HI Saltpetre. You say "mental illness is real". That may be true, but what is it? Why does being depressed get called a mental illness, but being angry does not? We say "he is angry" but don't typically say "he has anger". I think that is where the problem lies - failure to provide a definition. For many people, they assume that a mental illness is a chemical imbalance in the brain, and that's where the debates and arguing starts.

Hi Anthony,

You posted: >For many people, they assume that a mental illness is a chemical imbalance in the brain, and that's where the debates and arguing starts.<

From my passing experience of mental health issues, it does certainly seem that some 'problems' are at least partly based on brain chemical imbalance - and bi-polar and schizophrenia appear to be prime examples. In some cases medication has proven helpful, such as serotonin re-uptake inhibitors or dopamine balancing agents, etc. But this is an exceedingly complex field, which is why psychiatry is such a demanding profession, requiring many years of post graduate and continuing study - possibly also accounting for our continuing shortage of these important professionals.

This is not to say all 'disabilities' are brain chemical problems, for in some cases it is actual brain wiring that causes a problem - as in dyslexia and some optical and other sensory issues (but these would be categorised as disabilities and not as an illness).

Unfortunately, with various behavioural issues, it appears that diagnosis and treatment can often be a lengthy process, particularly with the young, and success may well be determined by the expertise and experience of the practitioner. While it may be relatively straight forward to identify, even to classify, aberrant behaviour, determination of cause and appropriate treatment - with or without chemicals - is obviously much more complex.

We really need a practicing professional to shed proper light on these issues, but they are probably too busy to bother with OLO.

That mental illness is 'real', I have no doubt whatever. That appropriate chemicals can often help (but not always), I also have no doubt. That all aberrant behaviour is either physical or physiologically based, I do doubt - though I cannot offer proof for this conviction, just a suggestion that environmental experience can sometimes be a major factor (as in post traumatic stress disorder). Our brain is not just a physical entity, but an inherently complex neurological system subject to a broad range of potential failings, and all of its mysteries may never be fully understood.

You stated "from my passing experience of mental health issues, it does certainly seem that some 'problems' are at least partly based on brain chemical imbalance - and bi-polar and schizophrenia appear to be prime examples." Can you elaborate on your 'passing experience' with regard to these “prime examples”? From my passing experience (reading journals everyday, keeping abreast of latest developments, etc.) these chemical imbalances have not been discovered yet.

You mention "In some cases medication has proven helpful." Well they don't seem to be working any better than placebos. What does that tell you? Can you give some examples of "actual brain wiring that causes a problem"?

You say "That mental illness is 'real', I have no doubt whatever." I think anger, fraud, rape are all real also. What I don't believe is that such behaviours are the result of faulty brain chemistry. What do you mean by ‘real’?

I shall leave you with a couple of quotes from Dr Dan Carlat (a psychiatrist) from his book "Unhinged."

"Naming psychiatric disorders reassures patients, who often improve markedly just be hearing that they have a condition that is well-recognised and treatable. But just because it has a name, is it actually a disease?"

“I wonder whether the essence of the psychological problem is really being addressed; generally, modern psychiatry has no way of even understanding what the ‘underlying problem’ might be. In treating emotional problems with medication, I worry that we are discouraging patients from learning life skills that they could use to truly solve their problems.”

Anthony,

My passing experience was a direct five year relationship with two young teenage men and their mother. The boys both had problems which were helped by medication and behavioral counseling. Without the medication only limited or no counseling was possible. They are both now mature responsible men, and medication-free. The medication utilised was to 'correct' a brain chemical imbalance. It worked. You may believe placebo effect was at play, but I have seen what happened when either of the boys forgot their medication, and when one decided to go off it too early. They got there eventually with perseverance, but the medication made that journey and outcome possible.

Brain wiring - try dyslexia and some related optical (eyesight) difficulties, including dysgraphia. Tinted lenses and eye exercises can be very helpful, and even facilitate eventual correction. Talk to a clinical optometrist or Professor Robinson at Newcastle University.

I don't call mental illness or aberrant behaviour a 'disease', and don't think relevant clinicians would either. Disease is something you contract or develop physically; and though some mental conditions may have a foundation in physiology or a physical abnormality (of genetic or other cause) I don't believe one could correctly classify such as a disease. As for anger and overly-aggressive behaviour, there is anger management counseling, and both the condition and the treatment are 'real'.

As for the use of chemicals >discouraging patients from learning life skills that they could use to truly solve their problems.”< This may well be accurate - where relevant counseling, psychotherapy and such may be effective without the use of medication. It is horses for courses, and not all horses have the same problems or needs - and it is up to the qualified clinician to determine.

Anger, fraud, rape - real? Sure, and some perpetrators may be diagnosed to be psychopaths, or as suffering from another underlying mental illness, or they may just be hoods, criminals, miscreants or opportunists - whose 'illness' may be a lack of conscience. Where to draw the line? It's up to a court, a psychiatrist, or both to determine.

Saltpetre, glad to see we share points of view on this. Reading the other comments it almost makes me wonder whether they are supporters/friends of Dr Dillon, out there in the real world. It's just too weird otherwise.

"In treating emotional problems with medication, I worry that we are discouraging patients from learning life skills that they could use to truly solve their problems.”

Anthony, this is a legitimate concern, but this is not the essence of psychiatry - it is the *misapplication* of psychiatry. It's what happens when psychiatric intervention is attempted by someone who is lacking in knowledge, or is being irresponsible in their approach to therapy, and I think you'll find the psychiatry profession is just as concerned about stamping out this sort of thing as you are.

As I said earlier, the science still has a long way to go in this area - but it's still science. If you disagree with it, then what you should be doing is using science to put forward an alternative way of conceptualising these phenomena. But with all due respect, what you are doing instead is purveying quackery - which if I may be frank is not something I'd advise an early career academic to do.

Sam, you start with "Reading the other comments it almost makes me wonder whether they are supporters/friends of Dr Dillon" and then go down hill from there. I do not know the people who have commented, but I suspect that like me, they are very enthusiastic when an article like mine comes up, given that the 'chemical imbalance' myth is so pervasive and unchallenged. you say "But with all due respect, what you are doing instead is purveying quackery - which if I may be frank is not something I'd advise an early career academic to do." I happy to discuss this, if you can point out to me what it is I have said that gave you the idea that it relates to quackery.

"It's what happens when psychiatric intervention is attempted by someone who is lacking in knowledge," Why don't you do some research and find out what proportion of people who see a psychiatrist come away with a presciption.

"As I said earlier, the science still has a long way to go in this area - but it's still science" Just because something carries the label of science, it does not mean that it is. Science deals with objectivity, truth, cause and effect, not consensus and voting on what is a mental illness.

"If you disagree with it, then what you should be doing is using science to put forward an alternative way of conceptualising these phenomena."
Well the burden of proof is always on the claimant, not the skeptic. These 'phenomena' have already been well conceptualised using non-medical language.