Saturday, January 9, 2010

Death to the diseased brain model is a-comin'

The hypocrisy of my New Year's resolution to write fewer, but better blogs has been pointed out to me by faithful reader Sister Jane Findlay. She has noted that I haven't missed a day, but thankfully judges that the quality of the writing isn't suffering. Trust a nun to know when good intentions have been cast aside. I will amend my New Year's resolution slightly, to not necessarily posting every day.

Which brings me to the latest article from the New York Times. The Americanization of Mental Illness explains many things about mental illness and schizophrenia through the lens of culture. If you are like me, totally confused about what schizophrenia is, suspicious of the disease label that has been affixed to it and wondering why people with schizophrenia in poorer countries have better outcomes, this article is for you.

EVEN WHEN THE underlying science is sound and the intentions altruistic, the export of Western biomedical ideas can have frustrating and unexpected consequences. For the last 50-odd years, Western mental-health professionals have been pushing what they call “mental-health literacy” on the rest of the world. Cultures became more “literate” as they adopted Western biomedical conceptions of diseases like depression and schizophrenia. One study published in The International Journal of Mental Health, for instance, portrayed those who endorsed the statement that “mental illness is an illness like any other” as having a “knowledgeable, benevolent, supportive orientation toward the mentally ill.”
Mental illnesses, it was suggested, should be treated like “brain diseases” over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma. This idea has been promoted by mental-health providers, drug companies and patient-advocacy groups like the National Alliance for the Mentally Ill in the United States and SANE in Britain. In a sometimes fractious field, everyone seemed to agree that this modern way of thinking about mental illness would reduce the social isolation and stigma often experienced by those with mental illness. Trampling on indigenous prescientific superstitions about the cause of mental illness seemed a small price to pay to relieve some of the social suffering of the mentally ill.

But does the “brain disease” belief actually reduce stigma?

The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. “Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”

In other words, the belief that was assumed to decrease stigma actually increased it.

I have always wondered why on earth people are so eager to accept the diagnosis that they or their relative has a deficient brain. It's amazing what people will allow their doctors to tell them that reflect poorly on them and give them no hope whatsoever to do anything about it. On the other hand, I have fallen into the peculiarly American trap this article explains, of high EE, or expressed emotion. I had heard about high EE families, and that people who have better outcomes with schizophrenia have low EE environments, but nobody has ever explained in a practical sense, as this article does, why being overly protective and prodding a relative to get through their problems through sheer willpower just doesn't work very well. So, I fell into a different kind of trap. Instead of thinking that Chris had a defective brain, which I know isn't the case, I fell into the trap of caring too much that he didn't. This "can do" attitude doesn't work very well as an incentive in schizophrenia.

Here's a tip for parents. Through trial and error, I discovered that the more I pretended not to notice Chris's, um, peculiarities, the less peculiar he became. I did read about that early on. It grates me that I had to pick it up by sniffing out and seizing on one sentence that I found in some obscure article I read. You won't find this useful nugget in the the so-called authoritative books on schizophrenia. Some doctor noticed that patients who had better outcomes, often had parents who barely noticed there was a problem. In my defence, maybe I had to became an EE parent to counteract the medical dogma being foisted on me and Chris by the diseased brain practitioners peddling their drugs. They still are not over-exposed to that model in Africa, thank goodness, where EE is very low.


  1. Americans are incorrectly defining mental illness for other countries? There is an obvious solution: other countries perform their own research. America performs most of the (quality) medical research done across the globe. [aside: That's a big reason why our healthcare is portrayed as having such a poor bang-for-the-buck (pharmaceuticals are expensive because pharmaceutical research is expensive - did you know it costs $250,000 to apply to the FDA with a New Drug Application?).] So the 'problem' is that American researchers research Americans (say that ten times fast) and other countries, rather than performing their own research, use the American research which may or may not apply to them? And this is somehow America's fault, for not being so considerate as to perform all studies on a global scale?

    There is absolutely nothing stopping these countries from performing their own research and coming to their own medical conclusions. Now you many of you will likely say, "But they can't afford it!" Well of course! That's why they're using our research in the first place! We spend more money annually on pharmaceutical research than some small European countries' GNP. There's an old saying: Beggars can't be choosers. America isn't changing mental illness for other countries - America is defining mental illness for America. Other countries are /choosing/ to incorrectly define their own mental illnesses by knowingly using American data which doesn't apply to them. It may be trendy in the 'certain leftward-leaning, college educated' crowd to blame America for messing up smaller or poorer countries, but trendy doesn't equal accurate.

  2. You make some very good points. I would argue that rather than perform their own research (which I take it that you mean pharmaceutical research) other countries should define for themselves what it means to be mentally ill. It's absolutely true that there is no excuse for other countries to buy into the pharma model and then complain about it. Mind you, it isn't unheard of that companies based outside the United States produce their own brand of meds. Serdolect (Danish), Clozapine (Novartis) and Abilify (Japan) come to mind. Corporations are entities unto themselves.


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