A recent article by Emily Korstanje details the story of Nadia, an 18 year old girl from Saudi Arabia who suffered from depression. Her religious parents took her to a faith healer who, through dubious methods involving choking her until she passed out, concluded that her symptoms were the result of demonic possession.

Fortunately Nadia was able to break away from that healer and defy her parents, but she still faces a more difficult challenge – her society.

“They need to separate religion from psychology, especially for us women, who suffer from depression because of our shitty circumstances, or we cannot—and will not—get help,” Nadia sad. “Society also needs to be rid of this of shame toward mental illness and stop saying that people are weak or not perfect believers, or possessed! Spirituality is important but it doesn’t mean that you deny what is really going on because it will only get worse.”

In the past, before science helped us understand things like psychology and neuroscience, it is understandable that prescientific cultures would reach for superstition to explain mental illness and neurological disorders. They had no way of understanding what a seizure was, let alone schizophrenia. So they used what explanations they had at hand and decided that such individuals were possessed by evil spirits, or cursed, or were being punished by god or the gods.

It amazes me, however, that in the 21st century this still occurs. Now, with all the knowledge of modern neuroscience, there is no excuse for confusing a brain disorder with spiritual possession. Further, we do not need to look to third world countries to find example – this is still happening in modern industrialized nations.

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Denialism is a thing. What I mean is that denialism is a definable intellectual strategy, with consistent features that tend to cluster together. I first wrote about denialism 12 years ago, before global warming denial made the term more widespread. I pointed out that certain beliefs tend to follow the same fallacious arguments – HIV denial, creationism (evolution denial), holocaust denial, and mental illness denial. I would add now global warming denial and germ theory/vaccine science denial.

I characterized denialism as a subset of pseudoscience, one that tries to cloak itself in the language of skepticism while eschewing the actual process of scientific skepticism. But further, denialism exists on a spectrum with skepticism, without a clear demarcation in between (similar to science and pseudoscience). People also tend to use themselves for calibration – anyone more skeptical than you is a denier, and anyone less skeptical than you is a true believer.

Geneticist Sean B. Carroll (not to be confused with the physicist Sean M. Carroll) in his 2007 book, The Making of the Fittest: DNA and the Ultimate Forensic Record of Evolution, lists what he identified as the six core features of denialism. I think they make an excellent list, and would like to expand on them:

1) Cast doubt on the science.
2) Question the scientists’ motives and integrity.
3) Magnify any disagreements among the scientists; cite gadflies as authorities.
4) Exaggerate the potential for harm from the science.
5) Appeal to the importance of personal freedom.
6) Object that acceptance of the science would repudiate some key philosophy.

As you will see, all of these strategies are insidious because they are extreme versions of reasonable positions. Their underlying principles are sound, it is their specific application that is the problem.

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The new Diagnostics and Statistical Manual, DSM-V, is out. Not surprisingly, it has sparked some controversy. Psychiatry deniers are proclaiming that this is the collapse of the mental-illness fraud (I believe reports of the death of psychiatry are exaggerated).

What the DSM-V does represent, to some degree, is an attempt to advance psychiatry to the next stage of our understanding of illness. It seems that we are not quite ready for this step in psychiatry, but the effort is sincere and interesting.

For background, the DSM (now in the fifth edition) is essentially a list of official psychiatric diagnoses, based upon clinical criteria. For mental illness and disorders we mostly lack clear biological markers or pathology, and so we have had to make do with clinical descriptions – lists of signs and symptoms. This is very much a descriptive phase of scientific understanding.

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Attention Deficit Hyperactivity Disorder (ADHD) has long been a target of those who dislike the very concept of mental disorders. This is partly because the emotional stakes are high – the diagnosis often results in children being treated with stimulants. Opposition to the concept of ADHD also reflects fundamental misunderstandings about medicine.

A recent opinion piece in The Blaze by Matt Walsh reflects this deep misunderstanding and unease with the concept of mental illness.

Throughout the piece he uses the terms “disease” and “disorder” interchangeably, without defining either. The distinction is important, because it relates to how medicine defines diagnostic entities. Not all diagnoses are created equal. I spend a great deal of time teaching medical students to have a sophisticated and nuanced understanding of the labels they will be attaching to their patients.

As with every branch of science, labels are used as placeholders of our understanding of phenomena, and also as a necessary contrivance to allow technical communication among experts, in the scientific literature, and also to the public. In medicine we need labels for certain practical applications, such as documentation, epidemiology, drug indications, reimbursement, and research. Labels are a scientific tool, and they need to be understood to be used properly.

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There was a lot of buzz over the long weekend within skeptical circles about a recent article by Mike Adams of Natural News infamy about the coming zombie apocalypse. In the article Adams, who is notorious among skeptics as a conspiracy theorist and promoter of every sort of dubious medical medical claim, reports the story of a Miami man who was shot by police because he was eating the face off another man and would not stop when instructed to do so.

Let me say right off that I get that Adams is being tongue-in-cheek through most of his article. He is using the current cultural fascination with zombies as a metaphor for the kind of medical zombies he thinks modern society is creating. I understand the use of satire and metaphor, and have done so myself on occasion. But I have also learned to be crystal clear about it (and even then you run the risk of being misinterpreted). I found Adam’s article, however, to blend points he was seriously trying to make with distortions and metaphors in a very unclear way. It doesn’t help that his serious points are themselves conspiracy mongering and fear mongering nonsense.

Here, I think, is the actual point Adams is trying to make:

Humans who subject themselves to fluoride, aspartame, psychiatric drugs, vaccines and street drugs end up lobotomizing their higher brains. Vaccines, for starters, cause extreme neurological damage, and some vaccines are actually made of aggressive viruses designed to “eat” targeted regions of the brain, resulting in a biological lobotomy.

See what I mean? Adams occupies that part of CAM world that is anti-government, conspiracy mongering, and anti-medical establishment. Those imperatives seem to trump science and reason at every turn. The anti-fluoride community is a very vocal minority who have had some success in scaring communities away from a safe and effective public health measure. They employ misinformation, distortion, and half-truths to fear-monger about fluoride.

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I have a strict “do not feed the trolls” policy on this blog. OK – so it’s more of a strong suggestion frequently flouted. It’s very difficult to enforce. Even saying, “Do not feed the trolls,” is feeding them, and there always seems to be someone who caves to their goading, and then the troll is off to the races.

Commenter Dirk Steele has given us the latest example on my blog from Tuesday. He left a completely off-topic comment with the intent of derailing discussion on the actual topic of the blog post, and someone caved (no hard feelings, I sometimes do it myself, it’s hard to resist sometimes). Dirk was apparently frustrated that I was not responding to his comments on a five year old blog post. I rarely respond to comments on posts more than a week old, let alone five years (I trust you understand why I cannot maintain active discussions on over a thousand posts).  I also did not respond because Dirk did not address any of the points I made in the post (actually a series of five posts), but was simply regurgitating Thomas Szasz mental illness denial talking points. My responses, in other words, were already in the posts and did not need repeating.

But it has been a while since I have addressed the issue of mental illness denial head on. I also receive frequent requests to discuss this topic, and ADHD (attention deficit and hyperactivity disorder) directly, so this is as good an excuse as any to revisit this topic. I predict my response will not satisfy Dirk, but at least it will keep him out of other threads for awhile. This is Dirk’s most relevant comment, in which he gives us a Gish gallop of standard mental-illness denial talking points:

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The Diagnostics Statistical Manual for Mental Disorders, a much maligned document, is in the midst of its fourth major revision (the DSM-IV will be replaced by the DSM-V). This process has been going on for over a decade. The revisions are now being made public in order to have a two year period of public comment and debate about the details of the revisions.

This has led to a new round of criticism of the DSM, and through it psychiatry, from those who either do not sufficiently understand, in my opinion, the nature of psychiatric diagnosis, and from those who are anti-psychiatry because of ideology (Scientologists, for example).

At the extreme end of criticism are those who deny the very existence of anything that can be called mental illness. I have already dealt extensively with their arguments, and won’t repeat them here. But even those are not so extreme fall into some of the same logical fallacies when criticizing mental diagnoses. Recently George Will, for example, wrote an editorial which I think confuses medical diagnoses with taking moral positions (I will get to his commentary below).

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I hate it when a side comment or example completely takes over the main point of a blog post. In my post on ADHD I made what seemed to be a very straight-forward analogy to feminism:

Some feminists insist, against the evidence, that there are no significant differences between the sexes.

My point was only this – that it is a mistake to base a moral position on scientific facts, for then either you must insist that the facts conform to your moral desires, or your moral position is vulnerable to falsification. I specifically referenced Steven Pinker who made this point in The Blank Slate. Pinker also, by the way, gives numerous examples of feminists committing this fallacy in his book – so this is a secondary reference, but sufficient for the minor side point I was making.

A few, however, have completely missed my point, despite my later clarifications in the comments. I will pick on M. Davies since he wrote such a long comment. He writes, regarding my claims that some feminists hold this position:

Do you have some citations for this, some evidence that a distinct philosophy within feminist theory adheres to this claim?

First I must point out that whether or not any feminists actually hold this position is not relevant to my point – it was an analogy. To the extent that anyone takes the position that there are no significant difference between the sexes, they are committing the fallacy I am discussing. But I do hold that this is a distinct philosophy within feminism, and as I said I gave Pinker as one source.

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Last week I wrote about some new evidence regarding the biological basis for ADHD. As commonly occurs with such pieces, the comments attracted some discussion of what I call mental illness denial. For those who are interested in this topic I recommend reading my five-part blog series on this topic beginning here. But I would also like to address some of the specific points raised.

Commeter Pious Fraud relates feedback from a friend who is a follower of Thomas Szasz. Szasz is definitely the father of mental illness denial. Forty years ago he had a point, and I admire his defense of autonomy, informed consent, and universal human rights. At the time a psychiatric diagnosis was akin to a loss of rights and autonomy. But there are two major malfunctions of the Szasz position today.

The first is that whatever legitimate points he had forty years ago were fought and won. He should just accept his victory – psychiatry has been reformed, partly from a series of legal precedents that reaffirm the rights of the patient. Second, Szasz committed a fallacy that is all-too common – making the scientific facts fit his ideology. Even when the ideology is a good one, like human dignity and autonomy, nature does not have to comply to our moral wishes.

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New research is shedding light on exactly what is wrong with the brains of people with several genetic disorders that lead to mental retardation – Down syndrome (a chromosomal abnormality where there are three copies of chromosome 21 instead of the usual two), Fragile X (a mutation of the Fmr1 gene on the X-chromosome) and certain types of autism. The problem seems to be in the way new connections, or synapses, are made.

Daniel Madison, PhD, associate professor of molecular and cellular physiology at Stanford University School of Medicine, and his colleagues have been looking at the connections that brain neurons make with each other. These synapses are largely responsible for the “hardwiring” of the brain, the pattern of information processing that results in memories and mental function. They looked at the brains of Fmr1 mosaic mice (so some neurons are normal and some contain the Fmr1 mutation), and discovered that affected neurons were less likely to form new synapses with other neurons.

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