Apr 23 2007

Mental Illness Denial – Part I

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

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

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

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

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

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

There is no disease without pathology

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

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

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

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

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

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

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

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

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

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

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