Jan 16 2018

More Mental Illness Denial

I was recently pointed to this article by Johann Hari in The Guardian that takes a critical look at depression and the treatment for depression. Unfortunately, it turned out to be nothing more than the usual mental-illness denial talking points, misdirection, and obfuscation.

As you will see if you follow the link above, this is a well-worn topic here. The basics are this – there are those, for various reasons, who are engaged in what I think qualifies as mental-illness denial. They include scientologists, because they push their cult/religion as an alternative to psychiatry. There are also those who follow Szasz who saw psychiatry as a mechanism for political oppression. I also find denial at times among rival professions who want to take psychiatry down a peg or two (often they just confuse their experimental expertise for clinical expertise – always a problem).

They all tend to have in common the core claim that “mental illness” is a fiction. How can thoughts be diseased? This is ultimately a straw man that confuses different types of illness. Some illness is based in biological pathology – cells are damaged, deteriorating, poisoned, genetically flawed, or essentially not functioning within healthy parameters for some reason. You can often see the pathology in a biopsy or measure it with some physiological parameter.

But not all illness is pathological disease. There are also disorders in which some biological function is outside of healthy parameters without clear pathology. The brain in particular is prone to this type of illness, and that is because brain function depends on much more than just the health of its cells (neurons and glia). Even healthy brain cells can be organized in such a way that their neurological function is compromised.

Let’s say, for example, that the anxiety circuitry in the brain is hyperactive creating spontaneous, unfocused, and debilitating anxiety. Now of course, anxiety itself is part of our natural neurological function. It serves a purpose. But excessive and spontaneous anxiety no longer serves a functional purpose, it just inhibits the ability to function. It is a mental disorder, in the absence of biological pathology.

Mental health deniers, however, twist themselves into logical knots trying to deny that there could possibly be anything about excessive anxiety that we can properly call an illness or disorder.

Like all campaigns of denial, there is also a range of approaches to denying the existence and implications of mental illness. At the extreme end you will find pseudoscience and conspiracy theories. At the milder end you will find softer denial, and denial that they are deniers. At this end there is the attempt to sound reasonable, and to conceal that at the end of the day they are engaging in motivated reasoning to deny the topic they oppose for ideological or other reasons. They give themselves away, however, by using the tactics of denial, and always flirting with the more extreme arguments.

For example, climate change deniers trying to sound reasonable will often acknowledge that the Earth is warming, we just can’t be sure that humans are causing it. But if you back them into a corner with evidence, they will acknowledge this but just deny that we can do anything about it. There is evidence that this behavior is rooted in “solution aversion” – in the end they oppose proposed solutions to climate change, and will deny the science only as much as they need to in order to oppose those solutions.

With mental illness denial, sometimes the motivation is psychiatry denial – opposition to the psychiatric profession. Of course you can do this by denying mental illness, but for those trying to seem reasonable you can also say you accept that there is such a thing, but then deny that we understand it well enough to treat it. Or you can simply deny the approach to mental illness of the psychiatric profession.

At this point I want to be clear – there are legitimate criticisms of psychiatric science and practice. Just as there are legitimate criticisms of medicine in general, and any applied science, including climate science. There is also no sharp demarcation between fair and legitimate criticism and motivated denial. You need some knowledge and judgement to see the difference at the fuzzy border. That is why I tend to characterize denialism as a process, try to define and understand the process as best as possible, and then be vigilant about the intrusion of denalism strategies at any level.

So let’s get back to Johann Hari’s article and see where I think he veers into denialism. Hari is writing about the difference between a depression disorder and normal grief. He is commenting on the DSM (the manual psychiatrists use to make diagnoses – a popular target among deniers):

The authors conferred, and they decided that there would be a special clause added to the list of symptoms of depression. None of this applies, they said, if you have lost somebody you love in the past year. In that situation, all these symptoms are natural, and not a disorder. It was called “the grief exception”, and it seemed to resolve the problem.

So, in order to avoid confusing normal grief with a depressive disorder the DSM included a grief exception. This is common in defining mental illness. The brain interacts with the environment, so if we want to decide if a certain pattern of mood, thought, and behavior is due to a brain disorder we have to rule out that it is just responding to environmental triggers. Like with the anxiety example above – anxiety is normal if you have something to be anxious about, but a disorder if it is spontaneous or clearly out of proportion to the stimulus.

Hari continues his narrative:

Then, as the years and decades passed, doctors on the frontline started to come back with another question. All over the world, they were being encouraged to tell patients that depression is, in fact, just the result of a spontaneous chemical imbalance in your brain – it is produced by low serotonin, or a natural lack of some other chemical. It’s not caused by your life – it’s caused by your broken brain.

This is an oversimplification to the point of being wrong. See above – depression is caused by life, and when it is, that is not a disorder. But if an evaluation rules out reasonable life causes of depression, then we are left with the possibility that there is something about brain function that may be causing depression. Also keep in mind that the depression, in order to be considered a disorder, has to interfere with one’s life. It has to cause “demonstrable harm.”

And now here is where Hari goes entirely off the rails:

The grief exception seemed to have blasted a hole in the claim that the causes of depression are sealed away in your skull. It suggested that there are causes out here, in the world, and they needed to be investigated and solved there. This was a debate that mainstream psychiatry (with some exceptions) did not want to have. So, they responded in a simple way – by whittling away the grief exception. With each new edition of the manual they reduced the period of grief that you were allowed before being labelled mentally ill – down to a few months and then, finally, to nothing at all. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.

Is he really claiming that a competent psychiatrist practicing within the standard of care would diagnose a client with mental illness and prescribe medication one minute after their child dies? You might be tempted to say he was using an extreme example to illustrate a point – but that misses my point. Making such a diagnosis is all about context.

Hari creates a neat little narrative here that serves his purpose of mental illness denial. In his narrative, psychiatrists removed the grief exception from the DSM because it was inconvenient. However, here is a passage from the DSM V that Hari neglects to mention:

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the contest of loss.

So what they really did was remove it from the list of criteria, which required putting a time limit on grief, and instead moved it to a note that was more open-ended and encouraged “clinical judgment.” Any fair and reasonable discussion of the psychiatric approach to mental illness and the evolution of the DSM should have contained this passage. But I guess it didn’t fit Hari’s neat little narrative.

After recounting his startling discovery that people are psychological beings with emotional needs (shocker), he finishes with this false dichotomy:

If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. The only real way out of our epidemic of despair is for all of us, together, to begin to meet those human needs – for deep connection, to the things that really matter in life.

This is a hopelessly simplistic approach to mental health, ironically as simplistic as the straw man “malfunctioning parts” approach he is criticizing. Rather, our mood, thoughts, and behavior are the net effect of a complex interaction between brain and environment. There are always a complex mix of psychological and psychiatric and sometimes neurological factors involved (rarely, it is a brain tumor). It takes care and clinical judgement to tease apart when someone just needs some counseling, or to make some practical changes to their life, or just time to process grief or other life events – and when they have a disorder that also needs to be treated in order to make it even possible for them to engage in therapy.

The DSM psychiatric approach to patients who have mental complaints, signs, or symptoms is to take a multi-tiered approach. First, rule out any underlying medical condition (make sure their anxiety isn’t due to hyperthyroidism, for example). Then assess their signs and symptoms in the context of their history to determine how much of it is likely to be due to life events. How much is personality. And how much, if any, may be due to some misfiring circuit in the brain.

This is really hard, and we have limited knowledge, but we have accumulated enough to take a practical approach to many patients and to help them improve their lives. This should include the full range of options available, including medication and counseling. To deny the role of medication can do great harm to those who may need it.

111 responses so far

111 thoughts on “More Mental Illness Denial”

  1. Here’s the part that mystifies me. He suggests that modern society isn’t meeting our psychological needs, noting that a Gallup poll found that 87% of people don’t feel engaged in their work. But, well, 87% of people aren’t depressed. If the modern world is so bad at providing a meaningful life, why isn’t everybody depressed? Hmm, maybe because there’s something different about those people for whom the meaninglessness of modern life is depressing…

  2. djnrrd says:

    There’s an in depth interview with Johann Hari on the comedy podcast Richard Herring’s Leicester Square Theatre Podcast (RHLSTP!) available on YouTube here https://www.youtube.com/watch?v=vo9I4ToS7yk

    I still haven’t finished watching the podcast, but my impression so far, including the Guardian article and some excerpts doing the rounds on Twitter, is of a do-gooder liberal (and I say this as a do-gooder liberal) who of course is absolutely right. Big Pharma and Doctors are pushing the lie of “chemical imbalance” while the _real_ solution were the friends we made along the way… OK, that’s a glib exaggeration, but to date most of the solutions have been based around anecdotes of people building communities or finding purpose.

  3. flacdo says:

    As a patient suffering from a schizoaffective disorder, I think replacing psychiatrists with neurologists would help people realise that “mind diseases” and “brain diseases” are the same thing, and thus exist. Nobody denies the existence of multiple sclerosis or Alzheimer’s disease, probably because when you scan the brain of those patients you see weird stuff, whereas in my case, you see nothing. But there is something, unless our understanding of the mind is totally flawed, there are necessarily mistakes in the way my brain is set up. Psychiatrists currently do the job of neurologists but only in the case where biological exams don’t reveal anything (except for headaches, I had to visit a neurologist for that). It feels arbitrary.

    Another issue is that people (including physicians) use the word depressed a bit too easily. If you’re not thinking daily of killing yourself, you’re not depressed. You’re sad, maybe very sad, maybe you need a break, maybe you need to talk to someone but depression is really something else.

  4. Gingerbaker says:

    Hari also pulls out the corrupt Big Pharma card in his dangerous article, claiming that there is a huge conspiracy of fraudulent anti-depressant research: drug studies not demonstrating efficacy are common but suppressed; the FDA in on the conspiracy by approving ineffective drugs; the psychiatric community wink-winking away enormous problems of drug efficacy and relapse for half a century.

    Hari is not helping himself here – he has a rather checkered past when it comes to honesty and ethical reportage, see https://en.wikipedia.org/wiki/Johann_Hari

  5. Tio says:

    I find your article to be a “straw man” expression. Why? First you want to argue that there are some health problems for which we cannot find bio-chemical markers, like say migraines, and we consider those real and medicate them, therefore (you conclude) that this is a reason to believe “depression” (for instance) can be the same. You make a wild correlation. I saw that in previous articles written by you and I see the same scent in this one. Second you want to put everyone in the same basket: mental illness deniers, climate change deniers, flat earth-ers. That’s ridiculous. The criticism of mental illness is very well founded and supported by psychologists/psychiatrists around the world (https://www.madinamerica.com/ – as one example) or the biggest health organizations that will always say that no one knows what creates these issues, but environment seems to be the most important factor. Read NHS – https://www.nhs.uk/conditions/clinical-depression/causes/, https://www.nhs.uk/conditions/schizophrenia/causes/, https://www.nhs.uk/conditions/bipolar-disorder/causes/, and more (Cochrane and Allen Frances – the guy who was in charge of DMS IV – https://soundcloud.com/therecodo/02-dr-allen-frances-leading-us-psychiatrist-author-of-twilight-of-american-sanity ). Are you really serious to compare this criticism with “flat earthers”? Or climate change deniers? Only if NASA doubted climate change you could compare that with the “mental disorders criticism”. See? NHS, NASA…good correlation this time :).

    And your approach is wrong because:

    1. Mental disorders are scarcely defined as we have to deal with a complex situation – brain + environment. Whilst cancer can be well defined in types and stages, mental disorders cannot. Read any scientific paper or ask any psychologist/psychiatrist and they will all agree it is something very complex for which there is no exact cause. But what all will say is that environment seems to cause them or worsen them: stress, loss in the family, lack of money, etc.. Cancer can never be treated by changing one’s mood, all other mental disorders can (to a high degree) through therapy or other approaches. That’s important because it complicates things in terms of treatment: is this pill treating this guy’s depression, or is it a placebo. Also, could we have treated this guy with therapy alone? See!? Complicated?

    2. Because of 1, mental disorders can ONLY be diagnosed via “observation of behavior”. There is no objective test (medicine wise) to diagnose someone with any mental disorder. THUS, this field is for sure subject to criticism and for good reasons.

    3. Money and Research is always an issue, and the “mental disorders” field is no exception to that. You must ask who funds the research for the pills they prescribe for these “mental disorders” – one example https://www.scientificamerican.com/article/many-antidepressant-studies-found-tainted-by-pharma-company-influence/

    From all I’ve read here’s the story of “mental disorders denials”: scientists do not see the definition and categorization of mental disorders, and the approach to treatment as scientific and objective. I saw psychiatrists suggesting for the removal of labels because they can’t encompass the complexity of the problem. What in the world does “depression” mean? Not much at all. So they suggest getting rid of labels or changing them to be more encompassing, and look at understanding people’s problems (that are complex). That being said I saw a lot of criticism about medicating these disorders instead of talking to the patient and finding a non-medicated solution that is as best (if not better) than any medication, they say. And on top of this they criticize the influence of money in research and prescription of drugs. I NEVER saw these people who criticize “mental disorders” to say that such things do not exist in the sense of “something that creates problems for individuals”.

    Short personal story: I too had tons of problems in high-school, for 4-5 years. I got depressed and suicidal. Tried to kill myself several times. I lost all my friends and had no will to live. Experienced lots of tics too, to the point of affecting my life severely. Had insomnia for many years. If I would have been labeled as “sick” with a “mental disorder” it would have been devastating for me. Instead, I change my environment (moved to a new place, had new friends, etc.), I learned that I have no “disease” so I forced myself to change, my financial situation also improved. I started to write a blog and so forth. Everything improved a lot to the point of now having no desire to kill me and I enjoy life a lot. No tics, no insomnia. Also, many times my sleepless nights made me think more about my problems and helped me, in the long run, to understand myself better. So, insomnia, in this case, was helpful. Maybe taking some medicine to “cure” my insomnia would have made my situation worse over time because I would not have the time to think about my problems. While these symptoms can be devastating for some, in some cases they might help people. Anyways, I think I know very well how it is to be in a very bad situation, so for sure people need help and “mental disorders” are real, it is the approach of today’s psychiatry and psychology that is troublesome. The label, the medication, the subjectivity of defining these behavioral states.

  6. BenE says:

    It’s just amazing that with all the neuroscience research out there that people can still cling to the belief that physical biological systems (like the nervous system) play no fundamental role in cognition. Or that you can’t impact cognition through changes to the biology that underpins cognition. Or that the biological systems that underpin cognition can’t function in ways that impact cognition. It’s just millenias-old dualism again.

  7. hardnose says:

    “To deny the role of medication can do great harm to those who may need it.”

    Medication for depression is over-used, and almost anyone can see that. Hari explained the drug companies’ deceptive research practices. NOVELLA is a denier for not acknowledging this.

    Supposedly, 25% of college students are on psychiatric drugs, many of them for depression. DO YOU REALLY THINK that millions of young college students have brain defects causing low serotonin? DOES THAT SOUND POSSIBLE? No, of course not.

    Depression can have physical, as well as psychological, causes, but the physical causes are NOT low serotonin! Chronic inflammation in the brain can cause depression and anxiety, and other mental disorders. And chronic inflammation has causes, usually related to an unnatural lifestyle. Adding chemicals to the brain that increase serotonin levels does NOTHING to correct the cause!

    Maybe some people need psychiatric drugs. But if what Hari said is true — that the depression returns and the dose must be repeatedly increased — then drugs are not a long-term solution.

    Novella is simply pro-drug and, to him, anyone who questions the current drug mania is a denier. That is ridiculous. There are very good reasons for being skeptical.

    Hari’s article focuses on the psychological problems our society tends to generate. It makes perfect sense to consider that. But we should also consider how our unhealthy unnatural lifestyle, and environmental toxins, contribute to chronic inflammation.

    It is KNOWN that physical exercise can help depression and anxiety as much as drugs. The big difference is that exercise helps correct problems that cause the inflammation that can cause anxiety and depression. Drugs DO NOT correct anything. They are likely to make underlying problems WORSE.

  8. bachfiend says:

    Hardnose,

    ‘Chronic inflammation in the brain can cause depression and anxiety, and other mental disorders. And chronic inflammation has causes, usually related to an unnatural lifestyle. Adding chemicals to the brain that increase serotonin levels does NOTHING to correct the cause!’

    Do you have any evidence that people with depression or anxiety have chronic inflammation in the brain? I agree that inflammation in one part of the body can lead to inflammation in other parts of the body. I have ‘athlete’s heart’ which in me is manifested by a very low sinus bradycardia which sometimes when I’m at very profound rest of 35 bpm (my cardiologist says in anyone else he’d be advising a pacemaker) and enlarged atria. It’s thought that prolonged high intensity endurance exercise (I ran many marathons) causes chronic inflammation in muscles and joints, and then leads, somehow, to chronic inflammation and fibrosis in the heart.

    Your hypothesis is possible. But do you have any evidence that chronic inflammation of the brain occurs in people with depression or anxiety? Chronic inflammation of the brain is easy to detect. I have done many post mortems in people, many of whom would have been depressed or anxious before dying. From memory, chronic inflammation of the brain is vanishingly rare, unless the person has something like multiple sclerosis or a post-viral encephalitis.

  9. bachfiend says:

    Hardnose,

    I missed your last paragraph. Exercise doesn’t make inflammation disappear. Or cause the problems that lead to inflammation to disappear. If anything, exercise leads to inflammation.

    Anyway. I’m off to the gym for my ‘exercise fix’, to increase my endogenous endorphins and improve my mood before I go to see the new Gary Oldman film ‘Darkest Hour’ which is about Churchill apparently.

  10. hardnose says:

    I said CHRONIC inflammation.

    Inflammation can be a healthy reaction to damage, but chronic inflammation means something is wrong. Chronic inflammation is related to heart disease, cancer, etc.

  11. Nitpicking says:

    “Medication for depression is over-used, and almost anyone can see that. Hari explained the drug companies’ deceptive research practices. NOVELLA is a denier for not acknowledging this.” You might read again. While he does not refer to this specific problem, Steve does acknowledge that psychiatry in particular and medicine in general are imperfect and in need of improvement, always.

    It’s also worth asking why you bring this up SINCE IT HAS NOTHING TO DO WITH STEVE’S THESIS.

  12. hardnose says:

    I bring this up because Steve is all upset that someone “denied” that standard depression treatments are all wonderful.

    Steve did not bother to mention the deceptive research paid for by drug companies. He is much more worried that someone dared to question the current drug mania.

    How many college students are on psychiatric medication? How many high school and elementary school children? WHY IS THIS OK?

    Once again, Steve is fighting hard to support unhealthy medical practices.

  13. BillyJoe7 says:

    HARDNOSE,

    “Medication for depression is over-used, and almost anyone can see that. NOVELLA is a denier for not acknowledging this”

    NOVELLA? What, are you shouting or spitting?
    To cover stupid complaints like this one, SN would have to write a BOOK. This is a blog post. Get over it. He can’t cover every single aspect of depression. My guess is that SN would agree with you on this point, as do I. But that’s not the TOPIC.

    “…the physical causes are NOT low serotonin!”

    And SN does not mention “low serotonin” even once in the article.
    And you are no damn expert, so your uneducated opinion – because that is all it is – is WORTHLESS.

    “Chronic inflammation in the brain can cause depression and anxiety, and other mental disorders. And chronic inflammation has causes, usually related to an unnatural lifestyle…environmental toxins”

    You are not an expert and your opinion is WORTHLESS.
    Ignoring experts and going straight to uneducated opinion of cranks, does not make you an expert, it makes you a CRANK.

    “if what Hari said is true — that the depression returns and the dose must be repeatedly increased — then drugs are not a long-term solution”

    And, if Hari is WRONG?
    The experts say that, if a decision is made to use anti-depressants (in other words, if the patient has SEVERE depression0, it should be used for a minimum of 6-12 months, otherwise a recurrence is likely.
    Who you gunna believe?
    I mean, who you gunna believe?

    “Novella is simply pro-drug”

    This simply a LIE.
    It is a false statement and you know it = a LIE

    “and, to him, anyone who questions the current drug mania is a denier. That is ridiculous”

    Yes, that is RIDICULOUS.
    SN did not even cover the topic of over-use of medication. This is a blogpost, not a book. And, as I said, I’m pretty sure he agrees that anti-depressants are over-used. But this is not the topic of his blogpost.
    Really, get over yourself.

    “It is KNOWN that physical exercise can help depression and anxiety as much as drugs”

    You are not saying anything NEW.
    Except that it applies more to mild and moderate depression for which medication is not recommended.
    This is just an example of alternative medicine cranks using perfectly normal mainstream recommendations in order to sneak in their unsupported evidence free CRAP.
    Like this:

    “The big difference is that exercise helps correct problems that cause the inflammation that can cause anxiety and depression. Drugs DO NOT correct anything. They are likely to make underlying problems WORSE.”

    Well, SHOUTING your ignorance does not make it true.
    It just makes you look STUPID

  14. BillyJoe7 says:

    HARDNOSE,

    “Steve did not bother to mention the deceptive research paid for by drug companies”

    THAT WAS NOT THE TOPIC OF THIS BLOGPOST!

  15. hardnose says:

    “You are not an expert and your opinion is WORTHLESS.”

    So … let us all defer to the infinite wisdom of experts. We should never speak, unless it is to say “yes, exalted expert I agree completely.”

    Even though Novella is not a psychiatrist, and I am a psychologist. It is his blog — therefore he is all-knowing here, and infinitely perfect.

  16. hardnose says:

    The article Steve referred to was about the over-use of psychiatric drugs. It suggested that maybe we should look at other factors besides defective brains and messed up neurotransmitters. I added that maybe we should also look at the role of chronic inflammation in mental illness.

  17. BillyJoe7 says:

    HN:

    “Novella is not a psychiatrist”

    No, he is a neurologist.

    “I am a psychologist”

    No, you are a LIAR.

  18. BillyJoe7 says:

    …or, at least, I hope he’s lying.

  19. Nitpicking says:

    “I bring this up because Steve is all upset that someone “denied” that standard depression treatments are all wonderful.” That is, um, not true. He doesn’t even mention “standard depression treatments” in this article except in passing. It’s about a crank denying that depression *exists*.

  20. bachfiend says:

    Hardnose,

    ‘I said CHRONIC inflammation.’

    And I said that chronic inflammation of the brain is easy to detect. You see a perivascular infiltrate of chronic inflammatory cells (lymphocytes and plasma cells).

    Your link to a Google search page with a news article on a paper from 2015 reporting that patients with depression have enhanced positron emission tomography doesn’t necessarily mean that they have increased microglial numbers/activity or chronic inflammation. And even if – it doesn’t necessarily support your hypothesis that chronic inflammation of the brain is caused by lifestyle choices and that it causes depression.

    I did notice an interesting link on the page though. Something about the hippocampus being small in patients with depression. I seem to remember (hopefully my hippocampus isn’t fooling me) that the hippocampus is one brain region that has neuronal stem cells in adults and which can form new neurons in adult life.

  21. hardnose says:

    “it doesn’t necessarily support your hypothesis that chronic inflammation of the brain is caused by lifestyle choices”

    I didn’t say that. There are environmental causes, including lifestyle. And it isn’t my hypothesis, there were thousands of pages in that search result. You only saw one.

  22. CKava says:

    Hardnose,

    Being a ‘psychologist’ provides you with absolutely no grounds to claim expertise on prescription medication, depression or the related biological processes. Steve as a clinical neurologist, in contrast, has much more relevant expertise in all of those topics. But even ignoring the issue of relevant expertise, there is a key difference that cannot be overlooked; you are an egotistical, contrarian crank without a skeptical bone in your body, whereas Steve is someone who has spent his entire adult life promoting critical thinking and skepticism (including writing articles addressing the very topics- drug companies skewing research- that you claim he ignores). Why anyone should heed your speculations about complex medical issues is beyond me.

    And on that note, despite your claimed credentials you have repeatedly demonstrated a complete inability to understand the basic principles of statistical analysis and experimental design. Your qualifications in psychology, real or exaggerated, seem to left you with an inflated ego and unwavering conviction in your capabilities that is entirely unjustified by the level of competence and knowledge you demonstrate on this blog, day in and day out. If you are a practicing psychologist, although I doubt that since you have never brought it up before, then you are the embodiment of the worst elements of the field and the kind of thinking that resulted in the replication crisis.

  23. bachfiend says:

    Hardnose,

    ‘I didn’t say that. There are environmental causes, including lifestyle. And it isn’t my hypothesis, there are thousands of pages in that search result. You only saw one.’

    Yes, you did. I’ll quote what you wrote again: ‘Chronic inflammation in the brain can cause depression and anxiety, and other mental disorders. And chronic inflammation has causes usually related to an unnatural lifestyle.’

    ‘Usually’ you wrote.

    A single page of a Google search means nothing. Haven’t you learned from your PhD in experimental psychology that you need to cite primary references instead of news articles or blogs on them?

  24. BillyJoe7 says:

    I guess hardnose thinks what’s good for Jennifer McCarthy – “The university of Google is where I got my degree from” – is good enough for him.

  25. TheGorilla says:

    Lol the entire field of mainstream medical psychology is focused on reconciling the difficulties of individuals with a world which is necessarily taken to be static. It is fundamentally incapable of challenging the social order, and in fact valorises it, and this makes it an inherently political enterprise. Dr Movella, as usual, uncritically lives in a world of markets and computer brains (as does this author, which is why his piece lacks any teeth — he criticises the profession while taking its premises for granted).

  26. BillyJoe7 says:

    One day, TheGorilla is going to say something that is actually decipherable, but I think it going to be too much to hope for that he will ever make any sense.

  27. bachfiend says:

    BillyJoe,

    I read TheGorilla’s comment 10 times, and I couldn’t work out whether it was a very, very clever parody, or… I think you’re right.

    Anyway. I saw ‘Darkest Hour’ today. It’s very good. Gary Oldman was brilliant as Churchill.

  28. HN, like other notorious commenters here, cannot follow a simple thesis. They can’t see past their own narrative, and so impose it on anything.

    My point was about mental illness denial and the tactics they use. In Hari’s article he constructed a neat little narrative about psychiatry that was demonstrably false, as a simple quote from the DSM showed.

    My point (which is pretty much the opposite of HN’s parody) is that mental illness is complex. It is not simply grief, or a reaction to events, or due to a single neurotransmitter, or any one process like inflammation (it is all of those things and more). The DSM is a flawed document, partly because we are limited in our understanding of the fundamental components of neurological function that make up our higher cognitive phenomena. But it is an honest attempt at categorizing the types of mental disorders we encounter, reflecting our basic science and clinical understanding, and accounting for as many variables as possible. It is very different than Hari’s cartoon, which was constructed to fit his false narrative.

    HN is simply introducing his own cartoon version of reality, with me as the convenient villain. And ironcially (often the case) he is just demonstrating my central thesis, which he failed to grasp.

  29. hardnose says:

    Hari’s article criticized the over-use of psychiatric drugs. It did NOT deny that depression is a mental illness.

    Hari claimed that depression often has psychological causes. That might be true. Why does Novella deny that?

    I think depression also has physical causes, which can be related to the unnatural lifestyle, which we all have to some degree. I did NOT say it is a choice. Most of our exposure to an unnatural environment is involuntary.

    However it is WELL KNOWN that physical exercise helps depression. This might be because exercise decreases chronic inflammation.

    Chronic inflammation underlies many diseases, such as heart disease, cancer, diabetes 2, autoimmune disorders. And seems to be related to depression, anxiety, and other mental disorders.

    bachfiend was unable to find any information about this, even though a simple google search returned a couple of million sources. Of course they were not all good sources. The point was, bachfiend never even tried to look. He simply denied that chronic inflammation of the brain could possibly cause depression. Even though LOTS of people have noticed this.

  30. hardnose says:

    Hari was mainly criticizing the drug companies, and had some valid criticisms. Psychiatrists, to some extent, mindless go along with the drug companies’ deceptive research and brainwashing. THAT was the main point of the article, which Novella ignores.

  31. hardnose says:

    CKava:
    “despite your claimed credentials you have repeatedly demonstrated a complete inability to understand the basic principles of statistical analysis and experimental design.”

    Oh really? And that implies YOU understand the basic principles of statistical analysis and experimental design? And yet you can’t give a single example of something I don’t understand about it.

  32. bachfiend says:

    Hardnose,

    ‘Chronic inflammation underlies many diseases, such as heart disease, cancer, diabetes 2, autoimmune disorders. And seems to be related to depression, anxiety, and other mental disorders.’

    I did my training in diagnostic anatomical pathology and practiced for decades, remember? I know about acute and chronic inflammation thoroughly. It may be true that some, even many examples of the diseases you mention may be associated with chronic inflammation, it doesn’t mean that chronic inflammation underlies the diseases.

    And I am not impressed by claims that imaging studies such as PET scans indicate chronic inflammation of the brain. Even you seem to be qualifying the claim with ‘and seems to be related to…’

    ‘I think depression also has physical causes, which can be related to the unnatural lifestyle, which we all have to some degree.’

    I don’t disagree with the first part – I’m a ‘materialist’, I think for everything there’s a physical cause or mechanism. I’m doubtful about the second, and want better evidence. It’s the ecology fallacy all over again. You’re more or less claiming that ‘unnatural lifestyles’ occur in a population, and ‘depression and anxiety’ occurs in the same population, so therefore they both occur in the same segments of the population, and that the former leads to the latter.

    The evidence just isn’t there.

  33. Nidwin says:

    I find Hari’s article extermely toxic. Above the mental-illness denial he also tries to send out the message that you only need to find the “cow” to resolve the depression and/or anxiety issues, no need for meds.

    Even when the reason(s) or cause(s) for someone’s depression and/or chronic anxiety are highly suspected or well known it can take Years to recover and some folks do need a boost to help them, very often with proper Big Pharma prescripted meds.

    I consider myself lucky as I didn’t suffer from any form of depression but I still can’t shake away that anxiety when I’m approached by a woman, especially women I meet for the first time. That anxiety that for 30+ Years of not knowing has been building up, brick by brick. I know now why, for more than two Years and a half, but the anxiety is still very present in my daily life.

    DSM isn’t perfect, indeed, but like all other scientific based “tools” it improves over time.

  34. HN wrote: “Hari claimed that depression often has psychological causes. That might be true. Why does Novella deny that?”

    Now seriously, that is a blatant lie. I never said or even remotely implied that I deny there are psychological causes of depression. You have to willfully misinterpret my position to make that statement. That, HN, is why you have no credibility at all.

    The entire first have of Hari’s article was on the psychiatric profession and how they define depression in the DSM. That is what I was writing about. They essentially lied about what the DSM says in order to feed their simplistic and harmful (in my opinion) narrative.

    The second part was then an attack of the pharmaceutical industry, which I did not address because that would take a separate post. But nothing I wrote could be honestly construed as a defense of the pharmaceutical industry. I have written about that before, so you don’t have to guess. There are many legitimate criticisms of pharma, and I have pointed them out, as have many other skeptics. But the “Big Pharma” hysteria mixes legit criticism with nonsense and conspiracy theories. It takes time and nuance to tease out the reality from the conspiracies. But that was just not the topic of this post.

  35. Regarding inflammation and depression, it is hard to see why HN thinks this is some sort of “gotcha” for my thesis. It actually supports my thesis, because it is a biological cause (not a psychological cause) of depression – if it is a cause.

    This is a complex topic, but here is a quick summary. There is evidence that increased markers for inflammation and oxidative stress are associated with depression. Any cause and effect has not been established, however. Further, there is high heterogeneity, which probably means that if inflammation or oxidative stress are playing a role in causing depression, it is in a subset of depressed patients.

    Further, those who respond to SSRIs demonstrate decreased markers for inflammation after treatment, more so than non-responders. Again, need more info to properly infer cause and effect.

    At this point it seems likely that inflammation is playing some role in a subset of people with major depression (I have not seen any significant evidence for mild to moderate depression). But, we are in early phases and there are many important unanswered questions. What is the the causative role, if any? What happens if we target inflammation? Do SSRIs work to some extent through an anti-inflammatory effect, or again is that just a downstream marker of something else that is going on?

    It is way too early to come to any conclusions. We have to let the research play itself out. This is an interesting lead to follow, and researchers are following it. I don’t see what any of this has to do with my post, except that it incidentally supports my thesis that depression is complex and includes potential biological causes.

  36. CKava says:

    [blockquote]Oh really? And that implies YOU understand the basic principles of statistical analysis and experimental design? And yet you can’t give a single example of something I don’t understand about it.[/blockquote]

    Yes. As I suspect do a lot of the other people commenting here. I work as a researcher and part of my job is to design and conduct experiments and statistically analyse the results.

    I have provided you multiple examples in previous threads to name but a few…

    1. You were impressed by a paper that showed a handful of ‘significant’ differences from 36 comparisons between groups, demonstrating a lack of awareness with problems with relying on p < .05 when running multiple comparisons. *Hint* Look up Bonferroni corrections.
    2. You frequently interpret results that find p < .05 as if they have proven the alternative hypothesis.
    3. You have praised Bem's advocacy of questionable research practices and shown no awareness of the well documented statistical and methodological errors with his paper.
    4. You have praised Seralini's papers showing no awareness of the well documented statistical and methodological errors with his papers.

    And so on, and so on.

  37. alhill says:

    I thank you, Dr Novella. I am reading this article as I wait at my doctors office for my son who has been diagnosed with depression and anxiety. There is nothing more frustrating than people who think he just needs to change his outlook or his diet. People who are judgemental and not supportive about a complex issue.

  38. hardnose says:

    Thank you, SN, for confirming what I said about the possible, or likely, role of chronic inflammation in depression (it is also likely to be a factor in anxiety disorders).

    The main point of the Hari article was NOT to deny that mental illness is real. The point was to express skepticism about the currently prevailing mythology — that mental illness is mostly genetic, and related to neurotransmitters being somehow out of whack.

    The prevailing approach emphasizes psychiatric drugs. THAT is Hari’s main complaint.

    Yes SN I agree, Hari was wrong to completely neglect possible physical causes of depression. Even when there are obvious psychological factors, physical factors may contribute.

    And genetics are involved in everything, so we can’t ignore that either. But genetics are NOT everything. Far from it. Hardly anyone becomes mentally ill solely because of genetics.

  39. hardnose says:

    bachfiend,

    How DARE you disagree with Novella about chronic inflammation and mental illness. HE IS AN EXPERT!!

  40. hardnose says:

    “I know now why, for more than two Years and a half, but the anxiety is still very present in my daily life.”

    Nidwin,

    Maybe you should try an anti-anxiety drug, like Xanax. It will solve your anxiety problem. Oh, but if you ever decide to stop taking it you will experience months of intense agonizing anxiety.

    Maybe heroin is a better idea.

  41. daedalus2u says:

    Oxidative stress mediated inflammation is something that I study and work on fixing in my day job. 😉

    SSRIs do reduce inflammation and oxidative stress through their effects on mast cell degranulation. I am pretty sure that the effects of SSRIs on mast cells is how the anti-itching effects of SSRIs in primary biliary cirrhosis are mediated, via hormesis. Serotonin is a major trigger of mast cell degranulation (itching powder works via that mechanism). SSRIs compel physiology to improve serotonin regulation of mast cell degranulation, and in some people that is experienced as reduced mast cell degranulation.

    I am pretty sure that the effects of SSRIs on depression occur via effects on mast cells in the brain.

    Whatever the mechanism, SSRIs do work to reduce depression. When large populations are treated with SSRIs (like Denmark), the suicide rate goes down.

    The idea that oxidative stress mediated inflammation is easy to fix via diet or exercise is not correct. Inflammation is a “feature”, it is a controlled physiological state that physiology has invoked to “do the things” that inflammation facilitates. A state of inflammation is too important to be regulated by dietary levels of nutrients or anti-oxidants. Our ancestors (all the way back to the Precambrian) didn’t have access to non-inflammatory diets or supplements, our physiology evolved to invoke inflammation with whatever diets our ancestors could find.

  42. bachfiend says:

    Hardnose,

    I don’t disagree with Steven Novella concerning inflammation and depression. I disagree with you regarding whether lifestyle choices cause inflammation in the the brain which then causes depression, and that exercising reduces inflammation, and hence reduces depression.

    As I noted. It’s possible, but the evidence isn’t there. As Steven Novella, it’s early days in the research along this particular line. It may be true. Or it may be bogus.

    And anyway – I’m passionate about everyone exercising preferably every day. I think exercise has health benefits, but I doubt that they’re related to any anti-inflammatory effect.

    And it’s not current mythology that mental illness is mostly genetic. Which specialist in mental disease believes that?

  43. hardnose says:

    bachfied: “I don’t disagree with Steven Novella concerning inflammation and depression.”

    You disagreed with ME, just because I said it! Now that Novella said it, you agree. Wonder why that is.

    D2: “The idea that oxidative stress mediated inflammation is easy to fix via diet or exercise is not correct.”

    No one said it’s easy to fix. The point is that chronic inflammation underlies some of the most common current diseases, and it is well known that at least some of them are related to lifestyle.

    It is well known that lifestyle improvements can help heart disease, diabetes 2, etc. This might be because lifestyle improvements can help fix chronic inflammation.

    CHRONIC inflammation is NOT the same thing as normal beneficial inflammation. Normal inflammation is a healthy response to damage. Chronic inflammation means the system is somehow malfunctioning.

  44. bachfiend says:

    Hardnose,

    ‘CHRONIC inflammation is NOT the same thing as normal beneficial inflammation. Normal inflammation is a healthy response to damage. Chronic inflammation means the system is somehow malfunctioning.’

    Inflammation, particularly acute inflammation, isn’t beneficial or healthy. Inflammation is a necessary response to damage (a better response is apoptosis – which is the programmed cell death and removal of cells lethally damaged without causing damage to surrounding cells).

    This is all just basic Pathology 101.

    Chronic inflammation isn’t just the presence of chronic inflammatory cells at a site in the body. It’s also the presence of tissue damage, shown by such phenomena as fibrosis and loss of specialised cells in that region. The gut contains a rich population of chronic inflammatory cells, but that doesn’t fulfill the definition of chronic enterocolitis.

    I’m still sceptical by the claim that increased activation of microglia on a PET scan indicates chronic inflammation. If there’s no chronic damage shown by loss of neurons and gliosis (which is the brain’s equivalent of fibrosis) then it’s not chronic inflammation.

  45. Willy says:

    This ain’t even close to being on topic, but maybe Dr. Novella could start a separate thread for it. In any event, check out this over on SBM: https://sciencebasedmedicine.org/cancer-quack-colleen-huber-sues-britt-hermes-over-criticism/

    I am going to make a donation of at least $100 (I’m not rich) and I am going to write to my local paper, plus at least two other AZ newspapers (I live in AZ) regarding this topic (Britt Hermes being sued for condemning naturopathic quackery). I’d appreciate any legal advice on what not to say in my letters to the editors and, even more, I’d appreciate any readers of this blog making contributions and to do whatever else they can to combat quackery. Let’s do what we can to STOP this shit in its tracks–NOW!!! (er, strangle this infant in its crib–lol) I’m hoping even Dr. Egnor will chip in here. C’mon Doc, let’s be a team for a change. Surely we can all agree on this!

  46. quasimodoh says:

    I am not as educated or experienced in medical matters as the other commenters here but enjoy reading these blogs, so excuse me if this question is irrelevant, but where does Anorexia or other such eating disorders fall in the discussion of mental health? Or is that seen as a linked to depression?

  47. Tio – you include a lot of tropes in your comment. First, I did not say mental illness is real because migraines are real. I said the argument that mental illness is not real because the symptoms are subjective is not valid, and it is false to say that psychiatry is the only branch of medicine that bases diagnoses only on symptoms, using migraines as an example.

    I also never equated mental illness denial with flat earthers like you imply. There are common strategies in all denialism – that does not mean they are the same in degree, which is what you are implying.

    So that is two straw men down.

    You then launch into typical psychiatry denial, cherry picking the negative and not providing any balance or nuance, and further strawmanning current belief. Yes, it is all very complex. Neuroscientists acknowledge that, so you are not stating anything new. Sure, pharmaceutical companies are coming at this from one perspective and are corporations based on profit. That is why we need good regulation. But don’t equate the profession with the pharmaceutical industry.

    There is also healthy debate about how to approach mental illness diagnoses, because we are trying to categorize something which is inherently messy. We can’t even agree if Pluto is a planet, mental illness is orders of magnitude more difficult. That doesn’t mean there isn’t a real utility to our current system. Also, it is not static, it is constantly evolving as research progresses and with greater clinical experience.

    Your cartoon actually just demonstrates my premise.

  48. Tio says:

    Steven – I don’t think anyone says “mental diseases” are not real because the symptoms are subjective, but because you can’t find anything “physical” to explain those symptoms. Chest pain is subjective to a certain degree, this is why you have to do some medical exams to see if it is the heart, or lungs, or who knows what. No one will diagnose you with a heart disease based on your symptoms only, then medicate you. The symptom was subjective therefore you search for a physical explanation (an objective explanation). If you find nothing then you don’t know what caused the subjective chest pain. The problem with mental diseases is that they only rely on symptoms, and once you search for an objective measurement you can’t find any. There are only correlations and nothing more than that. You can’t find brain patterns, genes, or chemical imbalance that would explain any of the mental diseases. That’s where the issue is. I don’t think anyone argues that the feelings these people feel are not real, or that they need help, what those criticizing are saying is simply that you cannot find a physical cause for these symptoms and therefore you should not rush to label these into “diseases” and try to “treat” them with medicine. That’s how science works.

    Tell me Steven what diseases are diagnosed and then treated with medicine and are ONLY based on symptoms?

    Short: I had abdominal pains for 3 months and indigestion. Went to several doctors in Spain. One of them specialist. I had endoscopy, abdominal ultrasound, stool sample, blood test, and so forth. They found nothing besides some gallbladder polyps that they said would not cause those symptoms. The specialist gave me some medicine to take for a month to see how I feel. My symptoms went away. But not for once was the specialist: “I think you have Irritable Bowel Syndrome”. That’s something very well know as a diagnosis in US I think, but not sure about other countries. And what IBS diagnosis says is basically: we have no clue what creates the abdominal pains and we label them as IBS. Is that helpful? Could be to give doctors a common approach for a bunch of similar symptoms. Is this explaining what created my abdominal problems? Not at all. That’s how mental diseases are. They were meant to give doctors a common approach for similar symptoms to find similar ways to alleviate those symptoms. But now they are transformed more and more into “diseases” on a wrong basis – unscientific approach. That’s why they are called “disorders” many times and not “diseases”.

    Yes, I apologize, you didn’t mention flat earthers, but it sounded to me like you at least put this at that level.

    “You then launch into typical psychiatry denial” – Well this is a classical “let’s paint all that you’ve said as nonsense and don’t address any of your points”. What are you views about what NHS, Cochrane, or even Allen Frances have to say about the topic? The sources I sent you.

    “But don’t equate the profession with the pharmaceutical industry.” – Never did that. I said people have the right to question the medication of “mental disorders” due to conflicts of interests that are huge. Look Steven, you have some symptoms that no one can properly describe nor find an objective physical trigger for them – no one can define depression properly for example, and there are no bio-chemical markers triggering these mental disorders – and now on top of that you have huge companies investing in pills to “treat” these “diseases” that are neither well defined as “diseases” nor proven to be caused by something physical. Don’t you understand why this is nothing like “climate change denial”?

    “We can’t even agree if Pluto is a planet” – We can see and study Pluto. It is just a matter of defining in which category it fits. You are talking about “dark matter” when you talk about “mental disorders” in the sense that we might see an effect of something, but we don’t know what creates this effect. We call it “dark matter” though more than likely it has nothing to do with “matter”. We call those “mental diseases” but we have no clue if those are “diseases”. We don’t build spacecraft and tech based on the theory of dark matter since we don’t know what that is. I think there is far more proof of the dark matter existence, than of any “mental diseases”, yet astrophysicists do not rush to conclusions as fast as psychiatrists do. Maybe the influence of money made some psychiatrists and institutions promote the mental disorders into mental diseases? Could be.

    I appreciate your work and follow it closely, but I think that you jump the gun with “mental diseases”. You should invite Allen Frances to SGU to discuss this and you’ll see from an experienced psychiatrist who was in charge of DSM for quite a while, how he never denies that people have problems but he will explain to you in detail that the bio-chemical modal is incorrect and at best incomplete.

  49. daedalus2u says:

    HN, inflammation is inflammation. If inflammation goes on for a long time, it is called chronic inflammation. The processes in acute inflammation and in chronic inflammation are all “the same”. The difference in chronic inflammation is that the inflammation does not resolve. Why it doesn’t resolve is complicated and idiosyncratic.

    My hypothesis is that the arrow of causation between chronic inflammation and chronic diseases goes the other way; that chronic inflammation “causes” these various diseases.

    The “association” of chronic inflammation with certain lifestyle choices also goes the other way; if your body is in a state of inflammation, it will “tell you” to consume foods that are devoid of antioxidants because regulating the intake of antioxidants is important if a state of oxidative stress is going to be regulated by physiology. A state of oxidative stress requires certain spacial distributions of free radicals, which requires that the spacial distribution of antioxidants be limited so there is not indiscriminate destruction of those free radicals before they have “done their thing” (which is mostly the activation of signaling pathways).

  50. Tio – you are conflating “disease” with “disorder” – this is sloppy and reflects sloppy thinking on your part. A disorder does not require pathology, only signs and symptoms that correlate with demonstrable harm. We can further study disorder epidemiologically – who tends to get them, what is correlated, and what is the natural history.

    I also sense you are not a clinician and much of what you say is both naive and designed to deny the legitimacy of a perfectly legitimate clinical science.

    We absolutely treat people who have only symptoms with no objective marker, including chest pain. If someone has angina, but their workup is normal, we don’t necessarily wait for them to have a heart attack. We can still treat the angina, if nothing else to make them more comfortable, based on what we do know about chest pain, correlating the symptoms with symptoms of known pathology.

    I am a neurologist. I treat people with symptoms in the absence of demonstrable pathology all the time. What you are doing is artificially and arbitrarily narrowing the definition of what qualifies as clinical science specifically to eliminate mental illness. that is classic denial. You are further mischaracterizing the rest of medicine in order to do so.

    You are also being entirely unfair to mental health science, and stating outright falsehoods. There are many genetic markers, functional brain markers, and observable signs of many mental disorders. They are not entirely based on subjective symptoms. The real problem (which is what the sources you are citing and misrepresenting are actually saying – more markers for denialism) is that mental disorders are very heterogeneous – because brain function is complex, affected by the environment, and plastic. What the experts are debating is how to think and talk about these disorders given how heterogeneous they are – not if they are real.

  51. Tio says:

    Well, moving beyond you making me sloppy and such (which is you stepping on your own toes since you accuse others of misdirection through ‘name-calling’), I’ll respond to your points as you avoid mines. I don’t conflict disease with disorder, you do. You say this in your article “They all tend to have in common the core claim that “mental illness” is a fiction. How can thoughts be diseased?” – exactly, how can? But then you use the term “disorder” throughout your article. You wonder how people can call thoughts as “disease” then go on to explain mental “disorders”, then you also call them “illnesses”. Maybe you can avoid confusion by simply referring to them as “mental disorders” instead of illnesses or diseases.

    Your angina example is a bad example. Angina is “caused when your heart muscle doesn’t get enough oxygen-rich blood.” (American Heart Association https://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Angina-Chest-Pain_UCM_450308_Article.jsp). So, we know what’s the objective cause of angina itself. But angina (less oxygen rich blood in heart muscles) is also triggered by something else (different causes making it more tricky to identify which one it is). This is why “angina” itself is not categorized as a disease since it is a symptom of a disease, but it is something that can be studied objectively. See how, when doctors are unsure what is the real cause of angina (less oxygen in heart muscles) they admit that can call it “not a disease” but try to find out what causes that lack of oxygen?

    “I am a neurologist. I treat people with symptoms in the absence of demonstrable pathology all the time.” – and if you do that I am sure you admit not knowing the pathology and only treating some symptoms, else you would invent diseases and your colleges won’t be happy with that. Same way psy-chologists/chiatrists should do. If certain pills work for certain mental symptoms then great, if therapy works then great. But at no point should they assert that they are treating a disease of the mind that they simply label based on symptoms of behavior only. That’s the issue Steven. At least call them “disorders” and admit that no one really knows what causes those symptoms and the classification of them is just a guideline for doctors to deal with these mental symptoms in a more organized way.

    Of course there are many symptoms without a pathology that are treated/ameliorated, but you admit you only deal with symptoms and do not know what causes them. Simple. So don’t pretend that you know what causes mental disorders because no one knows. That’s the only thing I am trying to make you admit :).

    “There are many genetic markers, functional brain markers, and observable signs of many mental disorders.” – correlations, yes. Until there is something strong to rely on, then it should be promoted as such: correlation. If there was anything of substance we would see therapies and treatments based on what it was discovered. So far we see nothing of that sort.

  52. bachfiend says:

    Daedalus,

    “Inflammation is inflammation. If inflammation goes on for a long time, it is called chronic inflammation. The processes in acute inflammation and in chronic inflammation are all ‘the same’. The difference in chronic inflammation is that the inflammation does not resolve. Why it doesn’t resolve is complicated and idiosyncratic.”

    No, that’s too oversimplified. Acute inflammation isn’t the same as chronic inflammation. The classic example of acute inflammation is bacterial pneumonia. It either kills the person or it resolves. It doesn’t progress to chronic pneumonia if it fails to resolve. The classic example of chronic inflammation is tuberculosis. When it’s clinically diagnosable, the inflammation it shows is chronic.

    The difference between acute and chronic inflammation is clinical – the time course of the disorder, whether short or long – and pathological – the tissue reaction, usually neutrophils in acute inflammation and macrophages, lymphocytes and/or granulomata in chronic inflammation.

    My main objection to hardnose’s linked Google search page with a news article on a paper claiming that increased activity of microglia (which is the brain’s equivalent cell to macrophages) on PET scanning in depression indicates chronic inflammation.

    Besides my doubts about whether any imaging is actually accurate, the presence of acute inflammatory cells – neutrophils – or chronic inflammatory cells – lymphocytes or macrophages – doesn’t make it acute or chronic inflammation. Both can occur in tumours, chloromas with neutrophils, lymphomas with lymphocytes, or microgliomas with microglia.

    Inflammation also has other pathological characteristics with tissue damage. There’s cell necrosis and cell repair. If there’s chronic inflammation in the brain, there should also be cell necrosis, with loss of specialised cells (neurons) and attempts at cell repair, with gliosis (the CNS’s equivalent of scarring.

    The hypothesis that lack of physical exercise causes chronic inflammation, which then causes depression, and that exercise in a person with depression due to chronic inflammation causes the chronic inflammation to go away (along with the depression) is possible.

    My objections are that increased microglia activity on a PET scan doesn’t necessarily indicate chronic inflammation. Exercise doesn’t cause chronic inflammation to go away. You can’t exercise tuberculosis away. You can’t exercise away a cause of chronic inflammation. Thinking that it can is just ‘magical’ thinking.

    I’m passionate about exercise. I think everyone should do some physical exercise everyday, but for reasons other some hypothetical anti-inflammatory effect. Exercise, unless overdone, makes a person feel good. If anything, particularly if overdone, exercise causes tissue damage and inflammation.

    I want better evidence that depression is due to chronic inflammation.

  53. mumadadd says:

    Tio,

    ‘Disease’ and ‘disorder’ have specific definitions in this context. If you go back and look at the use of the terms in SN’s post you won’t find the conflation or confusion you’re arguing against. Just do a Ctrl F and look for them.

  54. Tio says:

    Sure, I read it again, and still find it confusing. And it is because there seem to be no proper definitions of these terms. To me, and from what I’ve read, disorder is a disease without a known bio-chemical cause. I won’t go into a semantic debate because it seems there are no proper words to define the complex world of health and symptoms, but my point is the same: mental “disorders” (behaviors that are harmful to oneself and to others) are scarcely defined and so far there is no causation for any of them other than they seem to be triggered by the environment or worsen by it. There are some correlations with genes and some brain patterns, but they are subject to intensive dispute. That’s all it is from what I know.

    And personally, I find it damaging to label people with depression, schizophrenia, and such, because you make them believe that they are “sick” and “different”. And the most important aspect: if you follow the biological approach to these mental states you avoid the elephant in the room: the environment. You can medicate someone as much as you want, if that someone has a shitty job, and life, and no friends, that someone can be “cured” of his “depression” but still has a shitty life only that now he is more sedated so he doesn’t care. Did you know what created his depression or did you make him accept his shitty life? Is it bad? Is it good? Who decides? Maybe the “depressive” states are a result of being a worker and chasing profits all day long and have little time for yourself or your family, but if you blame the people for these issues and medicate them then I think you miss the point entirely and help no one.

    Anyways, as I said to Steven, invite Allen Frances to SGU. This is the guy – https://en.wikipedia.org/wiki/Allen_Frances

    Maybe listening to an expert in the field and a skeptic like Steven discussing, it will make things much clear. I am all for understanding if I miss or misunderstood anything. Cheers!

  55. BillyJoe7 says:

    Flacdo,

    “I think replacing psychiatrists with neurologists would help people realise that “mind diseases” and “brain diseases” are the same thing, and thus exist”

    I don’t think you’d have much luck getting a neurologist to treat their patient’s psychiatric illness, and vice versa. They are completely different fields.

    “Another issue is that people(including physicians) use the word depressed a bit too easily. If you’re not thinking daily of killing yourself, you’re not depressed. You’re sad, maybe very sad, maybe you need a break, maybe you need to talk to someone but depression is really something else”

    In the language of the medical profession:
    Your “sad” = their “depression”
    Your “depression” = their “depressive disorder”
    Hope that helps.

  56. hardnose says:

    “My hypothesis is that the arrow of causation between chronic inflammation and chronic diseases goes the other way; that chronic inflammation “causes” these various diseases.”

    That’s what I meant. I said chronic inflammation underlies heart disease, some cancer, some mental illness, etc. I meant it has some kind of causal influence.

  57. hardnose says:

    “My main objection to hardnose’s linked Google search page with a news article on a paper claiming that increased activity of microglia (which is the brain’s equivalent cell to macrophages) on PET scanning in depression indicates chronic inflammation.”

    bachfiend,

    You could have looked at more than one of the articles on that search page.

  58. BillyJoe7 says:

    Just a thought – maybe comments that go into moderation should go to the end of the comments list when they come out of moderation. I completely missed Tio and Flacdo’s comments.

  59. hardnose says:

    [The “association” of chronic inflammation with certain lifestyle choices also goes the other way; if your body is in a state of inflammation, it will “tell you” to consume foods that are devoid of antioxidants because regulating the intake of antioxidants is important if a state of oxidative stress is going to be regulated by physiology.]

    More artificial food is available now than probably ever was before. And physical exercise is no longer a necessary part of life. It only makes sense to think that chronic inflammation might result from the unnatural lifestyle, and the toxic environment.

  60. bachfiend says:

    Hard nose,

    ‘That’s what I meant. I said chronic inflammation underlies heart disease, some cancer, some mental illness, etc. I meant it has some causal influence.’

    I agree that chronic inflammation is associated with some diseases when there’s tissue injury. Sometimes the tissue injury follows chronic inflammation as when the inflammatory cells secrete defensive toxic compounds as in tuberculosis, or the chronic inflammation follows the injury as when ischaemic necrosis leads to an inflammatory response in a heart attack or in rapidly growing tumours.

    But tissue injury is an essential part of defining the presence or absence of chronic inflammation. No tissue injury, no chronic inflammation. The presence of a chronic inflammatory cell population isn’t sufficient to diagnose chronic inflammation.

    Which is one of the reasons why I doubt that chronic inflammation is a cause of depression. Increased activity of microglia on PET scanning doesn’t mean that it indicates that there’s chronic inflammation.

    And chronic inflammation being associated with some diseases doesn’t mean that it is the cause of the disease.

    ‘However it is WELL KNOWN that physical exercise helps depression. This might be because exercise decreases chronic inflammation.’

    You can’t exercise chronic inflammation away. Nor does being physically inactive cause chronic inflammation. There needs to be some other cause leading directly or indirectly to tissue injury.

    I agree that it’s very, very important for everyone to be as physically active as possible, that being a couch potato is very, very bad. But for other reasons besides a hypothetical and very implausible anti-inflammatory effect. Being physically active has health benefits beyond a putative and very implausible anti-inflammatory effect, such as weight control and stress reduction. I feel happier after exercising.

  61. BillyJoe7 says:

    This may not be of any interest to anyone and it’s a bit off-topic but…

    I found his part of the article by Johann Hari, resonated with me:

    “And that’s when, after two more years studying civil servants, [Michael Marmot] discovered the biggest factor. It turns out if you have no control over your work, you are far more likely to become stressed – and, crucially, depressed. Humans have an innate need to feel that what we are doing, day-to-day, is meaningful. When you are controlled, you can’t create meaning out of your work”

    I spent the first five years of my working life as an employee. It was frustrating and depressing. I could see how I could do things better (for me, not necessarily for anyone else), but there was no way I could make even a dent on the set-in-stone protocols of my employer. I took a big risk and started out on my own. I have never looked back. I can do things the way that suits my temperament, and structure my day the way that personally suits me. It’s a small business and I have only six employees at any one time. They have only ever left because of moving house or retiring. The trick I found was to let them feel in charge. In fact they are in charge of the everyday running of the business and I changed what I could to suit their particular needs. But I have control over the overall structure and especially over my own working conditions.

    A study linked to in the article concluded that only 1/6 are “engaged” with their work, nearly 2/3 “sleepwalk” through their work, and nearly 1/4 are “disengaged” from their work. These are damning statistics. I’m glad I fall into the minority in this instance.

  62. BillyJoe7 says:

    …I wrote that as I was reading the article. The article goes on to describe a couple making exactly the same sort of change that I did. 🙂

  63. bachfiend says:

    ‘More artificial food is available now than probably ever was before.’

    I’m going to have to add ‘artificial food’ to my list of hated terms. Whenever I go to the supermarket and see ‘organic’ products or (a first, yesterday) ‘natural walnuts’, I immediately go looking for the ‘inorganic’ products or the ‘unnatural walnuts.’ I never seem to find them. I’ve never seen non-artificial food in the supermarket.

    Food is food, regardless, they just vary in price. Woolworths sells a brand of apple, the Bravo, which is supposed to be organic and naturally selected for its qualities instead of being ‘GMO’ at the very proud price of $13.50 a kilogram. I’ve tried one – it’s good, but not much better than a Pink Lady at $3.50 a kilo.

  64. BillyJoe7 says:

    Tio,

    “I don’t [conflate] disease with disorder, you do. You say this in your article “They all tend to have in common the core claim that “mental illness” is a fiction. How can thoughts be diseased?” – exactly, how can? But then you use the term “disorder” throughout your article. You wonder how people can call thoughts as “disease” then go on to explain mental “disorders”, then you also call them “illnesses””

    Ah, I see your misunderstanding.
    Here is the full quote:

    “They all tend to have in common the core claim that “mental illness” is a fiction. How can thoughts be diseased? This is ultimately a straw man that confuses different types of illness. Some illness is based in biological pathology – cells are damaged, deteriorating, poisoned, genetically flawed, or essentially not functioning within healthy parameters for some reason. You can often see the pathology in a biopsy or measure it with some physiological parameter…But not all illness is pathological disease…”

    Can you see your misunderstanding?

    The first two sentences apply to the people SN is criticising (“They”). SN’s correction of this view starts with the next sentence (“This is ultimately a strawman….”). When SN says “different types of illness”, he means there are illnesses which are labeled “diseases” (because there is biological pathology) and other illnesses which are labeled “disorders” (because there is no biological pathology). That is why he uses the term “mental disorder” and why he also refers to it as an “illness”.

  65. hardnose says:

    There is an awful lot of artificial food bachfiend. I am talking about stuff sold as food that has no nutritional value, and that would never have been encountered in nature. No one really knows how our bodies react to this junk, especially over long periods.

  66. BillyJoe7 says:

    Tio,

    “And personally, I find it damaging to label people with depression, schizophrenia, and such, because you make them believe that they are “sick” and “different””

    I don’t really understand this. If they have a depressive disorder, they have a depressive disorder. If they have schizophrenia, they have schizophrenia. Why is this different from saying that a person whohas cancer is a person who has cancer. The problem to be overcome is the stigma that people apply to labels such a “depression” and “schizophrenia”, not to somehow pretend that they do not have depression or schizophrenia.

    As an aside, I do think we need to avoid saying “he is a schizophrenic” when what we mean is that “he has schizophrenia”. But I think this also applies to asthma. Instead of saying “he is an asthmatic”, say “he has asthma”. A person is not defined by their illness.

    Maybe that’s what you were getting at?

    “And the most important aspect: if you follow the biological approach to these mental states you avoid the elephant in the room: the environment”

    Well, this is where the strawman comes in. Maybe it was different in the past, I don’t know, but these days the “environment” is not neglected by psychiatrists and psychologists. It is not neglected as a cause and it is not neglected as a treatment. I would however agree that there is evidence that over reliance on medication is a problem.

  67. bachfiend says:

    Hardnose,

    ‘There is an awful lot of artificial food bachfiend. I am talking about stuff sold as food that has no nutritional value, and that would never have been encountered in nature. No one really knows how our bodies react to this junk, especially over very long periods.’

    Food is food. Even overly-sugared carbonated drinks have nutritional value in that they contain calories. And sugars occur in nature, albeit in low concentrations requiring a lot of effort to obtain them. In nature, they’re high value, hence humans have an excessive desire for them, along with that for salt.

    It’s better to talk of ‘empty calories’. And we know the effects of long term overconsumption of sugar – obesity, diabetes, and dental decay.

    The only things I can think of that are sold as food that we’d probably not have eaten in a hunter-gatherer society and that have no nutritional value are the various naturopathic herbal ‘remedies.’ Which is some cases are actually poisons.

  68. Tio says:

    BillyJoe7 – You can’t compare a disease with a disorder. Something that is physical and well understood with something that is neither. Especially not cancer that is something you can see and study and develop treatments for it, with a bunch of symptoms that you scarcely categorize as “depression” or “schizophrenia”. That’s my point. There is no “depression” in the sense that is a well-defined thing. It is a bunch of symptoms that you can ONLY diagnose based on observing behavior and asking questions to the patient. The comparison doesn’t hold.

    Depression, at least in most cases it seems, it is an environmentally based state of mind due to all kinds of personal problems one faces. Change one’s environment and put him/her through sessions of therapy and very likely they will get “cured”. You can never “cure” cancer by changing the way you think via those approaches.

    And what is it with you people and this “strawman” expression? Can’t you discuss without name-calling :)? It sounds like a cult to be honest when I see these. The average psychological session per patient in the US is about 10 minutes according to Allen Frances who was head of DSM IV. He too pointed out how psychologists cannot understand one’s behavior in such short sessions. Is he a “straw-man” for saying that? Remember, he is an experienced psychiatrist. And I’ve heard this from many other psychologists and psychiatrists. And one’s environment is complex. Not only that you need a lot of time, you also need solutions. If one guy comes over and says: “Doctor I lost my job, I have so little money, I don’t want to live anymore, I am so depressed.” The doctor says “It will cost you 50 bucks an hour.” – you need more detailed and pro-active approaches instead of pushing the unproven biological model.

  69. hardnose says:

    “The only things I can think of that are sold as food that we’d probably not have eaten in a hunter-gatherer society and that have no nutritional value are the various naturopathic herbal ‘remedies.’”

    Oh stop, bachfiend. You know that processed food has artificial flavor, artificial preservatives, etc. You know they are manufactured, and you know we did not evolve with them.

    There are natural chemicals that are poison, we all know that. That does not mean unnatural chemicals can’t be poison also. Especially when taken frequently over long periods.

  70. BillyJoe7 says:

    Tio,

    I tried to help you understand what you misunderstood in what SN said. That is all. But I see you are hopelessly lost in your narrative.

    (For example, I din’t compare “disease” and “disorder”, I contrasted them; and you don’t seem to understand what is meant by a strawman.)

    Let’s just leave it there.

  71. Pete A says:

    Tio,

    QUOTE from the Wikipedia article Straw man:

    A straw man is a common form of argument and is an informal fallacy based on giving the impression of refuting an opponent’s argument, while actually refuting an argument that was not presented by that opponent.[1] One who engages in this fallacy is said to be “attacking a straw man”.

    The typical straw man argument creates the illusion of having completely refuted or defeated an opponent’s proposition through the covert replacement of it with a different proposition (i.e., “stand up a straw man”) and the subsequent refutation of that false argument (“knock down a straw man”) instead of the opponent’s proposition.[2][3]

    https://en.m.wikipedia.org/wiki/Straw_man

  72. Tio says:

    BillyJoe7 – maybe you didn’t do a great job at explaining that. Ever considered that?

    “you are hopelessly lost in your narrative.” – well you too seem to suffer from “let’s accuse the other one of not understanding and close the discussion.”. You can’t communicate like that with people, it is very inefficient. Oh, do you have a word for such a person too?

    Pete – I could search for that too thanks, but it says nothing of essence, it is still name-calling. If you go to a tribe where people move around a fire with feathers on their heads praying to gods for better health, you can’t just go and call them primitive or irrational. You have to explain to them why what they are doing is inefficient and unscientific. Else you do nothing. Say I am the tribal man, you do nothing of value if you call me a “strawman”. You talk at me, not to me.

    Anyways, I am happy to learn if I misunderstood something despite people here not being able to uphold a conversation
    without taking magic words from their magic bag and labeling people with them and thinking they communicated something.

  73. Kabbor says:

    I could be mistaken but Pete A did not call you a straw man. As the definition he just now posted would inform you, that isn’t a proper use of the term. He posted the definition of it because it was misapplied in your first post and he wanted you to see what the case use is for the term. I don’t want to put words in Pete’s mouth but from my perspective this posting of the definition is to inform rather than insult.

    People are not straw men, posited arguments of others can be straw men, if they do not accurately reflect the views or propositions of the other person.

  74. Pete A says:

    Thanks, Kabbor, for explaining my comment.

  75. Tio says:

    Kabbor – I didn’t accuse Pete of anything. I just explained that you can’t communicate with people if you throw words at them like irrational, strawman, whatever. You have to explain yourself. Anyways, will have to leave this here because I can’t continue this discussion for days in a row, but my only point with this article written by Steven was that mental “disorders” are not well understood at all, and there is no solid evidence that any of them is caused by X or Y or what are “they” in the first place, therefore there is for sure a lot of debate surrounding this topic and for good reasons. This is nothing like the climate change denial or anything like that. I feel like Steven, over the years, made “mental disorders” look like “diseases” that are properly understood and that’s where science disagrees with him. Cheers!

  76. bachfiend says:

    Hardnose,

    ‘Oh stop, bachfiend. You know that processed food has artificial flavour, artificial preservatives, etc. you know they are manufactured, and you know we did not evolve with them.’

    ‘There is an awful lot of artificial food bachfiend. I am talking about stuff sold as food that has no nutritional value, and that would never have been encountered in nature. No one really knows how our bodies react to this junk, especially over long periods.’

    Processed food with artificial flavours or preservatives have nutritional value. You defined artificial food as having NO nutritional value, which is patently false.

    You should have made yourself coherent (something that’s difficult for you) by commenting about processed foods containing artificial flavours and preservatives – something I might actually have agreed with you about.

    Steven Novella has posted on preservatives in processed food, such as the one about nitrite-free bacon (I don’t know what the conclusion was, I didn’t read it since I don’t eat bacon).

  77. RickK says:

    Tio said: “Anyways, I am happy to learn if I misunderstood something despite people here not being able to uphold a conversation
    without taking magic words from their magic bag and labeling people with them and thinking they communicated something.”

    Let me reword that for you:

    “I’m sufficiently out of the loop that I’ve never heard this term used before, even though it is in common use in many areas of logic and debate, and is well-explained all over the internet. So to cover my embarrassment over my display of ignorance, I’m going to attack the people who used the term.”

    What is interesting in your response, Tio, is that even after reading the definition of “straw man”, you still accused people of labeling YOU a “straw man” when in every case the term was used to describe YOUR ARGUMENT. You are arguing against people for calling you a “straw man”, when in fact they didn’t.

    Which is an example of employing a “straw man” argument.

    Well done!

    https://www.theskepticsguide.org/resources/logical-fallacies

  78. hardnose says:

    “Processed food with artificial flavours or preservatives have nutritional value. You defined artificial food as having NO nutritional value, which is patently false.”

    There is plenty of food with no nutritional value, that has artificial flavors and preservatives. All you are doing here is being ornery, since you can’t admit I’m right about anything.

  79. mumadadd says:

    “There is plenty of food with no nutritional value”

    I wish there was a ‘thoughtful’ emoticon available on this site.

    How can something without nutritional value be considered ‘food’ [thoughtful emoticon].

    Does hn think processed food is made of aluminium and candle wax, I wonder?

    “All you are doing here is being ornery, since you can’t admit I’m right about anything.”

    Quite. [thoughtful emoticon].

  80. mumadadd says:

    That last post of hn’s has got to be a cry for help.

  81. mumadadd says:

    “There is plenty of food with no nutritional value”

    No jokes, this has really given me the giggles. I’ve shed a tear! But thoughtfully.

  82. bachfiend says:

    Hardnose,

    ‘There is plenty of food with no nutritional value, that has artificial flavours and preservatives. All you are doing here is being ornery, since you can’t admit I’m right about anything.’

    OK, since you claim that, you should be able to list 5 foods that have no nutritional value. It should be easy for you.

    As I noted, if you’d commented about processed foods containing artificial flavours or preservatives having less – perhaps significantly less – nutritional value than unprocessed foods, I might have agreed with you.

    And added it to the (very short) list of very sensible things you’ve written over the past 10 years or so. From memory, you’re up to 7. You remind me of ‘Darkest Hour’ (a strong film recommendation, I wouldn’t be surprised if Gary Oldman wins Best Male Actor in the Academy Awards) in which King George VI is supposed to have said of Churchill that even a stopped clock is right twice a day.

  83. Pete A says:

    “[hardnose] There is plenty of food with no nutritional value”

    food [mass noun]: Any nutritious substance that people or animals eat or drink or that plants absorb in order to maintain life and growth.
    https://en.oxforddictionaries.com/definition/food

  84. hardnose says:

    Yes junk food has great nutritional value. How could anyone question that.

  85. mumadadd says:

    ***hardnose isn’t available for comment right now.***

    Back at hn labs, serious questions are being asked of a team of dedicated researchers.

    1. Did you know that processed food has nutritional value, by definition?
    2. Did you know that processed food has nutritional value, by definition?
    3. Did you know that processed food has nutritional value, by definition?

    [Thoughtful emoticon]

    After hours of research and deliberation, hn labs has released the following statement:

    “Tins of tuna are made of TIN! People aren’t adapted to survive on a diet of tin, so tins of tuna have no nutritional value! For a healthy glow, one should eat only chiropractic.”

  86. bachfiend says:

    Hardnose,

    ‘Yes junk food has great nutritional value. How could anyone question that.’

    I’m keeping score from now on. You’re now up to 8 sensible comments.

    Agreed, junk food, however you define it, doesn’t have great nutritional value. However, it has some nutritional value (it doesn’t have ‘no nutritional value’) and given a choice between no food or junk food when hungry, most people would probably go for junk food.

    Personally, I’d go for no food.

  87. BillyJoe7 says:

    Tio

    It was you who used the term “straw man”. You used it in your very first comment. You used it to describe Steven Novella’s argument. But the criticism of SN’s argument that followed did not constitute the criticism of a “straw man” argument. What you were actually doing is accusing SN of making a “false analogy” (you were wrong about that also). That’s why I said that you did not seem to understand the meaning of a “straw man” argument, and why Pete posted a definition of that term.

    But then you doubled up in your misunderstanding. You then said that we labeled you a “straw man”. In fact, nobody did. Moreover, this just illustrated another misunderstanding on your part: The person making a “straw man” argument is not a “straw man”, the argument is.

    ———————–

    “I feel like Steven, over the years, made “mental disorders” look like “diseases” that are properly understood and that’s where science disagrees with him”

    But this is just another misunderstanding on your part. Medical illnesses can be divided into “diseases” and “disorders”. The distinguishing characteristic is as follows:

    A “disease” is an “illness based in biological pathology – cells are damaged, deteriorating, poisoned, genetically flawed, or essentially not functioning within healthy parameters for some reason. You can often see the pathology in a biopsy or measure it with some physiological parameter”
    (direct quote from Steven Novella).
    A “disorder” is an illness not based in biological pathology. A disorder is an illness “in which some biological function is outside of healthy parameters without clear pathology”
    (direct quote fromSteven Novella)

    He then goes on to describe how mental illnesses fit the definition of a disorder “the brain in particular is prone to this type of illness, and that is because brain function depends on much more than just the health of its cells. Even healthy brain cells can be organized in such a way that their neurological function is compromised”
    (direct quote from Stephen Novella)

  88. hardnose says:

    “food [mass noun]: Any nutritious substance that people or animals eat or drink or that plants absorb in order to maintain life and growth.”

    There is plenty of artificial garbage that pretends to be food, sold in the stores.

    Have some cocoa pops, mumadadd, they’re good for your poor pathetic brain.

  89. mumadadd says:

    hn,

    So, as junk/processed food has ‘no nutritional value’ the obesity epidemic across the developed world must he due to people eating ‘natural’, unprocessed food.

    You have outdone yourself, sir!

  90. mumadadd says:

    Pick any specific item of junk food you want — e.g. a Big Mac — then go on-line and look up it’s nutritional value. Seems like a contradiction in terms given junk food has ‘no’ nutritional value. Maybe you’ll expose a huge scandal in the process…

    You’ll find that a Big Mac contains fat, protein and carbohydrates.

    If you’re talking about what is optimal to human health if consumed in large quantities, the issue with junk food is more one of excess — too MUCH fat, unrefined carbs.

  91. mumadadd says:

    Missed etc off the last sentence.

  92. hardnose says:

    “the issue with junk food is more one of excess”

    Junk food is poison, especially to the brain. You apparently have been living on it.

  93. Average Joe says:

    Tio,
    I think I understand your defensiveness. SN said the word ‘sloppy’ in regards to what you wrote. And it fell like a personal attack, name calling as you put it. And then the words ‘straw man’ was chucked your way. In both cases, there’s a negative connotation. Yes, but you need to go past the labels and examine their meaning. First off, the labels are not meant to be personal. Take for instance, learning math for the first time. You didn’t get the answers to math problems correct every time. Maybe during a test, you got wrong answers because you rushed. If you rush to quickly, the teacher grading the test may call your work sloppy. Same goes for logical arguments. Learning about logical fallacies and how to present a logical argument is similar to learning math. It’s a process, it take practice and there’s a lot (I mean a lot) to learn. SN has been learning, practicing and teaching about critical thinking, logical arguments and skepticism for over 20 years now. He’s pretty damn good at it. And he can take feedback, examine it and admit if he’s proven wrong. If you were put off when SN called your work sloppy, the only practical solution I see is the get ‘a thicker skin’ so you can push past being triggered by labels and not conflate criticism of what your wrote and who you are.
    Terms like ‘strawman’ should be viewed as jargon. This blog specializes in critical thinking and as part of it, relays heavily on adherence to logical arguments. Jargon is used by specialized group to convey very specific meanings. The same words outside of the context of a group can have different meanings too, which can lead to confusion by outsiders. Mastering the jargon allows members of a group to be quick and very precise when communicating. It’s like a form of shorthand.
    This blog relies on accurately communicating ideas and arguments. SN often summarizes a logical fallacy but he cannot be expected to layout the meaning of the most commonly used logical fallacy argument every time.

  94. Average Joe says:

    Hey hardnose, since you’re a psychologist, you up for examining your atypical behavior on this blog? Why do you feel the need to constantly express your opinions to the extent of being viewed as a social pariah? How does that make you feel?

  95. hardnose says:

    My atypical behavior? Are you saying that most people only read blogs where they generally agree with the author?

    Maybe you are right! That would help explain why so many stay in their little “bubbles, ” and never hear about alternate views.

  96. Average Joe says:

    Of course I’m right. Are you the genius that uncovered that people are tribal? You must have also discovered y’all have bias, and motives, and filtered points of view. Thanks Captain Obvious; pointing out the obvious in a sarcastic tone makes you look so smart.
    And this blog is atypical in itself; not banning your troll ass for one. Maybe he just likes to keep you around as an example of what not to be like. Like Egnor. You’re a zoo exhibit.
    So, yessir, you have atypical behavior for an atypical blog. You are a snowflake on many levels. Yet, you’d be right at home among to commenters on Yahoo or Brietbart.
    I bet you made a typo and aren’t really a psychologist. And you’re too chicken shit to admit it.

  97. bachfiend says:

    Hard’arificial food’nose,

    ‘There is plenty of artificial garbage that pretends to be food, sold in the stores. Have some cocoa pops, mumadadd, they’re good for your poor pathetic brain.’

    Cocoa pops are food. They contain calories. Certainly far too much sugar, but sugar is necessary for the brain since it mostly runs on glucose. At least by adding some milk, there’s some added first class protein, minerals (except iron) and fat provided.

    Cocoa pops do contain nutritional value. Certainly not enough nutritional value to justify being anything more than a very small part of a healthy diet, if that.

    You should be railing against processed foods, which would have been sensible, instead of persisting with your idiosyncratic ranting against ‘artificial food’, which you’ve defined as having ‘no nutritional value’, which is patently false. ‘Low nutritional value’ maybe, but not ‘no nutritional value.’

    And ‘artificial food’ is a stupid term, on a par with ‘organic food’ and ‘natural food’ as I’ve seen in the supermarket with the ‘natural walnuts.’

  98. mumadadd says:

    hn,

    “Junk food is poison, especially to the brain. You apparently have been living on it.”

    Tell me, oh wise one, what should people eat to avoid poisoning their brains? And what, specifically, is in junk food that is poisonous to brains — at what dosage does it become poisonous; what are the effects of the poisoning; by what mechanism does the poison act?

    PS. I’m more of a Shreddies or Cornfalkes man, though you’ve now reminded me that Coco Pops exist.

  99. bachfiend says:

    Mumadadd,

    ‘I’m more of a Shreddies or Cornflakes man, though you’ve now reminded me that Cocoa Pops exist.’

    I’m more of a Bircher muesli man (when I rarely have breakfast, usually when I’m travelling and the hotel includes a ‘free’ breakfast in its accommodation. It’s a myth that breakfast is a necessary part of the diet started by Kellogg’s). I very rarely eat breakfast cereals, preferring oatmeal with no sugar added.

  100. mumadadd says:

    bachfiend,

    Did you know that Shreddies keep hunger locked up till lunch though?

  101. mumadadd says:

    (It’s to do with their mesh structure.)

  102. bachfiend says:

    Mumadadd,

    I find that if I don’t have breakfast, I don’t feel hungry till 2 or 3 pm – or even later. If I have breakfast (usually because I’m staying in hotels providing ‘free’ breakfasts), I eat too much (to get my money’s worth), then I start to feel hungry around 11 am, so I have lunch. And then I feel hungry around 2 to 3 pm so I run the risk of having afternoon coffee with hard’artificial food’nose’s ‘artificial’ food, and then I have dinner too, so I might actually eat twice as many calories as I normally would.

    I suspect what happens is that if I don’t have breakfast, my body ‘thinks’ there’s no point in feeling hungry – it’s not going to be satisfied. If I do have breakfast, then it ‘thinks’ it’s in a temporary period of feast, so it better ensure that it gets as many calories as possible as a buffer for the inevitable coming famine.

    Your comment about the mesh structure of Shreddies keeping Hunger locked up till lunch is a good one. It illustrates how stupid advertising is.

  103. hardnose says:

    It’s a myth that breakfast is a necessary part of the diet started by Kellogg’s”

    Oh no!! I have to agree with bachfiend on something!

    Yes you’re right, that idea that you need breakfast is a total myth. It might just depend on the person. If you are not hungry in the morning, your body is telling you not to eat. I never eat in the morning, and the result is that morning is the best time of day for me.

    There is a recent idea that fasting is good for you. Going without food, even just from the evening before to the next afternoon, can benefit health. This is called “intermittent fasting.” Going for longer periods occasionally is also recommended, but I have not tried that yet.

  104. bachfiend says:

    Hardnose,

    In my opinion that brings you up to 9 sensible comments (although the ‘breakfast is an extremely important part of the day’ crowd will disagree with us). I’m going to Europe this year, doing two tours separated by two weeks in which I’m self catering for myself in Cologne and Berlin (admittedly in very good hotels). It’s impossible to get tour operators to have an option in which breakfast is not included in the tour. And the tour price. They claim that almost everyone wants breakfast included. And it’s supposedly cheaper. The second tour finishes in Munich, and since I’d arranged to spend a further three nights in Munich at a different hotel (without breakfast included) I got the tour operator to drop the last night in Munich (and reduced the tour price by $250).

    I’m not certain whether ‘intermittent fasting’ is good for health or not. To me it just seems to be ‘natural’ in that humans in their hunter-gatherer stage weren’t guaranteed food every day. The only time I’ve gone without food for more than one day was when I was training for an upcoming marathon and I completely lost my appetite for several days, without any other symptoms. No nausea or anything. I just didn’t want to eat, despite still training. Otherwise, i was completely fine. I wondered if I had some viral infection which only the symptom was loss of appetite.

  105. hardnose says:

    Right, we did not evolve to eat 3 times a day, every day. The intermittent fasting advocates have theories about why fasting is good for health. I only know that I feel more awake and have more energy in the morning, because I don’t eat.

    Also, the things people eat for breakfast are often high in carbohydrates and low in protein, which can lead to weakness and hunger a couple of hours later.

    I started doing this decades ago, long before I ever heard of intermittent fasting. I started eating breakfast later and later, until I just skipped it altogether, because I noticed I felt better.

    I think everyone should at least try it and see how they feel. You might expect to feel weak and starving, but that does not happen at all.

  106. bachfiend says:

    Hardnose,

    I started skipping breakfast when I was training for a marathon. I’d do a 90 minute session of deep water running in an Olympic pool in the morning (in order to deplete muscle glycogen as much as possible) and then in the early afternoon I’d go for a 10 kilometre run in order to get use to running with no glycogen stores to mimic the final stages of a marathon. And then I’d have my first meal of the day.

    I actually didn’t feel hungry after the deep water running. I felt pretty good in fact.

    I agree that there’s a lot of nonsense written about diet based on theories that haven’t been verified.

    I personally think that the problem with people’s diets is not too much carbohydrate, but too much simple sugars, which causes wild swings in insulin levels as blood glucose levels suddenly increase and then precipitously fall, causing feelings of hunger.

    I’m not convinced by claims that increasing protein in breakfasts suppresses hunger. And people in developed countries generally eat too much protein already. Too much protein is toxic to the kidneys if there function is already marginal, as happens with normal ageing.

    The proof of a diet is in its results. I’m on a high carbohydrate/low sugar/low fat diet for decades, and I’d put my blood biochemistry and health against anyone’s. I’m in pretty good condition for a 63 year old.

  107. hardnose says:

    “I personally think that the problem with people’s diets is not too much carbohydrate, but too much simple sugars, which causes wild swings in insulin levels as blood glucose levels suddenly increase and then precipitously fall, causing feelings of hunger.”

    You aren’t alone in believing that, it is generally accepted as far as I know. The worst thing is too much refined sugars, or refined carbohydrates in general. And we live in a society where white bread and white sugar are probably the most common sources of calories.

    I don’t know if we need to avoid fat though, and maybe it depends on which kind.

    As for protein, I just go by how I feel. If I don’t have enough protein for several days, eventually I feel like I need it.

    Good for you, staying healthy at 63. I think if we paid attention to health all our lives, we have a better chance. So many people my age (a little older than you) are having lots of trouble.

  108. bachfiend says:

    Hardnose,

    I eat quite a lot of bread, but as sourdough (rice, San Francisco, French, or rye), which has a lower glycemic index than ordinary white bread. There are wholemeal sourdough recipes around, but my baker isn’t interested in trying them.

    I tend to have low protein days if I’m travelling, without problems.

    My main source of fat is the little amount of cheese I eat. And walnuts. I love walnuts. Including in the vegetable casserole which is my main meal.

  109. ddraiggoch says:

    It’s hard to plough through the mischaracterisations and blatent strawmen deployed by both hardnose and tio.

    It seems like quite a few folk have tried to address this but it not sinking in.

    For what it’s worth, the issue that I wanted to address was the suggestion that the current “dominant model” for depression is bio-Medical. That’s complete BS. Mental health care is firmly biopsychosocial in its outlook and the diathesis stress model is pretty key to understanding mental illness.

    Sure, some clinicians will be extreme in their practice but that’s completely different to characterise an entire field of expertise in a particular way.

    Also comparison of mental illness to cancer was ill thought out. There are lifestyle risk factors for loads of cancers, ditto mental illness. Treatments are different because mental illness and cancers are not the same problem. It’s just odd to claim otherwise. There are correlations between social factors and many illnesses, not just psychological problems/mental illness. Diabetes and obesity have correlations with poverty for example, as does depression.

    The brain is the most complex organ, I think, and comparisons between disorders and illnesses of the brain/mind is somewhat pointless.

Leave a Reply