Beyond Mental Illness: Transform the Labels Transform a Life

Copyright © 2014 by David Moyer, LCSW.

Library of Congress Control Number:          2014902320

ISBN:          Hardcover          978-1-4931-6820-0

                    Softcover           978-1-4931-6821-7

                    eBook                 978-1-4931-6819-4

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This book provides alternatives to assessment and treatment for those who are called mentally ill. The author and publisher are not providing professional services or medical advice. Matters involving health should be supervised by trained medical professionals. While the author has made every attempt to provide accurate and timely information, readers are advised to consult with health care professionals to assure currency and validation of any ideas contained herein. Neither the author nor publisher will be held responsible or liable for any harm or loss alleged to arise from information in this book. The information herein is educational in nature and shall not be construed to recommend a specific assessment or treatment option for the reader. The fact that a particular assessment or intervention discussed in this book has been safe and effective for many does not assure either safety or effectiveness for the reader. The novel diagnoses in this book represent the author’s efforts to challenge the reader to think differently about mental illness. The diagnostic terms are not approved, nor likely to be approved by any professional body in the foreseeable future.

Rev. date: 01/31/2015

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Contents

Foreword

Preface

Part I How We Got Here

1   A Tale of Two Futures

Beyond the media

Competing visions for mental health care, 2040

2   A People’s History of Mental Illness

Meks and memes

A new kind of possession

3   Beyond Mental Disorders

Schizophrenia, depression, ADHD

Autism: a biomedical model

4   Beyond the DSM-5

Evolution of the DSM

The DSM-5 and mental disorders

Limitations of the DSM-5

Tactics vs. strategy

5   March of the Corporations

Expanding markets; feet of clay

War against alternatives

Death, the final diagnostician

6   Perilous Symbioses

Additives

Toxins

Vaccinations

Electrosmog

Genetically Modified Foods

7   The Coming Age of Personalized Health Care

Beyond cookie cutters

Methylation, epigenetics, and genetics

Best practice: an oxymoron?

Part II Where We Are Going

8   Nutrient Mismatch Disorder

A revolutionary concept

Prevalence

The amazing power of micronutrients

Assessing and treating

9   Gut and Psychology Disorder

From four diagnoses to none

Some misdiagnoses

Lassie’s story

Celiac disease

10 Food Incompatibility Disorder

Suspect foods

Give us this day…

11 Hannibal Lecter Disorder

Fava beans and psychosis

Some treatment considerations

12 Burning Man Disorder

The redox dilemma

Free radicals and infections

Free radicals, sleep and aging

13 Burning Man Disorder and Mental Illness

The ROS-biobehavioral link

The dynamic brain

Effects of oxidative stress on the brain

Genetic and environmental links

Assessing for Burning Man Disorder

14 Treating Burning Man Disorder

Antioxidants, the neglected treatment option

Glutathione, the master antioxidant

Treatment implications

15 PKC Regulation Disorder

What is protein kinase C?

PKC and biobehavioral syndromes

Influences on PKC activity

A search for the villain

Genes and PKC Regulation Disorder

A PKC-related psychosis

16 Treating PKC Regulation Disorder

Drugs

Reducing inflammation with nutrients

New PKC inhibitors

17 Blood Transport Disorder

Free as a bird?

Blood Transport Disorder and biobehavioral syndromes

Treating Blood Transport Disorder

Implications of Blood Transport Disorder

18 Stuck Switches Disorder

Water in the ear?

The sticky hemispheric switch theory

19 Immune Response Disorder

Epidemiological evidence

Experimental evidence

The immune system, infections and brain function

Revisiting Koch

20 Faulty Brakes Disorder

The dopamine storm

The kynurenine pathway

Borrelia burgdorferi and the kynurenine pathway

The kynurenine pathway and biobehavioral syndromes

A depression/psychosis hypothesis

21 Treating Immune Response Disorder

The best-kept secret of psychiatry

Adoptive immunotherapy

Micronutrients and other alternatives

Mitigating the kynurenine pathway

Some promising and/or controversial possibilities

22 Shrinking Brain Disorder

Biomarkers

Current and future treatments

23 My Son Does Not Have a Mental Disorder

Anatomy of a mental disorder

Biomedical disorders and their treatment

What are the memes de jour?

24 Moving Beyond Mental Illness

Glossary

Notes

Tables

Table 1 Behavioral Overlap of DSM-5 Diagnoses

Table 2 Risk Ratio Averages among Family Members

Table 3 Antipsychotic Medications—Sudden Cardiac Death

Table 4 Pre- and Post-Anthrax Vaccine Health Data

Table 5 EMF Levels and Cancer Risk

Table 6 COMT Enzyme and Dopamine in the Prefrontal Cortex

Table 7 Val/Val COMT, Tyrosine Hydroxylase

Table 8 Energy Sources 2000

Table 9 RDA Intake

Table 10 Risk of Cancer in Celiac Patients

Table 11 Parental Reports of Dietary Effects on Autistic Children

Table 12 ROS, Antioxidant Enzymes and Compounds

Table 13 Factors Affecting Endothelium

Table 14 Phosphatidylinositol Cycle and DGKH

Table 15 Dysregulated Immune Biomarkers of Psychosis

Table 16 Goldberg’s Neuro-immune Dysfunction Biomarkers

Figures

Figure 1 Major Histocompatibility Complex

Photos

Photo 1 Devil’s mark?

Photo 2 Rat brains 50 days after two-hour cell phone exposure

Photo 3 Damaged and repaired rat brains

Graphs

Graph 1 Percent not meeting dietary reference intake

Graph 2 Medications and functioning

Illustrations

Illustration 1 Representation of nutritional, other risk factors.

Illustration 2 Excitation and inhibition

Illustration 3 Inadequate excitation, disinhibition

Diagrams

Diagram 1 Phosphatidylinositol pathway

Diagram 2 Simplified kynurenine pathway

Diagram 3 Kynurenine pathway and biobehavioral syndromes

Diagram 4 Kynurenine pathway and depression

Diagram 5 Kynurenine pathway and psychosis

Foreword

Beyond Mental Illness is a book that consolidates many truths and serves as a warning. Little did I realize that in looking forward to finding solutions to the complex and tangled mess that is ‘modern illness,’ I would need to look to our not-so-modern past and the Homo sapiens who shaped it.

Homo is an eighteenth century Latin term meaning earthly being. The species name sapiens, means sapient or wise. Ergo, we Homo sapiens are, by definition, wise earthly beings, although I am frequently confronted by evidence to the contrary. Notwithstanding religious traditions that address why we are here and what we should do while here, the fact remains that we Homo sapiens are tied to the earth. We walked out of the savannahs in Africa and uniquely evolved as we settled throughout the world. Our name is synonymous with the earth. When we shuffle off this mortal coil we return to the earth. A self-evident, but all-too-often ignored, truth is that the laws of physics and chemistry apply to all living things on the earth. To the extent that we understand those laws as they pertain to our species, we can do much to prevent suffering and disability.

Homo sapiens are a young species, blessed with capacity of forethought, given the gifts to plan and conceptualise beyond the capacity of other terrestrial fauna. We have the ability to judge what is ‘right’ and ‘not right.’ These remarkable gifts reside in a body designed to combat parasites and bacterial pathogens, to avoid death by diarrheal illness (still the most prevalent worldwide illness), to procreate and to reach the age of our progeny’s procreation so that we can assist at least one generation’s genetic survival. We can hunt, gather and process foods. However, we are poorly equipped for the petrochemical, heavy-metal—laden, perfumed, plasticised, mould-exposed, magnetic-fields-saturated, international-travelled, irradiated, viral, artificially-lit, medicated, carbohydrate-laden, stressed-out sensory overloaded onslaught that is ‘modern living.’

Beginning with the industrial revolution and accelerating exponentially, technology has provided Homo sapiens with so many new gifts and horrors for which our bodies have yet to adapt. Pandora’s Box has been opened and, as a species, we are reaping the ill-gotten gains in the damage perpetrated on our fellow humans, beasts, flora, fauna and ultimately this blue pearl known as planet Earth, a speck of dust floating in a vacuum proximal to other bits of dust proximal to fiery ball called a Sun.

On this speck of dust where life exists and where we reside, our frontal lobes have, through the eons, facilitated the satisfaction of our immediate needs and desires. Yet, these same lobes are rapidly destroying the delicate balance on this blue pearl. In the last sixty or so years, Homo sapiens have changed the face of life so dramatically that I fear that we may never be able to undo the damage.

Humans are controlled and at times paralyzed by fear. Fear is an innate response that protects us from actual or potential harm. Its origins come from the description of sudden danger or peril. Politicians, the media, persons perceived to be in power—bully us with fear. According to novelist Frank Herbert, fear is the mind-killer. It paralyses us and, like the proverbial deer in the headlights, disempowers us. We accept our plight. When we professionals accept the status quo, occasionally knowing it not to be the truth, our motives are driven by fear.

When I read Beyond Mental Illness I was confronted by profound truth. It felt and read as ‘right.’ David’s book drew together threads of so many learned concepts that for me it spoke of unafraid truth that for the first time, my cumulative knowledge felt right. I had an understanding, and in learning, understanding is everything.

My fear is that the problems we see now as physicians are a portent of more to come. We and other health care providers who have made a commitment to our art and to the patients whom we serve must act to change the face of our profession so that our patients are adequately cared for. Some of the paradigms we rely upon to manage modern conditions are centuries old. They must shift. The paradigm shift is yet to come. Dogma constrains and controls us. Vested interests, whether they are professional or financial, retain ‘lies’ because a commercial or credible loss is something some corporations or individuals are unwilling to bear. Symbolically, we ‘wash our hands,’ choosing to follow the status quo, actively or subconsciously avoiding the truth. Given the rapid expansion and transmission of knowledge, our patients and their families will no longer sit idly by. They are learning that they are not being served well by old dogma. This book is for them too.

Family members from Australia to the United States are given a variety of diagnoses, including psychiatric ones. They are treated with conventional medicine by conventional medical doctors. Still, a stable and healthy life eludes many who are not diagnosed or treated properly. The tragedies in his family history to which David refers in this and his first book are repeated many times over from Australia to the United States.

Clearly, his personal and professional history motivated his thirst for knowledge and understanding. As health care providers, these are our motivations, to provide care not just for our immediate family but to the wider community. I personally take this responsibility seriously. Those who provide such care do so occasionally at their own peril, personally and professionally. We must rebel. I care not for the ‘not-right’ status quo. We are all capable of making this judgment. The shift, I believe, is soon to come. It must, and we are at the forefront.

Dr Andrew Ladhams, bare bones medicine co, Noosa, Australia

Former researcher in immunology and virology

Former university lecturer in infectious diseases

Preface

If you want to change the world, you have to change the metaphor.

Joseph Campbell

Why is mental illness appearing earlier and with more severe symptoms than it did a generation ago? Why is autism increasing at such an alarming rate? Why is the average life span of a mentally ill person 25 years less than the rest of us? An increasingly sophisticated, skeptical and alarmed public wants to know. These days we need far less than six degrees of separation before we find children, grandchildren, parents, husbands, wives, friends and colleagues who are suffering from mental illness. Mental illness touches all of us.

Even though we mental health professionals claim progress in assessing and treating those who are called mentally ill—after all, we no longer house most of our mental patients in institutions—government statistics report a fourfold per capita increase in patient care episodes since the 1950s, when modern psychotropic drugs were first introduced.¹ Too many are suffering. Too many are being managed. Too few are being definitively treated. Such is the state of mental health care in this country in this, the second decade of the 21st century. This care is based on the latest version of the Diagnostic and Statistical Manual (DSM). It is called the DSM-5. For the foreseeable future, this manual will define mental illness.

Mental health professionals use terms like wellness, resilience and recovery to describe the promise of mental health care. The words foster public relations and secure funding for grants. However, from my personal and professional experience, they obscure reality. Current treatments ameliorate. They do not treat. Too many patients are chronically ill for life.

In my 28-year Air Force career as a clinical social worker I provided services to clients in inpatient and outpatient psychiatric treatment settings. I managed child and spousal abuse prevention and treatment programs. I served as the chief of the mental health clinic in a community of 15,000 at Clark Air Base, Philippines and served as social work consultant to the Pacific Air Force Surgeon, advising mental health professionals throughout the region. I worked in the Department of Social Services for the State of California, Behavioral Health Services for Nevada County and Municipal Probation Services in Seattle. As a provider of mental health services, I have seen enough suicides and murders to appreciate the limitations of our current service delivery system.

I have also dealt with mental illness in my own family. My father was diagnosed with a mental disorder and I am the father of an adult son diagnosed with a chronic mental illness. I have professionally and personally experienced a gap between the promise and the reality of mental health care. I write to help bridge that gap.

You may be wondering why a clinical social worker such as myself would wander so far from his area of expertise to write a book such as this, especially when the brain and its pathways are so complex. I have often asked myself that same question. In David and Goliath, Malcolm Gladwell says that a perception of unfairness and unreasonableness are two major reasons that have motivated ordinary people to become underdogs and take on the Goliaths in the world. So it is with me.

Your author is not an immunologist, an epidemiologist, an infectious disease specialist, an allergist, a geneticist, neurologist or a psychiatrist. He is not a PhD or an MD. He is a JSW, just a social worker, who has left the secure moorings of his profession and ventured into worlds that, by all accounts he has no business visiting, let along writing about in a 500 plus page book! If not for the perception of unfairness and unreasonableness, I would not have written this book.

The Internet has empowered citizen researchers. We are not scientists, but we know that the old distinctions between neurology, internal medicine and psychiatry are fading as abnormal biomarkers in each specialty are increasingly identified among those with psychiatric disorders. We health care professionals and our clients can access that literature, and, imperfect though our understanding is, can envision a world where the advances of science can improve our understanding and treatment of those called the mentally ill.

This book, an exploration into the future of mental health care, is the third in the Transformation Trilogy. The first book, Too Good to be True? Nutrients Quiet the Unquiet Brain, was published in 2002. This true medical detective story describes my family’s four-generation bipolar odyssey and explored new ways to assess and treat bipolar disorder. The second, 10 Ways to Keep Your Brain from Screaming ‘Ouch!’ was published in 2014. It describes practical interventions to ensure behavioral health by supporting healthy brain function.

This third book challenges the prevailing mental illness paradigm of the DSM-5 and offers ideas for a new one. Part I, How We Got Here, examines the evolution of psychiatric diagnoses, the influence of corporate/government practices and the promise of personalized care. Part II, Where We Are Going, explores a future where the traditional mental disorders are viewed as biobehavioral syndromes. It describes innovative out-of-the-box diagnostic terms for the layman while providing meticulously researched treatable biomarkers for the health care professional.

The prototypical diagnoses created for this book are designed to pique your interest and address biomedical conditions that I believe have been relatively ignored in mainstream psychiatry. They describe what a biomedical-based diagnostic system might look like in the future. Each diagnosis has two different names, one for the layman and one for the professional. I have attempted to use the layman’s term in a populist context and the professional terms in a more technical context. Even though I present them as if they are valid biomedical disorders, they are, in fact, hypotheses. If assessments were based on biomedical rather than mental disorders, which, in the introduction to the DSM-5 are actually defined as syndromes, I believe the emphasis could change from managing mental disorders to curing biomedical disorders like the ones described in this book. No professional bodies have ever heard of, recognized, or accepted any of these diagnoses.

Though this book contains many practical assessment and treatment ideas, it is not a treatment manual or a psychiatric textbook. It is not meant to replace the DSM-5, but it does depict a future where accurate biomedical diagnoses lead to more effective treatments. I believe that in the future, psychiatric diagnoses will take us beyond mental illness.

I once told the leader of an anti-psychiatry movement that my son’s brain was broken. He told me that my statement was discriminatory. I told him it was a biological fact. What we call mental illness is biological. Psychological stress, that is, stress of the psyche, is the body’s biological stress response. It plays a role in biobehavioral syndromes. Dr Avi Peled, from Israel, writes the obvious, but often neglected, truth, that the brain is physical. It is subject to understanding through mathematics and physics. He argues that a re-conceptualization of mental disorders as real brain disorders is needed. Such a paradigm shift would not only provide a diagnostic system based on etiology but also provide a means to develop curative interventions.² Moving beyond mental illness is happening, but it is happening at a glacial pace.

Ongoing discoveries are revolutionizing how we think about mental illness. They challenge our perceptions of, and responses to, mental disorders. They generate new ways to assess and treat. Existing diagnoses impede our ability to integrate that knowledge. As the literature attests, no one knows what causes the major psychiatric disorders. However, the measurable and treatable biological conditions that cause symptoms are increasingly becoming identified. A diagnostic system based on biomedical assessment offers a path toward curative treatments. This book is written to invite you, whether you are a patient, a concerned parent, or a health care provider, to question assumptions that we have taken for granted for far too many years.

Beyond Mental Illness contains data from hundreds of academic, highly technical reports. These reports, as befits academic writing, are narrow in scope. This book translates these exciting discoveries in brain research so that, patients, their families and their health care providers can benefit from them. A quick glance at the glossary demonstrates that understanding these discoveries requires an entirely new vocabulary.

Some of the topics are outside the traditional boundaries of a book on mental health issues. I believe a broader perspective of the forces promoting health and sickness is needed in order to understand the declining health, including brain health, in the citizens of this country. You will not find the traditional separation between physical and mental illness in this book. Instead, we will use a biomedical perspective, shifting frequently as we reframe traditional mental disorders and the physical disorders linked to them. Assessment and treatment are from a very different perspective than what I have been exposed to throughout my professional career.

In seeking help for my father, and then my son, I, like millions across the country, felt hopeless and powerless. I had to rely on health care providers, some of whose interventions aggravated my son’s condition. Searching for answers to the questions beyond the DSM series, I applied the social work perspective of person in situation to a broader context, the mental health professional in the culture. The result is a book designed to be populist enough for patients and their families and academically rigorous enough for mental health professionals and researchers.

A tipping point is coming. When this occurs, fewer will be managed. More will be definitively treated. Fewer will suffer. They will be treated for their biomedical disorders. My hope is that this book will significantly contribute towards that tipping point when the managed mental diseases of today give way to the cured biobehavioral syndromes of tomorrow. If you are as concerned as I am about the assessment and treatment of your patients, loved ones, or yourself, this book will be of use to you.

The theme of this book, indeed all three books in the Transformation Trilogy, is this: "To transform your life or the lives of your patients, first transform your labels." These books envision a future when health care providers perform personalized biomedical assessments and treat the biomedical conditions that contribute to what most of us still call mental disorders. All three books are written to move us beyond mental illness.

Without the assistance of subject matter experts this book would not have been possible. I am deeply indebted to Dr Bruce Ames for contributing to my understanding of nutritional aspects of health; Dr John Smythies, for a glimpse into the overwhelmingly complex nervous system; Dr Amy Arnsten for helping me to understand the role of protein kinase C in brain dysfunction; Holly Brothers for teaching me about the immune system; Dr Amy Zmarowski for sharing her extensive knowledge of the kynurenine pathway; Eva Edelman and Dr William Walsh for their valuable feedback and criticism; and for all the patients and parents who shared their personal journeys seeking health for themselves and their loved ones. Thanks to Dr Robert Bransfield for providing a Listserve called microbes and mental illness where physicians and advocates exchange information on the role of infections in mental illness. Also, thanks to Dan Stradford for establishing alternativementalhealth.com, an integrative psychiatry web site. Years ago, Dan witnessed the disastrous effects of mental health care treatment on his father. He founded Alternative Mental Health (alternativementalhealth.com), a nonprofit organization that promotes new approaches for assessing and treating mental illness. His integrative psychiatry Listserve allows health care professional to exchange information on the latest research and treatments. Dan, research assistant Dr Christine Berger and psychiatrists Dr Garry Vickar and Dr Hyla Cass, co-wrote Complementary and Alternative Medicine Treatments in Psychiatry.

I am indebted to the members of the Sierra Writers Group for their supportive feedback, to Susan Conlon and Greg Jones for their editing assistance. Thanks also goes to my son, Chris, who continues to be involved in this process and my wife, Gayle, for her very significant editing contributions and for her willingness to keep the do list current and prioritized for the day when her husband can stop obsessing about these issues.

Part I

How We Got Here

Strides in new knowledge are taken slowly, usually against the will of the currently knowledgeable; and education is designed more to freeze learning than to advance it . . . [Education] meticulously blunts imagination, and stultifies criticism. It but conveys a culture; in that task the errors of a culture and its unchallenged propositions, are handed down. It discourages the rebel and the innovator, and sedulously abets the conformer.

Philip Wylie

1

A Tale of Two Futures

Sit down before fact as a little child, be prepared to give up every preconceived notion; follow humbly wherever and to whatever abysses nature leads, or you shall learn nothing.

Thomas Huxley

In the words of Charles Dickens, It is the best of times; it is the worst of times. Breakthrough innovations promote lasting recoveries for many who carry the label of mentally ill. On the other hand, institutional forces support clinical practices that contribute to a life of chronic suffering, repeated hospitalizations and incarcerations for far too many patients.

In 2002, in the town of Grass Valley, nestled in the Sierra Nevada foothills, an elementary student is professionally diagnosed as having oppositional defiant disorder and attention deficit hyperactivity disorder. He is placed on psychiatric drugs and given an individualized education plan. His symptoms worsen. He takes new psychiatric drugs. His symptoms worsen again. Over time, diagnoses of obsessive-compulsive disorder and bipolar disorder are added. He takes different drugs and he develops different symptoms. His exasperated mother decides to try a novel approach. She takes over his treatment program. By the time he enters high school, this student does not need psychiatric drugs, an individualized education plan, or any of his diagnoses.

In 2004, in Ashland, Oregon, a middle-aged social worker who has been diagnosed with bipolar disorder attends a workshop entitled Alternatives to Mental Illness. He learns of a novel treatment program and five years later is free of symptoms without any psychiatric drugs. What do this student and social worker have in common? They were treated for what was wrong with them, not their labels. Unfortunately, these stories, told in chapter 9, are the exception, not the rule.

As a society we aren’t dealing with the underlying problems, but taking the easy way out, treating the symptoms.

Beyond the media

Representing the institutions that pay the bills for advertising, the new mass media shapes our beliefs, teaching us how to deal with mental illness. Before we can go beyond mental illness, it is necessary to go beyond the media. Those who control the media know we want the quick fix. They give us the quick fix. A cursory look at the July 16, 2007 issue of Time magazine ironically illustrates this. A reader thumbing through the magazine finds himself at a full-page ad for the antipsychotic medication Abilify. The headline reads, Treating Bipolar Disorder takes Understanding. How does he get to the ad so quickly? The reader cannot help but open the magazine to a self-addressed envelope to Bristol-Meyers Squibb attached to the binding of the magazine. The ad asks, Are You Ready to Move Forward? Then it gives a description of how Abilify may work by regulating dopamine or serotonin. The ad states, However, the exact way any medicine for bipolar disorder works is unknown. The reader learns that no one knows what causes the disorder but Abilify can help. Based on the name of the product alone, he might think the drug abilifies the user, that is, gives him more ability. As long as the treatment works, it is not important to know what is actually being treated, save for a mental illness called bipolar disorder.

On the back cover of the magazine is the ever-present Lunesta butterfly resting on the shoulder of a sleeping male with the caption, The sleep you’ve been dreaming of. Again, it is not important to determine the cause of the problem and fix it. The important thing is to get relief with Lune siesta, or a night-time siesta.

Then, on page 42, we read about addiction affecting the brain—not in an ad, but in an article entitled How We Get Addicted. After learning how addictions affect the brain, we learn that scientists have begun to design new drugs that are showing promise in cutting off the craving that drives an addict irresistibly towards relapse… .

The reader learns he can take a drug for bipolar disorder, sleeplessness and, in the future, even drug addiction, from just one magazine, let alone other media such as pharmaceutical ads on TV. Soma anyone? As Aldous Huxley stated in the 1932 classic Brave New World, everyone was given soma because it had all the advantages of Christianity and alcohol, none of their defects. He writes, . . . there is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a week-end, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon…³ A drug called Soma (carisoprodol) really does exist. It is a muscle relaxer.

As the media pervades our lives through increasingly small and ubiquitous devices, thoughtful reflection itself may become a victim of the Internet Age. Magazines shrink or go out of business. Newspapers look like Internet pages with an emphasis on graphics and minimal text. Pills are touted as the preferred solution to our health problems. Books like this one, of such size and detail, may be an anachronism in a culture where information is given in sound bites, and a delay in accessing a web site causes us to look elsewhere.

Getting back to the magazine ads, in 2013, the cost for a full-page, four-color ad in Time magazine was $339,000. Why do sponsors pay so much? Advertising sells products. The sponsoring companies wouldn’t pay for the ad unless it added to their bottom line. The above ads are to motivate you to motivate your doctor to prescribe their products.

Of course, selling products is the reason for ads, you say. So what else is new? A lot, but you may not have heard about it. Something as simple as Dr Charles Gant’s nutritional approach to stopping smoking has yet to make it to the airwaves. Meanwhile, a toxic drug with undesirable side effects, such as Chantix, has been aggressively advertised on television in spite of a 2008 FDA advisory suggesting that changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior may be linked to it. Finding answers to life’s problems from the compelling ads in the media can be harmful to your health.

Advertisers only give us what they think we want. They know we like quick fixes. We don’t want to know what is causing the problems. We just want to feel better.

One day I received an unsolicited email predicting headlines of 2040. They included the following:

• US Postal Service raises price of first-class stamp to $17.89.

• Average height of NBA players is now nine feet, seven inches.

• New federal law requires that all nail clippers, screwdrivers, fly swatters and rolled-up newspapers must be registered.

Predicting the future is an uncertain undertaking, useful in this case if, for no other reason, than to provide a preview of what is to come in this book. The predictions that follow are based on two future scenarios for 2040, one in which the existing paradigm for assessment and treatment is based on behavioral labels and one which is based on biomedical disorders.

Competing visions for mental health care, 2040⁴⁵⁶⁷⁸⁹

While no one has a crystal ball with which to divine the future, it is possible that by 2040 the mental health delivery system will be characterized by diagnostic and treatment methods that increasingly get people well and decrease social dysfunction. Continuation of the existing beliefs and practices will perpetuate the problems associated with the status quo. Until those called the mentally ill are treated for what is wrong with them, many will continue to chronically suffer and live at the margins, at great cost to themselves and society.

2

A People’s History of Mental Illness

The mere formulation of a problem is far more essential than its solution . . . . To raise new questions, new possibilities, to regard old problems from a new angle requires creative imagination and marks real advances.

Albert Einstein

In his bestselling book, A People’s History of the United States, Howard Zinn described US history from the viewpoint of the common people, not the elites. This chapter provides a brief history of mental illness from a similar perspective. To understand that perspective let’s begin by discussing Meks and memes.

Meks and memes

According to a unique Travel Channel reality show, Living with the Tribes, in remote regions of Papua New Guinea lives a stone-age culture, the Mek tribe. Small clans live within agreed-upon boundaries. Evil spirits live in areas of the primeval forests and swamps. They, too, have their boundaries. Humans enter at their peril. Trespass over the spirits’ boundaries and you may die, either by man or a spirit called the Swangi. This spirit brings ill fortune by possessing its victims. When bad things happen, anybody can accuse anybody of harboring the Swangi. The leaders of the clan take steps to remove the spirit from the village, whether by magical incantations, exile, or death to those possessed. An article in the London Telegraph tells of a young woman who was burned alive in January, 2008. The country’s Post-Courier newspaper reported that during 2007 more than 50 people were killed in Highlands provinces, allegedly for sorcery.¹⁰ Those possessed are guilty with no chance of proving their innocence.

The evolutionary biologist Richard Dawkins has given us a perspective by which to view the Mek as well as our own culture. In the 80s he coined the term meme (rhymes with seem). It is a symbol, concept or artifact that spreads throughout a culture. A meme can be shorthand for a reality believed to be true. Memes self-replicate and evolve because their properties are perceived to bring value to the culture. The ones that are useful remain and evolve while those that are not eventually become extinct. Just as the fittest survive in the animal and plant world, the fittest memes survive in the world of ideas. In the animal world the dodo bird didn’t survive. In the world of ideas, the beliefs of those in the Cargo Cults of New Guinea didn’t survive after World War II. Their life-size replicas of aircraft failed to get the deities to bring them the cargo treasures they expected.

Swangi possession is a meme. As a meme, it explains misfortune and provides a way to manage it, in this case by magic. Its very existence in the 21st century suggests it confers some value to the Mek culture. Some memes that appear barbaric and primitive to us today seemed eminently reasonable in times past.

A new kind of possession

In her book, Disguised as the Devil: How Lyme Disease Created Witches and Changed History, author M. M. Drymon discusses historical writings in which a large round spot was considered proof of possession by the devil. It was called the stigmata diaboli, also called the witches’ teat or the devil’s mark. This red mark, which looked suspiciously like the erythema migrans rash found in Lyme disease patients, was often found in body crevices where ticks are prone to attach themselves. Drymon hypothesizes that women, who were most often accused of witchcraft, were targeted, in part because of their greater risk of getting the disease. Women’s petticoats touched the ground where the ticks were. Drymon describes how people mistakenly saw invisible pins, probably due to poor uncorrected vision. The ticks looked like the heads of brass pins of that day and when they were removed there was blood, which was presumed to be the result of being stuck with a pin.¹¹

Photo 1

Devil’s mark?

(Courtesy Creative Commons)

In my previous book I discussed how rye contaminated with ergot mold provoked unusual behavior labeled as demonic. Given the history of the devil’s mark, and the existence of neuropsychiatric symptoms from Lyme and associated diseases, it appears that mold and Lyme disease may have been contributing factors in the witch hunts in the early colonies and in Europe.

To prevent needless suffering, written criteria were used by the authorities to determine who was a witch and who wasn’t. The famous minister Cotton Mather, in his article, The Wonders of the Invisible World, advocated searching for devil marks because he had read of the usefulness of this. In a list of seven criteria, one is written as follows: If the party Suspected be found to have the Devils mark; for it is Commonly thought, when the Devil makes his Covenant with them, he alwayes Leaves his mark behind them, whereby he knows them for his own:—a mark, whereof no Evident Reason, in Nature can be given.¹² That criterion was a paraphrase of one of seven criteria written by William Jones, a deputy governor of Connecticut and a member of some of the courts involved in the Salem trials.¹³ Jones was likely inspired by Malleus Maleficarum, the most infamous witch hunt manual from the dark ages. Malleus Maleficarum is Latin for Hammer of Witches. This book would probably have been number two on the bestseller list, second only to the Bible, if such a list had existed from 1468 through the Reformation.¹⁴ The culture accepted the paradigms of that day as reflected in the Malleus Maleficarum. This led to disastrous consequences for many.

In 1662 rural England, some four years before the Salem trials, a woman named Amy Denny was hanged for witchcraft. Learned scholars who were respected leaders in their communities presided over her trial, providing justification for similar trials that would occur later in such places as Salem, Massachusetts. One of her crimes was accurately foretelling that a neighbor’s chimney was going to collapse.¹⁵ Like Muslim fundamentalists who today execute infidels, those in power were simply obeying God’s commands. As the King James Version of the Bible says, Thou shalt not suffer a witch to live.¹⁶

Similarly, Benjamin Christensen’s 1922 cult silent film classic, Haxan, Witchcraft through the Ages, is a movie that is part documentary and part grisly horror film. It tells a story about a young attractive woman and her servant who accuse an old toothless woman of being a witch after the woman’s husband falls under some kind of dizzy spell. The old woman denies the charges until clergy-orchestrated torture compels her to confess, at which point she accuses her accusers, the wife and her servant, of witchcraft. After both the old and young women had been sufficiently tortured to the point of confession, both are burned at the stake.¹⁷ The film suggests that in the modern culture of the early 20th century, these women were not possessed by the devil, but by a mental disease known as hysteria.

Compared to the consequences of the witch diagnosis, hysteria must have been seen as a welcome innovation.¹⁸ Hippocrates invented the term. He said that madness occurred in a woman whose uterus had become too light and dry from lack of sex. This caused it to float or move upward towards the heart and lungs, causing symptoms. The symptoms, according to the French physician Pierre Briquet, in his 1859 treatise on hysteria, included not only moods, but a list of somatic complaints such as migraine, abdominal pain, muscle pain, palpitations, restlessness, and fatigue. One Victorian physician actually cataloged 75 pages of possible symptoms of hysteria and then called the list incomplete.¹⁹ When Sigmund Freud came on the scene, psychoanalytical thought became a foundation for understanding many forms of dysfunctional behavior, including hysteria.

Olmsted and Blaxill, in their book, The Age of Autism, provide a fascinating review of hysteria. They provide credible circumstantial evidence that mercury treatments offer a more reasonable explanation of symptoms than did Freud’s sexual interpretations of dreams and behavior. One hysteric’s symptom of numbness was more likely a result of handling mercury as she cared for her syphilitic father than deep-seated unconscious psychodynamic forces, as suggested by Freud.

They describe an interview with one of Freud’s much-cited long-term patients, Sergei Pankejeff (the Wolf-man). Freud used his psychoanalysis of Wolf-man to validate his methods and theories about which he wrote extensively. For example, Freud claimed that the patient’s need for a daily enema represented homosexual strivings. In a recorded interview Wolf-man said that damage to his intestines from mercury treatment for syphilis was the reason that he needed the enemas.²⁰ He denied having any homosexual urges. Had Freud been confronted with this, he might have suggested that Wolf-man was in denial.

In 1869 a New York neurologist, Charles Dana, used the term neurasthenia, a term that had been used as early as 1829 to refer to a mechanical weakness of nerves. His broader definition included symptoms of exhaustion, malaise, muscle aches, sleep disturbance, excitement and depression and a peculiar sensitivity to noises, odors and light. Freud considered neurasthenia to be a result of hereditary factors and excessive masturbation. Neurasthenia was a precursor to neurosis, a diagnosis that is today no longer used, having been replaced by anxiety disorders, phobias and compulsions. Most considered neurasthenia a psychological disorder.

In 2008, at the annual Orthomolecular Medicine Conference in San Francisco, Albert Donnay, MHS, presented Hidden in plain view: the role of oxygen and carbon monoxide. He proposed the MUlti-Sensory sEnSitivity or MUSES Syndrome. Symptoms of MUSES were similar to those of neurasthenia. He called it MUSES because of links with famous artists such as Edgar Allen Poe, who lived at a time when the neurasthenia diagnosis was commonplace.

Donnay says that some of Poe’s characters had symptoms similar to neurasthenia that today might be called chronic fatigue syndrome, fibromyalgia or various mental disorders. Poe wrote characters with these symptoms into his stories and poems when he lived in homes with coal gas lights such as his tiny house in Philadelphia.²¹ These lamps caused low-level carbon monoxide poisoning. Donnay researched the chemical composition of Poe’s hair, and found exceptionally high levels of uranium, which would be expected from the coal gas that was used to fuel the gaslights of that era. Poe’s wife, Virginia, also had high levels. It appears as if it wasn’t the winged seraphs of heaven that brought the chilly wind that took away his Annabel Lee. The coal gas that lit the lamps in their tiny house probably contributed to her demise. The areas where neurasthenia was prevalent correlated with the areas where coal gas was used. Even Abraham Lincoln complained of various symptoms while living in the White House, which was illuminated by this new technology.

Donnay points out that the number of articles written about symptoms of neurasthenia during the 19th century parallels the growth and decline of the coal gas industry. In his book, Carbon Monoxide Toxicity, he demonstrates that his hypothesis linking the use of illuminating (coal) gas with carbon monoxide exposure and symptoms of neurasthenia satisfied Evan’s 10 unified criteria for assessing the causation of disease.²²

At the 2008 International Lyme and Associated Diseases Society (ILADS) Conference in San Francisco, Deborah Metzger, PhD, MD, quoted from a 1952 scientific article. The authors described women with medically unexplained pelvic pain as mostly psychologically ill individuals, exhibiting conversion hysteria, anxiety hysteria, obsessive-compulsive neuroses, reactive depression and schizoid personality structure manifested by emotional immaturity and strong dependency needs.²³ Contrast that with Dr Metzger’s findings that among her patients with chronic pelvic pain, late-stage Lyme disease existed in 90 percent with endometriosis and 100 percent with abdominal wall neuropathy. Other infections included Epstein-Barr virus and different viral-like bacterial infections called mycoplasmas. Her conclusion was that chronic pelvic pain cannot be explained by simplistic psychological labels. They represent complex medical disorders, including infections.

Depressed patients with somatic symptoms may have mitochondrial disorders. A group of Swedish researchers found that a positive answer to six items from a questionnaire called the Karolinska Scales of Personality (KSP) could differentiate depressed patients with somatization disorder who had mitochondrial disease from those who didn’t. Those answering positively to the six questions had low rates of Adenosine-5'-triphosphate (ATP) in their muscles. ATP is a measure of energy production in the body. Similar results were obtained in a larger group.²⁴ In the DSM IV, a mental health professional could make a diagnosis of somatoform disorder by simply counting the number of reported symptoms with no known physiological cause.

Researchers at the University of California, Davis, found that in comparison with neurotypical children, autism syndrome patients were more likely to have mitochondrial defects than were controls.²⁵ ²⁶ Mitochondrial defects are not the same as a mental disorder.

Hysteria and neurasthenia, two widely accepted diagnoses in the 19th and early 20th century, were relegated to a historical footnote in a relatively short time, while the meme of devil possession lasted for centuries and in some cultures still exists today. For example, in late 2011, news reports out of Saudi Arabia indicated that a woman had been beheaded for witchcraft.

From a 21st century perspective, the different cultural beliefs and practices from a bygone era were archaic, if not barbaric. How do our beliefs and practices of today measure up? How do we know that our cultural beliefs about mental illness will not be viewed by succeeding generations as we now view these historical views of mental illness? It is true that we no longer torture and kill those called the mentally ill. However, our beliefs and practices do promote tardive dyskinesia, drug discontinuation syndrome, suicidal and homicidal behavior, shortened life spans, and lifetimes of chronic illness for all too many. If carbon monoxide poisoning, Lyme disease with associated infections and mitochondrial dysfunction produce mental symptoms, by what name shall 21st century health care providers call symptoms associated with these conditions, somatic symptom disorder or depression?

Our culture teaches us how to understand behavior that is outside the norm. A health care provider who has demonstrated competency, as defined by their professional association, and who is approved by the state, uses written criteria to determine if another person has (is possessed by) a mental disorder or, mental illness. That person is not demon-possessed, but mentally ill. The affliction is given a name and usually drugs are prescribed. From an historical perspective, mental illness is a relatively new kind of possession.

In Lewis Carroll’s Through the Looking Glass, Gnat is having a conversation with Alice. What’s the use of their having names if they won’t answer to them? Alice responds, "No use to them I suppose, but it is useful to the people that name them, I suppose. If not, why do things have names at all?"

How useful are these names? Do they help those with biobehavioral syndromes? Do they help those who name them? Do they differentiate those called the mentally ill by giving them a 21st century version of the stigmata diaboli? How will the people of the 22nd century view the mental illnesses of the 21st century?

The Malleus Maleficarum evolved in a culture in which superstitious memes could be used to identify, explain and prosecute those perceived as deviant. The DSM series evolved in the context of a culture influenced by body/mind dualism. Mental and physical do not meet in the DSM-5. . Most of the diagnoses exist on the pages of the DSM series, but not in the world of biology. The criteria of the Malleus Maleficarum determined who was a witch and who wasn’t. The DSM determines who has a mental illness and who doesn’t.

Future historians may view mental disorders as memes that not only prevented many from getting adequate care but, like the Malleus Maleficarum, actually caused harm. These memes may be viewed as having provided a way to categorize classes of people, facilitate management of disruptive behavior and financially reward those involved in such management. Mental disorders may simply be perceived as a meme of no use to them (the patients) but useful to the people (the culture) who named them.

A name is a symbolic representation that approximates with varying degrees of accuracy something that exists. A meme is an idea, belief, or expectation that, like a virus, spreads throughout the culture via family, media, educational and religious institutions and thousands of years of evolution. As the mental illness meme moves towards obsolescence, our culture will be ready for new biomedical names that move us beyond mental illness.

3

Beyond Mental Disorders

The greatest mistake in the treatment of disease is that there are physicians for the body and physicians for