The Myth of Mental Illness

[Walker]

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, and has become a classic, well known as an argument that "mentally ill" is a label which psychiatrists have used against people "disabled by living" rather than truly having a disease.

https://en.wikipedia.org/wiki/The_Myth_ ... al_Illness

[Iwannaplato]

To run in related parallel, we are starting to see general acknowledgement that the chemical imbalance leads to mental health issues myth is, well, a myth.
https://slate.com/technology/2022/08/ss ... ssion.html
https://www.psychiatrictimes.com/view/d ... yths-again
And it is no coincidence that this 'theory' fits nicely with pharmcological solutions to people's problems or apparant problems.

[Sculptor]

To run in related parallel, we are starting to see general acknowledgement that the chemical imbalance leads to mental health issues myth is, well, a myth.

But this is part of the problem.
Where do you start with all this?

People whose lives are damaged by modern living, by dysfunctional families, by trauma; get a chemical imbalance. THe chemical imbalance is not the start. not the be-all and end-all of a mental health crisis.

If you stick an ordinary person in prison and keep the lights on and play them Grunge Rock at full volume 24/7 they are going to acquire a chemical imbalance. No doubt. This chemical imbalance may well be the expression of problems.

When the neurochemist is asked to examine the brain chemistry of a "mentally ill" person, what would you expect him to find?? - a difference in brain chemistry as compared with other people that he is going to call "a chemical "imbalance".

This does not mean that the chemical imbalance is a cause. Nor does it mean that it will (in your words) "lead to mental health issues" IIt seems to be more accurate to say that in many cases of mental health issues there is a correlation with changes in brain chemistry.

Altering the chemistry with drugs is not going to simply restore "normality".

Nonetheless, there are serious and real mental health problems that might be triggered by life, but cannot explain them. Schizophrenia is a very real problem which comes with difficulties in certain types of cognition, in which the sufferer is incapable of certain types of discrimination we all take for granted. THis leads to the most bizarre types of pattern recognition which are blown completely out of proportion leading to paranoia and other serious delusions with high levels of complexity hard to unpack with CBT or other talking therapies.

[Iwannaplato]

But this is part of the problem.
Where do you start with all this?

People whose lives are damaged by modern living, by dysfunctional families, by trauma; get a chemical imbalance. THe chemical imbalance is not the start. not the be-all and end-all of a mental health crisis.

Part of what they have found is that it simply was not correct that depressed people, for example, had a chemical imbalance.

Don't take my post as saying no one should get certain medications. But this was a PR campaign by pharmaceutical companies that was part of overuse of anti-depressants amongst other drugs.

You have a chemical imbalance so chemicals are the right treatment.

And just like the whole statins issue, alternatives were considered alternative.

Nonetheless, there are serious and real mental health problems that might be triggered by life, but cannot explain them. Schizophrenia is a very real problem which comes with difficulties in certain types of cognition, in which the sufferer is incapable of certain types of discrimination we all take for granted. THis leads to the most bizarre types of pattern recognition which are blown completely out of proportion leading to paranoia and other serious delusions with high levels of complexity hard to unpack with CBT or other talking therapies.

Sure, and I think the patterns that get batched under the name of schizophrenia can be improved in many cases with drugs.

But schizophrenia 0.72 % is rare compared to the diagnoses of anxiety disorders, which they tell us 31% of americans will get at some point and depression 8.1%.

This discussion needs to be had without the harshest diagnosis coming immediately out as a counterexample. If I or Walker say that drugs should never be used or that schizophrenia is just a different way of seeing things, then we can deal with this kind of example.

We've had a long pathologization of emotions and large swathes of the country is diagnosible.

There are all sorts of studes that show that people get better from almost everything if they can spend time in nature, sleep better, have meaninful work and exercise more. Social connections also.

A great book on this is Lost Connections
https://www.amazon.com/Lost-Connections ... 136&sr=8-1

There are people who have been cured from schizophrenia using alternative methods. I have no idea what percentage could be and we probably will not find out given how beholden media are to the pharmaceutical companies. IOW we won't get a great sample size. But I know a few people personally who managed to avoid a lifetime of medication. Perhaps most do need that. But we do not live in a society, yet anyway, where such a thing can easily be looked into.

And yes, if there is a chemical imbalance, in those cases where there are, perhaps a drug solution is necessary part of the solution. Perhaps not. But it's not a coincidence that this was given so much play for so many years. Because it sounds like this person has a physiological problem like one might have diabetes, which is also, one could argue, a chemical imbalance. But one may well have a purely genetic origin, with little environmental factors, and nearly no options (diabetes 1). The cause in the other being possibly a mix of a wide range of things.

And we know pharma twists its results.

Did you know that only the most severely depressed patients do better on anti-depressants than placebo?

The research results that showed this should have led to core practice changes in psychiatry. But they did not.

Pharma wants people medicated. The public wants magic bullets.

Which ends up being that we are medicating people to make them get along in a society that they may not fit well. Instead of seeing if we can modify their lives and make society one in which most people thrive.

We are cutting off an incredibly important feedback about our individual lives and our collective lives.

It's like giving pain killers to people who have been in car accidents and not giving many of them x rays.

In the car accident we know that as a society we need to try to prevent accidents - driving under the influence laws, road laws, tickets - prevent severity of accidents (seat belts, better car structure, speed limits). We just assume that the car accident is a factor in the pain people have after them. With mental health, there is a jump to the pain killer in an unprecidented way.

[Sculptor]

You have a chemical imbalance so chemicals are the right treatment.

This is complete bollocks.

The problem is not the chemical imbalance it is the series of life problems that led to the chemical imbalance.
It's a total mirage.

People who lose their job, or get a job that does not suit them end up getting depressed. It is an absurd idea that you just chemically alter the brain to change your life.
WHat you need is to understand why you are feeling down and work on your life situation. Because one thing is for sure NO ONE, and I mean no one as a deficiency prozac, or metzoprime.
These are artificial substance that have no business being in the human body.

The chemical imbalance is not the problem, it is nothing more than a measure of the problem.

Drug companies want to sell drugs so they sell the idea of a chemical imbalance.
They even have teams of people working out how to (what they call) "export the category".
No one in the Indian sub continent had "depression", until drug companies exported to notion to middle class women. Who fell over themselves to outcompete their neighbours to who will get the first prescription.

You have swallowed the myth of Pharma: a pill for every ill.
Type2Diabetes can be "managed" with Metformin, a drug that mimics insulin. It forces serum glucose into the tissues. But the problem with T2D is too much insulin and insulin resistance.
Metformin is a way of attacking a symptom, in much the same way as attacking a chemical imbalance.
BUT.
If you want to be cured of T2D all you have to do is adopt a more natural low carb diet, this is a complete cure.
Metformin just makes you dependant, you need more and more for the same effect, and you are just delaying the problem.
This is exactly what diazepam, prozac and other antidepressants do.

I agree that schizophrenia is a more profound problem but the most common mental health problems are directly associated with actual things that happen in your life. THese are better addressed by relaxing with friends and sharing your problems. Going for a walk in the country. Hugging your dog.

[Iwannaplato]

You have a chemical imbalance so chemicals are the right treatment.

This is complete bollocks.

That was the entire point of my posts. That was the bs they were telling us and everything I wrote before and after that is saying why I believe that.

[LuckyR]

No doubt that negative life events are definitely correlated with clinical depression. I agree that in many cases they are a large part of the cause. However, clinical depression runs in some families (thus has a likely genetic risk factor separate from life events), there are also many cases of clinical depression unassociated with negative life events and many people experience severe negative events yet don't become clinically depressed. So brain neurotransmitter levels cannot be summarily dismissed as at least a partial cause in most cases and is likely totally causal in a minority of cases.

[Iwannaplato]

No doubt that negative life events are definitely correlated with clinical depression. I agree that in many cases they are a large part of the cause. However, clinical depression runs in some families (thus has a likely genetic risk factor separate from life events), there are also many cases of clinical depression unassociated with negative life events and many people experience severe negative events yet don't become clinically depressed. So brain neurotransmitter levels cannot be summarily dismissed as at least a partial cause in most cases and is likely totally causal in a minority of cases.

But that's no the only way one can have genetic or other biologically based problems. IOW I am not dismissing all nature causes and saying it's all nature and have talk therapy only. I am saying that the chemical imbalance hypothesis, which never reached the leave of theory, was very much the pr viewpoint of the pharmaceutical industry. And a number of metastudies have shown that the pharma approach does much worse than industry propaganda and research showed, then. I am sure that there are patterns that come out off genetics. But even this does not mean that approaches that are not chemical focuses should be dismissed - you didn't say this, but in many contexts it is taken as a self-evident conclusion. Meaningful work, time in nature, while not directly chemical have all sorts of chemical effects. For example. None of this means that I think no one is helped by drug approaches. I know many are. Though if this is an actual solution, even then, is another story. With extreme case, like schizophrenia, it would be very hard, gifen the nature of modern society to deal with it in another way. But interestingly enough there was a NYtimes article on several studies that showed that people in cultures that do not use pharma based approaches to dealing with schizophrenics actually do better with them. FAmily support and non-stigmatization often allow these people to move in and out of work, move in and out of bad phases much better than Western counterparts.

Money has guided research and media coverage for a long time on these issues.

[Sculptor]

No doubt that negative life events are definitely correlated with clinical depression. I agree that in many cases they are a large part of the cause. However, clinical depression runs in some families (thus has a likely genetic risk factor separate from life events), there are also many cases of clinical depression unassociated with negative life events and many people experience severe negative events yet don't become clinically depressed. So brain neurotransmitter levels cannot be summarily dismissed as at least a partial cause in most cases and is likely totally causal in a minority of cases.

I often think that the genetic factors are overplayed. Whilst genes might direct towards a vulnerability, they do not necessarily mandate and determine the problem.
There are good quoditian reasons why people descend into depression and measures that can be taken to avoid, and reverse. The world's highest incidence of childhood depression is in Gaza right now. Gosh - I wonder why? It aint genes

Neurotrasmitter levels correlate with mental health problems. The mistake is that people go away thinking that if you treat those levels you treat the problem without asking what is the underlying cause of the dysfunctions. Depression causes low neurotrasmitter levels; low neurotransmitter levels cause depression; or do they go hand in hand?
Maybe low NT levels are nothing more than an indication of mental health?
What about your life, family, diet, environment ad infinitem.
We have been done a huge disservice by the pharmaceutical industry by thinking that every ill has a pill, when a more thorough functional approach to medicine is a more sustainable and effective way to treat.

[LuckyR]

No doubt that negative life events are definitely correlated with clinical depression. I agree that in many cases they are a large part of the cause. However, clinical depression runs in some families (thus has a likely genetic risk factor separate from life events), there are also many cases of clinical depression unassociated with negative life events and many people experience severe negative events yet don't become clinically depressed. So brain neurotransmitter levels cannot be summarily dismissed as at least a partial cause in most cases and is likely totally causal in a minority of cases.

I often think that the genetic factors are overplayed. Whilst genes might direct towards a vulnerability, they do not necessarily mandate and determine the problem.
There are good quoditian reasons why people descend into depression and measures that can be taken to avoid, and reverse. The world's highest incidence of childhood depression is in Gaza right now. Gosh - I wonder why? It aint genes

Neurotrasmitter levels correlate with mental health problems. The mistake is that people go away thinking that if you treat those levels you treat the problem without asking what is the underlying cause of the dysfunctions. Depression causes low neurotrasmitter levels; low neurotransmitter levels cause depression; or do they go hand in hand?
Maybe low NT levels are nothing more than an indication of mental health?
What about your life, family, diet, environment ad infinitem.
We have been done a huge disservice by the pharmaceutical industry by thinking that every ill has a pill, when a more thorough functional approach to medicine is a more sustainable and effective way to treat.

I believe we are very close to one another in our understanding of the issue. I'm just saying that a health provider can't write a prescription for a better childhood upbringing, or more meaningful employment, but that doesn't mean they don't believe that such thing may not play a huge role in the overall process.

After all, rich folks are in therapy (with or without meds), working folks with insurance generally have little to no Mental Health coverage, therefore can only access their (overworked and under compensated) primary care provider who don't have the time, training or frankly the interest (otherwise they'd have chosen psychiatry) to do anything but talk for three minutes and write a prescription. And those without insurance (and some with it) are left to selfmedicate, with dismal results.

[Sculptor]

No doubt that negative life events are definitely correlated with clinical depression. I agree that in many cases they are a large part of the cause. However, clinical depression runs in some families (thus has a likely genetic risk factor separate from life events), there are also many cases of clinical depression unassociated with negative life events and many people experience severe negative events yet don't become clinically depressed. So brain neurotransmitter levels cannot be summarily dismissed as at least a partial cause in most cases and is likely totally causal in a minority of cases.

I often think that the genetic factors are overplayed. Whilst genes might direct towards a vulnerability, they do not necessarily mandate and determine the problem.
There are good quoditian reasons why people descend into depression and measures that can be taken to avoid, and reverse. The world's highest incidence of childhood depression is in Gaza right now. Gosh - I wonder why? It aint genes

Neurotrasmitter levels correlate with mental health problems. The mistake is that people go away thinking that if you treat those levels you treat the problem without asking what is the underlying cause of the dysfunctions. Depression causes low neurotrasmitter levels; low neurotransmitter levels cause depression; or do they go hand in hand?
Maybe low NT levels are nothing more than an indication of mental health?
What about your life, family, diet, environment ad infinitem.
We have been done a huge disservice by the pharmaceutical industry by thinking that every ill has a pill, when a more thorough functional approach to medicine is a more sustainable and effective way to treat.

I believe we are very close to one another in our understanding of the issue. I'm just saying that a health provider can't write a prescription for a better childhood upbringing, or more meaningful employment, but that doesn't mean they don't believe that such thing may not play a huge role in the overall process.

After all, rich folks are in therapy (with or without meds), working folks with insurance generally have little to no Mental Health coverage, therefore can only access their (overworked and under compensated) primary care provider who don't have the time, training or frankly the interest (otherwise they'd have chosen psychiatry) to do anything but talk for three minutes and write a prescription. And those without insurance (and some with it) are left to selfmedicate, with dismal results.

The brain is a delicate object. If there is what is laughingly called a "chemical imbalance" then the idea that you can take a oral solution is of limited use. It's a bit like increasing the voltage to a computer which has a corrupt hard drive. What you need to do is re-organise the hard rive in the same way it got disordersed.

And that solution is about using the brain as a brain, not hitting it on the head with a blanket-bombing drug.
The drugs that my brother was given for his schizophrenia eventually killed him and did little more than calm him down to such a degree that he pretty much lost all interest in life. Cognitive and behavioural therapies are expensive; drugs are dirt cheap.

To use another analogy - the drugs were a bit like doing the weeing with a sledgehammer or flamethrower, rather than carefully picking out bad thoughts and challenging them. Humans are complex gardens. Clearly the weeds with drugs also clears the good stuff too.

The result is a compliant person who appears to be no danger to the community.

[LuckyR]

Drugs are what they are. Not a panacea, but an important tool in the toolbox. Those with Mental Health problems would be worse off if one waved a magic wand and the only change was elimination of all MH drugs. OTOH, I agree that the optimal magical situation would be to severely lessen the need for MH drugs by magically giving everyone a non-negative childhood and a fulfilling employment and family situation. Since that's impossible the best achievable thing would be to mandate adequate MH coverage with all insurance.

[Iwannaplato]

I believe we are very close to one another in our understanding of the issue. I'm just saying that a health provider can't write a prescription for a better childhood upbringing, or more meaningful employment, but that doesn't mean they don't believe that such thing may not play a huge role in the overall process.

Right off the bat the health provider can stop pretending that the chemical imbalance model is supported by science. This pathologizes individuals, instantly, rather than seeing most of the problems as being normal reactions to trauma, meaningless or unstable work or unemployment, social isolation, and accepted addictions, including, for example, social media and internet use in general. As some examples. Health providers further isolate )and blame at the very least the bodies of) clients with a model that was made up by industry for income reasons. This gives the client right from the start a more realistic understanding of their problem. Yes, the health provider cannot get them more meaningful work, but suddenly the mental health worker is not depoliticizing a problem that is in part political. The are depathologizing reactions to past trauma, abuse and neglect and putting this in a better perspective. You are suffering x because this is a natural reaction that many people have to this pattern or event in your childhood.

Reponsible health care workers could then also approach media and legislators with proposals and explanation from this more realistic perspective.

Right now they are, generally, speaking and supporting unscientific views that benefit pharma and stifle society coming to grips with the real causes of much of the mental health problem base.

And lets not gloss over how much hatred of the limbic system is involved in the radical amount of psychotropic meds that are prescribed. We have normalize pathology. Normal emotional reactions are now treated like chronic infections. Again depoliticizing a wide range of issues, including workplace stress related power dynamics.

It's not just that health providers can't solve all these problems, they are actively promoting lies (unintentionally). This has all sorts of ripple effects. They are also prescribing meds for all sorts of people who do not have mental illness, let alone are dealing with PTSD. There is a huge hypocrisy related ot the judgement and criminalization or stigma related to self-medicating approaches with drugs and the addiction creation by giving millions of fairly normal people drugs with long, long lists of side effects and adverse reactions.

[LuckyR]

I believe we are very close to one another in our understanding of the issue. I'm just saying that a health provider can't write a prescription for a better childhood upbringing, or more meaningful employment, but that doesn't mean they don't believe that such thing may not play a huge role in the overall process.

Right off the bat the health provider can stop pretending that the chemical imbalance model is supported by science. This pathologizes individuals, instantly, rather than seeing most of the problems as being normal reactions to trauma, meaningless or unstable work or unemployment, social isolation, and accepted addictions, including, for example, social media and internet use in general. As some examples. Health providers further isolate )and blame at the very least the bodies of) clients with a model that was made up by industry for income reasons. This gives the client right from the start a more realistic understanding of their problem. Yes, the health provider cannot get them more meaningful work, but suddenly the mental health worker is not depoliticizing a problem that is in part political. The are depathologizing reactions to past trauma, abuse and neglect and putting this in a better perspective. You are suffering x because this is a natural reaction that many people have to this pattern or event in your childhood.

Reponsible health care workers could then also approach media and legislators with proposals and explanation from this more realistic perspective.

Right now they are, generally, speaking and supporting unscientific views that benefit pharma and stifle society coming to grips with the real causes of much of the mental health problem base.

And lets not gloss over how much hatred of the limbic system is involved in the radical amount of psychotropic meds that are prescribed. We have normalize pathology. Normal emotional reactions are now treated like chronic infections. Again depoliticizing a wide range of issues, including workplace stress related power dynamics.

It's not just that health providers can't solve all these problems, they are actively promoting lies (unintentionally). This has all sorts of ripple effects. They are also prescribing meds for all sorts of people who do not have mental illness, let alone are dealing with PTSD. There is a huge hypocrisy related ot the judgement and criminalization or stigma related to self-medicating approaches with drugs and the addiction creation by giving millions of fairly normal people drugs with long, long lists of side effects and adverse reactions.

Not a bad set of proposals for a Philosophy Forum. OTOH, of little practical value for patients and practitioners.

Firstly, folks who have the resources or the luxe insurance policies to see mental health professionals most commonly are in therapy, with or without medications.

Your comments apply to the vast majority of people who have scanty or no mental health coverage and can't afford to pay out of pocket to see a MH provider long term. They are left with a primary care provider who is not compensated for and isn't prepared to provide therapy. Their options are: advising patients that their problem is a natural reaction to an abnormal life situation so change your life situation (your advice) or write for meds. Just so you know the average patient hearing the former is going to walk out of the appointment grumbling "that a55hole said it's all in my head and didn't help me, what a jerk".

As an aside, you know what folks do when they are paying copays for meds long term for symptom relief that in their opinion are not helping? They stop paying for it (and therefore stop taking it). Thus pretty much the only folks taking MH meds long term feel that they're of some value, (but you know better?)

Lastly putting aside the value of legislators getting involved in the practice of medicine (see: abortion), if you think politicians care about the opinions of health professionals, you didn't pay attention during the pandemic.

[Gary Childress]

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, and has become a classic, well known as an argument that "mentally ill" is a label which psychiatrists have used against people "disabled by living" rather than truly having a disease.

https://en.wikipedia.org/wiki/The_Myth_ ... al_Illness

In my "continental philosophy" classes (in my college days), it was called "psychologism" if I recall correctly, the attempt to discredit ideas by calling them "unhealthy" or whatnot. It's an interesting concept, and I agree to whatever extent with the ideas in your post above. Good summation.