
The Epidemic of Mental Illness: Why? - d0mine
http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
======
nkurz
On the advice of people here on HN, I've started reading Whitaker's "Anatomy
of an Epidemic", which is one of the books reviewed here. It's a solid book,
but not doing a lot for me. As a counterpoint for pro-drug advertising it's
fine, but it feels more like a journalistic expose than science. It's not that
it's wrong, rather it feels like the author started out with a conclusion and
then did a lot of fine research to find supporting evidence. I feel like I'm
being given only half the story: a well-founded and less-told half, but still
I worry that the author might have chosen to omit any evidence that weakened
his case.

I'm enjoying another book (not reviewed in this article) that I grabbed off
the new book shelf much better. "What is Mental Illness" by Richard McNally.
He's a Harvard psychology professor who's served on committees for DSM-IV. It
touches on a lot of the same issues, seems a little more current rather than
historical, and by and large I trust that he's representing the field as he
sees it. I also like the prose better: a fun combination of low brow and
erudite. It's highly critical of the field, but also balanced in a way that I
don't find Whitaker to be. <http://mcnallylab.com/>

~~~
jonah
IANAP, but after reading about the process towards the DSM-V,[1] I'm reluctant
to give its "authority" much credence.

[1] <http://www.wired.com/magazine/2010/12/ff_dsmv/all/1>

~~~
JonnieCache
Doctors don't diagnose purely on the basis of the DSM or similar statistical
tools, and haven't for decades, at least here in the UK which is the system I
am most familiar with.

This is too big a subject area to go into here in a HN comment but if you want
to know more, a good place to start would be by familiarising yourself with
the difference between nomothetic and idiographic knowledge, which is
completely key to modern diagnostic practices in psychiatry.

<http://en.wikipedia.org/wiki/Nomothetic_and_idiographic>

VERY VERY simply, while someone might be considered severely abnormal from a
nomothetic viewpoint, from an idiographic viewpoint clinicians might decide
that they have always been that way and they have a history of being happy and
getting on well in their society and with those around them and being
successful, and therefore they _cannot call that person crazy,_ however
statistically abnormal their actions may be.

But yeah, it's a lot more complex than that.

EDIT: an important point to remember is that not every doctor is some sort of
sucker, prescribing whatever big pharma tells them to. When you see a
microsoft press release, do you read it and say "well that sounds convincing!"
and start building everything on MS platforms? Thought not.

Obviously this largely depends on the economic relationship between healthcare
practitioners and big pharma in your country and your healthcare system,
whatever that might be.

If you were unlucky enough to live in a country where MS could just pay you
per line of ASP.NET checked in, well I guess there would be a lot of misery
and shitty code.

------
davidhollander
Buddhism for computer scientists:

The default state machine

    
    
        thought: if good, go to grasping. if bad, go to repressing. if neutral, ignore.
        grasping: increment mood, repeat until fail. go to fail //always fail
        repressing: repeat until fail. go to fail. //always fail
        fail: decrement mood, goto thought.
    

The enlightened state machine

    
    
        thought: go to observe
        observe: go to thought
    

[http://www.urbandharma.org/pdf/mindfulness_in_plain_english....](http://www.urbandharma.org/pdf/mindfulness_in_plain_english.pdf)

~~~
BasDirks
Interesting, but (at least Theravada) Buddhist Enlightenment is quite free
from thinking. (Notice _free from_ , not _devoid of_ ). I suggest:

thought: go to null

~~~
joshcorbin
As I understand Theravada, it's about observing what is happening rather than
stopping or nullifying; so thought -> observe -> repeat is quite appropriate
for it.

~~~
BasDirks
null not as an act, but as the absence of act :) (the analogy is lacking, I
know).

~~~
joshcorbin
That's actually what I'm speaking to.

The Mahayana tradition (in particular Zen) is the one that focuses more on not
doing; where-as Theravada very much puts forth the practice as an act of
doing. The usual language is to "turn towards" what is happening, not to
simply "be one" with it.

------
Alex3917
There are a few comments from a previous submission here:

<http://news.ycombinator.com/item?id=2622912>

Perhaps most notably that the author of this piece is the former editor of the
New England Journal of Medicine. In addition to the three books reviewed,
Crazy Like Us is definitely also worth a read. It's a more anthropological
look at mental illness so it's maybe not quite as good as Anatomy of an
Epidemic as the first of these books to read, but it's still incredibly
fascinating.

------
throwaway_42_2
As someone who has taken a variety of treatments for depression (never SSRIs
-- only Bupropion, St. John's Wort, and most recently S-Adenosyl methionine,
or "SAM-e") I can say from my own personal experience that they most
definitely do _something_, and for me it's almost always positive. In fact,
the only reason I've begun to suspect the role of "chemical imbalances" (which
are likely caused by the environment and my own response to it) is because of
SAM-e's effectiveness.

I have absolutely no financial interest in saying so, but because of its
positive effects I'd like to make a plug: SAM-e has been completely wonderful
for me -- it's worth checking out the extensive literature on it, which show
results that are arguably more impressive than those of the SSRI and tricyclic
crowd, especially because SAM-e has virtually no negative side-effects.

~~~
Alex3917
The problem is that virtually every form of sensory or neurochemical novelty
elevates mood: acupuncture, aromatherapy, sex, exercise, socializing, sensory
deprivation, electrical stimulation, god helmet, music, binaural beats, self-
mutilation, menthol, etc.

Similarly, every conceivable way you can possibly monkey around with your
brain also raises your mood: raising dopamine, lowering dopamine, raising
serotonin, lowering serotonin, raising norepinephrine, lowering
norepinephrine, etc. You'd literally be hard pressed to find any form of novel
sensory stimulation that didn't improve mood, at least in the short term. So
why the focus on serotonin depletion? There's no real evidence for it, it was
just an arbitrary decision made by drug companies based on the very early
research in the field.

I don't think anyone would argue that messing around with a person's serotonin
levels can't elevate their mood, at least for a while. The issue is that there
isn't any real evidence that the depression springs from a chemical imbalance,
and there is definitive proof that longterm messing with your neurotransmitter
levels causes semi-permanent changes to the structure of the brain which we
don't really understand.

Also, for what it's worth, St. John's Wort is believed to be an SSRI, at least
according to Wikipedia.

~~~
quanticle
_The issue is that there isn't any real evidence that the depression springs
from a chemical imbalance_

Well, if its not a chemical imbalance, what is it? Neurotransmitters do the
work of transporting signals through the brain - they tell neurons when to
fire and what intensity to fire with. If its not a neurotransmitter issue,
then what is it?

~~~
sudoman
If the brain only had a couple of neurons, then it might make sense to pump up
the transmitters between them to get a more intense response because you don't
need very refined control. However there are 100 billion neurons in the brain,
and are connected in very complicated ways.

Since there's evidence that cranking up the seratonin for _every_ neuron or
suppressing the dopamine for _every_ neuron isn't healthy, it stands to reason
that treating "mental illness" is more complicated than turning a water faucet
on or off. Who knows exactly what causes it? It could be related to patterns
of connection, i.e. neuron A is better off connected to neuron B at site C,
but is connected strongly to neuron D at site E. And then comes the question
of whether the neuron is sending weird patterns of action potentials. Or it
could be the timing, speed or synchronization compared to other neurons is
off. Or it could be poor overall health of each individual neuron. Or subtle
brain damage. And the problem might be localized to just some neurons in one
part of the brain, and not another, making treatment of the whole brain with
drugs a messy approach. You see, there are no obvious answers right now, but
there are plenty of alternate explanations besides global chemical imbalance.
:)

EDIT: Also, you could think of mental illness as being psychological, and
something that the brain can heal on its own, given the right environment.

------
breakyerself
This all makes sense to me. My mom has been one one psychoactive drug or
another since 1989. Her cognitive ability is in the toilet and she's on a
cocktail of different things now. I had a breakdown 5 years ago. Was on some
drugs for a few weeks until I stabilized and I've been ok ever since. I think
the standard course of action would have been to stay on them indefinitely.
Thank goodness for lack of healthcare I guess. I wish there was a way society
could actually help the mentally ill instead of causing harm as usual.

~~~
BasDirks
That's terrible, and I'm sorry for you. I'm very thankful for my medication
though, because whilst not dependant on them, they do patch a few annoying
bugs.

------
gojomo
I'm a little surprised the review doesn't mention the Thomas Szasz critique of
the idea of 'mental illness':

<http://en.wikipedia.org/wiki/Thomas_Szasz>

------
6ren
Partly: if you look, you see.

Mental illness may have been formerly under-diagnosed.

~~~
leot
When we look at poor societies, or even much of Western Europe >100 years ago,
we see vast swaths of the population with stunted physical growth suffering
from preventable and treatable nutrient deficiencies. E.g., currently around
50-70% of people in Africa are anemic, in large part due too deficiencies in
dietary iron [1].

In the same way, I'm wondering if at some point in the not-too-distant future
we'll look back to today and see the mental health of whole populations as
"malnourished", the psychological equivalent of mean population height being 5
feet tall.

[1]
[http://whqlibdoc.who.int/publications/2008/9789241596657_eng...](http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf)

------
thaumaturgy
I am not a chemist nor a psychiatrist, so I know next-to-nothing about any of
this. However, I have on occasion read various reports on trace pharmaceutical
presence in drinking water supplies (e.g.,
[http://www.cbsnews.com/stories/2008/03/10/health/main3920454...](http://www.cbsnews.com/stories/2008/03/10/health/main3920454.shtml))
-- clearly the amounts are too small to have acute effects, but, taken over
the course of an individual's life? Especially in the earliest stages of
childhood? Is it a possible contributor towards this "epidemic"?

I know there are a few HN folks better versed in this kind of stuff. I'd love
to hear why those reports are bunk, or why it doesn't work that way. Just
curious.

------
StuffMaster
Humans aren't meant to stare at a computer all day, and they're not meant to
stay inside an isolated domicile the rest of the time. I think our lifestyle
is mostly to blame.

------
jpr
Here's my guess:

* people eat shit

* people don't exercise, not even a little, like walking a couple of miles

* doctors are too eager to medicalise everything so that they can put you on drugs

~~~
veb
As someone who suffers some psychological issues... I sometimes wonder whether
it's the result of our consumer-whoring-omg-think-of-the-children-be-vewey-
afraid society than drugs/exercise. I mean, are you really going to be all you
can when people are condescending towards you because you don't have an
iPhone? Shit, what are they going to be like if they ever heard what I've been
through _scared_ _hides_ _runs away_

~~~
gnaffle
If people are condescending towards you because you don't have an iPhone, I
think you should try to find other people to be around. Running away is the
correct response. :) It's easier said than done, of course.

------
chrisjsmith
I think that should be "there is an epidemic of diagnosis of mental illness".

