The Americanization of Mental Health Care

Crazy Like Us: The Globalization of the American Psyche

By Ethan Watters

Scribe Publication (2010)

Book Review

This book concerns the imposition of American mental health standards across the entire world, including indigenous and Third World cultures. According to Watters, this approach assumes human beings suffer from universal emotional disturbances that are unaffected by cultural beliefs and should be treated “scientifically” like medical conditions. It also advocates the best way to achieve “mental health” is to throw off traditional cultural and social roles and engage in individualist introspection like Americans do.

Watters divides the book into five sections: the first concerns the global commodification of anorexia, the second the global commodification of post traumatic stress disorder; the third the distinctly different presentation, management and outcome of schizophrenia in Zanzibar and other African countries; and the the fourth the corporate marketing of “clinical depression” and serotonin reuptake inhibitors (SSRIs) in Japan.

Part 1 mainly looks at the changing presentation of anorexia nervosa since the first case report in 1823. Back then anorexics were low income with somatic fixations of fullness and pain in the upper abdomen. During the 19th century, distressed middle class women were more likely to present psychiatrists with psychosomatic conditions, such as hysterical blindness or paralysis.

Owing to a complex  process Watters refers to as “symptom negotiation,” women presented with these conditions because psychiatrists recognized them as symptomatic of emotional distress. After World War II, it became more acceptable for women to acknowledge feelings of depression and anxiety and and diagnoses of hysteria became exceedingly rare.

Rare in Hong Kong prior to 2000, anorexia diagnoses followed the original European pattern and were limited to low income women complaining of abdominal discomfort. Thanks to the growing influence of Western media, more recently Hong Kong anorexics present a more Western pattern involving distorted body image and a fatal obsession to be as thin as glamorous Western models and movie stars.

Part 2 mainly looks at the army of Western traumatologists who have descended on every global trauma side since the 2005 tsunami in Sri Lanka. The result has been rowing evidence that, contrary to popular belief, early psychological intervention does not prevent the development of later PTSD. Watters is critical of professionals who fail to recognize that PTSD is a distinctly American and individualist way of suffering for  society that has almost completely lost natural social mechanisms for coping with tragedy.

Part 3 looks at the the tendency in Zanzibar (and other African countries) to regard symptoms of schizophrenia* as evidence of spirit possession. The effect of this approach is to keep the so-called “schizophrenic” within their natural social group, rather than excommunicating them, as occurs in the West. This consistently results in a far better treatment outcome.

Overall African societies are more tolerant of community members who display psychotic symptoms. In African societies an external locus of control leads people translates into the common belief that people can control their problems only with support. In contrast most Western societies favor an internal locus of control, which tends to blame individual patients for their problems.

Part 4 looks at the big spike in suicides (more than 30,000 per year) in Japan during their brutal 1990s recession. Traditionally Japanese culture has long supported the philosophical belief that suicide is a perfectly sane and legitimate act of personal will. However thanks to a massive marketing campaign Glaxo Smith Klein (manufacturer of the SSRI Paxil), the Japanese were trained to link suicidal thoughts and personal suffering with clinical depression and seek Paxil prescriptions.

This, despite three decades of outcome studies showing Paxil is no better than placebo in alleviating depression and increases suicide risk in adolescents.

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*Schizophrenia is a condition characterized by delusions, hallucinations, disorganized speech or behavior and flat affect.

Pill Pushers in Suits: The Addition Potential of Psychotropic Medication

 

Overpill: The Darker Side of America’s Mental Health

RT (2017)

Film Review

Overpill is a documentary based on the investigation of a Russian-born accountant into the massive overprescription of psychotropic drugs (medications for depression, schizophrenia, bipolar disorder and ADHD) in the US. He became aware of the issue while working for Health Care Communications, a company that markets prescription drugs to Americans for ordinary problems of living. He undertook this investigation after becoming romantically involved with a woman who was addicted to antidepressants and antispsychotics while, despite experiencing horrendous side effects.

The film features extended interviews with former patients who got their lives back after the excruciating ordeal of weaning themselves off medication, with others still struggling with side effects while weaning themselves off, with a malpractice attorney who represents patients experiencing permanent and painful psychotropic complications and Dr Peter Breggin, a controversial American psychiatrist and outspoken critic of the overuse of psychotropic medication.

Both men are alarmed by the deliberate effort by pharmaceutical companies to conceal the addictive potential of antidepressants and antipsychotics, as well as studies showing these drugs can permanently alter the submicroscopic architecture of the brain. This is of special concern with the growing number of psychotropics prescribed in children with developing brains. There are virtually no studies of the long term effect of these drugs in either adults or children.

While the film acknowledges that psychotropic medication can be literally life-saving in some patients with severe mental illness, it rightly points out there are far too many cases in which they’re being inappropriately prescribed.

As a class psychotropic drugs (which are heavily marketed to consumers), are the third most profitable for the pharmaceutical industry.

 

The Care and Feeding of Gut Bacteria

The Diet Myth: The Real Science Behind What We Eat

by Tim Spector

Weidenfeld and Nicholson (2015)

Book Review

The Diet Myth is all about looking after our intestinal bacteria – which are ultimately responsible for the proper functioning of our digestive, immune, endocrine and nervous system. As Professor Tim Spector explains, all mammals co-evolved over millions of years with the bacteria that inhabit their intestines. Because these bacteria produce a number of vital biochemicals that our bodies are genetically incapable of producing, without them the species homo sapiens would not exist. This relatively recent discovery has led many scientists to classify the microbiome (the collective name given to gut bacteria) as a vital organ like the brain, liver or kidneys.

Civilization hasn’t been kind to our intestinal bacteria. For various reasons (overuse of antibiotics, processed foods and pesticides like Roundup), urban life has caused us to lose half of the septillions of gut bacteria we started out with. Nearly all the chronic illnesses that plague modern society (obesity, heart disease, stroke, diabetes, cancer, autoimmune disease, depression, autism, schizophrenia and possibly drug addiction and alcoholism) can be traced to loss or malfunction of intestinal bacteria.

For this book, Spector has chosen to focus on dietary research into foods that improve the health and diversity of our remaining gut bacteria. He blames the myriad of contradictory diet fads on the reality that each human being has their own distinct collection of bacteria. This means the foods that keep them healthy depend on the preferences of their particular bacteria.

Fortunately he’s able to make a few general recommendations that seem to apply to most people.

According to Spector, people with the most diverse profile of gut bacteria are the healthiest. The best way to promote this diversity is through a diverse fiber-rich diet that includes:

• At least 20 different food types per week
• A daily serving of 5 vegetables and 2 fruits
• Daily servings of probiotic foods (fermented foods, such as yogurt, sauerkraut and miso, raw milk and unpasteurized cheeses) that contain beneficial bacteria.*
• Daily servings of prebiotic foods rich in polyphenols that gut bacteria love**
• A strict limitation on red meat,*** sugar, refined carbohydrates, transfats (hydrogenated fats found in vegetable oils, margarine and Crisco) and processed foods

Research also indicates that lifestyle factors such as exercise (athletes have the most diverse microbiomes) also promote bacterial diversity (and good health). As does episodic fasting.****

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*These mainly provide different strains of lactobacillus and bifidobacteria that crowd out harmful inflammatory gut bacteria.

**Foods rich in polyphenols include dark chocolate, coffee, green tea, turmeric, red wine, onions, garlic, (uncooked) extra-virgin olive oil, roasted nuts, Jerusalem artichokes, chicory root, leeks, asparagus, broccoli, bananas, wheat bran and fermented fruits and vegetables.

***Citing numerous studies, Spector totally debunks the claim that red meat is harmful due to its fat content. He maintains the risk associated with red meat is the conversion (by gut microbes) of L-carnitine to trimethylamine oxide, which causes plaque build-up in arteries (in Europeans – this effect appears to be absent in other ethnic groups). He recommends that Europeans limit their intake of red meat to ½ serving or less per day. Those who eat more than this have a 10% increase in mortality. Those who eat one daily serving or more of processed meat (sausages, ham, salami, etc) have a 40% increase in mortality.

****When people fast, a gut organism caused Akkermansia cleans up gut inflammation by feeding off the intestinal lining. Research reveals specific benefit from the 5/2 diet in which people fast two days a week and eat normally the other five.

Is Schizophrenia an Inflammatory Illness?

The Madness of Adam and Even: How Schizophrenia Shaped Humanity

by David Horrobin (2001 Bantam Press)

Book Review

The Madness of Adam and Eve advances a dual hypothesis: 1) that schizophrenia is a whole body disorder, rather than a “brain disease, as promoted by Big Pharma and the psychiatric fraternity and 2) that schizophrenia stems from the same series of genetic mutations that led to the appearance of the human species (homo sapiens) 100,000 years ago.

The specific biochemical “error” Horrobin credits for causing schizophrenia is a defect in the metabolism of arachidonic acid (AA), a fatty acid that facilitates smooth signal transmission between nerve endings. Horobin believes a genetic mutation around 100,000 years ago caused a massive increase in AA production, enabling a giant increase in dendritic connections between neurons. This, in turn, resulted in a sudden explosion in human intellectual capacity, as well as the sudden appearance of art, music and organized religion.

Horribin also maintains that schizophrenia was a relatively mild illness in hunter gatherer societies, owing to a diet rich in the omega 3 fatty acids essential for optiminal brain function. With the major dietary changes that accompanied the agricultural and industrial revolution, schizophrenia has become much more severe. The switch from omega 3 and omega 6 fatty acids to saturated animal fat was by far the most significant, as saturated fats can suppress the uptake and utilization of omega 3 fatty acids.

Horrobin’s hypothesis is born out by WHO research revealing that schizophrenia is more severe in the industrialized west, studies showing that schizophrenics improve when given large doses of the omega 3 fatty acid EPA, and the failure of schizophrenics to experience a “niacin blush”* when exposed to megadoses of niacin.

Aimed at a lay audience, The Madness of Adam and Eve doesn’t always distinguish clearly between theory and established fact. While Horribin’s ideas make an important contribution to the understanding of mental illness, his overemphasis on genetic determinism in the origin of mental illness is clearly dated. In 2002, the field of epigenetics** was still in its infancy and there was limited understanding of the role of noxious prenatal influences on gene expression and the development of chronic physical and mental illnesses. Nor was the role of harmful intestinal bacteria and endotoxin-related inflammation recognized in the etiology of autism, schizophrenia and depression.

His portrayal of the intellectual inferiority of Homo neanderthalensis (Neanderthal man) is also obsolete. More recent archeological evidence suggests that Neanderthal man was the intellectual equal of homo sapiens.

*A niacin flush is sudden reddening and burning of the skin caused when niacin promotes conversion of AA to the inflammatory peptide prostaglandin. Several researchers have proposed using a niacin skin test as a research tool in studying schizophrenia.

**Epignetics is the study of hormonal and other prenatal influence that affect the expression of genes as specific protein enzymes.

When Horrobin died in 2003, the British Medical Journal wrote a particularly nasty obituary describing him as “the greatest snake oil salesman of his age.” A decade of research into the beneficial role of omega 3 oil in the treatment of depression (particularly post natal depression, bipolar illness, schizophrenia and premenstrual syndrome) has clearly vindicated him. The supplementation of prescription psychotropics with omega 3 oils is now standard psychiatric practice. 

Research into his theory that schizophrenia is a whole body inflammatory illness, rather than a brain disease, is also advancing. More recent studies focus on inflammation caused by endotoxin-producing by gram negative intestinal bacteria. Thus far schizophrenics’ demonstrated impairment in prostaglandin synthesis has failed to translate into viable treatment options.

There have been numerous studies suggesting a beneficial effect of non steroidal anti-inflammatory (NSAID) medication (such as ibuprofen and naprosyn) in the treatment of schizophrenia. Unfortunately NSAIDs, like psychotropics, have numerous serious side effects, including peptic ulcer disease and reduced kidney function.