"Beyond the Brain"

September 20, 2012 6:16 PM

"Beyond the Brain" In the 1990s, scientists declared that schizophrenia and other psychiatric illnesses were pure brain disorders that would eventually yield to drugs. Now they are recognizing that social factors are among the causes, and must be part of the cure.
posted by St. Alia of the Bunnies (28 comments total)

Good to know that Nature and Nurture continue to slug it out through the millenia.

May neither ever win.
posted by ZenMasterThis at 6:18 PM on September 20, 2012 [2 favorites]

Good. I'm all for meds but this focus purely on them has made mental health resources scarce for those of us who medicine doesn't fix.
posted by kanata at 6:34 PM on September 20, 2012 [9 favorites]

Philosophers have know this for years. Who was it again that linked schizophrenia with capitalism???? Deleuze and Guattari I think it was...oh hey look what google found for me.
posted by AElfwine Evenstar at 6:35 PM on September 20, 2012 [2 favorites]

This seems sort of obvious. Behavior arises from neurotopology: neurohormones merely serve to bias the ultimate outcome of stimulus to said topology.

Drugs affect chemistry. Environment and genetics - filtered through the lens of those neurohormonal biases - are the forces that drive neurotopological development.
posted by Ryvar at 6:46 PM on September 20, 2012 [2 favorites]

Oh? Does the medicine fix people?
posted by Brocktoon at 7:13 PM on September 20, 2012

Yeah, but what the hell haven't Deleuze and Guattari linked with capitalism?
posted by phrontist at 7:52 PM on September 20, 2012 [3 favorites]

Yeah, but what the hell haven't Deleuze and Guattari linked with capitalism?

Given that it's the dominating paradigm shaping personal, cultural, political, and economic evolution--not much.
posted by AElfwine Evenstar at 8:00 PM on September 20, 2012

I'm all for a better understanding of how social factors affect schizophrenia and its course. However, the author's command of the biological end doesn't inspire confidence:

In part, this backlash against the bio-bio-bio model reflects the sophisticated insight of an emerging understanding of the body—epigenetics—in which genes themselves respond to an individual’s social context.

First of all, this is hardly an "emerging" view of the body. Scientists have known that genes can be turned on and off by environmental cues since at least the 40s -- the usual jargon is that the environment influences "gene expression". Also, what the author is describing is not "epigenetics" - those are specifically the changes in gene expression that 1) can be passed on to offspring and 2) are not due to changes in the DNA itself. The environmental changes the author is describing (homelessness, social support) happen to an individual, not their parents. Of course, epigenetics certainly could be involved -- but that would be a whole different article.

Maybe this was editorially mangled, and in any case I'm happy that the author doesn't think that molecular techniques for treating mental illness and social techniques have to be in opposition, or mutually exclusive. But ideally we would want people from both camps to be able to have a productive conversation and this makes it sound like maybe the relevant people aren't finding each other.
posted by en forme de poire at 8:01 PM on September 20, 2012 [2 favorites]

Not that I necessarily agree with their critique in all its forms. I was just throwing that out there for any interested parties.
posted by AElfwine Evenstar at 8:01 PM on September 20, 2012

I was surprised Thomas Szasz didn't get a metafilter obit post.
posted by bukvich at 8:37 PM on September 20, 2012 [2 favorites]

There's another interesting study done on what causes Schizophrenia:
Why Do Schizophrenics Hear Voices?

Here's some of my experience with schizophrenia and other things:
Surrounded By Spies
posted by andy_t at 8:50 PM on September 20, 2012 [2 favorites]

RIP Thomas Szasz

"I insisted that mental hospitals are like prisons, not hospitals; that involuntary mental hospitalization is a type of imprisonment"
posted by andy_t at 8:51 PM on September 20, 2012 [1 favorite]

There's also Julian Jayne's bicameralism which proposes that schizophrenia is a hold over from an earlier stage of the evolution of human consciousness.
posted by AElfwine Evenstar at 9:22 PM on September 20, 2012

A capitalist move on the part of health care and schizophrenia is that NAMI, which is mostly funded by Pharma, has rebranded "patients" into "consumers." I used to think that was awful, but who cares. Patients are shoppers, everybody wins.
posted by saber_taylor at 9:25 PM on September 20, 2012

The author, Tanya Luhrmann, is a relatively famous cultural anthropologist who has also done extensive work with evangelical Christians in the US. Given evangelicals' emphasis on the immediate presence of God (e.g. hearing Him speak) there seem to be some pertinent overlaps with this piece on schizophrenia. I'm too lazy to search, but maybe she compares these two cases somewhere else?
posted by cosmologinaut at 5:34 AM on September 21, 2012

It's true the author could have had better command of the science but at the same time for the love of god there are literally THOUSANDS UPON THOUSANDS of studies in mpubmed documenting the links between poverty, adversity, abuse, violence (and all of these factores during pregnancy, infancy and early childhood especially), parental absence, lack of nurturing interaction neghborhood safety, food quality, air quality, indoor air quality, roach infestations, household molds, peer abuse.. (ETC ETC ETC ETC) to extreme increases in later poor mental and physical health.

I would go through and link to like fifty studies but I know people here are metafilter and perfectly capable searching through pub med or university databases. I just can't wait til we stop seeing mental health as "those diseased people" and instead focus on envrionments that promote mental and physical wellness. And that includes better support and access for pregnant and parenting families to community involvement, enriching activities, home repair to deal with leaks,roaches etc, access to safe neighborhoods for families with children---- not to mention better acknowledgement that single parents who work full time or more than one job (or even dual family homes that work full time) pften aren't able to spend afternoons and summers with their children, and at older ages this is even more problematic because the kids get left to themselves at these times since there is no family available to spend time with.

I think we need to make part time work and summers off for single parents, personally, but in the absence of that it would really help to create more options for low income kids to get involved in community extracuricullar activities so they have something to be involved in other than drugs.

I also really think we need to rethink forcing parental bonding through drugs and judgemental interventionistic programs that see struggling mothers as the obstacle to be fixed-- rather than a human being who may be dealing with the affects of childhood adversity, abuse, trauma, poor sleep quality, poor diet, lack of supportive social group--- and then assuming her lack of radiant healthand bilssful joy with her child is simply a medical issue.

I think communities have loved the medical model of mental illness because it gives us a clear "us vs them" mentality with which non-mentally ill can feel safe from ever becoming mentally ill and we can isolate human behaviors that are dangerous through biological correlates allowing us to weed out unsafe people. These are understandable desires, but there is really not as much of an us vs them as people like to think. There ARE genetic disorders, but even among people with hard copy CNV and SNP mutations many of these are de novo mutations (not common to either parent,but new to the individual) that are more likely to arise if the mother had poor physical health or high environmental/social adversity. And if you consider that these can then be passed down, as well as the effects of toxic exposures-- we might be looking at generations of poverty (or social adversity or poor envionmental variables which can happen even in middle/upper classes) providing specialized or altered gene functioning (and higher levels of mutated DNA).

However this shouldn't be surprising considering many species can alter rates of mutations in response to higher levels of adversity so some of this might actually be "deliberate" in attempt to access beneficial mutations that don't necessarily work out. However if you stop looking at mutationsandgenecombinations as inherently good or bad-- you can certainly see why people in distressing environments might benefit from lack of connection with sensing reality accurately. Numbed environmental sensing could certainly be a benefit-- and after certain levels of pain even false sensing might seem a benefit. It's also the case for every species that we can only withstand so much adversity before cellular damage takes place and social adversity can literally cause damage to the physical health of the body and cells processing that adversity. The cells try to adapt, but they can only beput through somuch before there is damage. The body can repair cellular damage but some types of trauma leave alterations that take longer to repair. And not to mention when the immune system is down during times of emotional stress or adversity it opens the doors for viral and bacterial activations and the spiral from health to disease is deeper solidified.

I just can't wait til more people are discussing this in the general communities. Not to mention till we start actually making services that help people so I don't have to keep watching people on piles of meds not getting better because I don't like my fellow human beings suffering and not getting better and being without very comprehensive resources. I totally respect meds work for some people, and that's awesome, but there is a wealth of other things we can do to support mental wellness in human beings and I hope we get smart to that sooner rather than later.
posted by xarnop at 5:41 AM on September 21, 2012 [6 favorites]

Rethinking Madness by Paris Williams summarizes a lot of science that goes against the prevailing views about medication and the treatment of schizophrenia.
posted by zeek321 at 6:17 AM on September 21, 2012

There's an interesting critique of this WQ piece over at Ruminations on Madness. Stick around for the comments, where neuroanthropologist Daniel Lende pushes back a bit.

cosmologinaut: Luhrmann does have an explicit account about how her work on mental illness, her work on psychiatry, her work on evangelical Christianity (focused on "how people see God") and her work on modern-day witches all connect. It all comes back to classical anthropological concerns with rationality and irrationality. E.g.:
"Luhrmann was very influenced by Evans-Pritchard's notion of the closed system and wanted to understand how, in the modern world, people with normal mentalities could move into such a pattern of belief."

(The reference is, I think, to E.E. Evans-Pritchard's 1937 Witchcraft, Oracle and Magic Among the Azande.)
posted by col_pogo at 8:30 AM on September 21, 2012

WRT mental illness and religion: When I was at the height of my untreated depression, the idea of being a cloistered nun was very appealing to me. (Except for the part where I wasn't Christian and disagree violently with much of the Catholic church.) Just. . . a place where I could go, and be fed and clothed and housed, and told what to do and when to do it, and to be able to participate in activities that were seen to benefit my community, whether that be textile work or music or even just constant prayer.

Obviously, I am happier and better off now that my depression is treated. But I wonder how many cloistered nuns back in the medieval era were depressed, and I wonder if there isn't some benefit to having a culturally-sanctioned and contributory role to people with mental illnesses.
posted by KathrynT at 11:17 AM on September 21, 2012

Can anyone give me a reference for the studies that this part

The best data come from India. In the study that established the difference, researchers looking at people two years after they first showed up at a hospital for care found that they scored significantly better on most outcome measures than a comparable group in the West. They had fewer symptoms, took less medication, and were more likely to be employed and married. The results were dissected, reanalyzed, then replicated—not in a tranquil Hindu village, but in the chaotic urban tangle of modern Chennai. No one really knows why Indian patients did so well, but increasingly, psychiatric scientists are willing to attribute the better outcomes to social factors. For one thing, families are far more involved in the ill person’s care in India. They come to all the appointments, manage the medications, and allow the patients to live with them indefinitely. Compared to Europeans and Americans, they yell at the patients less.

and this part:

Indian families also don’t treat people with schizophrenia as if they have a soul-destroying illness. As an anthropology graduate student, Amy Sousa spent more than a year in northern India, sitting with doctors as they treated patients who came with their families into a dingy hospital where overworked psychiatrists can routinely have 10 appointments an hour. Many of the doctors didn’t mention a diagnosis. Many of the families didn’t ask. There was a good deal of deception—wives grinding medication into the flour for the daily chapattis they made for their husbands, doctors explaining to patients that they were completely well but should take strengthening pills to protect themselves from the ravages of their youth. As a result, none of the patients thought of themselves as having a career-ending illness, and every one of them expected to get better. And at least compared to patients in the West, they generally did.

are referring to?
posted by bardophile at 1:58 PM on September 21, 2012 [1 favorite]

I love the concept of the research dOmain criteria. Just considering the syndromes of mental illness comorbidity and the vast differences in response to treatment makes I apparent to me at least that traditional diagnosis of a single entity or disease is very constricting.
posted by Mister_A at 2:43 PM on September 21, 2012

The Grand Challenge of Schizophrenia Drugs
posted by homunculus at 6:01 PM on September 21, 2012

I think communities have loved the medical model of mental illness because it gives us a clear "us vs them" mentality with which non-mentally ill can feel safe from ever becoming mentally ill and we can isolate human behaviors that are dangerous through biological correlates allowing us to weed out unsafe people.

I think you're being a little unfair here. The medical model is also popular because it offers the hope of treating, preventing, and eventually curing the diseases it identifies. Our current understanding of schizophrenia is definitely failing a lot of people right now, but I don't see how the basic idea is borne out of a lack of feeling or empathy for people who are suffering.
posted by en forme de poire at 3:55 PM on September 22, 2012

and in some societies the disorder seems more severe and unyielding. Moreover, when you look at the differences, it is hard not to draw the conclusion that there is something deeply social at work behind them.

The fact that the impact and severity of schizophrenia are highly dependent on environment does not convincingly show that environment causes schizophrenia, does it? Doesn' it makes sense that someone with a non-environmental propensity towards a mental illness would be more susceptible to a difficult/unhealthy environment?

Hasn't there been some thought that some effects labelled as schizophrenia could be related to cognitive binding which I thought was not very well understood biologically or otherwise.

This seemed interesting: EEG Predicts Response to Medication for Schizophrenia
posted by Golden Eternity at 10:35 PM on September 22, 2012

Can anyone give me a reference for the studies that this part

Amy Sousa's dissertation.

Some India studies: 1, 2, 3.
posted by liketitanic at 5:39 PM on September 25, 2012

The medical model is also popular because it offers the hope of treating, preventing, and eventually curing the diseases it identifies.

But the medical model for schizophrenia is not hopeful. Schizophrenics (and people with serious bipolar disorder) are often told that the disease is incurable and incapacitating.
posted by liketitanic at 5:40 PM on September 25, 2012

But the medical model for schizophrenia is not hopeful. Schizophrenics (and people with serious bipolar disorder) are often told that the disease is incurable and incapacitating.

The medical research model is hopeful, though, because it offers a hope of eventually understanding what exactly is going on in the schizophrenic brain, and using this understanding to develop better treatments. And as of right now, schizophrenia is incurable, which these studies do not change.

How manageable it is is another story. I do agree that labeling schizophrenia as incapacitating is likely to be self-fulfilling, and that we definitely need to know more about ways to manage schizophrenia that rely less on drugs, especially drugs with side effects like obesity and uncontrollable muscle tics. So social interventions do seem particularly important. (Though note that the original article states that one probable cause of better outcomes was that families helped make sure their loved ones stayed consistently medicated, even if that meant giving them their medicine unawares, and as you can imagine that would be a complete non-starter in the USA!) But I think that concluding from this that it's not worth trying to come to a better neurological and molecular understanding of schizophrenia, or that it would be fundamentally misguided or myopic to try, would be pretty tragic. We need to use all of the tools at our disposal.
posted by en forme de poire at 9:24 AM on September 26, 2012 [1 favorite]

But I think that concluding from this that it's not worth trying to come to a better neurological and molecular understanding of schizophrenia, or that it would be fundamentally misguided or myopic to try, would be pretty tragic.

I agree. But I also think xarnop's cynicism is justified.
posted by liketitanic at 11:56 AM on September 26, 2012