I recently watched two videos offering differing ideas about the causes of psychosis.
One was a TED talk by Thomas R. lnsel, M.D. director of the National Institute of Mental Health (NIMH). The other was a BBC Horizon documentary, Why Did I Go Mad?
One is an interesting glimpse into psychosis via three people who hear voices and hallucinate. The other is a mystifyingly popular conjuring trick suggesting psychosis is a brain disease that we can discover before it even manifests and all but eradicate hopefully like Leukaemia.
Let's start with the magical thinking trick.
What Insel starts with is the common psychiatric approach to talking about madness. He talks about biological illnesses that have nothing in common with psychiatric conditions. It's what they do. He begins by listing a series of biological conditions; heart disease, leukaemia, etc. of which science has rather wonderfully cut the morbidity rates.
"Early detection, early intervention, that's the story."
You can guess where this is heading.
He then throws in suicide. "Of course, this is not a disease, per se."
Sorry, but it's not a disease at all. Unless you're going to count death as a disease.
"It's a condition or a situation that leads to mortality."
Suicide is a condition? It does lead to mortality if successful. That's a fact. Now remember that fact because that's the last you're going to hear in this talk.
He then goes on to argue it's just as prevalent (or popular) now as it always has been.
And so, we get the first level of the trick. You're now thinking that suicide is a condition like the others he mentions; leukaemia, heart disease. It's in your head now. This is how all conjuring works. You've completely forgotten that suicide is nothing like leukaemia. One is a biological illness or "disease" in the medical model sense. The other is an act one carries out on oneself. Like masturbation. Which, of course, was once seen as a medical condition by many doctors and alienists. And if carried out correctly is not fatal.
He then proceeds with the second stage of the trick. "Now when we talk about suicide there is also a medical contribution here because 90% of suicides are related to a mental illness."
There are 10% of suicides who aren't mad? Isn't that crazy?
So here we have the subtle "medical" word inserted into the conversation. Even though we're not talking about anything that has any basis in medicine (or at least, no proven basis). Yet we're just taking this for read that this is the case. That mental illness is medical. Like Heart disease. Like suicide.
He then typically shows us the financial burden of mental illness.
So we see at this point that suicide is an illness like leukaemia, that it has a medical basis and that it has a far greater economic impact than actual biological illnesses.
So what rational person could disagree with his thesis that we should try to detect and prevent this medical illness? Suicide, er no, actually he's now switched to the causes of suicide, mental disorders.
It's telling here that he also switches between "disorder" "illness" "disability" when discussing madness. Just like I just did with mental illness and madness. But I do that to not offend sensibilities. I never use the term mental illness. It's bio-medical disease model mumbo jumbo.
Insel then points out that unlike leukaemia or heart disease (biological illnesses) "onset" of these "disorders" tends to be 50% by the age of 14.
That's right, the classic appeal to emotion. "Think of the children!"
He reiterates that this is very different to all the biological illnesses he lists even though he's suggesting it's just like these biological illnesses. Why is that, Dr Thomas?
"These are the chronic disorders of young people." Sad face.
So now, the final part of the trick. "What I'm here to tell you is that I think we're about to be in a very different world as we think about these, about these uh illnesses [sic]."
Yes, future prophecy we can cure this thing with some unknown thing. You get a lot of climate change deniers or scientism types like Bill Gates (who Insel quotes) or Steven Pinker who claim that climate change will be solved by magical future technologies in the same way. It's religious fanaticism and faith not science.
Insel then, the bare cheek of the man, dares to show us how his trick works.
"The most important point here is a conceptual one."
Don't think about where the woman in the box is, look at me waving my cape around. It's the same principle. Don't take all available evidence just think about this subject differently. I would if he gave me some evidence.
"What I've been talking about to you so far is mental disorders, diseases of the mind [sic]. Actually that's becoming a rather unpopular term these days...it's politically better to use the term behavioural disorders. Fair enough, they are disorders of behaviour and they are disorders of the mind."
But I want you to ignore all that actual factual stuff and dream with me.
"What I want to suggest to you is that both those terms that have been in place for a century or more are actually impediments to progress."
And if you don't agree with me you're a back woods yokel trying to hold back progress. What be this progress oh master?
"What we need conceptually to make progress is to rethink these disorders as brain disorders."
You mean, go back to the pre-psychoanalytical revolution then? Think of it as phrenology. Or blood disorder. Or pressure on the brain that can be alleviated by a small hole?
"Now some of you will say, oh here we go again, we're gonna here about chemical imbalance or drugs or some simplistic notion that will take our subjective experience and turn it into molecules."
Oh if only it were that scientific.
"When we talk about the brain it is anything but unidimensional or simplistic or reductionist."
Here's some pictures of the brain. Wow, look 10 billion neurons. 100 trillion synapses.
See, the brain is so complex that mental illness has to be a brain disorder. Fact. Oh no wait, he hasn't offered any connection yet. Just scary walnut brain, neurons that look like a pretty bead curtain and synapses that look like a trippy spider web.
Insel weirdly then argues we should "use our own minds, which the brain supports to understand the very complex brain that supports our own mind."
So, you're going to use your mind, which is supported by your brain to understand mental illness that isn't of the mind but of the brain? If you're using your mind to understand things then why isn't mental illness still that old fashioned disease of the mind then?
Me confused. I'd still like, you know, evidence.
Insel ups some brain diagram things showing how our brains are affected by the different mental disorders; depression, OCD and PTSD.
So the "circuitry" is different in these conditions, he claims.
Hang on. Where did this evidence come from? No idea. If it is from a study, how were the participants diagnosed if not behaviourally? All you're then doing is having a patient who experiences PTSD because they were continually shot at in Afghanistan every day, every hour for months on end and they're brain is showing some different activity to someone not shot at. Actually, Insel doesn't bother with non-PTSD etc. brains as a comparison. Look, it's scientific!
And what "you find is there's a lot of variations in the way the brain is wired but there are some predictable patterns and these patterns are risk factors for developing these disorders."
Like what? This is a giant leap. Even if you had thousands of participants' brain scans showing the same 'abnormalities' whilst diagnosed with the same 'illness' all that shows is that the brain is affected by the illness. It doesn't follow that that abnormalities in the brain caused the illness. This is pretty basic stuff, n'est pas?
I think it's time to remind the audience that the mental disorders you're talking about are just like biological disorders...
"This is a little different to how we think of Parkinsons or Huntingtons or Alzheimers where you have a bombed out part of the cortex here we're talking about traffic jams or sometimes detours or problems with just the way things are connected. You could compare this to myocardial infarction...where you have dead tissue in the heart to an arrhythmia where the organ isn't functioning correctly because of the communication problems within it. Either one would kill you but in only one would you find a major lesion."
Huh? Mental disorders are like Parkinsons etc. though of course they're not as the latter are degenerative (though there's a debate on schizophrenia, see below). Parkinsons etc. have "bombed out" parts, as in bits that begin to fail to function, but mental disorders are like blockages. You know, like with heart disease, that biological illness, there's your standard heart attack and then there's irregular beats (which doesn't necessarily lead to death actually and is, of course linked to mental disorders via stress and anxiety). Parkinsons etc. is like the heart attack and psychosis etc. is like irregular beats. In a sense the analogy works because Parkinsons etc. does have a physical biological manifestation (that's why it's not a psychiatric condition) and mental illness doesn't. However, mental illness does not kill you. You kill you. So it's a really crappy analogy. But one that reinforces in the viewer the idea that mental illness is just like Parkinsons and myocardial infarction.
"I think it would be easier to go into one particular disorder, schizophrenia, because I think this is a good case where thinking of these as a brain disorder matters."
Here we get some scans showing less grey matter in the brains of schizophrenics. And lots of colourful pictures of brains that I have no idea what he's showing me as he's not showing me what a normal brain should look like. There's no point of reference here so it's all on trust that schizophrenics have less grey matter. I don't know. I do know you diagnose psychosis by behaviours that only the 'sufferer' experiences. That's not to say they don't, of course they do. But it's completely subjective.
From this we get a "Developmental Brain Model for Schizophrenia" which shows "the path to schizophrenia" and the "psychosis threshold."
Are you keeping up with this? Of course not. You're not meant to. You're meant to go, wow! Look at that.
Odd that Insel's talk is about this great technology that will future project the incidence of schizophrenia and this data is from a fairly obscure study by McGlashan and Hoffman from 2001.
Insel saves up his best lines for this finale. "At some point you overshoot this threshold and at that point we can say that this person has this disease because they have behavioural symptoms of hallucinations and delusions, that's something we can observe. They've crossed a brain threshold much earlier. Even at 15 or 16 you can see that the trajectory for development is different at the level of the brain not of behaviour."
Well. I think the problem with diagnosis of psychosis (I'm a poet) is problematic for the very reason that we can't see it like we can biological illness. To then extrapolate that you can see schizophrenia in the brain before it manifests in behaviours is absurd. How? How would you (computer modelling? based on?)? As diagnosis is based on behaviours how can you possibly intervene before those behaviours have manifested?
Are you scared? I am. This is all going a bit Clockwork Orange on us.
"For brain disorders the last thing to change is behaviours, we know that for Alzheimers..."
Except psychosis is nothing like Alzheimers is it? Where's the evidence for this? Alzheimers (dementia) is a late onset (over 65 usually) degenerative illness. What has that to do with, say depression or eating disorders (two of Insel's examples)? There's no evidence that there's anything in common between them. You could even argue that they don't both have a basis or manifestation in the brain. Obviously Alzheimers does.
"New tools can show us the presence of brain changes long before symptoms emerge."
Huh? How? What would these tools be? Mandatory brain scans for all 8 year olds? This is nonsense. The whole of psychiatry is about diagnosing patients based on presenting symptoms. If you don't have those presenting symptoms how would you know that anyone is mad?
"Early detection and intervention will give us the best outcomes."
How would you detect? Even with mandatory brain scans does this man really think that depression is going to show up? Really? In everyone? At the same time? Or are you going to stagger the scans? This makes no sense.
Much more disturbing is the "intervention" word. What would this intervention look like? What about consent? What if we're talking about children, is there really consent then for "intervention"? I don't think Insel's thought this through. I think he's caught up in his own fantasy (delusional?) about wonder technologies rather than real, concrete reality.
Let's just remind you that it's just like biological illness again, in case I'm losing you...
"If we waited till the heart attack we would be sacrificing 1.1 million lives every year in this country. That's exactly what we do today when we decide that everyone with these brain disorders, brain circuit disorders, has a behavioural disorder. Wait until the behaviour becomes manifest."
Now, I'm perplexed on two levels. Don't we wait until the heart attack? I mean, I live in the UK and I'm unaware of any heart disease prevention tools currently used. Unless I, as a patient, have some strange heart murmurings I'm left to my own devices until I keel over sweating like crazy and losing consciousness. Again, I think he's talking about after the fact intervention. As in, patients complaining of heart problems then receiving intervention. But then, that's exactly what we do with all illnesses (including so called mental illness) except some cancers later in life. You have to wait until it manifests to know you 'have it.' Again, is he suggesting some sort of mandatory mental illness screening? How?
Again, what is this intervention? With heart disease it's lifestyle changes (yes, environment affects illness) usually. Actual medical intervention if things have got worse. For schizophrenia, anti-psychotic drugs is de rigeur. Is he suggesting scanning every child's brain and if they have these developmental differences putting them on anti-psychotics? I'm genuinely baffled by his argument.
"We don't have all the facts. We don't even know what the tools will be. [We're confident it won't involve drills] Nor what to precisely look for in every case. To get there before the behaviour emerges."
O O
It's mumbo jumbo witch doctory. We don't know anything but we could save lots of people in some way unspecified if we could diagnose without relying on traditional diagnosis in some future time somewhere.
"But this tells us how we need to think about it. And where we need to go."
It does no such thing. You just said not two seconds ago that you don't have the facts and you don't know what the tools would be or what to look for or how to get there."
But when are we going to get to this whatever it is he's talking about?
"Are we gonna be there soon? I think this is something that is going to happen over the course of the next few years."
This is classic magical thinking as evinced in religion. The messiah will return. Soon.
You hold onto your dream, Thomas.
Some might say that basing your beliefs on wishful thinking and imaginary devices is classic psychosis manifesting. I'm no doctor but...
Over at the BBC, astonishingly they have a far more balanced and intriguing view of psychosis. I urge a watching of the documentary. A better copy here.
Not only do we get three survivors of psychosis talking candidly (and logically and lucidly) about their condition but we get actual evidence (well, of a sorts, as best you can about madness).
All three participants's psychosis manifests in hallucinations, hearing voices, classic schizophrenia or psychosis. And shock horror (spoiler) they all have PTSD from childhood abuse. We get a psychologist pointing out that psychosis more often occurs in urban dwellers, explicitly linking it to one's wider environment. No brain scans are harmed or involved in the programme and the upshot is clearly heavily linking psychosis to one's environment.
Thomas Insel could do with watching it. Though I'm sure he would still believe we could detect signs before they were manifested (aged 8 in the women's cases) and intervene (whatever that might entail) using brain imaging for this brain disorder.
I haven't given any evidence that psychosis or madness in all its forms is environmental. Unfortunately that would always be anecdotal. That doesn't mean that it's less reliable simply because the vast majority of studies in the area simply ignore environmental factors (as do psychiatrists most often) and as Insel states, we know nothing about the disorders, why they manifest or what we can do about them (even though we know a lot about all the biological illnesses he lists and for most have reliable interventions, funny that) . So that suggests to me that they are completely wrong to go down a bio-medical route and it would be far easier to assess environmental factors. Back in my psychotherapist days I can assure you I never say a client who told me that they had no life problems it was just something not right with their brain.
It's so startlingly obvious that there are strong links between environment and mental illness (there is stacks of evidence for PTSD (well, obviously, it's in the name), dissociation, depression, eating disorders, anxiety) that it seems bizarre that it's not simply accepted that madness (mental illness if you prefer) is directly correlated to life experiences. That so many psychiatrists and researchers are so very keen to see madness as biological in origin. My own analogy here is climate denial. Let's blame madness on natural temperature fluctuations rather than our impact on our environment and each other.
One was a TED talk by Thomas R. lnsel, M.D. director of the National Institute of Mental Health (NIMH). The other was a BBC Horizon documentary, Why Did I Go Mad?
Insel. Why did I go Mad?
Let's start with the magical thinking trick.
What Insel starts with is the common psychiatric approach to talking about madness. He talks about biological illnesses that have nothing in common with psychiatric conditions. It's what they do. He begins by listing a series of biological conditions; heart disease, leukaemia, etc. of which science has rather wonderfully cut the morbidity rates.
"Early detection, early intervention, that's the story."
You can guess where this is heading.
He then throws in suicide. "Of course, this is not a disease, per se."
Sorry, but it's not a disease at all. Unless you're going to count death as a disease.
"It's a condition or a situation that leads to mortality."
Suicide is a condition? It does lead to mortality if successful. That's a fact. Now remember that fact because that's the last you're going to hear in this talk.
He then goes on to argue it's just as prevalent (or popular) now as it always has been.
And so, we get the first level of the trick. You're now thinking that suicide is a condition like the others he mentions; leukaemia, heart disease. It's in your head now. This is how all conjuring works. You've completely forgotten that suicide is nothing like leukaemia. One is a biological illness or "disease" in the medical model sense. The other is an act one carries out on oneself. Like masturbation. Which, of course, was once seen as a medical condition by many doctors and alienists. And if carried out correctly is not fatal.
He then proceeds with the second stage of the trick. "Now when we talk about suicide there is also a medical contribution here because 90% of suicides are related to a mental illness."
There are 10% of suicides who aren't mad? Isn't that crazy?
So here we have the subtle "medical" word inserted into the conversation. Even though we're not talking about anything that has any basis in medicine (or at least, no proven basis). Yet we're just taking this for read that this is the case. That mental illness is medical. Like Heart disease. Like suicide.
He then typically shows us the financial burden of mental illness.
So we see at this point that suicide is an illness like leukaemia, that it has a medical basis and that it has a far greater economic impact than actual biological illnesses.
So what rational person could disagree with his thesis that we should try to detect and prevent this medical illness? Suicide, er no, actually he's now switched to the causes of suicide, mental disorders.
It's telling here that he also switches between "disorder" "illness" "disability" when discussing madness. Just like I just did with mental illness and madness. But I do that to not offend sensibilities. I never use the term mental illness. It's bio-medical disease model mumbo jumbo.
Insel then points out that unlike leukaemia or heart disease (biological illnesses) "onset" of these "disorders" tends to be 50% by the age of 14.
That's right, the classic appeal to emotion. "Think of the children!"
He reiterates that this is very different to all the biological illnesses he lists even though he's suggesting it's just like these biological illnesses. Why is that, Dr Thomas?
"These are the chronic disorders of young people." Sad face.
So now, the final part of the trick. "What I'm here to tell you is that I think we're about to be in a very different world as we think about these, about these uh illnesses [sic]."
Yes, future prophecy we can cure this thing with some unknown thing. You get a lot of climate change deniers or scientism types like Bill Gates (who Insel quotes) or Steven Pinker who claim that climate change will be solved by magical future technologies in the same way. It's religious fanaticism and faith not science.
Solved? You mean stop producing CO2 by not buying stuff like Microsoft products or swanning around the world in jets or eating meat? No, of course not, imaginary futuristic technology ""This is a pivotal moment. We need to adapt to the climate change that is already affecting the planet, and develop new tools that will keep the problem from getting worse. The good news is that there's a lot of progress to report on both fronts." This is faith nonsense.
"The most important point here is a conceptual one."
Don't think about where the woman in the box is, look at me waving my cape around. It's the same principle. Don't take all available evidence just think about this subject differently. I would if he gave me some evidence.
"What I've been talking about to you so far is mental disorders, diseases of the mind [sic]. Actually that's becoming a rather unpopular term these days...it's politically better to use the term behavioural disorders. Fair enough, they are disorders of behaviour and they are disorders of the mind."
But I want you to ignore all that actual factual stuff and dream with me.
"What I want to suggest to you is that both those terms that have been in place for a century or more are actually impediments to progress."
And if you don't agree with me you're a back woods yokel trying to hold back progress. What be this progress oh master?
"What we need conceptually to make progress is to rethink these disorders as brain disorders."
You mean, go back to the pre-psychoanalytical revolution then? Think of it as phrenology. Or blood disorder. Or pressure on the brain that can be alleviated by a small hole?
"Now some of you will say, oh here we go again, we're gonna here about chemical imbalance or drugs or some simplistic notion that will take our subjective experience and turn it into molecules."
Oh if only it were that scientific.
"When we talk about the brain it is anything but unidimensional or simplistic or reductionist."
Here's some pictures of the brain. Wow, look 10 billion neurons. 100 trillion synapses.
See, the brain is so complex that mental illness has to be a brain disorder. Fact. Oh no wait, he hasn't offered any connection yet. Just scary walnut brain, neurons that look like a pretty bead curtain and synapses that look like a trippy spider web.
Insel weirdly then argues we should "use our own minds, which the brain supports to understand the very complex brain that supports our own mind."
So, you're going to use your mind, which is supported by your brain to understand mental illness that isn't of the mind but of the brain? If you're using your mind to understand things then why isn't mental illness still that old fashioned disease of the mind then?
Me confused. I'd still like, you know, evidence.
Insel ups some brain diagram things showing how our brains are affected by the different mental disorders; depression, OCD and PTSD.
So the "circuitry" is different in these conditions, he claims.
Hang on. Where did this evidence come from? No idea. If it is from a study, how were the participants diagnosed if not behaviourally? All you're then doing is having a patient who experiences PTSD because they were continually shot at in Afghanistan every day, every hour for months on end and they're brain is showing some different activity to someone not shot at. Actually, Insel doesn't bother with non-PTSD etc. brains as a comparison. Look, it's scientific!
You know, I've just eaten, I'm then going to dispose of that food through my waste system by doing a poop, I might watch some TV. All of these things will change how my brain looks on a scan. Typing these words and thinking them effects my brain working stuff. Everything does.
Like what? This is a giant leap. Even if you had thousands of participants' brain scans showing the same 'abnormalities' whilst diagnosed with the same 'illness' all that shows is that the brain is affected by the illness. It doesn't follow that that abnormalities in the brain caused the illness. This is pretty basic stuff, n'est pas?
I think it's time to remind the audience that the mental disorders you're talking about are just like biological disorders...
"This is a little different to how we think of Parkinsons or Huntingtons or Alzheimers where you have a bombed out part of the cortex here we're talking about traffic jams or sometimes detours or problems with just the way things are connected. You could compare this to myocardial infarction...where you have dead tissue in the heart to an arrhythmia where the organ isn't functioning correctly because of the communication problems within it. Either one would kill you but in only one would you find a major lesion."
Huh? Mental disorders are like Parkinsons etc. though of course they're not as the latter are degenerative (though there's a debate on schizophrenia, see below). Parkinsons etc. have "bombed out" parts, as in bits that begin to fail to function, but mental disorders are like blockages. You know, like with heart disease, that biological illness, there's your standard heart attack and then there's irregular beats (which doesn't necessarily lead to death actually and is, of course linked to mental disorders via stress and anxiety). Parkinsons etc. is like the heart attack and psychosis etc. is like irregular beats. In a sense the analogy works because Parkinsons etc. does have a physical biological manifestation (that's why it's not a psychiatric condition) and mental illness doesn't. However, mental illness does not kill you. You kill you. So it's a really crappy analogy. But one that reinforces in the viewer the idea that mental illness is just like Parkinsons and myocardial infarction.
"I think it would be easier to go into one particular disorder, schizophrenia, because I think this is a good case where thinking of these as a brain disorder matters."
Here we get some scans showing less grey matter in the brains of schizophrenics. And lots of colourful pictures of brains that I have no idea what he's showing me as he's not showing me what a normal brain should look like. There's no point of reference here so it's all on trust that schizophrenics have less grey matter. I don't know. I do know you diagnose psychosis by behaviours that only the 'sufferer' experiences. That's not to say they don't, of course they do. But it's completely subjective.
From this we get a "Developmental Brain Model for Schizophrenia" which shows "the path to schizophrenia" and the "psychosis threshold."
Are you keeping up with this? Of course not. You're not meant to. You're meant to go, wow! Look at that.
See, it's completely meaningless. The images linked to another site critiquing (probably far more more eloquently) this nonsense here
Insel saves up his best lines for this finale. "At some point you overshoot this threshold and at that point we can say that this person has this disease because they have behavioural symptoms of hallucinations and delusions, that's something we can observe. They've crossed a brain threshold much earlier. Even at 15 or 16 you can see that the trajectory for development is different at the level of the brain not of behaviour."
Well. I think the problem with diagnosis of psychosis (I'm a poet) is problematic for the very reason that we can't see it like we can biological illness. To then extrapolate that you can see schizophrenia in the brain before it manifests in behaviours is absurd. How? How would you (computer modelling? based on?)? As diagnosis is based on behaviours how can you possibly intervene before those behaviours have manifested?
Are you scared? I am. This is all going a bit Clockwork Orange on us.
I wasn't actually thinking of that bit. You just can't get the staff nowadays...
Except psychosis is nothing like Alzheimers is it? Where's the evidence for this? Alzheimers (dementia) is a late onset (over 65 usually) degenerative illness. What has that to do with, say depression or eating disorders (two of Insel's examples)? There's no evidence that there's anything in common between them. You could even argue that they don't both have a basis or manifestation in the brain. Obviously Alzheimers does.
"New tools can show us the presence of brain changes long before symptoms emerge."
Huh? How? What would these tools be? Mandatory brain scans for all 8 year olds? This is nonsense. The whole of psychiatry is about diagnosing patients based on presenting symptoms. If you don't have those presenting symptoms how would you know that anyone is mad?
"Early detection and intervention will give us the best outcomes."
How would you detect? Even with mandatory brain scans does this man really think that depression is going to show up? Really? In everyone? At the same time? Or are you going to stagger the scans? This makes no sense.
Much more disturbing is the "intervention" word. What would this intervention look like? What about consent? What if we're talking about children, is there really consent then for "intervention"? I don't think Insel's thought this through. I think he's caught up in his own fantasy (delusional?) about wonder technologies rather than real, concrete reality.
Let's just remind you that it's just like biological illness again, in case I'm losing you...
"If we waited till the heart attack we would be sacrificing 1.1 million lives every year in this country. That's exactly what we do today when we decide that everyone with these brain disorders, brain circuit disorders, has a behavioural disorder. Wait until the behaviour becomes manifest."
Now, I'm perplexed on two levels. Don't we wait until the heart attack? I mean, I live in the UK and I'm unaware of any heart disease prevention tools currently used. Unless I, as a patient, have some strange heart murmurings I'm left to my own devices until I keel over sweating like crazy and losing consciousness. Again, I think he's talking about after the fact intervention. As in, patients complaining of heart problems then receiving intervention. But then, that's exactly what we do with all illnesses (including so called mental illness) except some cancers later in life. You have to wait until it manifests to know you 'have it.' Again, is he suggesting some sort of mandatory mental illness screening? How?
Again, what is this intervention? With heart disease it's lifestyle changes (yes, environment affects illness) usually. Actual medical intervention if things have got worse. For schizophrenia, anti-psychotic drugs is de rigeur. Is he suggesting scanning every child's brain and if they have these developmental differences putting them on anti-psychotics? I'm genuinely baffled by his argument.
"We don't have all the facts. We don't even know what the tools will be. [We're confident it won't involve drills] Nor what to precisely look for in every case. To get there before the behaviour emerges."
O O
It's mumbo jumbo witch doctory. We don't know anything but we could save lots of people in some way unspecified if we could diagnose without relying on traditional diagnosis in some future time somewhere.
"But this tells us how we need to think about it. And where we need to go."
It does no such thing. You just said not two seconds ago that you don't have the facts and you don't know what the tools would be or what to look for or how to get there."
But when are we going to get to this whatever it is he's talking about?
"Are we gonna be there soon? I think this is something that is going to happen over the course of the next few years."
This is classic magical thinking as evinced in religion. The messiah will return. Soon.
You hold onto your dream, Thomas.
Some might say that basing your beliefs on wishful thinking and imaginary devices is classic psychosis manifesting. I'm no doctor but...
Over at the BBC, astonishingly they have a far more balanced and intriguing view of psychosis. I urge a watching of the documentary. A better copy here.
Rachel Waddingham with visualizations of her voices. She writes good songs about her psychosis too.
Jacqui Dillon who spoke about her childhood abuse that had nothing to do with her madness, it's a disease of her brain, if only she knew
David Strange (nobody dare say that's a great name for someone with psychosis but I will) who is perhaps the most eloquent and interesting person I've ever seen on TV
All three participants's psychosis manifests in hallucinations, hearing voices, classic schizophrenia or psychosis. And shock horror (spoiler) they all have PTSD from childhood abuse. We get a psychologist pointing out that psychosis more often occurs in urban dwellers, explicitly linking it to one's wider environment. No brain scans are harmed or involved in the programme and the upshot is clearly heavily linking psychosis to one's environment.
Thomas Insel could do with watching it. Though I'm sure he would still believe we could detect signs before they were manifested (aged 8 in the women's cases) and intervene (whatever that might entail) using brain imaging for this brain disorder.
I haven't given any evidence that psychosis or madness in all its forms is environmental. Unfortunately that would always be anecdotal. That doesn't mean that it's less reliable simply because the vast majority of studies in the area simply ignore environmental factors (as do psychiatrists most often) and as Insel states, we know nothing about the disorders, why they manifest or what we can do about them (even though we know a lot about all the biological illnesses he lists and for most have reliable interventions, funny that) . So that suggests to me that they are completely wrong to go down a bio-medical route and it would be far easier to assess environmental factors. Back in my psychotherapist days I can assure you I never say a client who told me that they had no life problems it was just something not right with their brain.
It's so startlingly obvious that there are strong links between environment and mental illness (there is stacks of evidence for PTSD (well, obviously, it's in the name), dissociation, depression, eating disorders, anxiety) that it seems bizarre that it's not simply accepted that madness (mental illness if you prefer) is directly correlated to life experiences. That so many psychiatrists and researchers are so very keen to see madness as biological in origin. My own analogy here is climate denial. Let's blame madness on natural temperature fluctuations rather than our impact on our environment and each other.
Comments
Post a Comment