Are psychiatric disorders actually brain diseases?

Are psychiatric disorders actually brain diseases? | Steven Reidbord, MD | January 7, 2016

a long list of medical and surgical diseases include psychiatric features: stroke, anoxic brain injury, meningitis, lupus, diabetic ketoacidosis, and febrile delirium to name a few.  

One important job of the psychiatrist is to recognize such problems, treat the psychiatric manifestations when appropriate, and refer the case to one’s colleague — neurologist, internist, surgeon — for treatment of the underlying problem

Of the conditions deemed inherently psychiatric, some seem rooted in biological brain dysfunction.  

Schizophrenia, autism, bipolar disorder, and severe forms of obsessive compulsive disorder and melancholic depression are often cited.

Lately, however, some big names in psychiatry have taken a more ideological stance, declaring that psychiatric disorders, in general, are brain diseases — right now, no further proof needed.  Dr. Charles Nemeroff, widely published professor and chairman of psychiatry at the University of Miami Miller School of Medicine, writes:

In the past two decades, we have learned much about the causes of depression. We now know from brain imaging studies that depression, like Parkinson’s disease and stroke, is a brain disease.

Dr. Thomas Insel, recent director of the National Institute of Mental Health (NIMH) wrote:

Mental disorders are biological disorders involving brain circuits…

Psychiatrist and Nobel laureate Dr. Eric Kandel says: All mental processes are brain processes, and, therefore, all disorders of mental functioning are biological diseases

These claims by prominent psychiatrists agitate critics.  No biomarker for any psychiatric disorder has yet been identified

Functional brain imaging reveals biological correlates of mental impairment, not etiology, and no such imaging can diagnose a specific psychiatric condition.  

Our best account for most mental disorders remains a complex interaction of innate vulnerability and environmental stress, the “diathesis-stress model.”

How can they call psychiatric disorders brain diseases without scientific proof?

The brain mediates all mental activity, normal or not.  Consequently, any psychiatric intervention — or influential life experience — acts upon the brain.  This is not a new discovery.

No modern studies of brain tissue, no genetic testing, no advanced brain imaging were needed for the father of psychoanalysis to posit that mental activity arises from biology.

Psychiatric “brain disease” is neither an exaggeration nor a lie.  It does not require scientific proof — and brain imaging has neither strengthened nor weakened the case

In theory, all psychology can be reduced to electrochemical events in brain cells. All psychopathology can be reduced to aberrant electrochemical events, i.e., brain disease.

Calling psychiatric disorders brain diseases serves no clinical or research purpose, it only serves political ends: bringing psychiatry into the fold as a “real” medical specialty, impressing Congress and other funding sources, perhaps allaying stigma.  

As a tactic it smacks of insecurity and self-aggrandizement, wholly unbefitting a serious medical specialty.

A reductionistic account of this sort, festooned with pseudoscientific verbiage, has no practical significance.

Brain research is a young field.  It should be vigorously pursued for what will surely be learned.

Stumping for psychiatry as clinical neurobiology will be justified when basic research in this area affects clinical practice. Until then, “brain disease” is only a philosophical technicality, a spin, to give our clinical work and the institution of psychiatry an air of scientific credibility.  

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2 thoughts on “Are psychiatric disorders actually brain diseases?

  1. Kathy C

    This language about “Brian Diseases” is a long term strategy by Big Pharma, the Medical Industry, and the Insurance Industry to allow more Pharmaceutical Prescribing, less “Therapy,” and no expectation of improvement. The Definitions of Mental Disorders have gotten even vaguer than they were a decade ago, and little meaningful research has been done in years.

    If they sell the “Brain Disease” Model, they can effectively avoid any responsibility or accountability. The description will be set. The Industry will be given free reign to prescribe medications for these so called brain diseases. Anyone not taking these medications will be misguided or non compliant. The labels will also remove any further inquiry into how well this is working, and give the general public the idea that there much be something to this. They believe that “Experts” came up with this based on “Science.” They will blindly allow the Industry to dictate how these illnesses are treated.

    The focus on Mental Health issues in chronic Pain, and other illnesses, instead of research or treatment of the underlying condition is one more element. They have been running this narrative for a while. They can postpone or deny treatment for any condition, because the patient might be depressed or distressed. The distress caused by pain and other health issues, is now a “Psychiatric Problem,” to be “Treated” with one of their Pharmaceutical Products. This ,will be very profitable for the Pharma Industry, since there is no independent Research or oversight anymore. It allows the Medical Industry to deny care, due to these alleged Psychological Problems, and the Insurance Industry can deny claims due to “Mental Issues”, if the Condition is less than clear cut. The other Industry bonus is undermining the credibility of patients, now they have a Mental Issue, it isn’t the underlying condition, the failed treatments, or the lack of an effective treatment, it is the patients fault, they have a “Brain Disease.”

    There are very few Doctors or Psychiatrists speaking out, because the Industry discourages it. Between the Media False narrative, Gag Orders, Corporate Culture, HPPA Laws, and fear of retaliation by the Industry, no one is speaking up, and those that do might be alleged to have a Mental Health Condition. These Industries have pull over the Regulatory Agencies, Congress and even Academia. The Corporate Media mostly runs Articles “Studies” that support the narrative, using and occasional Industry funded “Study” which will go Viral if is reinforces the narrative, or casts doubts on Science or questioning this. Journalists are no longer interdependent enough to ask real questions, they parrot the same Pseudo Science, they do with other issues.

    The most frightening part of this is that they have managed to explain away Environmental Stressors, including the Socio-Economic ones.income inequality, Battlefield Injuries and exposure to toxic stress. They are already drugging children, whose only “Disease” is an unstable home, where even the ability to sleep or eat with regularity is an issue. Children are living with fear or uncertainly due to poverty and other problems. The Media runs a constant narrative of fear, as there are School lock downs and active shooter drills. Now the issues can be ignored because there is a big Pharma Solution. The Industry has described the Issue, the Language, the Diagnosis, and of course the treatment, one of their products.

    We are in the Post Fact Era. 16% of our National Budget is spent on Healthcare with the worst outcomes in the developed world. Congress is actively attacking an Insurance program that will force millions to lose their Health Insurance.We are in the Post Fact Era. 16% of our National Budget is spent on Healthcare with the worst outcomes in the developed world. Congress is actively attacking an Insurance program that will force millions to lose their Health Insurance and further destabilize the healthcare Industry. We would be kidding ourselves if we thought the Industries were not anticipating a threat to their profit structure, and working on ways to increase profits at all times The Industry has access to the best Lawyers, Public Relations, Marketing, and Policy Makers. The Corporate Media also has a stake in this. The same billionaires own the Companies, or have Investments in the profitable Healthcare and Pharma Industries. One positive casual mention of a Pharma product, in Media can send Stocks and Profits soaring.
    The “Research” they found more effective was in Marketing and Public Relations, not Science. The real Science is often inconclusive. The “Studies” they refer to in Healthcare or Psychology, nearly all have one important disclaimer, that they are inconclusive, and that due to the limited nature of the Study they recommend further Research. This way if there is any False Conclusion, they are not liable. The Studies that go Viral, or are referred to by Mainstream Media often are short Term and inconclusive, attention grabbing headlines promote a Conclusion that is not scientifically valid.

    The Headline or the Industry supporting narrative is what the casual reader, the politician or Policy Maker takes away. This is then bolstered with a few Cherry Picked “Facts,” which often leave out entire questions. Most people skim over these conclusions, relying on Journalists, or Media and Public relations “Experts” to do their questioning for them. This information is often repeated until it becomes fact. These “Studies” will be referred to in Editorials, Advertising, and by other Journalists. Government Agencies and Statisticians are using the Billing Codes, written by the Industry, for Research.
    The Data is often very limiting, the Industry has so much control, they found some data is inconvenient so these Agencies have to soften the impact or they are not allowed to collect it at all. There are also different Reporting Requirements, .measures, and Opinions. The Data used is not as clear cut as we are led to believe. An example would be Hospital Death Reports. Due to the obvious things like Patients Demographics, and the Population, some Hospitals would logically have more deaths than others. This forced Medicare Data requirements to soften or offset the importance of the numbers. They rely less on this indicator, which should be a hard number or a fact, X number of people admitted, died.

    The problem is that there are ways around reporting. They can deny admittance, to certain patients likely to die. They can also “Dump” some patients to other facilities, like Nursing homes, or Discharge them to die at home. These are all factors that can be manipulated by the loose reporting requirements. The Mental Disease Model throws another factor into the mix of data. These Patients can be denied care, or referred elsewhere. They can be treated and released with Medication. They can also avoid treating any condition they deem to not be in their financial Interest or that might add to the overall Death Rate. There is a percentage of risk with any hospitalization or Surgical procedure. They have plenty of Research in this area. They are also able to factor things in like Reimbursement, Age, Underlying Health Condition, and Outcome. These Calculations are Scientific, because they can be measured in Numbers or dollars, they are clear hard numbers, not conclusions or perceptions. The Pseudo Science that Psychological Research is based on is not numeric. These numbers are often biased, or based on Self Reporting, and Confirmation Bias.

    The Industry has found it very profitable to mislead the public, it is all about perception. A local Religious Non Profit Hospital, which due to it’s Media perpetuated perception does not get reimbursed enough. They have to treat uninsured poor people, so the general public has low expectations, and often overlooks the negative outcomes. The “Religious” and “non Profit connotations, give them the appearance of credibility, morality and working for the common good. This is an image they carefully cultivate. A celebrity was hospitalized there, most of the wealthy go out of town for Medical issues. Many have second homes here, but would more likely leave town for Serious Medical care. The celebrity of course was treated like royalty, and said some glowing things about the Hospital, they “saved her life.” She was then featured in Advertising, Articles, and Benefits.

    The public was misled by the focus on this one Anecdotal Celebrity Story. The Media still mentions it, when she gets mentioned. The PR Spin, repetition and celebrity worship led the public away from any negative issues at that hospital. This hospital is a monopoly in the area, most residents don’t have a choice, unless they want to drive an hour or more away, which many do even though it is inconvenient. Some even have negative experiences, previous bad outcomes, or know of someone who has. There is no way to track the negative outcomes. The hospital has an Ombudsman or Patient Advocate who is nice old lady who patronizes the patient, and the issues goes nowhere to deflect attention. The Patient Satisfaction Surveys appear to be looking for ‘feedback” bu the questions are limited to the behavior of staff, and impressions.

    The “Local Media” does a lot of expensive Adverting, promoting, and Spin for them. Any time there is a negative mention, there is a full Page Advertisement of the Wonderful Doctors there. Coincidentally there will be an “News” Article about a Charitable event or positive occurrence. Each Article leads with the narrative of how beleaguered they are since they never get enough reimbursement from Medicaid, Medicare, or a mention of a Benefit or promotion of a “Health Fair.” They print an occasional Advertorial, Editorial” or Letter from the Editor, promoting the Hospital. The CEO makes at least 4 million a year, and rubs elbows with local Politicians and Celebrities at their “Wonderful Benefits.” The “important people” are all there, lending more credibility and perceived goodwill.
    In the meantime the CMS ratings are dismal, they are under performing. Though they are a religious non profit, they are part of a multi billion dollar national corporation. They have the best available PR people lawyers, and well paid Administrators. When Antibiotic resistant Infections were trending on Social Media, they were able to get in front of the issue, with a well placed “News” Article. It appeared to be “News” the hospital had a new device for sterilizing rooms. The “Journalist” who also writes for the Business Section, used the name of the Corporation that sold them the devices, to promote the Corporate Image, perhaps a paid Advertisement.
    He could also be promoting the company because he owns Stocks or has a financial Interest. They touted this device as a Strategy to lower Infections. There is little evidence these devices do much to lower infections, it just sounds good, and High Tech. They avoid covering the employee issues too, since the underpaid overworked janitorial Staff, would be the ones using it. The Staff, have a high turnover and little incentive or time to pay attention to room sterilization. Many of them are in “Supported Employment,” the Hospital receives a percentage of their Salary back because they are in a group of under served. One more way these Businesses are Taxpayer Subsidized.
    Nurses went on Strike a few years ago, claiming they were concerned with Patient Safety over staffing levels. This was reported in another town, local Journalists ignored the Story. Physicians who should have supported the Nurses and Patients were ominously silent. They are silent on all issues, unless it is Advertising or a Positive PR piece. They are not allowed to speak up, except in approved ways. They would face a Lawsuit, or violate a Corporate Contract.
    To the healthcare Industry is is all about perception, the adverse events are only occasionally counted. The occasional Lawsuit, is downplayed or attributed to greed. . Many adverse events are not Actionable, not enough proof. When the Mental Health Diagnosis is added, they can avoid any accountability and the patient has virtually no rights or credibility. There are degrees of Mental Illness also. Schizophrenic or Bi Polar or even misguided people can neglect their health or be too involved in their Mental illness to describe a Medical Symptom. They often don’t have good outcomes. The open categorization of Mental Illness due to depression or anxiety because of an underlying health problem allows the Provider do focus on the mental Issues instead of the underlying physical Complaint. This is not accidental, this is profitable. It give the Health Industry one more way to deny care, and avoid accountability. They have a pill of that.

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    Reply
    1. Zyp Czyk Post author

      It’s all one big mess and I think it’s because our healthcare being managed like any other purchase in a capitalist system.

      Corporate profit and “doing the right thing for a patient” are usually NOT the same thing – and money/power always wins. This is social Darwinism, where those that cannot earn the highest incomes are left to die in the streets because there’s no profit to be made by treating them.

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