#10 : The scientific paradigm-shift in psychiatry.
THE SCIENCE OF PSYCHIATRY has proved so elusive for so long, that when the real thing finally arrived, in 1996, it got mislaid. If you or any of your immediate circle have ever wondered if psychiatrists were “fishing in the medical dark”, read what follows, to find out scientifically, that that’s the best they can currently do. Only those “brave enough to see it”, as Amanda Gordon’s invigorating verse puts it, can improve matters. So, before you close the page, check out the 2 minute video listed below. What happened with “Germ Theory”, 120 years ago this year, is being repeated again, only this time it’s our mental health that’s been pre-judged and ossified.
Microscopes had long shown the existence of microbes, but that didn’t prevent a leading expert in medical hygiene shooting himself, because he had got it so terribly wrong. Max von Pettenkofer drank a beaker of cholera contaminated water, and survived. He didn’t believe it would kill him, and it didn’t. His error was his inability to bring himself to accept what is now a public health commonplace – that reliable sewage disposal cures all cholera epidemics, 100%. You simply cannot get cholera if the sanitation is intact. That’s not controversial, it’s not subjective, no one disputes it, we all implement it, without a second thought. It’s what you might call highly scientific.
Today, exactly the same medical confidence and assurance is available to psychiatry, where it is desperately needed, if only opinion formers were brave enough. All that’s required is strict adherence to solid objective science. Sadly, medical policy continues to ignore concrete, readily reproducible scientific evidence that shows where all mental afflictions come from. The upshot is that, as a direct result, mental disease is even more rampant today, than cholera ever was.
Suppose you put a person in a brainscan machine, and could thereby learn more about what was going wrong with their mind, than what they could tell you themselves. Sounds unlikely – but that’s precisely what you can do, and have been able to do for 25 years. And just as anyone with a microscope can see the causative agents of cholera, so anyone with a brainscanner can highlight where mental dysfunction comes from – all mental dysfunction, that is. It doesn’t tell you how to put it right, but given concrete, irrefutable, objective evidence of what's so obviously gone wrong, it’s not difficult to work that out.
Once you see it, it’s blindingly obvious. But you do have to believe your eyes, which, as with Pettenkofer, is proving more difficult for leading medical experts that you’d have thought. So what is this 100% reliable brainscan? What can possibly cut across the unending cacophony that has afflicted psychiatry since long before Freud? Suppose you had a technique which worked everytime, with everyone, and did not depend on your preferred preconceptions about what the mind is, how consciousness works, nor where insanity comes from. Sounds unbelievable, and if you listen to most psychiatric experts, it is.
So when, in 1996, Dr Bessel van der Kolk, a Massachusetts’s psychiatrist, played audio tapes of the gun shot or car crash, or whatever had traumatised the person in his brainscan machine, he was surprised to find that their frontal lobes and speech centres stopped. Pause for a moment, to appreciate what this means. Here we have an individual, who functions perfectly well everywhere else, whose brain cells cooperate and deliver what they need to do – except when listening to audio evidence of a near life-or-death experience – when they don’t.
Now you don’t have to be an expert neurologist to know that if your frontal lobes and speech centre don’t work, then this stops you thinking and speaking – not about everything, but certainly about whatever it was that closed them down. Worse, if it’s the worst thing that has ever happened, then you are the last person to ask – you are simply unable to say. It’s not because you wouldn't want to, nor because you don’t like the person asking you – it’s because trauma has disabled the means you generally use to inform either yourself, or anyone else.
Is this really scientific? Is it objective? Is it really independent of any of your (or my) beliefs about what the mind is for, or does? There are so many schools of thought, so many different versions of why we cannot think straight – which leads to an infinite number of “therapies”, all competing to be better than the rest. Can it really be that a single, simple, brainscan test applies to every single one of them? Well, it sounds so unlikely, that it’s not been tried, nor put to the test. And until it is, we’ll continue to have even more controversy about insanity than ever there was with infections. When we needn’t.
If you want to know how medical practice can be turned upside down, as much of psychiatry is today, picture yourself, as a doctor, sitting in your clinic, when a patient walks in. Normally you expect them to tell you what's wrong i.e. what the symptoms are – this part doesn’t work, that bit is painful. And it’s your job as a doctor to work things out, and come up with an answer, or partial answer to what has brought that person to you at that time.
Start with that classic of all medical challenges – the Acute Abdominal Emergency. You start by taking a careful history. Like my favourite clinician put it – Listen to the patient, s/he’s telling you the diagnosis (William Osler). You take careful note of where the pain first started, where it moved to, whether it comes in waves, or is constant – all tricky stuff, and suitably challenging. It could be appendicitis, a burst ulcer, gall stones. Get it wrong, and lives are in danger. And all this is totally dependent on the patient talking, telling you, describing in as much detail as they can, what it feels like from the inside. Without this solid, verbal data, the diagnosing goes haywire, and with it, the prognosis.
So far, so good. Now picture the same scene, only this time the patient is unable to talk straight, they are preoccupied, and unable to come clean. In reality, they are just too ashamed to admit anything remotely resembling a “tummy ache”. Worse, what if s/he was too terrified to describe what the abdominal pains were really like – s/he had had such bad experiences in the past, that now s/he couldn’t put two and two together, couldn’t talk coherently about the symptoms, if at all. Without TALK, you're stymied. Vets would have a better chance. You need TALK to learn what's wrong, else you’re fishing in the medical dark.
Now this is exactly what Dr van der Kolk brainscans show to be the case – not everywhere, not all the time – only when the past trauma was on a life-or-death scale. But when it is, you can neither think nor speak about it. He called this SPEECHLESS-TERROR – and it is. In 1901, there was obvious microscopic evidence of cholera’s existence, though it was still invisible to the naked eye, and to the person in the street or clinic. Here we have speechless-terror, just as difficult to visualise in clinical practice either to clinician or sufferer, without suitable training or equipment.
Now if these brainscans tell us one thing, it is that trauma paralyses cognition, and with that, all sensible TALK. If you step back a minute, you can see that people thus afflicted, fill the gap with all the astonishing things that orthodox psychiatry floridly documents – voices, hallucinations, depressions, ADHD, paranoia – endless symptoms, limited only by the human imagination. What those suffering from this medley cannot tell you, at least not at first, is that dad raped them, or mum died, or some other life-or-death event from long ago. Until psychiatrists put two and two together, the prospect will remain just as cloudy as too many non-psychiatrists keep telling us it is.
For the first time ever, this objective brainscan evidence brings a coherence, a rationale to psychiatry that has never been there before. All the contradictory theories which currently muddy the field, arise because the sufferer cannot tell you what is really going on – a fact which arises solely because of the speechless-terror, which imposes this speechlessness, 100%.
The beauty of this approach is, that if you can once gain the sufferer’s trust, their confidence, then they can begin (ever so gingerly at first), to verbalise. Once they can do that, then they can put the rape, the abandonment, the rejection, the violence, whatever the violation was, put it all the way back into the past where it came from, and deserves to remain. Only then does the speechless-terror abate. But not before.
And here’s the medical punch line. Just as you cannot get cholera if the sanitation is intact, so you cannot remain mentally ill, once speechless-terror relents – worth looking into, at the very least, wouldn't you say? Amanda Gordon has been trying to tell us something – but how many are listening? These 2 minutes of video could change how we look at mental health, for the better – why not check them out? When enough do, we can avoid being stuck indefinitely, in the equivalent of the Germ Theory – a controversy without end.
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Dr Bessel van der Kolk is at https://www.youtube.com/watch?v=53RX2ESIqsM
The 2 minutes run from minute 22 to minute 24. (Dr van der Kolk didn’t know how to put it right – that takes us on to the next topic.)
Further reading at http://www.davidpublisher.com/Public/uploads/Contribute/5f7fbbfa4e4ce.pdf
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MEDICAL NOTE – at one level this is just as simple as it sounds. At another, it involves life-or-death emotions – which is why it all gets so gummed up. So you need to be extra careful when discussing these points with people who might have similar, deeply buried problems. IF IN DOUBT, DON’T. Life-or-death could mean yours.
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MEDICAL NOTE – never stop psychiatric drugs abruptly – seek expert help – see next post when it comes. I’m happy to answer Qs & As (if slowly), but can no longer discuss individual cases, I closed my clinic when I retired.
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NOTE These posts are a new venture for me. I’ll aim for at least twice monthly. If you like what I write, please encourage me by responding, all but the latest will be free. You can always read the academic background to it all, free, by clicking The Simple Science of Sanity. Thanx.
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