Are Mental Illnesses Brain Disorders?
Why is it that medical men and women practising the honorable profession of psychiatry are sometimes disrespectfully referred to as ‘headshrinkers’, or ‘shrinks’, or even, by a deliberate mispronunciation of the word, as ‘trick cyclists’?
Perhaps the answer is to be found in a production of the American Psychiatric Association – where else? – called Diagnostic and Statistical Manual of Mental Disorders, specifically the latest (5th) edition published in 2013. Within its hallowed 947 pages we can find the diagnostic criteria of no less than 297 so-called disorders. These are thought up – I kid you not – by committees of psychiatrist who arbitrarily assign number and duration of symptoms to fit the invented diagnoses.
I say so-called, because to talk of a disorder in this context implies the presence of a brain abnormality such as a chemical imbalance or other kind of dysfunction. For example, it used to be thought that deficiency of serotonin was the cause of depression, even though it’s impossible to measure the level or activity of serotonin or any other neurotransmitter in the living human brain. This idea has recently been thoroughly debunked. In fact, there is no reliable objective evidence for the existence of any so-called mental disorder. Even changes that may be seen on brain scans in people suffering from mental symptoms are in no way diagnostic of any mental disease.
Mental illness and mental health
One might approach this problem in another way by asking: Does mental illness exist? However, if we talk of mental illness this implies a corresponding state of mental health. What, then, is mental health?
A common definition is ‘emotional, psychological, and social well-being’ but this is a tautology because ‘well-being’ is the same as ‘health’. It’s like saying mental health is mental health.
The WHO defines mental health as: ‘A state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, work productively and fruitfully, and is able to make a contribution to his or her community.’
This definition is unclear and overly broad. Do they mean ‘realise abilities’ in the sense of being aware of them, or in the sense of putting them into effect? What are ‘the normal stresses of life’ and what do they mean by ‘cope’ with them? What’s the difference between working productively and working productively and fruitfully? Do they mean able in theory to make a contribution one’s community or in practice making a contribution? How do you define ‘contribution’ anyway? There must be many people who, for lack of education, money, or opportunity, although they may in theory fulfill the criteria for perfect mental health, in practice are unable to do so. Are these unfortunates by definition mentally ill? And who is qualified to judge whether someone is mentally healthy? Is it psychiatrists? Or is it the person himself or herself?
One with the universe
If a man were to retire from the rat race to sit in a cave in the Himalayas and spend all day meditating, he could hardly be said to be coping with the normal stresses of life, working productively and fruitfully, etc., but does this mean he doesn’t possess mental health? Depending how you look at it, someone in this situation might be said to have superior mental health compared with living a conventional life. He might even be regarded as having reached a higher state of consciousness or become ‘one with the universe’.
If it’s so difficult to define mental health, then it’s equally difficult or even impossible to define mental illness, so we’re back at the original question: Do mental illnesses exist?
Professor Joanna Moncrieff
This is what Professor Joanna Moncrieff, the lead author of the paper referenced above, has to say on the matter:
There is no evidence that mental disorders are the product of abnormal brain mechanisms…There is no state of the brain, nor even particular features of brain activity, that corresponds to depression or anxiety, or any other mental state.
There is a further problem with the attribution of mental symptoms to brain disorders: it disempowers patients by implying that they are victims of something beyond their control and may need treatment with one or more psychoactive drugs, even indefinitely, since some of these diagnoses are regarded as incurable.
It needs to be understood by both doctors and patients that drugs such as antidepressants and antipsychotics cure no disease, but by their side effects, particularly emotional blunting and sedation, may make some patients feel better and this may preferred to the undrugged state. These drugs also have many other potential side effects.
This does not mean that the profession of psychiatry is redundant – far from it. But the emphasis needs to change: instead of being disease- or diagnosis-centred, it would better be regarded as ‘drug-centred’. This means that people with certain distressing symptoms – depression, anxiety, intrusive thoughts, hallucinations, unconventional behaviour, and the like – instead of being diagnosed with a so-and-so disorder, are taken at their word and asked what they are seeking help with. For example, if someone is distressed by hearing voices, instead of diagnosing the patient as suffering from schizophrenia and offering an ‘antipsychotic’, he or she may chose to take a drug which experience has shown may quieten the voices and thereby make life easier for them and their carers. Such a drug may be what’s called an antipsychotic but it wouldn’t be presented as a specific treatment for schizophrenia. Instead, it would be offered as symptomatic treatment with no presumption as the length of time for which it might be needed.
Finding meaning in mental symptoms
Another important advantage of this approach is that it leaves open the possibility of exploring the background of the patient’s distress such that it may be possible to find meaning in what the voices are saying, or in the other symptoms. This is where psychotherapy can be of great value.
Otherwise, the reductive approach of assuming the presence of a brain disorder may forestall such exploration. Symptom: hearing voices; Diagnosis: schizophrenia; Treatment: antipsychotic. Next, please!
This is not to be confused with the situation with which all psychiatrists are familiar: acutely disturbed patients suffering severe distress and causing concern or alarm to others. They may need restraint and even custodial care, though this should be limited to the absolute minimum time while they are treated with sedatives until they have calmed down.
In conclusion, rather than such patients being regarded as suffering from a brain disease, their behaviour could be seen as an adaptive, if ill-chosen, response to an intolerable situation in their lives.
Text © Gabriel Symonds
Picture credit: Library of Congress on Unsplash