The Professor,  in the Yurt,  with the big TV

Richard Bentall dresses up like a bank manager to give a talk in a big tent* with a big TV about how the world we’ve built for ourselves and each other makes us mad.

[*apologies, its Yurt – a “gurt Yurt”, as they might say in Brizzol]

In this talk Richard Bentall summarises what we now understand about how factors like migration; social inequality; racism; trauma and the built environment all play a key role in generating the kind of experiences that can get  called “mental illness” – and all play a bigger role  than the bio-bio-bio establishment and its boosters would have us believe.

He’s  not just wearing the suit because he wandered in from a wedding and he’s not just making this stuff up – he’s talking about a growing body of long-term, large scale studies that show how the way live – and the way we frame what happens when the way we live messes us up – itself  contributes to the many ways that we might experience being overwhelmed,  feeling distressed and going mad. 

And you thought it was all down to alchemy,  chemical imbalances and genetics; or aliens and area 51; or  an insufficiency of pills, eh?

The impact of psychiatric services on global health

“Psychiatric services [and that includes psychologists such as myself] haven’t had much in the way of a global impact on mental health.”

“Although since [the 1950s], there have been significant developments of technologies:  anti depressants and anti psychotic medications; …CBT… ; in terms of the long-term impact on the health of nations it’s been negligible or non existent.”

“I’m not saying that nothing that psychiatrists or psychologists do can be any good – psychiatrists and psychologists often help people in the short term – but in the long  term there’s been no global impact:  particularly in the case of  people with severe mental illness.”

Comparing global impact of psychiatric services over last 150 years or so.

“So for example, so far as we can tell, there’s been no improvement in outcomes compared with the Victorian era – just as many people stay ill for the majority of their lives.”

Comparing outcomes in countries that can’t afford psychiatric services with those that can…

“Rather more alarmingly, in terms of outcomes, they seem to be better in countries which can’t afford psychiatric services.”

Comparing progress made in psychiatric services with progress made in other branches of medicine

‘we  suck’ – note that’s my paraphrasing.

“If you’re going to have a heart attack, it’s better to have a heart attack in London, Washington or somewhere like that than places in rural Africa. But as far as we can see , it looks like in rural Africa the outcomes for psychosis are at lease as good and possibly better than in the west.”

The delusions of  biological psychiatry as a “smashing success”

Next he  uses as example,  a quote from a paid [and Toronto based] bio-bio-bio booster to illustrate how psychiatric services and their supporters feed the delusion that bio-bio-bio-based psychiatric services have this puzzle that we call “mental illness” all licked and tickety-boo and kidding ourselves like we’re in a TV advert that bio-bio-bio-medication deals with bio-disorders just like a bio-detergent deals with  the  stains on your whites.

“For me, that’s the mental health professions and their supporters deluding  themselves that they’ve achieved much more than they have.”

The role played by genes

“It seems to me that part of the problem is this idea that “the psychoses” -the severe mental illnesses – are genetically determined brain diseases… and I don’t think that’s really supported by science – which is not to say that genes don’t play a role of some sort.”

He then goes on to set out how the conventional wisdom is based on two lines of evidence: one from from behavioural genetics [which does not actually involve looking at genes at all] and the other from  molecular genetics, and is a conclusion that is not supported by science. This explanation includes some of the assumptions and  measures like concordance rates  and heritability coefficient that geneticists use to form their conclusions.

The science is far less certain than the headlines claiming that scientists have [yet again] found the gene for this and that and the other would have you believe. We have been on the cusp of this exciting breakthrough hundreds of times and yet we are still [according to researchers themselves ] ten years away from the next cliffhanger breakthrough.

Neither genes nor environment but genes and environment

“Genes and environment always interact: so genes may lead us to do things, which exposes us to particular environments, which causes a  bad thing to happen to us.”

He goes on to illustrate with a hypothesised example,

“Imagine if there were a gene for nerdiness: that gene makes us a bit awkward in the playground,  because we’re awkward in the playground we get bullied;  being bullied is a stressful experience that increases our risk of psychiatric disorder. Is the cause of that psychiatric disorder the gene, the nerdiness or the bullying? Genes and environment just can’t be disentangled that way.”

The environment isn’t what’s left over when we’ve taken the genes away…

“The environment isn’t what’s left over when we’ve taken the genes away”

“It turns out that when we look at the literature there is a huge amount of evidence of environmental causation in psychiatric problems in general and  severe psychiatric disorders – ‘the psychoses’ – in particular. “

Poverty and inequality

“Wilkinson and Picket , epidemiologists, have shown roughly that every negative outcome in society is related to social inequality  and this includes psychiatric disorders:   unequal societies have more psychiatric disorders …” 

“The weird thing is this: it seems that growing up in poverty doesn’t make you vulnerable to psychiatric disorder, but growing up in poverty next to rich people does.”

Migrants have  higher risk of psychosis

“There’s lots of evidence that migrant groups have particularly high risk of psychosis.

“An Afro-Caribbean in Britain has a risk of psychosis about four times that of white indigenous people and a particularly high risk if they live in a white neighbourhood,  Afro-Caribbeans living amongst black people don’t have such a high risk.”

“The conclusion is this: racial discrimination actually drives people mad.”

Cities are mad and make us mad-er

“Since 1930’s its been known that psychotic people are more likely to live in cities than in the countryside.”

Trauma

“There’s a truckload of evidence that shows a link between trauma and psychosis , particularly trauma in early life “

Why does this matter?

“The notion that psychosis is a genetically determined brain disease has structured the way that people respond to people with severe mental illness over the last century.”

“If you didn’t believe that psychosis was a genetically determined brain disease, it would never occur to you to give people pre-frontal leucotomy, it would never occur to you give people  insulin coma therapy, it would never occur to you to give them ECT [electroshock] .

“These “treatments” of which some are ineffective, some are close to  barbaric it seems to me, only come about because people believed that psychosis was a genetically determined brain disease. “

So, what do you want Richard Bentall ?

He ends by outlining some changes he’d like to see…

“I don’t want to get rid of psychiatry [although I did used to] I don’t want to see psychologists taking over…”

• I just want psychiatrists to be better trained.
• I think we need services that prioritise psychological treatment over medical treatment.
• I think we need to look more at environmental factors and acknowledge them, rather than ignore them.
• I want services that encourage listening to people’s stories, that foster hope and encourage recovery.
• Above all, I want to democratise psychiatry – so its not about putting psychologists in control.
• The people I believe should be in control of psychiatry are the service users.”

Richard Bentall, like the best scientists, loves to get his geek on – handy since he’s is Professor of Clinical Psychology at Liverpool University, he may   also be available to talk in your tent – or Yurt if you have one –  so long as it has a big  enough TV.

Related

• see a psychiatrist? are you mad? https://recoverynetworktoronto.wordpress.com/2012/07/25/see-a-psychiatrist-are-you-mad/

• What if Richard Bentall is right? http://mentalhealthcop.wordpress.com/2013/02/28/what-if-richard-bentall-is-right/
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  • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • DSM and the Crisis in Psychiatry – Phil Thomas
                                                                                                                                                                                                      • https://recoverynetworktoronto.wordpress.com/2013/08/05/dsm-5-and-the-crisis-in-psychiatry-phil-thomas/