Apr 23 2007

Mental Illness Denial – Part I

On Friday I appeared on The Debate Hour hosted by the Infidel Guy, the topic of discussion being “Is psychiatry a legitimate science?” I was defending psychiatry as legitimate while Dr. Fred Baughman, also a neurologist, defended his long time position that psychiatry is (to quote his website) “100% fraud.” I thought I would use my next few entries to delve into some of the issues raised more deeply.

Now, there is much to criticize about the mental health professions. It is a very diverse collection of beliefs and methods, and it is not possible to paint this diversity with a single brush. It ranges from rigorous science to pure pseudoscience. It is also an extremely challenging field, dealing with the complexity of human thought and behavior and confronting difficult ethical issues such as autonomy and legal responsibility.

But the notion that mental illness itself does not exist, and therefore there is no legitimate “mental health,” is untenable given our modern knowledge of neuroscience. The arguments used by those who deny the reality of mental illness are a collection of logical fallacies, semantic misdirection, and misrepresentation of the scientific evidence. I will address the main issues raised by Dr. Baughman during the debate and in his book and articles.

For some further background, there are two prominent groups who deny the reality of psychiatry. The first are scientologists. They deny mental illness for the same reason and in the same manner that creationists deny evolution – it is not in accord with their religious faith. Without going deeply into the beliefs of scientology, they have an alternate view of mental health relating on one level to traumatic memories called engrams, but on a deeper level to alien ghosts infecting our brains.

The other group is comprised of those who follow in the tradition of psychiatrist Thomas Szasz. Dr. Baughman is clearly in this second group. Szasz has railed for decades against the abuses of psychiatry, and fifty years ago he had some legitimate points to make. However, his legitimate points have been rendered obsolete by advances in the practice and ethics of psychiatry. He and his followers still cling to points that never were legitimate, and further have been rendered quaintly absurd by advances in neuroscience over the last few decades.

Both groups incorporate to some degree conspiracy theories involving big pharma and the mental health industry, and conspiracy theorists may even form a third subgroup of deniers.

There is no disease without pathology

During the debate Dr. Baughman returned often to his central point – that you cannot have disease without pathology, and mental illness has no demonstrable pathology; therefore it is not a disease. He concludes from this that psychiatrists therefore lie to their patients. They are practicing pure fraud, and prescribing medications (“dangerous poisons”) is malpractice.

This claim can only be understood in the context of modern neuroscience. There are a few premises on which the standard position (which I accept) is based. The first is that almost every part of a biological organism (except those that are vestigial) has some function. For every structure and physiological function that medical science has identified, there is a disease or disorder associated with its malfunction. It may function too much, too little, improperly, or not at all.

The second premise is that the mind is a manifestation of brain function. Our thoughts, mood, and behaviors are, in fact, the biological function of the brain. There is no spirit, magic, life force, or quantum woo hiding inside our heads. Further, many specific mental activities (even those that we are not consciously aware of) correlate to specific areas of the brain – brain structures that evolved to create a particular mental function.

When we combine the above two premises, the conclusion is ineluctable. The brain must malfunction also, and in fact each brain function should have a disorder associated with its malfunction, including cognition, mood, and behavior.

Another important premise relates to our current understanding of brain function. It is dependent upon, as all organs are, the health of the cells that make up the brain – the absence of infection, inflammation, and tumors, the presence of adequate nutrition, oxygenation, and blood supply, and the proper regulation of many metabolic and hormonal factors.

But the brain is not the liver – it is also dependent upon a deeper level of complexity unique to the brain. Specifically, brain function is determined by the pattern and robustness of connections made among its 100 billion neurons. Further, brain activity is determined by the action of neurotransmitters and the distribution and structure of receptors for those neurotransmitters. The brain is also an electrical organ (in this way it has some features in common with heart and skeletal muscle). Therefore electrical problems, including the structure and activity of protein channels that control the flow of charged ions in and out of cells, also influence brain function.

Now let’s get back to Dr. Baughman’s position. He argues that mental illnesses are not real because there is no observable pathology – by which he means the first category of problems generic to all biological tissue (what I will call “classic pathology”). In other words, the brain cells are normal, without tumors, infection, abnormal histology (microscopic structure), etc. When these problems are present the result is a neurological disease. Psychiatry, he argues, involves only fake diseases where no classic pathology can be seen.

Szasz, Baughman and others simply deny those factors that are unique to the brain, that relate to patterns of neuronal connections and neurotransmitter activity. They have no legitimate reason to do so. Rather, they rely upon semantic misdirection and evasion to avoid this core fallacy of their position. They cannot reasonably disagree with any of the premises I laid out, as all are demonstrably scientifically true. The logic also is valid, so the conclusion is sound – if part of the brain allows us to pay attention, in some people that part of the brain must function poorly causing a deficit of attention.

Baughman argues that this is not true. Why? Because there is no disease (read classical pathology) present, and everything else must be deemed normal. Why is it normal? Because there is no disease. What about abnormalities of neurotransmitter function or faulty patterns of neuronal connections? All normal. No pathology = no disease = normal.

My debate on Friday with Dr. Baughman was not my first with a denier of mental illness. His tactics of argument I found typical of my prior experience. Tomorrow I will discuss these tactics in more detail.

7 responses so far

7 Responses to “Mental Illness Denial – Part I”

  1. […] I have to admit, this rivals McCarthy for abject ignorance. I understand that radio hosts have to fill a lot of air time, and they typically do so with their opinions and analysis rather than hard data – but this does not justify speaking utter ignorant nonsense to millions of listeners. This is simple-minded mental-illness denial. […]

  2. studio34on 15 Jan 2009 at 7:29 pm

    Hi Steve – do you know what happened to the original recording of your debate? It no longer appears in the Infidel Guy’s feed nor does the link you provide lead to it.

    Many thanks … S

  3. NeuroLogica Blog » ADHD Revisitedon 14 Sep 2009 at 10:57 am

    […] those who are interested in this topic I recommend reading my five-part blog series on this topic beginning here. But I would also like to address some of the specific points […]

  4. Dirk Steeleon 26 Mar 2012 at 10:37 am

    I have been reading the works of Thomas Szasz for many years and I feel you do not quite understand the position that he takes. Firstly Szasz accepts that there are brain diseases and that these can result in ‘mental’ abnormalities. Neurosyphilis and Alzheimer’s disease are examples that have a clear pathology. Szasz states that the term ‘mental disease’ is actually a metaphor. It has no scientific validity. The mind is not a physical object, unlike the brain, and so cannot be examined by x-rays, blood tests, fMRI scans etc. George Lakoff has explained that the language we use to describe the mind is metaphorical and that we describe it as a thing. So for example we can ‘lose’ our minds or that we can ‘hold’ ideas in our mind. The metaphors that we use to describe our mind can therefore obscure the scientific reality.

    Therefore Szasz’s position is that there can only be brain diseases (if we accept the definition of a disease). If for example a mental disorder is shown to be caused by a measurable physical abnormality then, like neurosyphilis, it will be removed from the sphere of psychiatry to be treated by neurology.

    In this part 1, I think that Szasz would generally agree with you up until your ‘sound’ conclusion which to me appears as a jump of faith. i.e

    ‘if part of the brain allows us to pay attention, in some people that part of the brain must function poorly causing a deficit of attention.’

    Of course we know that those who suffer from a measurable brain disease will experience a deficit in their ability to pay attention. But for those, for example, who suffer from ADHD, how do we know the lack of attention is caused by brain abnormality as opposed to simple lack of interest. I know from my personal experience that I found it difficult to pay attention to those things that I had no interest in. Many years ago when I was at school there were many lessons which I found to be so boring that I could not listen to. I would look out the window and daydream and ignore the Religious Instruction teacher, much to his dismay and anger. I think today because of cultural changes, and not medical advances, I would be diagnosed as having ADHD, or even ODD. My ex-wife would certainly concur that I suffer from adult ADHD!.

    Let me also state that I am not a scientologist nor am I anti-psychiatry nor am I a ‘denier’! I have an interest in the subject and I argue my position not through antagonism, but from a desire to find out more.

  5. Dirk Steeleon 26 Mar 2012 at 12:15 pm

    Quick question. What is the difference between a neurological disease – such as a stroke, brain tumour or even neurosyphilis and a psychiatric disorder such as ADHD, or DID, otherwise known as multiple personality disorder?

  6. Dirk Steeleon 16 Apr 2012 at 7:35 pm

    The Breivik trial commenced today. He, after a lengthy detailed study by experts, has been deemed a paranoid schizophrenic and also totally sane. Psychiatry does not have a clue who is ‘mad’ or not. Obviously in your view, Dr Novella, those with the latter view are mental illness ‘deniers’. Psychiatry is a pseudoscience. Period.

  7. karenkilbaneon 24 Oct 2015 at 2:23 pm

    Dr. Novella, you make legitimate points.

    I do not come from the perspective of Scientology or Thomas Szasz.

    There is no way to deny there are people who are extremely mentally unstable and who suffer unmanageable amounts of mental anxiety and anguish.

    There is also no way to deny that psychiatry has made puzzlingly few strides in prevention and alleviation of this kind of suffering.

    Psychiatry has made many fine contributions, but this does not take away from the fact the field has been completely unable to prevent the forms of mental illness that are actually preventable.There are certainly some forms of mental illness that cannot necessarily be prevented, only treated, but there are some that certainly can be prevented all together.

    The field of psychiatry, neurology, medicine, and biology all rely on foundational theories provided by psychological theorists that are sloppy, imprecise, and were not established with the scientific method. Psychological theories are assumed to be scientifically accurate but they are not and they misdirect all scientists doing research or treatment in the field of mental health.

    One of these sloppy notions you brought up – the only part or your essay I would disagree with. There are a whole class of mental illnesses deemed mood disorders. There exists no such thing as a mood or a temperament. Our brain can make predictive decisions, period. Formulating predictive decisions by associating new information with stored information is the only active thing the brain, as an organ, is able to do. All other activities are automatic or autonomic. If the brain is stuck making decisions that are always unsuccessful or always result in negative consequences, the brain suffers. This is not a mood disorder, this is a decision-making disorder.

    Psychology has mixed up what the brain can do as an organ with what they would like it to be able to do. We have never tried to come up with healthy practices that can preserve the health of the brain as an organ. We have only come up with theories of human development and behavior that are philosophical and focused on the results for what we want people to achieve.

    Throwing all that out and thinking about the brain as an organ and how to preserve its decision-making capacities could help us shed all the psyho-babble. Psychology has fabricated an elaborate narrative about emotions, self-esteem, the ego, the subconscious, narcissism, and empathy to name a few. Psychology has a laundry list of personality traits developed by a handful of psychological theorists who believe these personality traits, in large part, determine a human’s personality.

    Building a new theory of personality and a new theory of human behavior would help all the sciences immeasurably to move forward and start making more effective kinds of progress.

    Currently, the ability of a human being to take the perspective of another is the major benchmark for his or her personality health. Lack of perspective taking, or lack of empathy, is listed as a symptom of all personality disorders. My ability to think the thoughts you are thinking from your brain and feel the emotions you are feeling is necessary for me to be considered mentally healthy. This is backwards of what it should be. There is almost no reference in psychology to how well I am able to make optimal decisions by thinking the thoughts I am capable of thinking from my own brain and effectively relying upon the emotions my brain supplies to help me optimize my personal decision making. Psychology is more concerned with how well I understand other people.

    This shows that psychology has perspective wrong all together. Psychological theorists are just off on how they have defined the human personality.Psychological theories are built on many inaccuracies that are keeping us stuck. Psychological theories were not developed by using the scientific method. They did not start out as hypotheses. They started out as full-blown theories and hit the ground running. This is the reason psychiatry so often seems illegitimate.

    What if we gathered all the psychological theories in use, re-evaluated them for their legitimacy, and then went to work forming hypotheses to establish biologically accurate theories of human behavior?

    Cleaning up the foundational concepts we use to understand how humans integrate sensory-motor perceptions, thoughts, emotions and behaviors to make successful predictions for what to do next will help us clean up many areas in our sciences that deal with brain health.

    I just substituted in a kindergarten class. A bright, smart, capable boy I am pretty sure will be put on ADHD meds pretty soon. This boy cannot learn well by traditional methods. If he could be looked at in terms of how he is able to manage information in the ways that make sense to him based upon his sensory-motor and nervous system capabilities, then he would not be considered disordered. He would be defined by how he is ABLE to sense, think, move, and process information optimally for him. He would not be defined as disordered for not being able to process information while attending to that information in a seated position.

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