Greenfield goes from Royal Institution

At last.

I hope this fine old scientific establishment can return to its main duty of doing science and communicating it to the young and the interested.

Click to Enlarge

uugh

Prof. Susan Greenfield

http://www.guardian.co.uk/uk/2009/feb/24/social-networking-site-changing-childrens-brains

Once a good scientist, she now campaigns for purity. She's anti-drugs, anti-television, and most recently anti-computers, saying (along with a newcomer, whose name I failed to record, in an Institute of Biology publication) that brains are actually messed up by watching screens (and of course social deprivation).

It's all nonsense, of course. Just a prejudice for order and abstract "cleanness". It's a weird mental illness, to which many fall prey.

God and Stuff

All evidence for God's existence as religions would like Him to be derives ultimately from "intuition" or "revelation". Yet we know from everyday existence that many of our intuitions are wrong.

As one who has actually had a revelation due to delusional psychosis, I know that revelation is an unreliable source.

But, of course, there is reason. It is possible that God exists. In an infinite universe of space and time, anything that is possible exists somewhere or somewhen.

We know infinity exists in mathematics. So God exists, at least in mathematics.

I'm a sort-of follower of Neale Don Walsch, but I really don't like the hypocrisy of many religious people.

Not that any of this is very important, compared with the vital business of living.

What about an Anti-fussy law

Anti-fussy law: people have to put up with more from their neighbours, instead of suing them all the time. Same with health and safety.

Also -- a "spirit of the law" law.

This is lonely . . .

Not a lot of people really care about what I think. I've now learned that it's OK. So I'll be using this from time to time for a quick thought-dump, but it doesn't really matter if you read it. I'd be happier if somebody did, but only so they could think about psychiatry and society. Anyway, others do this stuff a lot better than I can.

Psychiatry in Context

Researched for Your Voice in Sheffield Mental Health
by James Friday (mental health service user, retired lecturer in history of science)

“Anyone can behave in an insane way. Take rage, excitement, fear, love. “Insanity” is when you don’t know that how you’re behaving is “insane”. Only a Psychiatrist can make you understand that you’re “insane”. He’ll do it by force, if necessary.”

A Psychiatrist I once knew

Psychiatry – Some Views:

Psychiatry is the practise of healing the mind. It comes from the Greek “psyche” meaning “breath of life” – or soul -- and “iatros”, healer. At one end of the psychiatric spectrum the soul, character and personality are all in the definition of mind. At the opposite end, the mind is just a bunch of electrochemical reactions. Biologists see the mind in terms of survival and adaptation. Others see it as a store for culture and transmitter of information. All agree that -- whatever the mind is -- some people are “disordered” and need help to cope.

The anti-psychiatry movement holds that society itself is sick. Mental illnesses are natural reactions to that sick society. Most in this movement blame capitalism and authority for all the ills. No one is more of an authority figure than the psychiatrist. Therefore, psychiatrists cannot cure anything, because they are a big part of the problem. R.D. Laing and Thomas Szasz are the main figures in the founding of this movement.ⁱ They offer few answers to individuals who want help.

The sociologist Thomas Scheffⁱⁱ came up with a different “anti-psychiatry” view. He believed that all mental illness is cultural rule breaking at a very basic level. People turn to medicine to try to explain their loved-ones’ behaviour. Doctors oblige them by inventing terms and labels These, in turn, exclude and stigmatise the mentally ill, often leading to custody and control. The doctors become rich and famous, and the people (except for the labelled few) feel that their safety and culture are secure. All psychiatry is just labelling.

Advances in neuroscience have shown that much of this labelling is, indeed, nonsense. The brain is not just a machine, not even a computer. It is, instead, the most complex piece of jelly that could ever be imagined. For example, people have at least 10 billion brain cells. There may be 100 billion, but a large number of those cells are structural. Brain cells are very peculiar. They can form up to 10,000 connections per cell with each other and change them often. Using only a few connections out of a possible 10,000 each, just 3% of the brain's neurons can record nearly 1000 memories during every second of a person’s existence for about 100 years (See Box)ⁱⁱⁱ.. The brain has a simply massive overall ability.^iv

With such power, people can retain every event that has ever happened to them. All this “stuff” generates internal conflicts. Natural cell death, trauma and many chemicals make for even greater conflicts. “Missing bits” produce slight functional flaws in any of the myriad things the brain does. The unique pattern of such flaws, plus every feeling and every piece of thought, creates the Personality and Character. Big systemic flaws create either “mental illness” or Personality Disorder.

Personality:

Personality is the collection of learned actions and responses. These interact with unique systems of memory, perception, thought, drives and non-conscious processes. Some call this Character (and others call it superego). A person cannot judge his or her own personality. It only exists in a social context. The more a person’s self-image matches the feedback given by others, the more integrated that person’s personality is. Personality Integration is the foundation of sanity, according to some. Others say that a person who integrates into a sick society may end up more disturbed, especially if they then encounter a healthy society.

Personality Disorders arise when the underlying systems are “maladaptive”. Bad adaptation causes actions and responses that are at or beyond the extremes of social acceptability. Typically, teachers or others recognise these disorders in childhood or teen years and do nothing about them. They hope that the bad behaviour and lack of empathy are just normal teenager “acting-up”.

In less settled times, and in some jobs (e.g., assassin, commando, slaughterhouse work and cutthroat business), such personalities might not be maladaptive. When stability returns to a society (or when society curtails war, meat-eating and free market forces), people with these disorders quickly sink into unhappy obscurity. They sometimes emerge to attack the society which has disowned them.

Labelling of Personality Disorders is random at best.^v

From various lists, there are importantly:

1. Psychopathic Disorders, characterised by fearlessness, non-empathy, rigidity of thought, narcissism and manipulativeness, plus the so-called “Cluster A” odd or eccentric types – i.e., paranoid, schizoid and schizotypical, which are, frankly, just meaningless names;

2. Sociopathic Disorders, including pyromania, megalomania, egomania, stalking and (controversially) nymphomania;

3. Simple narcissism, combined with indifference to others or utter dependence on others;

4. So-called Character Disorders, including amorality, purposeful cruelty, rapaciousness, constant lying, self-piteous victimhood and hatefulness (including all the “isms”);

5. Some odd conditions, such as coprophilia, infantilism and “berserker syndrome”^vi

People with Personality Disorders usually find it hard to change. They do not grow to fit in with society’s norms in settled times. Their personalities are not integrated with society. This leads some psychoanalysts to state that they have no access to a superego. What treatments there are include heavy drugs (especially in prisons) and long-term psychoanalytical discussion. Some short treatments (like Cognitive Behavioural Therapy) have been tried, but they are almost completely unsuccessful.

Character:

Some older forms of psychiatry saw character as the main focus for mental health. In these systems (mainly those of Wilhelm Reich [1897-1957] and his followers), the Character is the integration of all the traits peculiar to a person. These include his or her “character defences”, and analysts tackle these if change is to occur. Reich’s psychoanalytical techniques were much more open and “cuddly” than Freud’s. Most modern therapists do not distinguish between personality and character.

Character disorders overlap largely with personality disorders. There are a few additional ones, however. These are based on accepted settled social norms. Violations of these norms include bullying, entrenched sloth, gluttony, inability to be unselfish, inability to be wrong, irresponsibility and lack of any sense of loyalty.

Character disorders arise from bad parenting and education, for the most part. Some also think that traumatic experiences in childhood shut individuals off from instruction or development. Others claim that Personality and Character Disorders have a genetic base. This is almost certainly untrue.

Note: People with these disorders can and do change, in a good few cases. Unfortunately, there is no one method that works for all, and there are many for whom there is no treatment. However, people with such disorders are also prone to “normal” mental distress and illness. They can benefit from treatment of these conditions, just like anyone else.

Mental Illness – Background:

Historically, and in different cultures, people treated what we call mental illness practically. Ancient doctors based their theories of madness on observation, philosophy and religion. Behaviour that outraged people in different times and places came from spirits, magic and, interestingly, breakdowns in family life.

Experience also showed that physical things like foods, drugs, injury or disease caused some symptoms of madness. The 2^nd Century Greek medic Galen used these facts to devise a medical and “psychiatric” framework which lasted until the early 1800s. In Europe until at least the 1600s, most people were tolerant of mental illness. The idea that Bedlam and other madhouses were typical of the treatment of insanity is wrong. Such places were mainly used by the well-off to get rid of unwanted, difficult relatives. For ordinary people, mental illness was mostly just like physical illness – a view which has now been partly resurrected.^vii

The Quaker York Retreat (founded in 1796) showed that therapeutic communities work well for many types of mental distress. Enlightenment views of society as rational and progressive led to better practises. In most retreats, staff used diet, exercise and discussion (though not about any “mad” thoughts) more or less effectively.

Unfortunately, this view collapsed over the 19^th Century in Britain (though France never lost the idea of “asylum” in its proper sense). Asylums became very large dumping-grounds. In England in 1800, there were only about 1000 people in the enlightened homes and retreats, but by 1900 this had risen to 100,000.^viii Such numbers could no longer be treated with dignity, or even much humanity. Asylums became much worse than the old madhouses. Abuse, drugging, restraint and simple cruelty were rampant.

Mental Illness – Psychoanalysis and Other Therapies:

In 1895, Sigmund Freud published his Studies in Hysteria, and Ivan Pavlov did his first experiments on conditioned reflexes in dogs. The former started modern psychiatry; the latter showed that learning is connected with “instinct”. This was the foundation of modern neuroscience, which has almost taken over psychiatry.

Sigmund Freud (1856-1939) is often rubbished now. True, he did over-sexualise everything; true, he did view women as more prone to mental illness; true, his emphasis on transference was a bit perverted. However, Freud provided a truly modern set of metaphors for mental processes – metaphors that allowed for much new thought in many disciplines.

According to Freud, we know that we have a conscious mind. We also know for certain that we also have an unconscious mind. We dream, forget things and do not direct our breathing or heartbeat. This unconscious mind makes many decisions for us and is not subject to reason. The unconscious holds our basic drives for food, water, safety, sex and so on, and at this level – called the Id – we are absolutely unreasonable. The combination of our conscious mind with unconscious memories and thoughts makes up our self-image. This is our Ego. The Ego is selfish but is subject to reason. Above the Id and Ego, and because we are social beings, there is a set of social rules which we learn in childhood, and which are reinforced daily by our culture. This is the superego – our internalised moral sense. The interplay of these three mental structures with ever-changing external conditions gives us our mental health or illness.^ix

Freud also believed that our psychosexual development from childhood complicates these structures. Thus we get the Oral Phase – early childhood where we get comfort primarily from taking things into our bodies and minds; the Anal Phase – where we learn to control things and actions; and the Phallic (or psychosexually mature) Phase – where we want to give and to create things and ideas. Any person can be “frozen” at one of the two early phases by trauma (or paradoxically by being over-comfortable at any one phase). Thus “orally fixated” people were self-indulgent, greedy, messy and so on, while “anally-fixated” people were basically “control freaks” -- fussy, meticulous and perfectionist.

Finally, Freud re-emphasised the need to talk to those in distress – teasing out the different strands of difficulties and encouraging people to apply reason to the unreasonable. Largely due to Freud, Psychoanalysis and Psychotherapy developed into large industries in the 20^th Century.

Indeed, there are now so many schools of psychotherapy that it is very hard for anyone to find the “right” one. Under various headings, The Penguin Dictionary of Psychology (see notes) refers to the following:

1. Freudian Psychoanalysis – (largely about sex, these days)

2. Jungian (after Carl Gustav Jung – 1875-1961) Analytical Psychotherapy – (largely about the wider human spirit or “soul”)

3. Adlerian (after Alfred Adler – 1870-1937) Individual Psychotherapy – (largely about the “drive to power”, and the individual’s tendency to inferiority or superiority complexes)

4. Non-directive psychotherapy – (Carl Rogers’mid-20^th Century idea that people can get better by just rambling on to someone every week)

5. Existential Analysis -- (Ludwig Binswanger’s [1881-1966] Gestalt Theory, a holistic approach in a social and cultural context)

6. Cultural Psychoanalysis – (Erich Fromm’s [1900-1980] method, which insisted on people making real human relationships, based on simple love)

7. Short Session Supportive Psychotherapy (pragmatic, crisis-centred work)

8. Group Therapy (providing artificial but very significant human relationships; Alcoholics Anonymous is extremely successful because of its supportive group therapy)

9. Behavioural Therapy -- (sticks and carrots to encourage correct behaviour – see A Clockwork Orange – it does not work with psychopaths or perhaps anyone else)

10. Transactional Analysis – (Eric Berne’s [1910-1970] practical psychotherapy for day-to-day use, much abused these days by charlatans. Berne helpfully equates the Id with the “Inner Child”, the Ego with the “Inner Adult” and the Super-ego with the “Inner Parent”)^x

11. Cognitive Behavioural Therapy – (practical method for tackling negativity in any aspect of distress)^xi

12. Psychodrama – (a practical development of Group Therapy which allows the expression of emotional conflict in safe circumstances)

13. Family Therapy

14. Art Therapy

15. etc.^xii

There are lots of others. Many claim to be “holistic”, simply because that word sounds good. In any case, holistic approaches are wrong for suicidal people who might really need to bury memories of horrible events. This can be achieved through Electroconvulsive Therapy (ECT), and it works well for the few who need it. Honest self-revelation is not always the answer to mental distress. “Opening up” is not always right for everyone.

There are also many phoney therapies, because crooks make a lot of money from people in distress. One to avoid is “Neurolinguistic Programming”, which is truly bad mumbo-jumbo, despite its wide cult following.^xiii There are many other mumbo-jumbo therapies.^xiv

The therapist and academic Rudi Dallos^xv noted five frameworks into which all psychological therapies fall. These were Bio-medical, Behavioural, Psychodynamic, Humanistic and Systemic. All treatments share the ideas of the need for empathy with the distressed person, leading to a working therapeutic relationship involving in-depth communication. He also noted that all therapies must take account of the potential for vicious circles of patient-therapist interactions which can actually make things worse.

Mental Illness – Sources:

Early thinkers attributed mental illness to supernatural causes. You could be struck mad by the gods; your soul could be eaten up by daemons (imps, sprites and other ill-willed spirits). Some churches still believe such things, but this view is neither evidenced nor effective. Scientific psychology and psychiatry concern themselves with problems of the mind created by natural and social factors. With help, most people can, in theory, eventually resolve them, no matter how complex the underlying strangeness of the brain and mind.

So, in addition to personality and character, there are physical and semi-physical foundations for mental distress.^xvi These are roughly as follows:

Disturbances of Survival Systems:

1. Eating Control – anorexia, bulimia, gluttony

2. Sleeping Control – psychosomatic narcolepsy, insomnia, body-clock disorders

3. Perception Control – hallucinations of any or all the senses, including phantom pain, some dissociation and depersonalisation, body dysmorphia and Attention Deficit Disorder (if it exists)

4. Sexual Control – psychosexual disorders of unwarranted domination or submission; obtaining sexual gratification from non-sexual contexts (extreme fetishism); inability to connect sexuality with pleasure, etc.

5. Excretion Control – some forms of coprophilia, coprophagia and urophilia; extreme anal fetishisms; the mental substitution of excreta for sex

6. Communication Control – from some forms of autism to extreme forms of shyness; back-repetition of everything someone else says; extreme hermitism

7. Social Context Control – extreme superiority and inferiority complexes; solipsism (the fixated belief that there is nothing and no-one outside one’s mind).

Disturbances of Fear Response:

1. Panic and anxiety disorders

2. Phobias

3. Some Obsessive Compulsive Disorders (and aspects of all kinds of OCD)

4. Most hypochondria and psychosomatic illnesses

5. Extreme recklessness (exaggerated efforts to fight fear)

6. Paranoia in general

Disturbances of Memory:

1. Post Traumatic Stress Disorder flashbacks

2. False memory disorder (a person comes to believe that someone else’s story is their own – sometimes planted by over-zealous therapists), and rarely dissociated memory (where someone believes that their own story is actually someone else’s)

3. Psychosomatic amnesia

4. Personality-fixing memories – those which fix a person at a particular time in life, often in childhood, leading to behaviour as if a grown person is still a child. Some believe this is the cause of paedophilia and infantilism.

Disturbances of Reason:

1. Inability to distinguish truth from falsehood when given full evidence

2. Inability to tolerate differing thoughts

3. Atomistic thought – inability to connect thoughts even when shown

4. Delusional thinking – including some religious/mystical types of self-confirming thought

5. Mobile judgement – variable, unpredictable and whimsical thought processes (in mild forms, this is the origin of much humour)

6. Inability to judge competing thoughts (when given full evidence)

7. “Normative Sensitive Disorder” – inability to recognise even the most basic social and cultural bounds of behaviour.

Disturbances of Emotions: The old “Neuroses” (See below)

Disturbances of Mood: Bipolar and unipolar mania and depression; failure of anger control; some paranoia (See “Psychoses” below).

Addiction and Addictive Behaviours:

1. Adrenaline addiction, leading to excessive risks, sex, gambling, etc.

2. Food and drink (oral) addictions, including some forms of bulimia, alcoholism and obsession. This is a classic stimulus-reward system – one feels good about the mouth (since this is the largest “brain image” organ of the body)^xvii, and if by putting things into it one obtains additional pleasure, this creates a positive “feedback loop”

3. Other drug addictions, including some types of alcoholism, arising from inability to face the mental pain of reality

4. Other entrenched addictive behaviours, including pacing, some Obsessive Compulsive Disorders, constant “stream-of-consciousness” talking, repetition and some forms of self-harm.

Mental Illness – Diagnosis:

First, psychiatry is interested in physical causes (as above) but concerns itself mostly with the mental and behavioural results of such causes. For example, organic dementia is not a psychiatric issue, except in terms of management and neuroscience. Psychiatric disorders have many physical effects, but the psychiatric viewpoint looks at underlying mental pictures.^xviii

Second, disease classification (labelling) is almost entirely practical, rather than scientifically justified. There are observations and experiments in psychiatry. Usually, however, by the time a psychiatrist comes to practice, he or she has internalised the idea of labelling so much that scientific questioning is unlikely. Labels are often demanded by patients, relatives, employers, insurance companies and government benefits bodies. So doctors impose them. The American Psychiatric Association developed the incredibly detailed Diagnosis and Symptoms Manual (now in its 4^th edition, 1993 + updates, called DSM-IV) to meet these needs.^xix The World Health Organisation produced a less dogmatic list called International Classification and Diagnosis (10^th edition in 1993+updates, called ICD-10).^xx

The aim of these lists is to make diagnosis faster and uniform across the medical system. Many, many workers in psychiatry and allied disciplines do not believe in the DSM-IV or ICD-10 types of lists or methods.

For example, DSM-IV excludes neuroses altogether, though the ICD-10 includes them. Also, DSM-IV holds that psychosis is merely a symptom of illness. Most psychiatrists outside the USA believe that psychosis – the critical break with reality – is the very definition of severe mental illness, which then expresses itself in myriad ways.

Mental disorders overlap very significantly with “normality”, especially in stressed societies. The two sections that follow express both old and new ideas of mental conditions. There are no simple truths in this most complex area, so it is better for clinicians to have as many ways as possible to understand personal mental distress.

Mental Illness – Neuroses:

“Anybody who hasn’t got a neurosis has gotta need therapy.”

Woody Allen

In the older system of Psychiatry, Neurosis was the heading given to a collection of less severe mental illnesses. These could nonetheless make people’s lives hell, and the bread and butter of the psychiatrist’s life was care for the neurotic – mainly through medications, psychotherapy and re-education in thinking processes.

Neuroses are just inner conflicts (especially between the id and the superego). There is little or no loss of contact with reality, and most importantly, the neurotic person recognises that they have “inappropriate or incorrect feelings”. Neurotic people typically spend a lot of time with doctors and counsellors. Many try to find some physical cause for their mental condition. Inner conflicts often exhibit outward signs, like rashes, panic symptoms and in very many cases, false psychosis. The neurotic mind can not easily accept its own deep conflicts, especially where social control of deviant thought is very rigid.

The classic neuroses are as follows:^xxi

1. Anxiety reaction, or chronically, anxiety neurosis – a feedback loop where people’s internal “ought to do this” or “must not do that” systems are overwhelmed by internal urges – such as those for freedom (e.g., not always having dinner on the table when the partner comes home from work, or wanting to leave a relationship which is old, stale and abusive)

2. Non-psychotic dissociative reaction – unreal states which include “victim depersonalisation” (often seen when someone talks about themselves in the third person – you do not actually have to be a victim, just feel like one), neurotic fainting, some kinds of sleep walking, déjà vu, fugue states, harmless “multiple personalities”, amnesia for bad events, etc.

3. Most phobias (except those that have a survival component)

4. Non-psychotic depression – “frozen rage” caused by real or perceived maltreatment. This leads to most suicide attempts.

5. “Character Defences Neurosis” – the exaggerated and constant need for attention and reassurance

6. Emotional fatigue reaction – leading to withdrawal, over-dependency, self-absorption and regression to earlier (usually childhood) behaviours

7. Hypochondria in all its forms, though some believe that this is really just a symptom of other neuroses

8. So-called “hysteria” – including psychological blindness and paralysis and other extreme psychosomatic illnesses

9. Post-Traumatic Stress Disorder and generalised stress reactions. Indeed, PTSD as seen in World War I (1914-18) gave a huge boost to the understanding of the mind. The study of PTSD showed that calm talking therapy among those who had experienced similar events could help people manage their flashbacks and fear.

Mental Illness –Psychoses

“Mental Alienation”:

Since Karl Marx first used the term” alienated labour” in the 19^th Century^xxii, those interested in mental patterns have tried to define the really serious disorders in terms of “separation from self” and “anomie”. Earlier psychiatrists called themselves “Alienists”, and the French asylums were for les alienés. Alienation gave way to the less descriptive word “psychosis” in the early 20^th Century.

In psychosis, the mind becomes separated (or alienated) from the world that most people view as real. Worse, structures or functions within the mind may become alienated from each other, and from the physical body. The more complete these alienations become, the more “insane” a person is.

Of course, psychiatrists have to rely on outward signs of these mental disturbances, in order to assess how best to reach the person within. Sometimes they cannot be reached. Sometimes they recover more or less completely. Most manage to limp along through miserable lives to early deaths. Psychosis is very serious stuff.

Aside from organic psychoses, caused by disease of the physical brain itself, there are only three major “batches” of labelled psychotic illness. The names for these are utterly deficient in describing the human misery they cause, not only to the psychotic, but also to families and society in general.

The first is such a bad label, and there is little merit in continuing to use it. Schizophrenia simply means “split mind” or “broken mind” (it never means “split personality”). It applies to hundreds of different conditions that have only a few things in common.

The clearest symptom of untreated schizophrenia is the distance between the “sufferer” and any other person. Schizophrenics who have talked about their condition note that, when ill (which may not be all or even much of the time), they can only pay attention to their “inner selves”. Outside distractions are either ignored or angrily rejected as confusing. Paradoxically, the voices or visions they sometimes have are much more “real” to them than family, friends or medical staff.

For this reason, active schizophrenics are often irritable, irritated and irritating. Some say, as well, that normal thought does not work with their inner selves. They perceive that other sorts of thought – often dripping with symbolism and associated with fear and magical ideas – are superior. These other thoughts more or less force themselves onto the besieged mind.

They differ from, for example, spiritual hermits, who may have the same kinds of processes in their heads. They tend to appear haunted, and they may develop strange, disturbing behaviours. Their impulsiveness can sometimes lead to suicide, or rarely, murder. Through social rejection, they develop rigid personalities and social incompetence.

Some become catatonic, occasionally by choice. Most become paranoid, for very good reasons. Some fluctuate, others decline steadily, and a few recover spontaneously.

Treatment usually starts and ends with drugs. Doctors force confinement in hospital to make sure the drugs work. They follow this with various kinds of unpleasant regimes which restrict personal freedom. Few doctors try talking therapies and self-help group attendance is extremely low. Schizophrenics have very low positive social outcomes, and the stigma against those with this condition is probably higher than with any other mental illness.

If schizophrenia is associated with loss of commonly accepted reason, Manic-Depression or Bipolar Disorder is mostly about loss of judgement. There are many versions of this disease, but what separates it from Psychotic Depression (below) is a consistent inconsistency of thought, values and behaviour. Heightened and depressed moods can be so extreme as to lead to death by accident or suicide. Some 75% of manic-depressives plan suicide, and 15% succeed.^xxiii

Manic-depression is now so over-diagnosed that many with mere moodiness consider themselves to be psychotic. It seems that people want labels. In fact, only eight in 1000 people are truly bipolar, and the figure stays the same in every culture of the world, and at all times we know of in history. It seems to be genetic.

Treatment is only through drugs and self-management. Talking therapies themselves do not work, and self-help groups are largely social. The reason for this is that in this disease uniquely there is no consistent mind on which to build a return to “normality”.

Psychotic Depression is a horrible disease, but many recover from it through drugs and talking with others. Doctors often call it unipolar, monopolar or endogenous depression. It is a living death, and suicide rates are very high, indeed.

In this psychosis, there is a mental certainty of deserved damnation. Not only is there no self-esteem, there is not even a basis for building such confidence. People with this condition sometimes become catatonic, utterly withdrawn, uncontactable by anyone else, or in a stupor (often sleeping, for example, in their own excrement). There have been many cases of such people starving to death or dying of thirst. The condition erodes the whole character and personality, but unlike schizophrenia, there is not even an “inner self” to turn to.

This is the main legitimate use for electroconvulsive therapy. If doctors can “awaken” a person with this condition for just a while, they can medicate them with antidepressants. Talking therapies – to rebuild shattered egos – can and do work then.

Aside from these main conditions, a few more odd and rare conditions are clearly psychotic. Three of them are : Chapgras’ Syndrome (genuinely believing that, say, a person’s spouse has been replaced by a clever impostor), Ganser Syndrome (prisoners’ genuine loss of reason when facing trial or other pressure) and Latah Syndrome (unknowingly constantly repeating back to people what has been said to them, with no real ability to communicate).^xxiv

Conclusions:

Small societies did not need psychiatry. People helped their families and friends, and got rid of anyone who behaved too badly. As population and mobility grew, people began to turn strange people over to priests or magicians for treatment. There was little observational or therapeutic science. Mentally disturbed people either got well or died. Perhaps there was less mental distress.

Industrial society and overcrowding in cities increased mental pressures. The Enlightenment, however, had brought new ways of thinking, and specialists started to analyse the mind. They began to name symptoms and certain diseases. Eventually, people like Freud created large and testable theories of mental illness. The Age of Psychiatry lasted about 90 years in the 20^th Century. More doctors with authority meant that more patients had to be found. More patients showed that there were apparently more and more conditions. People or governments paid money for treatment; doctors grew rich; a few patients were cured. Real mental distress, however, did not decline until adequate medications came into use.

As scientists became better at analysing the brain, neuroscience grew as a possible long-term solution for all mental problems. Analysis of the thousands of chemical processes in the brain gave hope that something would eventually be there to treat each disease.

Like snake-oil salesmen of old, therapists of all kinds hawked their own cures in books and on television. By the 21^st Century, people measured success in terms of money, security for the public and brevity of hospital stays. Proper psychiatry declined; great theories of mental illness languished; everyone seemed content with labels. The future belongs to the brain scientists. The profession of psychiatry itself will probably be dead within a generation. There will perhaps be “Mind Specialists” at many levels in medicine – rather like social workers.

This might be all right if people were happy, but they are not. Mechanistic “therapies” help for a while, but true distress defies such systems. Medications will improve, with fewer side effects, but many people do not want medications. A few good therapeutic communities will continue in places.

Nevertheless, the stigma of mental illness remains, and psychiatry has done little to help reverse this. As society demands more security, large asylums may rise again. Certainly, behavioural control will become the new focus of government at every level.

For individuals with mental health needs, the prospects frankly look bleak. Perhaps the anti-psychiatry movement is right. Perhaps those with mental distress would be better off finding fellow sufferers and friends, practising meditation and supporting each other. Erich Fromm’s “loving networks” may be the only answer.

Maybe humans were just not meant to live in such a world as we now have. If so, those who suffer will have to make their own arrangements. Otherwise, psychiatrists and their successors will lock them up.

Psychiatrists individually are not bad people. They have just lost the courage to try to find humane answers for those who genuinely suffer. It is in their own interests to get the guts to try something different.

Notes:

i

R. Laing and Esterson, A., Sanity, Madness and the Family, Penguin Books, 1969; Szasz, T., The Myth of Mental Illness, Paladin, 1972

ii Scheff, T. J., “Labelling Mental Illness”, Mental Health Matters (ed. T. Heller, et al.), Palgrave, 1996, pp. 64-9.

iiiNeural Configuration: Factorial Numbers and Combination Theory

Factorial numbers (shown by the mathematical sign !) are the multiplied products of a number and every whole number that leads to it. So, 6! would be 6 x 5 x 4 x 3 x 2 x 1 = 720. Let us look at just 3 brain cells -- A, B, C. Each can be on or off (stimulated or dormant), and the order of the three cells is important. We get the following combinations:

A AB BC ABC BCA

B AC CA ACB CAB

C BA CB BAC CBA

There are 15 different states (configurations) just among these three cells. The formula by which this is derived is as follows: 2n! + n, or in this case, 2(3!) + 3 = 2 x 6 + 3 = 15.

So let us just take a few cells, say eight -- scattered around the brain -- and let us just deal with one brain function -- memory. The number of possible configurations among the eight cells is 2 x 8! + 8, or 2 (8 x 7 x 6 x 5 x 4 x 3 x 2 x 1) + 8 = 80,648. So, for example, the memory of Aunt Gladys on the beach with her skirt blowing up could be just one of the multitudes of cell configurations within the eight cells. If you use mathematical combination theory (gamblers know this high-sounding technique), it turns out that, just in 3% of the brain, one can store more than three trillion separate memories. The mechanisms for getting to and from those memories are handled by other kinds of neural cells.

iv V.S. Ramachandran & S. Blakeslee, Phantoms in the Brain – Human Nature and the Architecture of the Mind, London, Fourth Estate, 1999, passim

vSee Reber, A.S. & E.S., The Penguin Dictionary of Psychology, Penguin, 2001, p. 525 et passim

viNational Institute for Mental Health in England, Personality Disorder: No Longer a Diagnosis of Exclusion, Department of Health Modernisation Agency, 2003

vii Linda Jones, “George III and Changing Views of Madness”, Mental Health Matters, op. cit., pp. 121-131

viii Ibid, p. 130

ix Wikipedia, “Sigmund Freud”, 2007 (http://en.wikipedia.org/wiki/Sigmund_Freud/Psychosexual_development)

x Eric Berne, Games People Play, New York, 1964; cf. Thomas A. Harris, I’m OK-You’re OK, London, 1981

xiBeck, A., Cognitive Therapy and the Emotional Disorders, NY: Penguin, 1993

xii American Society of Group Psychotherapy & Psychodrama (http://www.asgpp.org/) and The British Psychodrama Association (http://www.psychodrama.org.uk/)

xiiihttp://en.wikipedia.org/wiki/Neuro-linguistic_programming -- where it notes, “The broad judgment of the evidence-based psychology community is that NLP is scientifically unvalidated as to both underlying theory and effectiveness.”

xiv See Francis Wheen, How Mumbo-Jumbo Conquered the World, London, Harper, 2004, for hosts of business-related self-help therapies that are just garbage.

xv Rudi Dallos, “Psychological Approaches to Mental Health and Distress”, Mental Health Matters, op.cit., pp. 6-16

xviInformation from many sources, including New Scientist Special Report on Mental Health 1994-2007 at www.newscientist.com/channel/health/mental-health/ , passim, and UK Mental Health Specialist Library at www.library.nhs.uk/mentalhealth/

xvii V.S. Ramachandran& S. Blakeslee, op.cit.; and V.S. Ramachandran, The Emerging Mind – The Reith Lectures 2003, BBC and Profile Books, 2003

xviii R.E. Kendall, “Nature of Psychiatric Disorders”, Mental Health Matters, op.cit., pp. 17-26

xix http://psyweb.com/Mdisord/DSM_IV/jsp/dsm_iv.jsp

xx www.who.int/classifications/icd/en/GRNBOOK.pdf

xxi H.P. Laughlin, “Psychoneuroses”, Encyclopaedia Britannica, 15^th Edition (1981), Vol. 15, pp. 167-173. The 15^th Edition is perhaps the last scholarly version of Britannica. In any case, it gives a good picture of mainstream psychiatry at the height of its influence. See also “Neurosis” in Wikipedia at http://en.wikipedia.org/wiki/Neurosis

xxii K. Marx, “Alienated Labor”, in Man Alone: Alienation in Modern Society, edited by E. & M. Josephson, Dell, 1962, pp. 93-105

xxiii Please see, among others, McMan’s Depression and Bipolar Web at www.mcmanweb.com/index.html

xxiv S. Arieti, “Psychoses”, Encyclopaedia Britannica, op. cit .pp. 173-179; see also: “Psychosis” http://en.wikipedia.org/wiki/Psychosis ; “Bipolar Disorder . . .”, NICE clinical guideline 38, July 2006; Royal College of Psychiatrists, “Mental Health Information” at www.rcpsych.ac.uk/mentalhealthinformation.aspx ; National Institute of Mental Health (US) at www.nimh.nih.gov ; World Psychiatric Association at www.wpanet.org ; and see (for Anti-Psychiatry) www.psychiatric-help.org/ .

Copyright James R. Friday/Your Voice Magazine, 2007, 2008