Fwd: Questioning

Morgan Brown (morganbrown@hotmail.com)
Fri, 05 Dec 1997 06:33:17 PST


Hello all!

This is a forward regarding "mental illness" that I pulled from the 
ACT-MAD listserve which may be interest to some.

Morgan <morganbrown@hotmail.com>
Morgan W. Brown Montpelier Vermont USA
Please visit my Home Page at:
http://members.tripod.com/~Norsehorse/index.html
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-------forwarded message as follows-------

Date:         Fri, 5 Dec 1997 06:42:38 -0500
Reply-To:     ar402@freenet.carleton.ca
From:         David Harris <ar402@freenet.carleton.ca>
Subject:      Questioning
Via:          ACT-MAD@MAELSTROM.STJOHNS.EDU

This was posted on the newsgroup alt.society.mental-health by Jon Winet, 
and is
a forward from D.J. Jaffe.  The initial sentence is from him:


==========
(I thought this article from 11/22 MN Star Tribune was one of the more
thought provoking articles I've read recently)

  No proven physical cause for psychiatric disorders

 Charles E. Dean

    At the risk of suffering the wrath of my colleagues and the National
Alliance for the Mentally Ill, I have to say that your well-intentioned 
Nov.
3 editorial on the Mental Health Parity Act misses the boat - but not by
much.

The bulk of your argument is correct: Insurance companies and employers
should provide "equal lifetime and annual dollar limits for mental and
physical illnesses. " And there is no doubt that attempts by President
Clinton and others to sabotage this long-overdue law smack of the usual
discriminatory approach to psychiatric disorders - an approach clearly 
based
on the historical stigma attached to mental illness, and the 
now-discredited
claim that equivalent coverage would lead to economic disaster.

Unfortunately, your argument for parity rests on the claim that 
"depression,
schizophrenia, and bipolar disorder are every bit as physical in origin 
as
epilepsy and diabetes - and every bit as treatable. "

Alas, this is not the case. In fact, there is no proven physical cause 
for
any psychiatric disorder.

There are plenty of interesting theories about biological causation. 
With
regard to schizophrenia, for example, theories involve practically any 
area
of the brain you'd care to mention. A short list would include the 
prefrontal
cortex, hippocampus, cerebellum, the limbic system and/or the basal 
ganglia.

To this should be added the thalamus, an area dear to the heart of Dr. 
Nancy
Andreasen, editor of the American Journal of Psychiatry, who in February
adduced multiple lines of evidence to show that thalamic dysfunction is 
at
the heart of schizophrenia.

However, not even Dr. Andreasen - a hard-nosed biological psychiatrist 
if
there ever was one - claimed that she had discovered a clear physical 
cause
for schizophrenia, nor did she describe any other causal agent. Instead, 
she
repeatedly used the word "theory, " a wholly appropriate term for the 
present
state of affairs.

That being the case, why are so many - including your editorial writer - 
so
convinced that the origins of mental illnesses are to be found in 
biology,
when, despite more than three decades of research, there is still no 
proof?

Well, first of all, psychoanalysts and psychologically minded 
investigators
provided no good answers.

Second, once the biochemistry of antidepressants and antipsychotic drugs
became understood, psychiatrists began reasoning backward from the 
mechanisms
of drug action to the supposed causes of the illnesses for which they 
were
given - a dead end, but still popular: Witness the new life give to the
transmitter serotonin after Prozac and Peter Kramer's book became
bestsellers.

Third, as theories and drugs accumulated, research in these areas became 
the
best way to obtain grants and promotions.

Fourth, technology provided us with marvelous instruments such as MRI 
and PET
scanners, which made research on the living human brain both possible 
and
highly informative.

Fifth, biological research has produced thousands of papers on brain
chemistry and function, resulting in an explosion of knowledge.

You should be aware, however, that these studies have not shown much 
about
causation. Instead, they have demonstrated hundreds of correlations 
between
psychiatric symptoms or illnesses and changes in brain chemistry or
structure.

Let's be clear: Correlations aren't necessarily equivalent to causation, 
but
can easily be mistaken for such. This can lead to unwarranted 
conclusions
about etiology, rather than the more subtle and accurate lesson: that 
mental
illnesses are mediated by the brain.

The absence of any well-defined physical causation is reflected in the
absence of any laboratory tests for psychiatric diagnoses - much in 
contrast
to diabetes and many other physical disorders. Not even the most
sophisticated studies of chromosomes or other cellular components can 
aid in
the diagnosis of any psychiatric disorder - as of late 1997.

In other words, despite decades of biological research, we have no means 
of
independently validating any psychiatric diagnosis. Worse, there are 
multiple
diagnostic systems, but we have no way of telling which is better - 
since we
have no gold standard. This in turn leads to significant differences in 
the
rates of diagnosis - in the case of schizophrenia, a sevenfold 
difference,
which is absurd.

Finally, whether psychiatric treatments are as effective as medical
treatments can be debated. The standard 70 to 80 percent improvement 
rates
for depression and 60 percent for schizophrenia are based on short-term,
highly controlled research studies in which patients are selected for 
the
absence of complications. Naturalistic studies, in which treatment is 
given
under everyday circumstances, reveal rates that are considerably lower.

Where does this leave us? Clearly, the argument for parity should rest 
on the
immorality of discriminating against those with mental illness - no 
matter
what the cause.

- Charles E. Dean, M.D., Apple Valley. Director, Psychiatry Residency
Program, Minneapolis Veterans Medical Center.



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