Category Archives: Brain

Reflections on Marx, Religion and Opiates For the Masses

By Dr David Laing Dawson

When Karl Marx opined that religion is the opium for the masses it was not the throw away line it is today. I am writing this as I watch the sun set over the gulf of Mexico and smoke my $5 robusto and sip my $20 dollar bourbon.

Within my limited historical scholarship it seems to me that humans, ever since evolution bestowed upon them the awareness of suffering, temporality, and death, have been seeking substances to dampen, or ideas to vanquish, the horrifying experience of that reality.

While some of those substances (LSD, mescaline, ecstasy, opium!) give one a temporary sense of alternate and eternal realities, others merely dampen it.

As I write this the clouds briefly accrue a God-like glow of crimson and then slip into filaments of white against the darkening sky, and the temperature drops a few degrees at this moment on this region of a small planet. I go inside to replenish my glass. Our two dogs come with me; one, oblivious to my thoughts, wants to share his chew toy with me.

While religions, all of them, from the old and organized, to new and old ideas of enlightenment and “oneness with the universe” attempt to obliterate the terror of being sentient beings with limited life spans, substances like marijuana and alcohol merely dampen that reality.

And while religion works for many it has also been the unholy source of corruption, perversion, suffering and death for others.

With a sweater it is warm enough to sit outside and miraculously the WiFi reaches a chair by the barbecue. The sky has become both misty and mystical. A scattering of stars appears between the low clouds. I know I should leave my cigar alone, for the second half will give me an overdose of nicotine and a dry mouth through the night. The replenished glass of bourbon with much ice to soften it will let my eyes linger on the beauty of the night without too many intrusive thoughts.

Marijuana would let me do the same I’m sure.

It is one of those realities that could be used to argue both for and against intelligent design: anything that can make us feel good, or relieve us of the terror of existence, when used excessively, can harm us. I will leave the cigar butt in the ashtray and I resolve to not replenish my glass again. The dogs lie on the cool patio stones beside my chair.

My companion comes out to join me, commenting how lovely it is, and asking if I would like a refill. My resolve vanishes as quickly as a startled gecko.

We sit together in the balmy night air, breezes bringing mist from the gulf, the dogs at our feet, and I think how quickly time passes, and I tell myself to stay in the moment.

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Understanding the Disease Model

By Dr David Laing Dawson

I had a friendly argument with a colleague the other day. He reminded me that we had been arguing about this topic for 40 years. I think our arguments are mostly ways of clarifying our own thoughts about a very complicated question involving concepts of mind, of cognition, and of the brain, that organ who’s function makes us human.

Mental illness, disease, disorder, serious mental illness, continuum, spectrum, problem, affliction – when is it both valid and useful to consider aberrations (or non-typical) variations in behaviour and thought, illnesses? In some ways these words are just words, and few would care if we referred to arthritis in any of these terms. But when it comes to behavior, thought, and communication (rather than joint flexibility and joint pain) our dearly held beliefs about self, autonomy, will, power, consciousness, and mortality come into play. The discussion becomes political.

Before the medical disease concept evolved in the 18th and 19th century most afflictions were considered very personal and specific, and the causes very personal and specific. An obvious grouping of afflictions might mean God was particularly disappointed in a whole family or tribe. The Miasmists thought that perhaps God did not have that much control over everything and proposed that the causes might be found in the atmosphere, the miasma, physical, spiritual, emotional. An excess or a deficit. The Naturopaths liked this idea but knowing nothing of physiology, metabolism, or nutrition, concocted potions and powders with dozens of ingredients positing that the body might choose from the lot that which it needed. Each of these ideas continues to echo in the pursuit of health today. Especially in the commercial exploitation of our pursuit of health.

The disease model is founded on the idea that if a number of people suffer the same symptoms and signs, and if their affliction follows the same course with the same outcome then perhaps these people suffer from the same “thing”. This in turn raises the possibility that the cause is the same in all cases and that a treatment that works for one will work for the others. To study this we need to name (diagnose) the thing and describe it’s symptoms, signs, and natural course. Given that we are biological beings it is reasonable to think that some of the signs of these diseases will be biological, and that the causes might be as well. But first the chore is to observe, study, collate, find groupings and test this hypothesis.

In a sense the disease model has picked off all the low hanging fruit, those illnesses with very specific causes and courses and, of course, those for which we have found specific treatments, cures and prevention.

The disease model, and some rudimentary epidemiology, led Dr. John Snow to the source of an outbreak of cholera and then to speculate that the cause, residing in the water supply, “behaved as if it were a living organism”. This before we knew about bacteria, let alone viruses, prions, DNA, and neurohomones.

The same disease model has led to the near eradication of Polio. Drs. Alzheimer and Kraeplin applied the disease model to older people with failing cognitive processes and singled out an illness we now call Alzheimers. Dr. Alzheimer had the advantage of being able to examine the brains of his patients soon after diagnosis. Dr. Kraeplin went on to apply the disease model to a younger group of patients with peculiar cognitive difficulties, some similar to dementia, some not, and singled out a group he called dementia praecox, and another group he called manic depressive. Similarly and more recently the disease model singled out autism from the broader group of mentally handicapped children.

The disease model also allows us to study afflictions and find remedies before, sometimes long before we establish with certainty the causes of the affliction. Who on earth but a cruel idealogue would want us to stop treating and reducing suffering until we find an exact and specific cause of the affliction in question, be it cancer, arthritis, or schizophrenia. Yet that is the cant of the anti-psychiatry folks.

Yet the disease model allows us, sometimes by accident, to find remedies that work, can be proven to work, before we nail down etiology. Now, as mentioned earlier, the disease model has picked off the low hanging fruit, those afflictions caused by single alien organisms, and very specific genetic aberrations. We are left with those that are undoubtedly the product of complex combinations of genetic vulnerability, epigenetic influences in the womb, environmental influences, developmental timing, excesses, and deficits.

But we should no more give up on the disease model for schizophrenia and depression than for heart disease, cancer, arthritis, ALS, and dementia.

Our argument was actually about OCD. Having some Obsessive and Compulsive traits can be an asset of course, and of great help in medical school, while extreme OC traits can be debilitating. The “D” of OCD is the initial for “disorder” of course, but is OCD, in annoying to debilitating form, a disease?

Unfortunately the word “disease” has become freighted with negative association, and for my friend, too much associated with “biological cause”.

Ultimately he may think of OCD as a mind problem, while I may think of it as a mind/brain problem, but it is the discipline of the medical disease concept that allows us to study it and find remedies we can test.

Mental Illness Literacy

By Marvin Ross

In a recent Huffington Post blog, Susan Inman (After Her Brain Broke: Helping My Daughter Recover Her Sanity), wrote about the need for greater literacy about mental illness. And, like me, Susan often gets inundated with comments from opponents. One was from John Read, a psychologist at the University of Melbourne.

Susan was arguing that we need greater understanding of the biological causes of serious mental illness and I agree. Read, however, commented that:

“The evidence is over 50 studies all showing that biological beliefs increase fear and stigma. I’m afraid you are swallowing drug company propaganda, there is no evidence that these drugs prevent violence.”

When challenged to provide sources, he countered with:

“If anyone is interested in what the reserch (sic) says on this issue……

READ, J. (2007). Why promulgating biological ideology increases prejudice against people labeled ‘schizophrenic’. Australian Psychologist, 42, 118-128.

READ, J., HASLAM, N., SAYCE, L., DAVIES, E. (2006).Prejudice and schizophrenia: A review of the ‘Mental illness is an Illness like any other’ approach. Acta Psychiatrica Scandinavica,114, 303-318.”

In an article  that I wrote for the World Fellowship for Schizophrenia and Allied Disorders in 2010, I mentioned the Read approach. Basically that approach states that we should ignore the illness in favour of viewing mental health problems as part of our shared humanity. One of the research papers by Read that I commented on was a 2002 paper which compared the biological explanation of mental illness to a psychosocial explanation. And while Read points out that the psychosocial explanation helped reduce stigma more that the biological, he admits there was no statistical difference between the two.

This is the link to his first article that he cited in his comments to Ms Inman. You can decide but note the lack of objectivity in his title. Biological explanations are cited as ideology that are promulgated and schizophrenia is in quotes. The second paper he cited deals mostly with surveys  asking people what they considered to be the causes of mental illness. Many of them believed that the causes were psychosocial which just proves that Susan Inman is correct in wanting to see greater literacy.

But again, to prove his point, he says that a study that showed a video of a person describing their psychotic experiences increased perceptions of dangerousness and unpredictability in viewers. However, a video explaining the same experiences in terms of adverse life events, led to a slight but non significant improvement in attitudes by those who viewed it.

Again with the non significance. It means there was no difference between the two. The responses were the exact same! Someone who acts scary and displays very abnormal and aberrant behaviour is going to be shunned regardless of the explanation for that behaviour. He does cite a number of papers but they date from 1955 to the latest in 2005.

In my 2010 article, I quoted Dr Heather Stuart, an expert in stigma at Queens University in Kingston, Ontario who said that there have only been six controlled studies of stigma. One of them by Patrick Corrigan found that education did lead to improved attitudes. I could not find a reference to that paper in the one by Read.

As an example, those with advanced symptoms of Hansen’s Disease looked very frightening and were isolated from society. The Leper Colonies existed because no one understood the disease and were afraid they might get it too. But then, modern medicine came along, discovered Leprosy was caused by a bacteria, learned to treat it early and we no longer have people disfigured when treated early. We might still cringe at the thought of leprosy but likely no one has ever seen an advanced case.

In a similar vein, the solution for schizophrenia stigma is not to pretend it isn’t what it is but to provide treatment. As Queen’s University psychiatrist Julio Arboleda-Flores said in his 2003 editorial in the Canadian Journal of Psychiatry, “the best approach is to limit the possibilities for people to become violent via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence;” he writes that “this could be the single most important way to combat stigma.”

And one way to ensure that is to have greater mental illness literacy as Susan suggested.

Now I also have to comment on a post to Susan’s blog by someone who is continually criticizing both Susan and I for our writing on the medical model for schizophrenia. Suzanne Beachy did post a number of comments which you can see for yourself but my favourite is her announcement that another critic of the medical model, Rossa Forbes, has just announced that her son is cured of his schizophrenia.

It seems that his cure was delayed by their being “sidetracked by institutional psychiatry perpetrating the false belief that there was something gone horribly wrong with his brain and only they knew the magic formula to set things right again.” If you go to Ms Forbes blog, you will see her extolling how well her son now is which is wonderful. In fact, she says, he is so well that he has reduced his Abilify to half its dose and is planning to go completely off slowly over time. Abilify, of course, is an anti-psychotic used to treat schizophrenia and is prescribed by psychiatrists.

I am dumbstruck as I am with all the critics of modern science.