often the very symptoms that they are supposed to aid; suicidal thoughts and anxiety are fairly common side effects with Remeron/Mirtazapine and the weight gain is astonishing (though how getting extremely fat is going to help one's depression is yet to be discussed anywhere)
It does give you pretty whacked out opium-induced like dreams though.
When you take any drug (I just ate some chocolate) you experience changes to your mood, thoughts, feelings, motivations, etc. If you're given a drug or placebo and don't know which it is but experience physical or mental alterations this would naturally result in you assuming you are not on the placebo. The anti-depressant thus boosts the placebo effect.
In articles from the Guardian, above, claims were made, on the basis of this incredibly fragile evidence. Unravel this...
"The debate over antidepressants has unfortunately often been ideological, said Cipriani. Some doctors and patients have doubts over whether they work at all and point to the big placebo effect – in trials, those given dummy pills also improve to some degree. Some people suspect drug companies of fiddling trial results. Some patients simply do not want to take pills for a mental health condition."
"Antidepressants and psychological therapies – of which the most frequently used is CBT (cognitive behaviour therapy) – have similar success rates. Around 60% of people respond by about two months to the drugs with about a 50% reduction in their symptoms - an improvement in mood, better sleep and so on. But, he said, “about 80% of people stop antidepressants within a month”."
My maths is bad but...only 20% continue anti depressants after one month? Of that 20% just over half respond after two months? And those experience a 50% reduction in symptoms? So of those put on anti-depressants only 10% experience a half reduction in their symptoms?
Wow. Effective.
"Professor Carmine Pariante, spokesperson for the Royal College of Psychiatrists, said the analysis “finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression. Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin.”"
You can go on believing that pharmaceutical companies gave access to studies showing their drugs were useless. Keep on believing that.
Carmine Pariante has claimed that depression could be caused by brain inflammation.
"Because there is no difference between medicine and psychiatry. And nothing has changed since the beginning of times, when our ancestors first used latex from the opium poppy and leaves from the salix tree. We have a body (which includes a brain) that feels changes in functions or sensations or emotions (symptoms), which sometime other people can see (signs), and that can be induced, or modified, by external agents: the poison of a snake; the deadly effect of a bacterium; the extract of a leave; the assault of a predator; the ruthlessness of discrimination; or the chemical product of a pharmaceutical plant. Nothing more, nothing less...We and others are testing anti-inflammatory drugs to treat depression: this is targeting a biochemical system in the body, to induce downstream effects in the brain, to eventually affect processes relevant to depression. How is this different from the rest of medicine?"
Because, Carmine Pariante, depression is almost certainly not organic (and it's just ridiculous to suggest inflammation of an organ causes mental illness, what century is this?) so the analogy is completely false and depression, oh God do I have to say this again, is NOT a brain disease. So yeah, take everything this man says with a pinch of salt. It's worth reading his whole piece to see how wrong headed his argument is (and yes, he does liken using anti-depressants to using biomedical interventions for cancer...sigh). But other than that, can you trust him?
"Dr Carmine Pariante has received Funds for a member of staff and funds for research. Professor Pariante’s research on depression and inflammation is supported by: the grants ‘Persistent Fatigue Induced by Interferon-alpha: A New Immunological Model for Chronic Fatigue Syndrome' (MR/J002739/1) and ‘Immuno-psychiatry: a consortium to test the opportunity for immunotherapeutics in psychiatry’ (MR/L014815/1; together with GSK), from the Medical Research Council (UK); the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre in Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London; by Johnson &Johnson as part of a programme of research on depression and inflammation; and by a Wellcome Trust-led consortium that also include Johnson & Johnson, GSK and Lundbeck."
Probably not.
In the Guardian piece:
"Dr James Warner, reader in psychiatry at Imperial College London, said: “This rigorous study confirms that antidepressants have an important place in the treatment of depression. Depression causes misery to countless thousands every year and this study adds to the existing evidence that effective treatments are available.”"
According to the study leader, Andrea Cipriani, the treatment is marginal at best.
The most bizarre argument is put forward by Mark Rice-Oxley in the Guardian, above.
"It’s official: antidepressants work.
They are not a multibillion-dollar conspiracy dreamed up by Big Pharma Bond villains. They are not a snake oil distilled in secret laboratories, designed to stupefy us all. They are not a futile cop-out from overextended family doctors.
They are an effective treatment to alleviate symptoms of depression, a global scourge that affects as many as one in 20 people on the planet. Even the least effective antidepressants are better than placebos, the sugar pills dished out in trials. And placebos are better than nothing. [my italics]"
* Except there are studies suggesting that long term use, habituation (relying on the drug if not actual addiction) and withdrawal are actually less effective for some than simply trying to cope without.
Rice-Oxley's piece brings me back to my initial argument. Mental Illness. His muddled thinking is typical of discussion around the subject:
"The upshot of this, the most intensive piece of meta-analysis ever conducted into antidepressants, is that the millions of people (including me) who take them – reluctantly, sceptically, hopefully – can continue to do so without feeling guilt, shame or doubt about the course of treatment."
Guilt? Shame? Doubt? This sounds like some bizarre religious experience (psychiatry anyone?) rather than anything like science. Rice-Oxley has cashed in on (or reached out with) his depression by writing a memoir on how he recovered from depression. Sort of. Many famous people find it cathartic and financially conducive to write about their own misery. For Rice-Oxley the way forward is thus:
"Moreover, doctors should feel no compunction about prescribing these drugs, though really they should be reserved for serious cases, and should be offered as part of a mix of interventions such as CBT, group therapy, work sabbaticals, mindfulness-based cognitive therapy, exercise, education and local support networks."
What is a serious case? How does one measure that other than asking the individual (usually using an index, do you feel suicidal? a) Sometimes b) Quite a lot c) All the time d) how do you tie this damned knot?) CBT is about as effective as anti-depressants (or sugar pills) and is not usually reliable in suicidal cases, which are surely serious cases. Most of this is either obvious or sticky plasters. Where is the cure? Far more importantly, what is the cause? No one's mentioning this. Isn't that weird? Imagining treating cancer without having any idea how to not get cancer in the first place.
If anti-depressants don't cure mental illness but merely ameliorate symptoms then what is their function beyond making you, the mentally ill, function?
Imagine some doctor going on TV and saying we need to cure cancer now.
Why? asks the presenter innocently.
Because cancer patients are a burden on the state and its finances.
Imagine that. We'd all be shocked, right. Yet this illness, mental illness, is talked about in exactly those terms.
This is how mental illness is widely reported by media organizations. The loss to the economy.
Try and think about the last time you read a media piece about what causes depression.
No idea how that got in there. Isn't it pretty?
And in his study, Cipriani helpfully opens by pointing out once more what a burden the mentally ill are, the huge cost of keeping them upright and stopping them throwing themselves off cliffs en masse and best of all, explains why so many people are depressed...
"Psychiatric disorders account for 22·8% of the global burden of diseases. The leading cause of this disability is depression, which has substantially increased since 1990, largely driven by population growth and ageing. With an estimated 350 million people affected globally, the economic burden of depressive disorders in the USA alone has been estimated to be more than US$210 billion, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs.3 This trend poses a substantial challenge for health systems in both developed and developing countries, with the need to treat patients, optimise resources, and improve overall health care in mental health."
Yep, the depression rate is rising because we're getting older and there's more of us. Again, using an actual illness, cancer, as a kind of control subject here, imagine some doctor going on TV and saying, no no no, we're not seeing more cancers because of higher UVs, poorer diet, lack of exercise, smoking, drinking blah blah it's just that we're getting older. And there's more of us.
Even the toilet door man when depressed does that Prince thing...though interestingly, it's poorer countries that really do well on the suicide scale...
Russia are the gold medallists. Notice how few in the Middle East kill themselves. That's because in the repressive Islamic countries it's still a capital offence
Cancer is caused by environmental effects and a helpful dose of genetics and random happenstance.
It's a biological illness that you can actually look at under a microscope.
Mental illness unfortunately, as mentioned above, cannot be seen under a microscope, in a telescope or kaleidoscope (though sometimes the latter might be a good metaphor for how one feels with depression). It can't be measured (except by self reporting and, of course, the mentally ill are highly unreliable, it's part of the diagnosis of schizophrenia, bi-polar, personality disorders and so on). There's no treatment, no sign of a treatment, because, see above, we don't know what it is, how to measure it, why it exists and so on.
So why isn't it an illness then? Because it is treated as an illness. And see where that gets us. It means we take mind altering drugs that have a marginal effect on this supposed illness. We have CBT which teaches us that this illness is in our mind and it's our fault in some way because we aren't thinking correctly. If we think correctly then the illness might go away, it might not but, at least, you'll be able to appear more normal. Like those who aren't mentally ill (or are they? and they just don't know it, as that's a symptom, of course). We can do mindfulness, a kind of bargain shop Buddhism where you distract yourself by thinking about nice things and thus your misery can take a back seat for a while. As Rice-Oxley argues, you can take time off work. Except, of course, you can't. Not if you're poor and mental illness affects the poor in far greater numbers. Why could that be? You could exercise, except our whole society is built around not exercising from the micro (TV remote, take out food(except those making said take-out...and that's a depressing job)) to the macro (the ubiquitous car). You could use education, though, see above again, the poor are greatly disproportionately affected by both mental illness and lack of opportunity in all forms of education. You can use local support networks, except our current society has drastically cut public spending, funding to such organizations, and our society is geared to atomization and increased aloneness and isolation. See what I'm doing here? I'm suggesting, and I know this is crazy talk (can I say that?), that perhaps, just perhaps, so called mental illness is actually a response to our environment.
There's a lot of evidence that animals in zoos simply go mental. Tigers walking back and forth in a repetitive pattern. Gorillas listlessly staring at nothing in the distance. Dolphins and Killer whales simply dying with no apparent physical cause. David Attenborough doesn't hike about Africa saying look at those dolphins and tigers there, you know 20% of tigers and dolphins suffer from mental illness. Hopefully Attenborough would sigh and say in that upper class less likely to experience mental illness voice, you know, killer whales, out in the Serengeti, are social animals who galivant about happily. It's caging them up that makes them go plumb crazy.
Why not visit Sriracha Tiger Zoo in Thailand where the tigers roam free and happy
That's really depressing
It's nothing to do with intelligence (or is it?) as working class people are more likely to be depressed (assuming working class/intelligence thing there). Even a squirrel would be depressed in these conditions. Actually all animals would be because it's completely against their nature. Strange then that we assume that such conditions aren't against our nature. Humans. Human animals.
And it's not just garment workers in Dhaka. It's just about all grinding meaningless hopeless work.
It's about money, housing, relationships, families, sex, love, opportunity, actual illness, life, death, especially life and death. What if...what if depression is actually our default setting but with modernity we've fooled ourselves into believing that happiness is the default, or the pursuit of happiness? Historically, most of us lived in grim, grinding poverty. A tiny handful lived in splendour. Royal types and whatnot. But since the Second World War those dreams of wealth are in the hands of most in the west. Even the poorest are materially wealthy. Yet, strangely we appear to experience more mental illness. In a sense, paradoxically, if depression is our default then all this splendour (ready meals, smartphones, hot water, sex aids, etc.) takes us away from our default. It makes us depressed not being depressed. Or rather, all these things are mere temporary distractions from our default depression and we occasionally get glimpses of our real raw selves. You know, like the Hobbesian argument that really underneath our fine clothes we're just savages, given the right conditions we would gestate back to our savage selves at the flip of a hat.
A happy workplace makes a happy workforce
But what of young people then? Depression is rife among the young. Well, they've grown up immersed in the splendour more than anyone before. Thus they see through the splendour so much quicker than the old. They know this is just shiny stuff to distract us. It's sometimes considered a low boredom threshold. Like that experiment where students were found to prefer an electric shock to just being left alone with their own thoughts. With their own default depressed selves.
They know.
But even if depression were not a mental illness but just life, what of schizophrenia? I mean, that's hardcore mental illness. It's not just insomnia, hopelessness, melancholia, hopelessness, impotence, hopelessness. It's voices and different personas and all manner of things that are downright strange to the average non mentally ill person. Yet voices, personas, hallucinations are a key symptom of dissociation. Dissociation was first outlined by Pierre Janet who believed it was just the weak willed giving into hysteria. It was Sigmund Fraud who suggested that it was a mental defence mechanism. A contemporary of Fraud, Victor Tausk worked on schizophrenic patients and wrote a paper about the Origin of the Influencing Machine. It was based on one of his cases, Natalija A, who believed a machine influenced her thoughts from afar. It was operated by her tutor at university who had almost certainly sexually assaulted her. Natalija claimed the influencing machine had got to her family too, as her mother was very keen on Natalija marrying her suitor, the aforementioned sexual predator tutor. It was Fraud who explicitly linked 19th century hysteria (a precursor term for dissociation) to repressed memories of sexual abuse. An idea he later recanted because of the sheer number of hysterical women he was seeing in consultation. Dissociation now has clear links to PTSD.
The young and dynamic Pierre Janet and Victor Tausk
Alongside the rising numbers of dissociated has been a drastic fall in the number of diagnosed schizophrenics. There's some interesting data on schizophrenia in the US here.
Onset is most often post puberty. That seems odd to me. You become schizophrenic. Also there are disparities in diagnosis between races. There is a common assumption, backed up by diagnostic data, of higher prevalence among African Americans (Study).
Looking through the literature on diagnosis rates of around 5 times more among Black Americans something interesting jumps out. All the studies do not reinforce the notion that schizophrenia thus must be a genetic disposition in those of African descent, after all, the argument goes that schizophrenia is genetic (though evidence is very patchy indeed, twin studies, at best suggest around a 50% link, but that seems strange in twins sharing the same DNA if it were genetic, after all if it were environmental then the link would be just as strong, or weak, in twins brought up in the same households). They all focus on diagnosis, suggesting that diagnosis is skewed towards diagnosing 'deviant' African Americans with a mental illness.
As with other life circumstances (I'm thinking here of domestic abuse and sexual assault/child abuse*) mental illness diagnosis might be skewed towards diagnosing poorer people and placing them on anti-depressants. *I'm not suggesting you diagnose these but that similarly, figures are skewed towards working class numbers because, in the former, middle class women are more likely to have financial/emotional support systems and thus less likely to report DV and with the latter, working class perpetrators are more likely to get caught and sentenced and working class victims/survivors more likely to be caught up in the care system.
Working class people can't just take some time out of work like Mark Rice-Oxley. They are, thus, more likely to seek medical intervention, more likely to be diagnosed. Judging from what I could find of Rice-Oxley's memoir, for instance, he had a strong support network as well as being financially wealthy and educated. That isn't meant as a criticism of him. I criticize his views not him.
So if working class people, black people, women (see DV, abuse) are more likely to be diagnosed mentally ill are they actually mentally ill? Are upper middle class white males just less likely to be diagnosed or less likely to be mentally ill?
Spandau Ballet
Judging by suicide rates (high in the UK among young white males) I'm guessing it's about diagnosis. If it's about diagnosis (where one person decides on your mental health based upon an index, like The Beck Inventory, and a brief interview) and this is skewed by things like race, gender and class then how can we truly call mental illness an illness? I would not be the first person to suggest that it's a way of pigeonholing 'deviant' behaviour.As I mentioned above, cancer, for instance, while it has its measure of ill luck and genetics also relies on the individual's life habits to foster its carcinogenic self (can cancer be carcinogenic?). If depression isn't our default setting, if it isn't biological (it isn't in the sense of a disease), then it seems reasonable to believe it's caused by our life habits. As there's no link between smoking and depression or drinking and depression (as in drinking alcohol causing depression) etc. then it's reasonable to assume depression, if not all mental illnesses are environmental. Look it's in the name, environ mental.
A recent poll by Mind, the 'mental health' charity, found that poor housing severely affected those with 'mental illness.' Benefit cuts and unemployment also had great effects. Mind
Personally, I prefer to be called mad than mentally ill or depressed. There's a truth in Michel Foucault's argument that the more benign the mad industry became the more restrictive it became and rather than ceding power the mad doctor, alienist or psychiatrist became ever more powerful.
Rather than believing in some pharma conspiracy I'm well aware how corporations work. They work for one motive, profit. And they'll do anything for profit. Enslave workers in suicide netted factories, blow exhaust fumes in the faces of monkeys, etc. Anyone who believes a single thing a corporation PR arm tells them is an idiot and deserves the horrific mess our planet is in because of it.
So when I argue that mental illness does not exist I'm in no way suggesting many of us do not feel distressed, psychotic, mad, if you like. I'm not suggesting that anti-depressants do not ameliorate symptoms for some people. I'm not suggesting it isn't real or doesn't exist in the sense of people who suffer any form of mad feelings, from so called mild depression through to psychosis. I am saying that it isn't an illness (in the bio-medical sense), that it isn't curable by medical intervention and that its root causes are not bio-medical.
Relatively recently, Autism has undergone a radical change in classification from being marked against 'normal' behaviour (Neurotypical) to high functioning (Asperger's) to low functioning (Autism) and is now seen as a spectrum condition. I don't actually agree with this definition but the idea would be useful for 'mental illness.' What we consider mental illness is actually just varying extremities of normal behaviour. Depression may be seen as prolonged and heightened sadness, for instance, we all feel sad sometimes, depressed people feel sad just about all the time and their weight of sadness is greater. Psychosis (which I'll explore in another post) is a response to unlivable conditions. Dissociation, a rational 'splitting away from' the self in extreme traumatic events. And so on. None of these are illnesses. They are responses to life events. We then, however, have actual biological illnesses as a response to these forms of 'madness,' heart disease from stress and anxiety, insomnia and its various physical difficulties, and so on.
The psychiatric model wishes to define madness as an illness in order to appear to be a science. And quack psychiatrists like Carmine Pariante, often aided by pharmaceutical or psychiatric college funding, look for biological markers of this disease in order to maintain this illusion of madness being an illness, one you can treat, as a psychiatrist and by a pharmaceutical industry. It's no conspiracy to see that both psychiatrists and the drug industry have a vested interest in the medical model of mental illness, their lives depend on this.
Again, this is not to say that all psychiatrists are out for their own ends and do not care for their patients. Psychiatry itself is the problem. The so called anti-psychiatry movement did not intend to do away with psychiatry but change its parameters and explicitly engage with the inherent power relationship between the psychiatrist and the patient.
Though RD Laing did drift into spiritual mumbo jumbo, his famous epigram that "insanity" was "a perfectly rational adjustment to an insane world" does hold true. I shall explore that within the nature of consent.
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