“Saving Psychiatry” – Dr. Joe’s Blog

Mind/Body Argument: Stop It, Just Stop It!

If you are not sick and tired of the question, “Is MADNESS a neurological disease of the brain or is it a mythological disease of the mind?” you should be! I defy you to have a thought without your body or to work your body without a brain. There is no mind/body split. And the countless scholarly papers regaling us with the proofs of how schizophrenia is a disease of the brain and not the mind or that schizophrenia is a disorder of the mind and not the body (remember, the brain is part of the body), well, to my mind they are all for naught.

Some historical perspective: There is a 1924 paper in the American Journal of Psychiatry, authored by the then prominent pathologist, Charles B. Dunlap, M.D., entitled, “Dementia Praecox. Some Preliminary Observations from Carefully Selected Cases, and a Consideration of Certain Sources of Error”. I reviewed this paper because one of my favorite mentors, Harry Stack Sullivan, who died in 1949 when I was 6 years old, referred to it when making the case that schizophrenia is NOT a brain disease.

Read the very first sentence of the paper: “Too many changes have been described in [autopsy] brains of dementia praecox even to be enumerated in this paper” (p. 403). He continues on page 404: “We have considered control brain [autopsy] material, collected from so-called normal persons [italics mine] without psychoses to be absolutely necessary…. No one knows the limitations of what is normal in the brain anyway…. Nissl [a prominent pathologist] who all his life was searching for a normal brain, died without finding one…”!!

Suffice it to say that Dr. Dunlap was not able to find any consistent gross or microscopic (cell counts & cellular pathology - pain staking work) abnormalities in these schizophrenic brains to warrant "an organic [my italics] basis for dementia praecox.” Thus, H.S. Sullivan was satisfied he was not dealing with neurological issues in his schizophrenic patients.

What interested me even more, though, was what was said in the discussion of the paper by other prominent physicians including Dr. William Alanson White, a pioneer of 20th century psychiatry and the director of St. Elizabeth’s Hospital (where I currently supervise residents). By the way, White was also a mentor to H.S. Sullivan.

Anyway, White points out that there was so much wrong with these patients whose brains Dunlap studied, that “… a pathological explanation of the mental disease [need not] be found in the [cerebral] cortex.” There were “defects of organs, thyroid, gonads, and adrenals and the circulatory system…that we would not expect the individual to be able to function efficiently, at least under stress.” Don’t you love that phrase “function efficiently”? In other words Dr White is beginning to suggest what I am more emphatically proclaiming, that schizophrenia, madness, is a “disease” of the PERSON, not the brain and not the mind.

Fast forward 78 years and E. Fuller Torrey in his “Studies of Individuals with Schizophrenia Never Treated with Antipsychotic Medication: A Review”, in Schizophrenia Research, Vol 58, pp. 101-115. Torrey wants to take on Breggin’s and Whitaker’s and others’ arguments that the brain pathology in people diagnosed with schizophrenia is all iatrogenic. He concludes: “…schizophrenia is a brain disease in the same sense that Parkinson’s disease and multiple sclerosis are….”

But wait, two other observations in his paper: “…psychiatrically normal individuals also [may] have structural changes in their brains” (p. 102) and on page 111, “It should be emphasized, however, that there is no single abnormality in brain structure or function that is pathognomonic for schizophrenia.” Torrey is an honorable man, I think. But he too is stuck in an either/or world of mind or body. None of the papers he reviews take up the challenge of examining the whole person, physiologically, psychologically, spiritually, and sociologically.

I say let’s be forgiving though, for indeed that is no simple task. We human creatures are so complex as are our ape relatives and other mammalian creatures. It is the role of the psychiatrist, ideally, to take on this task with each individual he treats. Few of us do that, I fear. The system is just not cut out that way yet. If we are to “save psychiatry” there has to be a change in medicine as a whole not just psychiatry. You might want to read Jim Gordon’s A Manifesto For A New Medicine. He takes on this dilemma. More to come.

Psychiatry, Medicine, and the Commonweal

Let me introduce myself and my blog.

I am a physician, first and foremost. Ironic though, when I first decided to become a doctor, at age 19, it was “psychiatrist” that I told myself was the goal, not simply physician. And throughout my training I oscillated between medicine and psychiatry. Intrigued by psychosomatic medicine yet hounded by my mentors, “Joe, you have to decide! Medicine or psychiatry.” Little did I realize at the time that this quandary, physical OR psychological, would become the hallmark of psychiatry’s split-personality: mental illness, a disease of the brain; no, mental illness a mental/social problem-of-living construct. And the debate has been belabored for millennia. Throughout this blog I will favor the concept that ALL ILLNESS IS PSYCHOSOMATIC/SOMATOPSYCHIC. There is no mind-body split.
In future blogs I will address what motivates one to become a physician but here just a few ethical reminders associated with the Hippocratic Oath:

(1) Primum Non Nocere (First Not To Harm)

(2) Keep confidential what the patient tells you, and

(3) Never promise more than you can deliver

I made #3 up but it is implied in the oath to honesty. Alright, it was not exactly how Hippocrates said it. In fact, the first do-no-harmer was a Frenchman, Auguste Francois Chomel (1788-1858) in his oral teaching to students. Then as now, I think, the debate centered on natural healing vs. radical intervention.

So, I want to SAVE psychiatry. Really? Psychiatry seems to be thriving without my help. Well over 10,000 psychiatrists attend their yearly conference, the American Psychiatric Association. No, I say “save” because I belong to ISEPP, I have contributed to Mad in America, I support Mind Freedom, and other similar organizations. In all of these and others there are folk who would like to disband psychiatry all together.

“No,” I say, if we rid ourselves of Psychiatry: WHO WILL MIND THE MAD HOUSE? WHO WILL MIND THE PHYSICIANS?

I liken this Anti-Psychiatry movement ushered in by the likes of Tom Szasz and Ronald D. Laing to the Anti-War movement of the 60’sand 70’s. But first I must clarify, Szasz would be livid to be placed in the same category as R D Laing. He saw Laing as an irresponsible “trickster” and miscreant. In fact he wrote a book about it:”Antipsychiatry: Quakery Squared” published in 2009. Szasz makes the case that Laing and others abandoned liberty, responsible science, and ethical social commentary. “Anti psychiatry” was merely a catch phrase for Laing and his followers, Szasz believed, in an attempt to appear like authentic critics of the status quo.

But back to the Vietnam war: We who were against the war were told to “Love It (i.e., the USA) or Leave It!” Most of us knew we were patriots but patriotic to the ideas of liberty, justice, and international peace. We knew the war was a horrible mistake, immoral, foolish, and ultimately self defeating. We opposed the war policy, not our country. We paid a heavy cost for that military adventure: 56,000 Americans dead, over a million Vietnamese dead. Laos suffered the worst per capita dead ever in the history of war! As you probably know given the front page publicity, the suicide rate of veterans is 2-4 times the civilian rate. More soldiers have been dying from suicide than in combat. And most of these suicides are Vietnam vets. Yes, 40 years after the fact of that foolish war, the moral, spiritual and psychological ill effects still haunt us. Some commentators believe, and I agree, that the moral injury of our current 14-year (and counting) middle east war(s) will be worse.

In my next blog rendition I will be asking the question “Are you really anti psychiatry?”—IF THIS IS AN EMERGENCY GO TO YOUR LOCAL EMERGENCY WARD. Hmmm.