CoDI Show: Why is mental illness so goddam controversial?

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Credit: Pixabay, Westfrisco, CC0

Psychiatrist Professor Stephen Lawrie talks about his CoDI show, which explores why he thinks mental illness is needlessly controversial…

Mental illness is stigmatised and controversial. So much so that it dare not even speak its name! We talk these days of ‘mental health’ – a euphemism that allow people to talk about some of the issues, which is probably a good thing, but also reinforces that it is somehow different from all the illnesses we can talk about, e.g. cancer, heart disease etc. Where psychiatry does differ from the rest of medicine is in (generally) lacking diagnostic tests – but, contrary to pervasive myths, our diagnoses are similarly reliable and our treatments are just as effective. Physical illness however gets much more funding for services and research, and more positive press and other media coverage than mental illness. Other doctors criticise psychiatry for being ‘soft’ and ‘unscientific’ while many mental health professionals, journalists and other commentators, especially from arts and humanities’ backgrounds, complain it is too ‘biological’ and inhumane. Some ‘psychiatric survivors’ bitterly criticise the treatment they got, still others that they didn’t get any from underfunded and overstretched services.

My show discusses the controversy behind these attitudes to mental illness and the role of psychiatry, and offers a different perspective. Here’s a brief preview….

Ongoing controversy

Most controversy in mental illness seems to centre around two core issues: whether diagnostic categories have value, and, relatedly, whether treatments work. In 2014, a landmark report in Nature, the worlds’ leading scientific journal, reported finding 108 genetic regions which were associated with schizophrenia. This makes schizophrenia research arguably the most successful such field in the whole of medicine. If this had concerned any other branch of medicine, such as cancer, this would be seen as a major breakthrough. But the on-line discussion about this research degenerated into ridiculous assertions that the researchers were Nazi’s.

If diagnosis is controversial, treatment and, in particular whether it should be pharmaco- or psycho-therapy, is downright contentious. A paper published in the Lancet showed that some patients with schizophrenia did well with Cognitive-Behavioural Therapy. This prompted media headlines such as ‘time to flush the meds?’. While these are probably examples of sub-editors devising catchy headlines to attract reader attention, they fan the flames of controversy.

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Credit: Pixabay, rtdisoho, CC0

Underlying reasons

Some of these problems can be attributed to psychiatry’s sometime ignominious history, but the same could be said about many other parts of medicine. To some extent, some psychiatrists (especially academics like myself) can be blamed for over-stating the value and promise of biological approaches to understanding and developing new drug treatments. Yet even critics such as Andrew Scull in his recent ‘Madness in Civilisation’ acknowledges that we have made some progress. Psychiatrists and mental health professionals must also accept their share of responsibility for failing to communicate the evidence for what they do to the public and their patients.

Damned by association

In my opinion, much of the negativity towards psychiatry can be attributed to the stigmatisation of people with mental illness. Psychiatrists and our practices are partly criticised and damned by association. Patients have to deal daily with relationship, occupational and social problems because of people’s often false assumptions about their illnesses, e.g. that people with schizophrenia are dangerous and incurable, and that people with depression just aren’t trying hard enough. And that in turn can be attributed to a lack of awareness of, or sometimes an ignorance about, the realities of mental illness.

Until you have had to detain someone for their own or others safety it is difficult to appreciate just how ill some people can be. And until you have seen first-hand how someone benefits from antipsychotic or antidepressants in a week or two it is difficult to appreciate how effective treatment usually is. This is why it so important that people hear patients’ stories. But of course, that very discrimination and prejudice makes it difficult for patients and carers to admit to taking and benefitting from treatment.  Hence the value of the celebrity disclosure – people who are widely admired are less likely to be tarnished by such confessions.

The fundamental reason – and an opportunity!

But we are still missing the crucial point. We all perceive, over-simplistically, our minds as separate from our bodies; even though we know that physical influences, like alcohol and drugs, can alter our experience. We tend to see mental ills as having mental causes, hence antipathy to genetic and other body-focussed research, and therefore favour talking treatments for them. But both mind and body are in general equally important in understanding all illness.

Ultimately, then, mental illness is so controversial because it is so interesting! It touches on what we are, what makes us human – it concerns our-very-selves! This is a two-sided sword we can turn to our advantage. The subject is so inherently fascinating that educators and writers can retain interest while being balanced.

To explore this controversial topic further, you can book tickets here to see my show, Why is mental illness so goddam controversial?, on  August 11, 8.10pm, New Town Theatre.

Professor Stephen Lawrie

Professor Stephen Lawrie is Head of Psychiatry at Edinburgh University, Director of the NRS Mental Health Network, and Director of PsySTAR – a UK PhD training programme for psychiatrists. As an Honorary Consultant Psychiatrist with NHS Lothian, he works as a general adult psychiatrist in Edinburgh and as part of a community mental health team with psychologists, nurses etc. Professor Lawrie’s overarching goal is to develop research tools to provide objective diagnoses and improve the management of major psychiatric disorder.

3 comments

  1. Thank you Professor Lawrie, having read your blog, I find that you are truly an inspiration and a compassionate medical doctor with regards to mental illness. Having suffered for many years, not from mental illness in itself, but from the debilitating side-effect of stigmatisation and persecution, and a side effect which hinders mental wellness, it is truly gratifying to know that service users can rely on a sympathetic ear and a champion for our cause. Change is desperately needed in a system for too long banished to the bottom of the ladder in terms of time, attention and funding – a Cinderella service. Just today it has been quoted that 84 people commit suicide in the U.K. in a week, the majority being men. This has to be addressed and the Government must listen to our voices of the severity of our illnesses which so far has wrecked and killed many lives.

    Unfortunately I missed your show at the EdinFest Fringe, but am confident it went well.

  2. Psychiatric treatment, while it has helped many – induced a horror show of wrongly dx and wrongly treatment bipolar illness in my then seven yr old son. No testing – other than OTHER testing to rule out other disorders: was a guessing game of meds they hoped would calm him. Three life sucking depressing years we spent – hopeless; dejected and dx with additional illness due to the additional symptoms the wrong meds induced. Finally – thankfully – We found two physicians who work with patients like my son we found two physicians who work with patients like my son- they tested him – simple blood and urine clinical tests – showed he has a severe methylation disorder. Marked by extremely high levels of whole blood histamine; In the brain other neurotransmitters fell far too low in the brain other neurotransmitters fell far too low- hence explained his many troubling symptoms – conveniently called bipolar… The reason every medication didn’t work The reason every medication didn’t work- The psychiatrist had no idea that his methylation issue; low methylation – required specific medications or supplements…… the total opposite of someone who was over methylated – Tested and shows very low histamine tested and shows very low histamine and elevated brain chemicals… crucial to know where a person falls…
    Also elevated copper and low zinc…. I don’t psychiatrist know that zinc is involved in hundreds of cofactors in the human body and it’s these processes that end up forming neurotransmitters in the brain…. likewise copper when elevated – And the range they used was much tighter than main stream and the range they used was much tighter than main stream- levels above 114 are elevated- When copper is high the dopamine pathway is bypassed and norepinephrine is formed from the high copper.when copper is high the dopamine pathway is bypassed and norepinephrine is formed from the high copper…. as copper climbs zinc always drops….. top are extremely stimulating and too much so when converted to norepinephrine….. And zinc is calming…. ideally these to stay in a ratio 7 to 1 in favor of zinc….. when levels are off disaster strikes… mental health symptoms. by the way 99% of women with postpartum depression really have elevated copper and low zinc. They have a copper zinc imbalance. These are the women killing their babies and shooting their husbands and spending the rest of their lives in jail they don’t need Prozac or Zoloft they need a blood test to measure copper and zinc and they need a nutrient balancing program that would take about a month to help them heal. This is a travesty that has played out for years and it’s killing lives!
    For my son, following testing his doctors devised an individualized and very targeted nutrient program designed to correct his specific issues that clinical lab tests clearly showed…. a compounding pharmacy made am and pm supplements: his doctors added in a few other ones designed for calming – within one month his anger decreased significantly… each month he became better happier calmer could handle frustration – he became a normal little boy… by four months he wasn’t anywhere near the little boy he used to be……. A healthy happy little boy who did not have bipolar or ADHD or anxiety. Been over 10 years and he remains on his supplements and he is tested once a year by his doctors…. he is thriving.
    So you ask what’s wrong with psychiatry? I emailed Francis Collins MD head of NIH. Told him our story and he messaged me back and said that’s great fascinating we are hearing more and more of these cases….. my response ?then do them, because I know for a fact NIH as well as the APA is well aware of these evidence-based advanced nutrient therapies. William Walsh has spoken to the APA on this ; he has worked for the CIA in testing and interviewing many serial killers and he has more research than probably anyone in the world; he is also a published author and has a multitude of double-blind studies..
    Please don’t tell me it’s not safe it’s not researched…. We know that big Pharma will not make money if this becomes white known. The very least it should be offered by every insurance company as an option. Medicaid if a patient wants but please test first so you know which one is safe and effective… because the guessing games they play can be hell… they also are largely responsible for many mass shootings as well as suicides. Look up Walsh’s research on that and the APA as well as NIH is well aware of it.
    Mensah Medical is where we go -2 doctors Walsh trained – they are healing bipolar schizophrenia all kinds of depression; they have great success with autism and often can eradicate it entirely; they are integrative medical doctors they are not opposed to drugs and will use them if necessary but mostly they are not necessary because for every drug there is a nutrient that can have the same affect; without the toxicity or debilitating side effects…. In some cases a patient may remain on a medication likely with a much lower dose along with his individualized supplements…..
    I will never again in my life ever go back to psychiatry they were the worst three years of my life and they almost stole my son. Thank you

  3. Thank you – perhaps my comments will help others learn – because it completely and utterly changed my life and the life of my son!

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