By Marvin Ross
Covid highlighted this problem but it is more extensive than just covid as those of us working in serious mental illness know all too well. A recent survey in the US found that about 75% of doctors surveyed felt that misinformation negatively impacted their ability to treat patients and negatively impacted their patient outcomes. But its not just covid. Almost 70% said that misinformation is common in weight loss, dietary supplements, mental health and vaccines in general.
A significant source of this misinformation comes from doctors themselves and other docs think they should be quickly disciplined. There are MDs who deny that covid is a serious problem or that vaccines are necessary and there are MDs who argue against the need for psychiatric medication.
Why some doctors take this contrary approach is difficult to comprehend but there is the old joke that asks what do you call the student who graduated last in his/her medical school. The answer is doctor. Medicine is highly complex and not everyone knows all there is to know about everything which is why there is specialization. A family doctor once told me that he likes family medicine because he enjoys knowing a small amount about many aspects of the profession. For complex issues, patients are sent to those who specialize in that area and have taken an extra 4-6 years of study and apprenticeship and then passed rigorous exams.
The key question we should ask when it comes to disease causes and best treatments is who is to be believed – the health store clerk, the internet, other media, MDs in opposition to main stream science or trained competent medical staff.
Now, I had intended to write a review of Dr Jeffrey Lieberman’s new book called Malady of the Mind Schizophrenia and the Path to Prevention which I will discuss in a minute but I got sidetracked by the survey mentioned above. Then I got further sidetracked by my friend Lembi Buchanan in Victoria whose book, An Accidental Advocate, is soon to be released. Lembi is a fierce advocate who spent years fighting the Canada Revenue Agency to get serious mental illness recognized as a legitimate disability deduction equal to physical disabilities. She won and the book describes that battle as well as being a touching love story and a revealing look at bipolar disorder as her husband suffers with that disease.
Lembi sent me an e-mail to say she had permission from Kay Redfield Jamison to include quotes from her personal memoir on bipolar disorder An Unquiet Mind. She then mentioned that Dr Gabor Mate, in his most recent book, speaks highly of Jamison’s book but states that her “gorgeously rendered recollections are faulty assumptions that exemplify the simplistic genetic narrative to which psychiatry still clings.” He goes on to say that “today we know that the hard, scientific evidence is not only not compelling; it is nearly nonexistent.”
Dr Jamison has a PhD in psychology and is a professor of psychiatry and Behavioral Sciences at Johns Hopkins and was named by Time Magazine as a Hero of Medicine.
In case you’re not familiar with Mate he is a Vancouver based family doctor who has popularized the idea through his books for the lay public and lectures that trauma is at the cause of addictions and mental illness. Earlier this year, he live streamed an interview with Prince Harry and diagnosed him with PTSD, ADHD, anxiety and depression. This is rather unorthodox and some have criticized him for doing so as experts do not believe you can diagnose ADHD from someone’s life story.
“An accurate and well-rounded ADHD diagnosis is a complex, multi-step process including a clinical interview, a medical history review, and the completion of normed rating scales by loved ones, educators, and/or colleagues,” says Thomas E. Brown, Ph.D., a clinical psychologist who served on the clinical faculty of the Yale School of Medicine for 21 years and has published six books on ADHD.
Trauma can increase someone’s chances of developing ADHD but it does not cause it. “Research does tell us that ADHD is a condition that’s largely genetic and inherited and that it causes specific areas of the brain to be underdeveloped or otherwise impacted,” says Nicole M. Brown, M.D., MPH, MHS, a general pediatrician and health services researcher and Chief Health Officer of Strong Children Wellness Medical Group in New York.
The role that genetics plays in causing diseases is very complicated as one gene alone is often not the culprit as Dr Jeffrey Lieberman explains in his most recent book Malady of the Mind. Lieberman is the author of Shrinks – the Untold Story of Psychiatry that I reviewed a few years ago. He is a professor of psychiatry at Columbia and a prolific researcher into the neuroscience and pharmacology of psychosis and headed up the the largest and longest independent study ever funded by the United States National Institute of Mental Health to examine existing pharmacotherapies for schizophrenia called the CATIE Trial.
Lieberman’s book contains just about everything you could want to know about schizophrenia but I’ll just focus on genetics. The standard criticism from those like Mate is that no one has found the gene responsible so a genetic explanation can’t hold. Lieberman counters that we know that diabetes, hypertension, coronary artery disease and others have a genetic component but no one gene has been found. The cause of those conditions and mental illness is not monogenetic but polygenetic. These diseases are caused by multiple and sometimes hundreds of genes.
There are many types of genetic mutations with the most common being single nucleotide polymorphisms or SNP. These are the smallest and involve an error in a single base. Larger mutations involve a piece of DNA being removed (deletion) or added (insertions). These can cause a signal to a cell to stop it from doing what it is supposed to do or doing too much so that protein functions abnormally. The explanation for schizophrenia and mental illness shifts from asking what gene caused the condition to whether a vulnerable person inherited certain genes from parents or because there were certain mutations that came about spontaneously.
As geneticists learn more, the potential explanation goes from the simple (one gene) cause to the more complex cause of multiple errors in various genetic material. Because science has moved beyond the simple does not make genetic explanations wrong.
Who we should listen to is another problem or, as my mother used to say, “don’t believe everything everyone tells you”. The American psychologist and skeptic, James Coyne just provided an excellent example. He circulated an article by psychiatrist Awais Aftab on how Mad in America (MIA), the anti-psychiatry site founded by Robert Whitaker, reported on an article from JAMA Psychiatry. That article argues that psychiatry does not track success rates and that should be something that is done.
MIA translates that into stating that there is no proof whatsoever that psychiatry has any successful outcomes. Then they go even further to say that the treatments today are no better than lobotomies, insulin shock or even the moral treatment of the early 1800’s. If we lay readers want to check the original article, we can’t because it is behind a paywall.
I did have a bit of a chuckle when I read this as I ran into a similar issue with MIA over 10 years ago. They ran an article that quoted Dr Robert Zipurski and his research claiming that “decreases in brain tissue volumes are attributable to antipsychotic medication, substance abuse, and other secondary factors. The authors conclude that the majority of people with schizophrenia diagnoses have the potential to achieve long-term recovery.”
As I said in my commentary in the Huffington Post, I know Dr Zipurski and did not believe he would ever say that so I called him. What he actually said was that improvements are dependent on medication and that “for those who discontinue medication early, the relapse rate is up to 78 per cent compared to 0-12 per cent for those who remain on medication. but you can read the entire discussion here.
What is sad is that science and medicine should be about improving the lives of all of us and not a pissing match between egos.