And Now?

Sometimes it is difficult to write about present times. No one can reach sufficient “height” or have sufficient insight, to see the warp and the woof of the patterns in life that are being woven.

I know that I have written about this before but I still want an answer!

Many will know that I have an abiding interest in psychology – trying to determine why we do the things we do. Allied to this it is always necessary to remember that every action in life, individually or collectively, has consequences – generally unexpected.

But then, firstly, I have tried to establish what we humans actually are – this has puzzled me for a very long time. What are we? Just an accident of nature (but what is nature?) or is there some design and purpose behind the creation of life?

In this regard it is worth remembering that the words Psychology and Psychiatry derive from the Greek ‘psyche’ (pertaining to the Mind or Soul). It would be to the advantage of all not to lose sight of this primary meaning because it should guide our thoughts on these matters. Furthermore, my personal life experiences, a psychology degree, the examination of published papers and extensive reading, have led me to the rather uncomfortable conclusion that research into this subject is trying to reconcile the irreconcilable. There is an attempt to reconcile the objective, quantitative, scientifically measurable aspects of the biological brain with the subjective, qualitative and immeasurable aspects of the mind/consciousness with the intention of arriving at some meaningful answer. 

Any answers arrived at, however, will be dependent on the deep consideration of some difficult concepts that in themselves give rise to many questions. For instance, what is Intelligence? What is “Life”? What is “Consciousness”? Is “Life” the same as “Consciousness”? Is there a difference between brain and mind? What is it that is absent when something that was “alive” is now “dead”? What is a thought or an emotion and how are thoughts or emotions generated? These terms (intelligence, alive, dead, consciousness, mind, thought and emotion) are in the common lexicon, yet there is no agreed definition or consensus as to what they are. The brain is believed to “contain” the mind and consciousness and yet the mind and consciousness may not be confined to the brain – even though they appear to be related in some manner as one affects the other. 

Regarding the brain, while imaging techniques, for instance, have shown that certain areas of the brain are activated when thinking or remembering something, it has yet to be determined whether thoughts or remembrances, by some means, activate the neurons or whether the activated neurons, somehow, create the thoughts and remembrances.

Similarly it will be recalled that all observable forms of matter are constructed from atoms and molecules. This becomes interesting if “Matter” (in the form of the human body and brain) together with “Life” and “Consciousness”, are considered in the light of quantum physics which states (very basically) that Energy = Matter (remember E=MC²?). Einstein, with this famous equation, revealed that the Universe is not just trillions of distinct items separated by inert space but in fact is a dynamic construct in which matter and energy are so inextricably mixed that it is not possible to consider them as separate elements. If this is true, where does this leave ‘life’, the ‘mind’, ‘consciousness’ and ‘intelligence’? How can energy/matter be intelligent or conscious? What is ‘dead’ energy (i.e. some matter which was alive and is now dead) compared to ‘live’ energy (i.e. some matter which is animated and alive)? Furthermore, physics tells us that there is no foundation for a view of life based on the pre-eminence of matter. Energy is indestructible and outside of time, and as a result the total quantity of energy is constant. This is known as the law of conservation of energy. But one of the astonishing results of relativity theory is that there is no law on the conservation of mass (matter).

Something else - humans presume to consider themselves as the epitome of the universe. As confirmation of this assertion the human brain has been described as the most complex single object known to science, with an estimated eighty six (86) billion neurons. The feasible connectivity of these gives rise, literally, to an astronomical number of possibilities. But does this connectivity explain the mind or consciousness? 

There is also this further matter - our freedom to choose – known as the “problem of mental causation”. It is a fundamental fact of science - a maxim - which states that nothing can happen that is not governed by natural laws of material causation (i.e. physical events cause physical effects). Thoughts are non-physical (they are subjective), therefore by definition cannot cause anything physical to happen. How then is it possible for subjective (non-material) thoughts of the “self” to so influence the function of the (material) brain that they compel the brain to direct the (material) body to perform a particular action? This has yet to be resolved.

So where does this leave us?

I really have no idea! That is why I am so interested in this subject.

Mental health - again!

I know that this is a highly contentious subject but I just cannot understand why it is now proposed that Australian schools should be provided with “mental health and wellbeing counsellors”.

These are children growing up in a fractured world with raging hormones just trying to “fit in”! 

Now don’t get me wrong! I am fully aware of the indisputable fact that there are many mentally distressed people who are in desperate need of help and support. My “beef” is with how this distress is diagnosed, categorised and finally the efficacy of any treatment offered. 

Firstly, let it be known, and widely known, that there is no consensus or definition of “normal”. What is a “normal” human being? There are roughly 7.2 billion people alive today. That means there are roughly 7.2 billion different people going about their lives, doing different things and behaving in different ways. Does this mean there are roughly 7.2 billion different ways of being “normal”?

Please tell me!

Then we come to the diagnosis of “mental illness”. A popular “diagnostic tool” is the HONOS – Health Of Nations Outcome Scale (please check this on line if you doubt me). Now this scale, as with any others used to “diagnose” a patient’s mental health, and there are plenty of them, is purely subjective. It is a “tick a box” exercise. Using this HONOS each question – there are twelve of them – must be rated 0 to 4. More than a previously determined “score” and you are diagnosed as depressed, schizophrenic, psychotic – or whatever and in need of help. 

Ok. When that is done – what now?

The important question now arises - what is the cause of any distress?

The answer? Nobody knows. Simple. There are plenty of, “the inference is”, the assumptions are”, “there is hope that further research will determine”, etc, etc….!

Again let it be known, and widely known, that there are no objective tests, no biological cause – no blood tests, no fMRI tests (functional Magnetic Resonance Imaging), no genetic link, and particularly no causal link between an apparent “symptom” and the distress evident in the presenting patient. The symptoms enumerated in the DSM5 (Diagnostic and Statistical Manual version 5 of the American Psychiatric Association –APA), used world-wide, were agreed by a committee.

The simple fact is that the “etiology” - the cause – of most mental disorders (Huntingdon’s and Alzheimers disease are more or less determined) are not understood enough to accurately distinguish the “mentally ill” from the rest of us.

Now we enter the minefield of the treatment of “mental illness”. The fall back position of psychiatrists and clinical psychologists is to consider a “mental illness” as a biological condition and treat it as such with a perfect cornucopia of psycho-pharmaceutical drugs produced by “big pharma” to their enormous profit. There is limited evidence regarding the efficacy of these drugs compared to other treatments (“Big Pharma” are very reluctant to release any research that does not support their advertising). Furthermore the side effects – heightened risks of metabolic disorders, rapid weight gain, diabetes, sexual disfunction and heart disease for instance – are carefully sidelined.

That some people do derive benefit from these drugs cannot be denied. They do. But these drugs never “cure” – they are a stop-gap offered to often desperate patients by medicos “stumbling in the dark”.  Often a “suck it and see” approach is applied – “Try this one. If that doesn’t work, try this at double the dose”, kind of thing. But then again, many people get better on their own or feel better with a placebo (sugar pill).

So – to get back to my opening statement about treating school children - until we know the CAUSE of the obvious mental distress experienced by some patients, how can anyone determine, with any certainty, what treatment should be offered? 

Finally I will repeat a quote, from the Indian sage Jiddu Krishnamurti (1895-1986), who said, "It is no measure of health to be well adjusted to a profoundly sick society".

There we have it in a nutshell!

Germanwings flight 4U9525 disaster.

Shocking and senseless! A few general facts are necessary, however, to stop the various notions about why the unfortunate, and relatively inexperienced pilot, Andreas Lubitz committed  such a horrendous and apparently entirely selfish, mass murder/suicide – as is so far alleged to be the theory - before the actual facts (and suppostions) are presented in a sober and reasoned manner.

First up, no test (or tests) is (are) available which will confirm any “mental illness” (Alzheimer’s and Huntington’s diseases excepted). Mental issues are not (repeat not) similar to any physical illness such as the much quoted phrase “diabetes or heart disease”. Any person presenting with a mental issue is “diagnosed” by observed behaviour and by the presenting person’s self-reported mental state – and then subjectively judged, by a Mental Health professional, using an “approved” check list of “depression indicators”.

The operative word is “presenting”. Anyone with any intelligence and who has been psychologically tested many times before will “know the ropes” and be able to circumvent questions which may be “compromising” or which may impact unfavourably on that person’s future.

It was therefore not possible for any mental health professional to have determined, with any degree of absolute certainty, that Lubitz was “mentally ill”- whether he was depressed or a closet sociopath or had psychopathic tendencies. Possibly he was just someone who was trying to fulfil a dream and was found wanting – something he may have had difficulty in accepting.

We will never know.

My second point is that, as I understand it, anyone working for an airline must attend that particular airline’s approved doctor or doctors. It is that doctor who has the responsibility to inform the airline of any misgivings he (or she) may have about a particular employee’s health – mental or physical. I am sure that an airline with Lufthansa’s standing would have had such a medical regime in place.

It would appear, therefore, that either the doctor involved did not pass on the medical details (regarding prescriptions or any other concerns) to Lufthansa. Or, and I would find this very difficult to comprehend or believe, Lufthansa ignored the doctor’s concerns and/or advice regarding Lubitz.

Either way – if there is blame to be apportioned (and believe me there will be) it should lie somewhere in the orbit of the medical doctor and/or the pilot administration of Lufthansa.

Lubitz’s life, family, friends and career will be eviscerated by the investigators and the media trying to find any possible reason or reasons for such a horrendous and callous act. This is to be expected because the airline industry survives on trust and its fiercely protected safety record. Anything which impacts on this will be examined as never before.

And so it should be.

However research into suicide is notoriously difficult. It is always referring to an historic act – something that has already happened. Police, coronial, autopsy, psychiatric and psychological and counselling reports are analysed and carefully combed to try and establish some reason or motive for the suicide. This is fraught as it is impossible to know what was actually going through the person’s mind at the precise moment in time when they took their own life and (particularly, as in this case) when this includes the lives of so many other innocent people. At some moment – sometime earlier that fateful day - Lubitz made a choice.

Why? We will never know.

Mental Health

It has been reported for years that the rate of mental disorders in Australia (and, I might add, most of the developed nations) is an alarming one person in five (1 in 5). This is a truly astounding figure. In fact I would call it a national catastrophe.

Just imagine the outrage and panic if 1 in 5 were diagnosed with AIDS or contracted influenza. There would be panic and a national enquiry and millions would be spent on research and medications of some sort. But mental health? If 1 in 5 of the population will suffer from some mental problem – what then is normal and how is this determined?

It is worth remembering that with mental health: “the facts are uncertain, values are in dispute, stakes are high and decisions are urgent”. In such circumstances it is difficult to resist the temptation to cherry pick data to suit whatever popular theory is being promoted at the time. The flow is from theory to observation to statistical analysis and back again – if great care is not taken then cherry picking will again take place in a misleading and apparently endless loop. Convention, it seems, must be followed – this is obvious from the fact that authors of articles that are not “politically correct” find it very difficult to have them published in mental health journals!

Prescribing mind altering drugs to people already suffering mental issues is counterintuitive. Yet this is what happens. The problem, which the “experts” seem to find difficulty in accepting, is that medications in various formulations and strengths have been prescribed for mental “illness” for something like one hundred years. Yet the problems remain. Logically this leads to the conclusion that, ipso facto, either the medications are ineffective or the aetiology (the study of causation, or origination) of mental disorders is misunderstood and therefore, by default, misdiagnosed – or all three.  

Using the same methods over and over again expecting different results each time is not very clever – in fact I believe this is an indication of some mental problem! Following the same course of action – prescribing medications that cause problems that further application of more powerful medications cannot alleviate is, also, not very clever. And yet this is what we seem to be doing with the current approach to mental health!!!

It is almost as if psychiatrists and psychologists are circling around the subject of mental health without fully appreciating what needs to be done (for example, after nearly one hundred years of research there is no effective biological test for any mental disorder – it's a matter of a health professional’s judgement regarding the apparent behavioural and thought disorder patterns presented by an individual. Furthermore if some mental disorders are deemed to have a genetic base the questions relating to any evolutionary advantage will need to be answered). I find it bizarre that there are over 360 different psychiatric disorders listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders – fourth edition – text revised, published by the American Psychiatric Association) with the further understanding that U.S. insurance companies (through their close relationship with pharmaceutical companies) now require a DSM-based diagnosis before they will reimburse prescription drugs on health plans. So again I ask the question that needs to be asked - what now is considered normal?

In this regard an over reliance on pharmacology is fraught; a “chemical imbalance” in the brain means what, exactly? What is the “correct” chemical balance and how is this determined? There is no known test that can determine the “correct” level of chemicals in the brain! Furthermore it should not be forgotten that behaviour can never be considered a “disease”, as an illness. A person may behave in a seemingly bizarre fashion and may be ill at ease but this does not mean they are “sick” – unless there is a pathological (medical) reason, which would then be beyond the scope of psychiatry or psychology.

Nothing is more fitting or useful than to be considered a normal human being living a fulfilling life in society but then, if the Australian Bureau of Statistics is correct, and 19% of Australians will suffer some degree of mental disorder during their lifetime then, once more, what is normal?

The needs and necessities of individuals vary. What is a prison for one sets another free. Yet “normal” can range from mildly eccentric with not a few who are apparently happy when leading a life some may think as abnormal, non-social and “odd ball”. There are seven billion individual ways human life is currently being expressed. I repeat, what is normal and, more importantly, who is checking?

What is needed is a complete rethink on the “medicalization” of mental health; a complete rethink on the causes (aetiology) of mental problems and a greater realisation that there are real problems in the administration and application of the law - as it applies to mental health; real problems caused by the obscene imbalance of income between the very rich and the very poor and the continuing, corrosive, effects of injustice which is prevalent in all societies. These have a major impact on mental health generally.

More drugs are not the answer.

What is Schizophrenia?

What is schizophrenia? The short answer is that no one knows. The effects are well documented even though they are not necessarily unique to schizophrenia. Since the term was first used by Eugen Bleuler in 1911, intense research has so far failed to identify the condition’s causes though it is thought to be a combination, in varying degrees, of genetic, environmental and neurological factors. This debilitating mental disorder is believed to affect about 1% of the World’s population and is generally first diagnosed in late teenage and early adulthood. For reasons not yet established more males than females are affected.

Not only is schizophrenia difficult to define but is without any confirmed pathological, molecular or genetic origin – it has no confirmed biological basis. Diagnosis is made from observed behaviours meeting the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV Axis 1) criteria. These criteria relate principally to the determination of an afflicted individual’s mental state, from their speech patterns and perceptions which may indicate possible hallucinations and/or delusions. This is supported by observed unusual behaviour which may affect the afflicted person’s ability to function effectively in the broader community. Therefore any diagnosis cannot be objectively “scientifically” proven, it is subjective - someone’s opinion and interpretation of behaviour. Furthermore it is not an illness which prescription medication can cure. It is certainly an unfortunate and debilitating condition but it is not an illness – and to call it such is misleading and wrong.

There appear to be many factors involved in the causes of schizophrenia. Obstetric complications, such as foetal hypoxia (foetus deprived of oxygen); viral infections the mother may have experienced during pregnancy; even the season of the year when giving birth, (winter being statistically the least favourable); the patient’s social status; even where the patient resides - in an urban or rural locality (urban being the least favourable), all appear to have a bearing on the incidence of this condition.

While not one single factor has been identified as common to all patients with the condition researchers are working on some evidence that schizophrenia may be a polygenic disorder (influenced by many genes) which is further influenced by environmental factors and a person’s emotional vulnerability while developing in teenage years. Stress appears also to be a factor in the development of schizophrenia as it is recognised in playing a significant role in many medical conditions. It is now thought, with some individuals, that certain levels of stress experienced may exceed their adaptive capacity and thus compound the vulnerabilities of the person concerned. Comments critical of the patient’s demeanour and behaviour together with the alternative of an over-protective relationship have a significant bearing on the course of schizophrenia – this is called a high level of Expressed Emotion. Some patient’s may suffer a relapse from a relatively stable condition which allowed for their discharge from a treatment centre. There is, however, no agreement on the meaning of relapse.

It is now known that people suffering schizophrenia are more likely to recover and less likely to suffer a relapse if they live in a calm, non-critical, non-overprotective environment – a low level of Expressed Emotion. It is well documented that early intervention programmes are of vital importance in determining a favourable outcome for schizophrenia patients but there appears to be no agreement on what recovery actually means. Recovery varies considerably in effect from individual to individual – is it a “clinical” objective recovery (decided by using DSM IV criteria) or an individual’s subjective assessment of their quality of life? It was believed that, once diagnosed with schizophrenia, there was no chance of recovery. There is now, however, a body of evidence suggesting that the situation, for many sufferers, may not be quite so dire, particularly with those individuals not using street drugs and not drinking to excess. With a correct balance between antipsychotic drug treatments and other psychosocial and psychological interventions it is now known that between 20% to 30% recover sufficiently to lead relatively normal lives, with a further 20% to 30% manifesting continuing moderate symptoms. Other reports show that the recovery rate is actually quite high though generally under-reported and is actually somewhere between 50% and 60%. All this shows that the “experts” still don’t really know.

Given the astonishing lack of knowledge about what causes schizophrenia, expressed emotion, relapse and recovery together with the limited understanding of how they relate to one another, how scientists can claim statistical “evidence” and validity proves anything is really surprising. Research is consistent in reporting that high levels of expressed emotion are likely lead to a relapse by patients with schizophrenia. Why this should be, however, is not fully understood. The many factors involved may possibly be partly genetic but certainly involve subjective elements which are difficult to define and measure. No one knows what it really means to recover or relapse nor is it understood from “what” a recovery or relapse is occurring! Also no one knows why high levels of expressed emotion (an “un-calm” environment) may be a predictor of a patient’s relapse.

A mental condition as complex as schizophrenia cannot be artificially restricted to fit the requirements of the DSM-IV. Nature will not be governed by man-made conditions which attempt to force it to answer questions required for statistical analysis to satisfy the ideals of “scientific research”. Statistics are unable to adequately assess the nuances and subtleties of words, gestures, feelings, imaginings, desires and beliefs that, in varying degrees, are so tied to and characteristic of each individual and which are known to have an effect on the outcome of schizophrenia and any relapse or recovery.

To force a patient suffering from schizophrenia to take medication – without knowing what the medication actually does or how it works (and with significant side effects) – is ethically questionable and quite wrong in my opinion. The better way is to look at the physical and emotional environment and conditions which spawned the patient’s affliction. It is necessary to find out what all this means to the patient – their interpretation of the events and how it has affected his or her thinking.

Schizophrenia is as much a mysterious condition as it was 100 years ago, certainly the "experts" have no idea what it really is or how to "cure" the condition.