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Is mental illness real?

Posted Oct 22 2008 6:15pm

I just stumbled across this, a brand new paper by a couple of Spanish psychologists, positing something they call a "Charcot effect." Charcot was the 19th century Frenchman many consider the founder of modern neurology, who treated lots of patients with a mental illness he called hysteria, which today has long been discarded as a legitimate diagnosis by mainstream psychiatry and psychology. While the full article isn't yet accessible, and so I can't really speak to its details one way or another, its abstract describes it as follows:

This article proposes the Charcot effect, in which clinicians describe what they themselves prescribe. It is argued that the Charcot effect can be a critical instrument for exposing how mental illnesses are invented in the process of developing diagnostic systems and conducting psychopharmacological research. We argue that the Charcot effect helps explain the expansion of depression to epidemic proportions, the promotion of social phobia as a pharmaceutical marketing strategy, the profile of panic disorder according to the available medication, and the worse prognosis of schizophrenia in developed countries than in developing countries.

The bottom-line argument here seems to be that mental illnesses are not objectively definable, but are defined to fit the symptoms current drugs are able to treat.

This is quite possible, and worth exploration. But it definitely raised some red flags for me, in that it hearkens back to Thomas Szasz and his The Myth of Mental Illness, which claims, among other things, that the accepted concept of mental illness is bunk because we have no proof that they're biologically recognizable diseases. Szasz has long been argued to be off base, but in recent years his thought has pretty much fallen by the wayside with new discoveries that indicate that mental illnesses are indeed "biological disease states" (e.g. genetic markers for different mental illnesses, brain structures and processes that are different in healthy folks and mental patients).

While I understand that this new study doesn't claim that mental illness isn't real (and I really get people's suspicion of things like road rage syndrome ), it upsets me that some might spin it that way.

For me, this issue isn't academic -- it's personal. I was a relatively well adjusted young man, on his way to a relatively successful life, when one day all that was disrupted by my first panic attack. That wasn't made up. From that moment on, I have been struggling to one degree or another with mental illness. That my ailment was "invented" by psychopharmacologists seems unlikely to me. A doctor didn't listen to my symptoms, then match me imperfectly to a diagnosis. Rather, I walked around for 5 years knowing that something was wrong with me, but having no idea what it was (while all kinds of neuroses and phobias that I probably won't ever fully shake developed). It was only when I saw an ad in a newspaper listing a bunch of symptoms that were instantly recognizable to me, and naming my problem as panic disorder, that I had any clue what doctors call my problem. It was a real lightbulb moment, one I can remember utterly clearly: The ad was in Newsday, and I was living with my parents after quitting my young-Wall-Street-professional career because I could no longer make it to the office and back each day without having at least one panic attack.

That panic disorder is a discreet, objectively recognizable problem is patently clear to me -- and as much recent neurology and biotechnology show, that panic disorder involves biological differences from states of health that are not disposed to panic is equally clear. While there may indeed be a "Charcot effect," I want people to be damn sure that mental illness is neither invented nor a myth.

NOTE: The painting at the top of this post, "A Faulty Diagnosis," was created by Chris Mars, who was the drummer of the Replacements (one of my favorites bands of the 1980s).
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