Mental Health Science: Who Are You Calling Crazy? (VIDEO)

Hi everybody, Cara Santa Maria here. You voted and the results are in. It's officially December, and this month, we're going to engage in a conversation about the science of mental health.

In the past, our minds were viewed as entities unto themselves; spiritual manifestations of all of our positive and negative emotional experiences. If you were suffering from "lunacy" or "hysteria," treatments like hypnosis, psychoanalysis, and sheer willpower were used to bring the mind back into balance. And if your mind couldn't be saved, at least it could find solace behind the bars of the nearest asylum.

We now know that the mind does not exist somewhere outside of the brain. Consciousness is a function of neurobiology, and mental illness cannot be separated from biochemistry. Believe it or not, early man hypothesized a brain-behavior connection long before science was on anyone's radar screen. Over 8000 years ago, we have evidence of trephination, a procedure in which a hole was bored in the skull to free the evil spirits trapped inside. We know that this was in fact a surgical procedure and not a fluke, because many of the skulls found at these archaeological sites show evidence of regrowth. This regrowth suggests that the patients lived for some time after taking a sharp tool to the head.

With the advent of antipsychotics in the 1960s, the asylums were slowly emptied and individuals with some of the most difficult psychiatric disorders, like schizophrenia, could finally come closer to having a normal life and a healthy mind...

But what is a normal life? What's a healthy mind? Aren't normal and healthy subjective terms?

This month, let's work together, me and you, to separate fact from fiction and evidence from opinion. Let's start a conversation about the science of mental health.

At what point does a behavior stop being normal and start being abnormal? When does mental health turn into sickness? And where is the fine line between sanity and insanity?

Do we all have mental illness to some extent?

There are so many antidepressants on the market today. How common is depression in this country? Why do so many people seem to suffer from it?

And what about the kids? Autism is on the rise. ADHD is rampant. How do we explain this?

And the question on everyone's mind: Are we overprescribing psychotropic medication?

There's a lot to talk about, and I can't wait to hear what you have to say. Join me on Twitter, Facebook, or right here on my blog. Come on, Talk Nerdy To Me!

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Comments

[jf12]

11:41 AM on 12/05/2011

Although the common interpretation by archeologists of the last century of ancient was that trepanning was for mental health and/or "let the demons out", it was acknowledged to be a misinterpretation not corrected in popular accounts.
http://www.trepanationguide.com/trepanation_in_ancient_times.htm
Most of early trepanation is now considered to mostly be for the purpose of relieving intracranial pressure following traumatic brain injury. Akin to the recently adopted Army treatment guidelines for TBI, involving removing portions of the skull.

[jf12]

06:01 PM on 12/05/2011

Now known as decompressive craniectomy, "Decompressive craniectomy has defined this era of damage-control wartime neurosurgery"
http://www.ncbi.nlm.nih.gov/pubmed/20568925
"blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan"
http://rstb.royalsocietypublishing.org/content/366/1562/241.long
At least many hundreds of patients who would have died from brain swelling, as in previous conflicts, now survive due to early surgery i.e. before the brain swells.

[aloha12u]

04:08 PM on 12/04/2011

@GoldenGateCA:
Science base on genetic factors thus far:
"It is of much interest, though, that the correlation of schizophrenia between identical twins, who have identical genomes, is less than one-half. This indicates that schizophrenia is NOT entirely a genetic disease.

The current belief is that there are a number of genes that contribute to susceptibility or pathology of schizophrenia, but none exhibit full responsibility for the disease. It is believed that schizophrenia is much like diabetes, which is caused by a number of genetic and environmental factors. Research also increasingly suggests that - like diabetes - many cases of schizophrenia may be preventable. See "Schizophrenia Prevention" for more information.

In fact in a September, 2004 presentation Dr. Daniel Weinberger, Director of the Genes, Cognition and Psychosis Program, at the National Institute of Mental Health" stated that he estimated the current number of genes variations linked to schizophrenia was approximately 10. The gene variations that have been identified as being linked to schizophrenia are common in every population - but he believes that it is likely that if a person has a number of these gene variations then the risk of developing schizophrenia begins to rise. The more of these gene variations that a person has, the greater the risk of developing schizophrenia. For example, in 2002 researchers led by NIMH’s Dr. Daniel Weinberger linked a gene on chromosome 22 to a near-doubled risk of schizophrenia."
(more...):
http://www.schizophrenia.com/research/hereditygen.htm

[aloha12u]

03:59 PM on 12/04/2011

"Environmental psychology is an interdisciplinary field focused on the interplay between humans and their surroundings. The field defines the term environment broadly, encompassing natural environments, social settings, built environments, learning environments, and informational environments."
(more): http://en.wikipedia.org/wiki/Environmental_psychology

[aloha12u]

03:53 PM on 12/04/2011

Rain forests and desert winds have negative and positive ion environments respectively. These influence health and emotive responses. Serotonin, for one, can be depleted rapidly by excessive positive ions. Yet there are variations in how people respond and to what degree. These factors, as well as what are termed circadian rhythms are potent ecological factors in human health and disease. Add to these the artificial environments that we create around us which contribute "chemo-environments" and electromagnetic field spectrums...and we begin to see that "epi-genetic" cofactoring may be more complicating to our lives than we realize.
see:
http://search.aol.com/aol/search?s_it=webmail-hawaii1-standardaol&q=positive%20ions%20and%20stress
and try:
http://search.aol.com/aol/search?s_it=topsearchbox.search&v_t=webmail-hawaii1-standardaol&q=positive+ions+and+circadian+rhythms

[aloha12u]

03:37 PM on 12/04/2011

"Diathesis-stress hypothesis A hypothesis about the cause of certain disorders, such as schizophrenia, that suggests that genetic factors predispose an individual to a certain disorder, but that environmental stress factors must impinge in order for the potential risk to manifest itself."
(source) : http://www.apa.org/research/action/glossary.aspx
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http://www.pbs.org/wgbh/nova/body/epigenetics.html

http://www.enviroblog.org/2009/02/epigenetics-environmental-exposures.html

http://search.aol.com/aol/search?s_it=topsearchbox.search&v_t=webmail-hawaii1-standardaol&q=epigenetic++and+environment

[GoldenGateCA]

01:51 PM on 12/04/2011

A sizable percentage of people suffered from depression and anxiety, even 40 or 50 year ago. There is a theory based on an analogy to the genetics of sickle cell anemia. In that disease (a single gene recessive genetic condition) if you are a carrier, you are resistant to malaria. If you have two genes for it, you have a life shortening illness. Similarly with mental illness, if you have some of the genetics for say schizophrenia, you are creative or something else adaptive. If you get too much of it, you have a serious life altering illness. Heard it many years ago, not sure of the current thinking on the theory. Seems like current advances in genetics should be able to test it easily.

[aloha12u]

02:55 PM on 12/04/2011

Genetic predispositions are evolutionary pattens and the analogy you are pointing to has an adaptation that provides immunity to a killer disease...hence it makes sense. It is difficult to rationalize why pain and suffering from unstable feelings and cognition would play a role in some adaptive sequencing. Years ago, as an anthropologist, I suggested to a psychologist that what they sere calling disease were actually "adaptive" mechanisms that were either distorted or overcompensating in some way. I pointed out that we all do a good deal of things that appear in psychiatric populations, but for us these are foot notes and for some it becomes headline. Complimentary overlapping in disturbances may confuse a good deal of what we classify...consider what inflammation looks like in emotive terms, or perhaps what a delusional distortion might do to the stress response; still further, how much of sleep deprivation is involved in the cycles of distress syndromes, or how much does our complicated demands cause cycles of anticipatory anxiety that push us towards escape and evasion of the stimulus (not to mention the sequencing of painful response from the wrong actions and decisions that commit us to a "path dependency" cycle. WE need to recognize that we are dealing with complexity and reductionist thinking under pure biological determinism must be proven accurate before it is speculated as causality. Ultimately what is coming "on-line" as "epi-genetic" environmental factors seem to have a much more promising horizon for explanatory modeling.

[GoldenGateCA]

06:47 PM on 12/04/2011

Well, either you aren't responding to the theory I mentioned, or I am not understanding your comment (or both). The theory says that the "bad genes" stay in the population because if you don't have all of them, they are adaptive (in sickle cell anemia, 2 carriers will have only 25% offspring with the disease). I am sure there are both genetic and environmental factors in mental illness, but I don't really buy this idea that somehow modern society makes us all mentally ill. If there is biology involved and all people don't respond to the same pressures in the same way, I start to suspect genetics are involved somehow. I guess it is possible differences in the way different people respond is all based on past experiences, but I don't really buy that. Babies can have very different personalities very early in life.

[aloha12u]

08:55 PM on 12/03/2011

3) http://www.crossingdialogues.com/balbi.htm
2) http://www.crossingdialogues.com/issue12008.htm
1) http://www.crossingdialogues.com/fulford.htm
A fascinating Journal open to free distribution.
consider this article:
Dialogues in Philosophy, Mental and Neuro Sciences
The official journal of Crossing Dialogues

Volume 1, Issue 1 (December 2008)
ORIGINAL ARTICLES
The Third Revolution: Philosophy into Practice in Twenty-first Century Psychiatry

KWM (Bill) Fulford & Giovanni Stanghellini
"Three revolutions in psychiatry characterised the closing decade of the twentieth century: 1) in the neurosciences, 2) in patient-centred models of service delivery, and 3) in the emergence of a rapidly expanding new cross-disciplinary field of philosophy and psychiatry.
Starting with a case history, the paper illustrates the impact of this third revolution - the new philosophy of psychiatry - on day-to-day clinical practice through training programmes and policy developments in what has become known as values-based practice. Derived from philosophical value theory and phenomenology, values-based practice is a partner to evidence-based practice in supporting clinical decision-making in the highly complex environment of mental health care."

[jericarla]

03:31 PM on 12/03/2011

one problem with psychiatry and psychology begins with the idea that "im a clinician why should i tabulate and report the treatments and results? thats for research specialists!" until all practitioners understand this is still needed as feedback to the researchers true results will be long in coming We need to begin to tabulate their work with a central repository for colating or mental health will not become a true science, it will remain in the provence of speculators. this idea was developed not by me, but by a masters level class in psychology at uc san diego in 1981.

[aloha12u]

01:23 PM on 12/03/2011

Off shoots: Evidence Based Design: Imagine the future....
http://en.wikipedia.org/wiki/Evidence-based_design
"Evidence-based design often shortened to EBD is a field of study that emphasizes the importance of using credible data in order to influence the design process. The approach has become popular in Healthcare Architecture in an effort to improve patient and staff well-being, patient healing process, stress reduction and safety. Evidence-based design is a relatively new field of study which borrows terminology and ideas from several disciplines including Environmental Psychology, Architecture, Neuroscience and Behavioral Economics."
(more):
http://en.wikipedia.org/wiki/Evidence-based_design

[aloha12u]

01:14 PM on 12/03/2011

http://en.wikipedia.org/wiki/Healing_environments
Can we imagine to "emerge" qualitatively from the equivocations of a market valued "health" perspective for civilization or are we doomed to a "reductionist" dollar theory of medical care and empathetic delivery? Of course the "quip" is always..."somebody has to pay the bills..." but that makes one wonder: "How did Humanity ever survive before market politics paved the way...?"

All jousting and jesting aside; this is a major consideration for all of us on the planet mankind:

"Healing environment, for healthcare buildings describes a physical setting and organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, the process of healing, and sometimes, bereavement.

The philosophy that guides this concept is rooted in research in the neurosciences, environmental psychology, psychoneuroimmunology, and evolutionary biology. The common thread linking these bodies of research is the physiological effects of stress on the individual and the ability to heal." (more):
http://en.wikipedia.org/wiki/Healing_environments
Drop the market mentality and read the article with an open critical mind: it is only the beginning!

[aloha12u]

12:02 PM on 12/03/2011

Music inspired the quantitative mind in Western thinking, and the musical scale is a great analogy for the mind that confers meaning and responses. The scale begins with a tonal note (a reference base) and the intervals in the frequencies will determine harmony and discord. In musical expression the sequence can be a various levels of "translation" (technical term in calculus) but in real expression it seeks "resolve" back to the tonal note. Solutions are synchronic composites that encompass a compositional resolve. Variations occur in timing and pitch, but the fundamental arrangement is relatively constant in real time experiences.
Experimental models are, of course, stretching the point! Life and its comprehension is a systemic sequencing of tension and resolve: demonstrated by both art and science and the practice of success into successions of living. Life becomes a living model; and perhaps we become all too much ...the porcelain doll in social relations.

[aloha12u]

11:51 AM on 12/03/2011

Science based evidence is a product of strict methodology and systems methods advise us that input will determine the parameters and perimeters (variables & measures) of output. Science seeks repetitive confirmation of that output and raises that against empirical experiences for a truth value in explaining or modeling a most authentic replica of real living conditions. Ultimately the search for a universal "field theory" is the grand prize, but Western thinking in the History of Ideas has been both enhanced and hampered by what has become to be known as a bias towards a "germ" theory; or, a single bullet theory of causality. The complexity of patterning rightly begins with a confusion and chaotic or phrenetic / frenetic scatter plot. Science attempts to make "sense" of this input without resorting to conjecture.
First steps: observe and measure. (Selective Research becomes critical judgment)

[aloha12u]

11:51 AM on 12/03/2011

Epidemiologist instituted the idea of "evidence based medicine"; it is a good place to begin seeking data. Social graphics begin with demographic variables and measures:

Re-Search page: Epidemiology of Mental Illness:
http://search.aol.com/aol/search?s_it=webmail-hawaii1-standardaol&q=epidemiology%20of%20mental%20illness

Psychiatric epidemiology - Wikipedia, the free encyclopedia

Psychiatric epidemiology is a field which seeks to study the conceptualization, etiology, and prevalence of mental illness in society.
en.wikipedia.org/wiki/Psychiatric_epidemiology -
Clinical Practice and Epidemiology in Mental Health

Nicola Poloni, Simone Vender, Emilio Bolla, Paola Bortolaso, Chiara Costantini, Camilla Callegari Clinical Practice and Epidemiology in Mental Health 2009, ...

www.cpementalhealth.com/ -
The Descriptive Epidemiology of Commonly Occurring Mental ...

Data on the epidemiology of commonly occurring mental disorders in the United ... The NCS, like the ECA, documented high prevalence of mental disorders and ...

www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.29.020907.0... -

Jun 2, 2004 ... Objective To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ...

jama.ama-assn.org/content/291/21/2581.full -
Prevalence and Treatment of Mental Disorders, 1990 to 2003 — NEJM

Jun 16, 2005 ... The New England Journal of Medicine — Prevalence and Treatment of Mental Disorders, 1990 to 2003.

www.nejm.org/doi/full/10.1056/NEJMsa043266 -

Epidemiology of Mental Disorders: The Current Agenda. Scott Henderson.

epirev.oxfordjournals.org/content/22/1/24.full.pdf -

[aloha12u]

11:25 AM on 12/03/2011

appeals to authority are rampant in the medical profession and it is sometimes necessary to remind ourselves that physicians are not necessarily scientists utilizing grounded data as methodology but are directing us from experiences within the template of their own expectations and professional myopia. Science itself can be "reified" as some entity rather than a methodology and the "reductionist" approach must be off-set by what is essentially an empirical "emergent" perspective that demonstrates "phase" changes in reality than can not be reduced or inferred from a pure "deterministic" inference frame. In logic it is axiomatic to state that one can not deduce from the particular (individual) to the general; and inductive inferences from that direction are largely fallacies of conjecture.

Good science can bring polarities to synthesis:
Zen and the Brain:
James H. Austin
http://www.amazon.com/Zen-Brain-Understanding-Meditation-Consciousness/dp/0262511096/ref=
sr_1_sc_1?s=books&ie=UTF8&qid=1322928362&sr=1-1-spell

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Zen-Brain Reflections
http://www.amazon.com/Zen-Brain-Reflections-James-H-Austin/dp/0262514850/ref=
sr_1_sc_2?s=books&ie=UTF8&qid=1322928362&sr=1-2-spell
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Zen and the Brain: Toward an Understanding of Meditation and Consciousness
James H. Austin (Author)
http://www.amazon.com/Zen-Brain-Understanding-Meditation-Consciousness/dp/0262511096/ref=
sr_1_sc_1?s=books&ie=UTF8&qid=1322928362&sr=1-1-spell

-----------------------------------------------------------------------------------------------------------------------------------------
Zen-Brain Reflections
James H. Austin (Author)
http://www.amazon.com/Zen-Brain-Reflections-James-H-Austin/dp/0262514850/ref=
sr_1_sc_2?s=books&ie=UTF8&qid=1322928362&sr=1-2-spell

[MF173]

08:42 AM on 12/03/2011

CSM; I'm a physician, psychiatrist and psychoanalyst. We always knew the mind was rooted in the brain. Researches that I studied during medical training made that clear. For example, the neurosurgeon, Wilder Penfield, in Montreal, showed how vivid, detailed memories in the mind could came into mind when particular neurons were stimulated during surgeries for epilepsy. One of the problems that exist these days, is that one gets the false impression that all mental illnesses are "caused" by "abnormalities of the brain" whereas the severe and disabling symptoms (symptomatic character patterns, phobias, OCD, etc.) I encounter in my field prove to be the results of early experiences programmed into the circuits of normal brains and coming to rest as unsolved, still-active conflicts in their memory structures (e.g. in the temporal lobes). Because psychoanalysis at large has had a problem developing and applying scientific clinical research designs that led to scientifically-developed and tested theories (e.g. multiple hypotheses, validation critera, tests for predictive capability) its research has not allowed systematic explorations into the bedrock roots of symptoms and hence hard data that proves the above point. My own experience has been different in that I was inspired by the researchers encountered during medical training and carried their examples into an analytic treatment and scientific- research career, and ended up with a thirty-five-year series of unplanned discoveries that allows that unequically settled the point. Thanks for stimulus to respond to this discussion. Harry M. Anderson

[aloha12u]

12:16 PM on 12/03/2011

@MF173: My compliments to you for becoming a participant in this stream of conscious exploration...most Physicians hold a barrier up and (cynically stated)...treat the uninitiated as mushrooms...fertilized with excrement and kept in the dark...as the phrasing goes.

The above sequence of open thought is dedicated to yourself and physicians like you who care enough to be directly involved and "risk" being human.
Bruce E. Woych, Cultural Anthropologist (aloha12u)

[63blonde]

05:46 AM on 07/24/2012

Yes, MF173, thank you. I have the impression that emotional abuse over the lifetime of a child, and even continuing into adulthood can express itself as appearing to be a mental illness. Do you think I'm mistaken?