The following article titled, “Q&A: He’s studied mental illness for 50 years. Here are all the things we’re doing wrong: a portrait of professor Andrew Scull” was published at the Los Angeles Time's website. I retrieved it May 11, 2022 at 1:39PM EST and I submitted it to archive.org on May 11, 2022 at 1:43PM EST.
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like to read the article without my commentary, please click the link
above. If you want to read my commentary, keep reading. The text of the
original article is in regular font. My feedback is in italics.
"The history of mental illness - and its treatment - is not for the faint of heart.
And modern mental illness - and its treatment --- is? It appears the dynamic that fueled the errors of yesterday, fuel the errors of today.
"From ice-water plunges to the early days of electroshock therapy, from lobotomies (honored with a Nobel Prize in 1949) to Thorazine catatonia, its treatments belong to the pages of a dark dystopian novel. Often targeting the poor, the indigent, the most vulnerable, the attempted cures were cruel, unethical and often racist.
Yet the history demands to be understood.
Yet these "modern methods" need to be questioned. I am getting the impression that the last 15 years of my life - of everyone's life - has a name, and like electroshock treatment, was once deemed illegal. Now, if I could only remember some the names for it. Perhaps someone can mention that name or somehow give me a clue. Things, whose legal status is questioned, have a long reputation of being cruel, inhumane, ineffective, if not downright damaging. Those administrating these methods are, at the extreme least, often frowned on. Would either the interviewer or interviewee inform us what it's name is or is the patient supposed to invest in hundred of books and make a lifetime vestment to figure it out? Hm, a wasted human life forced into locking horns?
"The author of numerous books that delve into human psychoses and their treatments, Andrew Scull graduated from Oxford University in 1969 and arrived in America not long after the Community Mental Health Act of 1963 began to shutter hundreds of custodian institutions around the country.
"Community health centers and
treatment programs were meant to fill in that void by providing
education and job training for the intellectually disabled. Yet today's
crises in homelessness and mental health make clear that these goals
were either never achieved or simply abandoned.
Yes,
for both the intellectually challenged and the student on the National
Dean's List, who has won awards from department chairs because of their
writing. But dontcha know - housing felt I didn't know how to read or
something because they felt I did not understand a paragraph in their
pamphlet.
"Scull's work was initially driven by one
simple question: "Why did society imagine that institutionalizing people
was so important, and why was so much capital - intellectual and
financial - devoted to this end?"
One word: greed.
"The search for an answer made Scull, a professor of sociology and science studies at UC San Diego, a singular authority on more than 200 years of the medical profession's tangled relationship with mental illness. In delineating this history - from asylums to psychopharmacology - he considers the challenge that individuals with mental illness pose for the health of a modern society.
I
encourage you to read my blog. I don't own a firearm to shoot it 127
times in a year. I descend from a firefighter, I have no interest or use
in house fires. A burnt down house is no longer a home.
"Yet he knows how solutions are elusive and still far out of reach.
Sir, please, come off your high horse. I beg you.
"What
impresses me most," he said, "is how recalcitrant mental illness is,
how difficult it is to comprehend, how hard it is to come up with
effective treatments and ultimately, how it is best to be honest about
what we don't know, so we can pursue a more eclectic approach to
treating it and not be certain we know the right answer."
I guess simple things like ethics and compassion are difficult for the clinician.
"In
his latest book, "Desperate Remedies: Psychiatry's Turbulent Quest to
Cure Mental Illness," out this month, Scull is especially critical of
the last 20 years when research narrowed its focus onto possible
biological factors for mental illness. The lack of concern with the
social and psychological dimensions of mental disturbance, he argues,
has precipitated inequities in treatment and led to the consignment of
the mentally ill to the streets and jails of this country.
I
guess there is a biological factor why a clinician or politician
would physically lunge at someone who is, within bounds of the law,
questioning them. Because the violence that result when ethics and
policy are disrespected is merely a chemical imbalance, and we need to
involve more people in a what will turn it into a violent stalemate?
"The interview with Scull has been edited for length and clarity.
"Over
the last 20 years, the plight of the mentally ill has become most
conspicuous among those who are living on our streets. Is it time to
declare that the community-based treatment model is a failure? What do
you believe are the first steps we need to take in order to begin
remedying the tragedy we see just outside our doorstep?
Do
we deem community based treatment is a failure? Well, if you want
homelessness, yes. Especially in an era where the poor need to rely on
Craigslist to find affordable housing.
"We need look no
further than our jails and the gutters of our streets to view what the
failures of contemporary mental health policy have wrought. The emptying
out of asylums without any serious consideration of what was to replace
them has contributed to problems of the homeless and the sidewalk
psychotic that are now part of the fabric of our cities.
So
are you going to justify what I experienced with some strange
psychopathic logic? Or are you going to shield yourself with the
diagnostic manuals?
"We
ought to recoil from arrangements that condemn helpless and suffering
human beings to homelessness and prison and stop pretending that
chemistry is the sole and singular way forward. Those afflicted with
serious forms of mental illness have been cast into the wilderness - a
brutal and often fatal outcome for many with few resources of their own.
These are people who lack the capacity to function in an environment
where they are seen as a drain on the public purse. Chronically
dependent on the not-so-tender mercies of a shrinking welfare state,
they are doubly stigmatized: for their illness; and because they show
few signs of reform or recovery.
You said it. But I
will also point out with the prospect of returning to work while
brutally ill and more insane than I started, the clinician, and their preferred patients, are also very
much a drain on the public purse.
"If matters are to
improve, we need to develop a multifaceted approach to understanding and
dealing with the problems posed by serious mental illness. This
requires a major commitment to housing, supporting and sheltering people
who are incapable, for the most part, of providing for themselves. It
means serious engagement with research about the best ways to provide
these services. Families often find these burdens impossible to bear,
and in other cases, patients flee their families. In either case, the
alternatives are grim.
Yes,
serious engagement to research on the part of the clinician and the
patient, so hopefully we can avoid the serious engagement of research on
part of politicians, lawmakers and lawyers; correct? The voluntary
outpatient has rights - we still qualify under 'consent of the
governed.'
"Stop pretending that chemistry is the sole and singular way forward." This is at the heart of your critique of Thomas Insel, who directed the National Institute of Mental Illness from 2002 to 2015. Can you explain your argument? And what approach would you recommend its current director, Joshua Gordon, take?
"Thomas
Insel is busy promoting his new book, which carries the odd title of
"Healing: Our Path from Mental Illness to Mental Health." It is a
curious endeavor, given that his 13 years in charge of the nation's
mental health research produced such uniformly dismal results. That's
not my opinion. It's his.
Yes, their new books... mhmm *folds arms*
"When
Insel stepped down as director of NIMH in 2015 he gave an interview
about his accomplishments, after spending by his estimate $20 billion.
"I spent 13 years at NIMH really pushing on the neuroscience and
genetics of mental disorders, and when I look back on that ... I don't
think we moved the needle in reducing suicide, reducing
hospitalizations, improving recovery for the tens of millions of people
who have mental illness."
What
an interesting place for an ellipses. I contacted the Department of
Homeland Security when someone committed suicide in a second-to-last
ditch effort to make CERTAIN people wake up! It didn't do anything. I
had to take it to the Internet to make it calm down. I had to make my
PERSONAL problems PUBLIC to even try to get anything done. Dontcha think
that's a bit much to ask? And wow - 20 billion dollars would pay for a
lot of independent housing and work training.
"Karla
Finocchio, 55, tears up as she talks about being a homeless woman on
the streets, Monday, Jan. 24, 2022, in Phoenix. Finocchio is one face of
America's graying homeless population, a rapidly expanding group of
destitute and desperate people 50 and older suddenly without a permanent
home after a job loss, divorce, family death or health crisis during a
pandemic.
"Actually, the situation is even worse than this
implies. People with serious mental illness live, on average, 15 to 25
years less than the rest of us, and that gap seems to be widening, not
narrowing. While genetics and neuroscience have flourished within the
confines of universities, their therapeutic payoff has been minimal or
nonexistent.
Yes, the entire community, city, county, so forth appears to survive 15-25 less years.
"I'm
a sociologist, so you may think I'm biased. Perhaps I am, but in my
judgment, Insel's fixation on biology and biology alone has been a
profound error. It threatens to undermine the prospects for progress in
the mental health arena.
Mhmm... *folds arms*
"Unfortunately,
it is the same approach that seems to dominate the thinking and
priorities of his successor at NIMH, Joshua Gordon. Gordon is a
neuroscientist whose own work, focused on neural activity in mice, and
his appointment indicates that the federal research enterprise will
double down on neuroscience and genetics.
Yes, if the poor are to survive we are often referred to as 'a mouse.' Mhmm...
"That's a lot of time and money with little to show for it. Surely other voices are calling for a new approach.
Mhmm...
"Increasing
numbers of psychiatrists, particularly those now entering the
profession, are beginning to voice their discontent and dismay with the
direction the profession has taken over the last four decades. That may
prove a more potent source of pressure to change current priorities. But
within academic psychiatry, as opposed to clinicians who work in the
trenches, change is likely to prove harder to come by.
Clinicians
are clinicians. They are the they at this point for me. Whether they
work in an office, in the trenches, behind a computer (esp. in this
Covid age), whether they claim to work for the system, or against it.
Are you saying you want the patient to risk our freedoms to clearly
specify who or what the problem is? Sounds like baiting to me.
"Careers
in academic medicine are built on grant moneys and publications, and
those have dried up for psychosocial research. It would take a brave
psychiatrist to push against the status quo when the money and prestige
that medical school administrators crave and rewards continue to flow
toward scientists trying to find a biological link to the disease.
Perhaps we shall at some point see the breakthroughs these folks have
been promising us for years. Or perhaps these are once more soon-to-be
dishonored promissory notes.
Or
we leave it to the patient to risk themselves to figure out. They mock
the patient - oh, the patient is arguing that getting everything they
ever wanted is bad. No, I am arguing over getting a blatant mockery and
bastardization of what was NEEDED. So perhaps I should mock right back?
Or am I going to be put away for that?
"Your book,
"Desperate Remedies," focuses on the psychiatric profession, but we all
bear responsibility. Despite the prevalence of mental illness, it still
lies in the shadows, marginalized and stigmatized. What are we so afraid
of? Why is it so difficult to acknowledge and so easy to ignore?
Yes,
more references to books you will make a profit from. I have not found
mental illness that it is easily ignored. There is another person trying
to take a stand about the mental health system in my little city. They
recorded their interactions. I darn well know people aren't level-headed
enough to listen because they start watching their videos with the
mindset that this person is crazy. If taken out of the context that they
are crazy instead of taking the crazy's words out of context, the
videos reveal the patient was NOT in the wrong. And
neither am I.
"Mental illness haunts us, frightens us,
and fascinates us. Its depredations are the source of immense suffering
and not just for the mental patient. The havoc caused by depression,
mania, and schizophrenia extends its tentacles to the family of the
sufferer, and usually to the community at large.
De-predations? Wow - a very vague word considering some of the schools of thought used in modern psychotherapy.
"Mental
illness challenges our assumption that we share a commonsense universe.
It injects uncertainty and often menace into our lives. It threatens on
both a symbolic and a practical level the fabric of the social order.
It is incomprehensible, and deeply disturbing, and we tend to respond by
avoiding and stigmatizing those who suffer from it.
I agree with the last 13 words.
"That
stigma adds to the pain of those experiencing mental disturbances,
often renders family members silent, and even extends its reach to those
who claim to treat it. Psychiatrists are among the least respected
medical professionals, and shrinks are a routine target of jokes about
their competence and even their own mental stability.
At
this point, I doubt it is the stigma or of being branded with mental
illness that makes my family silent. It is not the judgment of the
common man that makes that stigma so terrible, it's the judgment of
people like you.
"These attitudes are deep-seated and
hard to erase. The problems they create are exacerbated by how
pernicious mental illness is. The needs of people with mental illness
are great, but in the competition for public resources, they are poor
advocates for themselves, and the plight of their families generates
only token sympathy from many. In the competition for resources, they
are heavily handicapped, and in hard times, mental health budgets are
routinely targeted for cuts.
Mhmm...
"Research,
searching for the cause of mental illness, is often divided by the
nature-versus-nurture debate: Either we are born with a predisposition
for the disease, or is it acquired in the course of private trauma. You
recommend that we abandon these lines of inquiry. Why?
Or powerful versus powerless debate. Or abuser versus abused debate.
"I'm
convinced that madness cannot be divorced from the cultural, social,
and psychological matrix within which human beings exist. To deny that
social and psychological factors play a major role in the genesis and
course of mental illness is to blind ourselves to a mountain of
evidence, epidemiological and otherwise, that teaches us that the
environment powerfully matters.
It also cannot be divorced from ethics or policy...
"Treating
the biological and the social as separate entities is profoundly
misguided. To an extent unparalleled in any other part of the animal
kingdom, humans' brains continue to develop post-natally in ways heavily
conditioned by the environment. Culture and society, on both a grand
and a microscopic scale, interact powerfully with our lifestyle choices
and our biology, and the physical structure and functioning of our
brains are shaped by psychosocial and other sensory inputs. Human
neuroplasticity extends far beyond childhood.
Mhmm *fold arms*
"To
think of the brain as an asocial or pre-social organ is thus deeply
mistaken. So too is the crude parallel notion that mental illness - the
breakdown of our cognitive and emotional life - is just brain disease.
That said, I would be astonished if it turns out that biology has no
role to play in the origins of many major forms of mental illness. To
dismiss any role for biological factors is to don a different set of
blinkers. One self-imposed blindness is as bad as the other.
Yes, self-imposed blindness is bad.
"The
treatment of mental illness has often been worse than the disease. Is
this the case of best intentions going tragically awry? Why do you
suppose psychiatry's attempts to cure mental illness have been so
lacking in humanity?
No,
this isn't a case of best intentions gone awry - this is the case of the
worst intentions going awry; there is a big difference. And for the
second question, well, you said it.
"Mental
illness has forced psychiatry to wrestle with profoundly difficult
matters. As my history shows, the intractable nature of the disease and
the desperation of the afflicted has often proved a toxic combination,
an invitation to therapeutic experimentation and excess.
I
have not seen the clinician, and yes that is the word I will use until
it is safe for me to post names, wrestle with anything except a patient.
From my observation, they are self-important and feel the need to be
viewed as Gods. As for the
second sentence, you said it.
"It is true many treatments added to the suffering of the mentally ill. Compulsory sterilization; removal of teeth, tonsils and internal organs to eliminate the infections that were allegedly poisoning their brains; inducing life-threatening comas with injections of insulin; subjecting them to multiple episodes of electroshock treatments day after day till they were dazed, incontinent, and unable to walk or feed themselves; damaging the frontal lobes of the brain, either with an instrument resembling a butter-knife or by using a hammer to insert an icepick through the eye socket and sever brain tissue: these were unambiguously, horrendous interventions.
This
paragraph must explain my MRI and how these clinicians don't give two
shits about it; correct? And what about things that cannot be photographed? Or
that can and cannot go through spectral analysis to prove? What about
the underhanded things clinicians do that cause permanent psychological
damage that aren't so straightforward?
"The
antipsychotics and antidepressants that have come to dominate
psychiatric practice since the mid-1950s are a more complex matter.
These drugs are no psychiatric penicillin. For some sufferers, they
provide a measure of symptomatic relief - and we need to acknowledge
that - but at the same time we should be clear-eyed and not exaggerate
their value.
So that
explains why an antidepressant that worked extremely effectively for 20
years suddenly and out of blue stop being effective causing withdrawal
symptoms with a new refill? And what about the wordplay of the name of
that prescription and what I'm doing now?
"While
we do not have cures for diabetes or AIDS, we have managed to turn
those afflictions into manageable diseases, but our pharmaceutical
treatments for mental illness are nowhere near this effective.
Meanwhile, the big drug companies, having made a fortune from
antipsychotic drugs, and ruthlessly marketing them while concealing
their drawbacks, have abandoned any attempt to develop new and improved
chemical remedies. Prospects on this front, I regret to say, seem dismal
at present.
Hm, see my previous comment.
"After nearly 50 years studying mental illness and following these trends, what hope can you offer us?
"Hope, in my opinion, is not yet in sight. Before we get there, we need to take a few steps.
Mhmm. *folds arms*
"First,
I think psychiatry has to be more honest about its limitations and not
treat biology as the primary cause and recognize the social dimension of
mental illness. It needs to stop chasing magic bullets.
Yes, bullets are bad.
"Second,
states and the federal government must recommit to providing the
services that mental hospitals once offered: shelter, food, clothing and
some semblance of social support. We need our political system to act
appropriately rather than have politicians wash their hands of the
situation.
MHMM... *FOLDS ARMS*
"Third,
we have to rethink mental illness and accord a high priority not just
to those with mental illness, but those who are incapable of providing
for themselves. The depth of pain and suffering they experience is
almost unimaginable, and we should be making serious efforts alleviating
problems for them and the families.
Yes, SERIOUS efforts - not some bastardisation or locking of horns.
"Finally,
we need to be cautious and properly skeptical when we hear of the
latest claims of major breakthroughs in this field. There have been far
too many false dawns. Madness refuses to bend itself to the rule of
reason. It is nonetheless a riddle we must continue to strive to solve.
The misery and suffering mental illness brings in its wake demand
nothing less of us."
