Futurismic

A fascinating (if slightly grim and worrying) article at the New York Times by Ethan Watters suggests that Western psychiatry may be successfully homogenising the mental illnesses of the entire planet, thanks to aggressive programs designed to export “psychiatric literacy”. The intent was good, but the results may not be – as it seems that the expression and symptoms of mental illnesses around the world have changed to suit the blueprints brought by the white man..

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

[...]

Of course, we can become psychologically unhinged for many reasons that are common to all, like personal traumas, social upheavals or biochemical imbalances in our brains. Modern science has begun to reveal these causes. Whatever the trigger, however, the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession, semen loss or serotonin depletion, predict and shape the course of the illness in dramatic and often counterintuitive ways. In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. This does not mean that these illnesses and the pain associated with them are not real, or that sufferers deliberately shape their symptoms to fit a certain cultural niche. It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.

Well worth a read.

You’ve heard of the placebo effect, right? Well, apparently it’s becoming stronger, much to the chagrin of the pharmaceuticals industry who are finding that less drugs are passing clinical trials as a result:

MK-869 wasn’t the only highly anticipated medical breakthrough to be undone in recent years by the placebo effect. From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.

The upshot is fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmaceutical industry. Last November, a new type of gene therapy for Parkinson’s disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn’s disease, an intestinal ailment, citing an “unusually high” response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.

It’s not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late ’90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

You’ll not find me shedding many tears for Big Pharma, frankly; as pointed out in the rest of the article, their profit margins of the last few decades has been based on turning psychiatric treatments into mental cosmetics, and the increase in the placebo response may well be tied to their incredibly effective marketing procedures – by associating drug consumption with positive images of well-being, they’ve stimulated our response to all pills, regardless of their chemical make-up. Research is increasingly suggesting that one of the biggest prerequisites for getting better is simply a reasonable expectation that one actually will. [via BoingBoing]

I’ve got something of a personal stake in this, having seen far too many friends diagnosed with one form or another of psychiatric condition and promptly put on a regime of drugs that have shattered their personalities – and lives – permanently. I’m not denying the existence of mental illness, but I’m quite convinced that overdiagnosis is rife, with many drug-treatable “syndromes” being little more than completely natural phases of mental development or reasonable responses to environmental conditions which would respond far better to counselling and emotional support. Hence I was intrigued to read an article by medical anthropologist Eugenia Tsao [via @somatosphere], who recommends that members of her profession and others should start pushing back against the relentless attempts to pathologize (and hence monetize) our reactions to our social environment:

What is revealed about a society, in which drugs are touted with increasing regularity as a treatment of choice for entirely natural responses to conditions of unnatural stress? How have we been persuaded to equate such things as recalcitrant despair (“Dysthymic Disorder,” DSM-IV-TR 300.4), adolescent rebellion (“Oppositional Defiant Disorder,” DSM-IV-TR 313.81) and social apathy (“Schizoid Personality Disorder,” DSM-IV-TR 301.20) with aberrant brain chemistry and innate genetic susceptibilities rather than with the societal circumstances in which they arise? What does it mean when increasing numbers of people feel as though they have no choice but to self-medicate with dubious chemical substances in order to stay in school, stay motivated, stay employed, and stay financially solvent?

Anyone here remember an obscure industrial band called Consolidated? They had a lyric on their Business of Punishment album that went something like “they must remain sick / so we can continue to treat them”. [image by neur0nz]

Computer games, especially persistent MMOs like World of Warcraft, are highly addictive – or so we’re told, albeit principally by people with money to make from treating said addiction. Indeed, gaming addiction is such a potentially lucrative market debilitating social cancer that psychiatrists want to form their own guild and start treating WoW addicts within the framework of the game itself. [via TechDirt; image by jerine]

Yes, you read that correctly. Treating people for MMO addiction. In an MMO.

Dr Graham said that some players were so addicted to these massively multiplayer online games that they played them for up to 16 hours a day, leading them to neglect their social lives and education.

He has called on Blizzard Entertainment, the company that makes World of Warcraft, to waive or discount the costs associated with joining the game so that therapists can more easily communicate with at-risk players in their preferred environment.

“We will be launching this project by the end of the year. I think it’s already clear that psychiatrists will have to stay within the parameters of the game. They certainly wouldn’t be wandering around the game in white coats and would have to use the same characters available to other players,” said Dr Graham.

“Of course one problem we’re going to have to overcome is that while a psychiatrist may excel in what they do in the real world, they’re probably not going to be very good at playing World of Warcraft.

“We may have to work at that if we are going to get through to those who play this game for hours at end.

Now, forgive me if I’m wrong, but isn’t this more than a bit weird? If an expert in alcohol addiction started saying “well, we think we should start drinking in bars so we can really reach the people who need our services, and moreover the bar owners should let us drink for free. Granted, we don’t really have a taste for alcohol ourselves, but I’m sure we’ll pick it up eventually if it’s for the good of the patient,” they’d be discredited immediately, right?

I suspect the real story here is one of psychiatry quacks chasing the hard-to-win money of middle-class parents who don’t understand their kids and who think that there must be a treatable medical reason for that… which is a market that will probably never completely die off, sad to say.

“We have nothing to fear but fear itself!” President Franklin D. Roosevelt famously said (about the time he was enacting policies that may have lengthened the Great Depression, so he may have been wrong about that, but still, it’s a good quote).

But thanks to a team of Dutch researchers, led by Merel Kindt at the Universiteit van Amsterdam, we may not even have fear to fear in the future: using the beta-blocker propranolol they weakened the fear response and fear memories in human volunteers. Not only that, the fear did not return (Via EurekAlert):

Before fear memories are stored in the long-term memory, there is a temporary labile phase. During this phase, protein synthesis takes place that ‘records’ the memories. The traditional idea was that the memory is established after this phase and can, therefore, no longer be altered. However, this protein synthesis also occurs when memories are retrieved from the memory and so there is once again a labile phase at that moment. The researchers managed to successfully intervene in this phase.

During their experiments the researchers showed images of two different spiders to the human volunteers. One of the spider images was accompanied by a pain stimulus and the other was not. Eventually the human volunteers exhibited a startle response (fear) upon seeing the first spider without the pain stimulus being administered. The anxiety for this spider had therefore been acquired.

One day later the fear memory was reactivated, as a result of which the protein synthesis occurred again. Just before the reactivation, the human volunteers were administered the beta-blocker propranolol. On the third day it was found that the volunteers who had been administered propranolol no longer exhibited a fear response on seeing the spider, unlike the control group who had been administered a placebo. The group that had received propranolol but whose memory was not reactivated still exhibited a strong startle response.

The volunteers could still remember the association between the spider and pain stimulus, but it no longer elicited any emotional response. The researchers hope this work may lead to new treatments for patients with anxiety disorders.

Being the SFfish guy I am, I’m thinking more in terms of fearless super-soldiers, but I’m sure that’s just me.

(Interestingly, propranolol is already used by musicians and actors to deal with stage fright.)

(Image: Wikimedia Commons.)

[tags]drugs,medicine,psychiatry,psychology, pharmaceuticals, fear[/tags]

The recent hospitalization of a woman at the hands of her pet chimp has raised questions about the use of human psychiatric medicines in animals, after the victim’s initial (and now retracted) statement that the chimp had been given Xanax to control his agitation. Apparently it’s more common than I’d have expected:

As recently as the early 1990s, it was practically unheard of to treat animal behavior problems with drugs. Today it’s routine.

Prozac, for example, has been used in a few zoos to treat wild animals, including Johari, an adult female gorilla at Ohio’s Toledo Zoo that had been prone to violent fits.

But dogs and cats are by far the most common animals to be drugged to combat separation anxiety, obsessive-compulsive disorder, aggression, noise phobia, and other issues.

The majority of anti-anxiety medications given to animals are the same ones used for people, although in different doses.

There’s a whole ethical can of worms here, and the sensitivity of the subject is exacerbated by the closeness many pet owners have to their charges. The angle I’d tend to take is that I’m not entirely convinced that the drugs in question are the best solution to the problem in humans, let alone animals – psychiatric pharmacology has what appears to be an alarming obsession with treating the symptoms rather than the root causes, and pharmacology in general seems to promise cures when it can only deliver crude controls.

But even if we take the efficacy of anti-anxiety or anti-depressant drugs as a given, is it right to give them to animals? Who are we to judge their mental states as being in need of correction? I know for a fact that my mother – an animal owner and breeder since long before I was born – would be appalled at the idea of giving psychiatric drugs to animals to control their mood, as she would consider dysfunctional behaviour to be a direct result of poor training and care. [image by Phil Romans]

Furthermore, as George Dvorsky points out his responses to the article, it begs the question of whether we should own pets at all. I think most of us could agree that keeping a chimp as a pet is not just unethical but foolish, but what of dogs and cats? The more we understand about animal psychology, the trickier these questions become.