Why The Brain Disease Model Doesn’t Work In PAEDIATRICS Either.Why The Brain Disease Model Doesn’t Work In PAEDIATRICS Either.

A chapter in a forthcoming book, aiming to dethrone the current psychiatric hegemony

Why The Brain Disease Model Doesn’t Work In PAEDIATRICS Either.

By Professor Bob Johnson,

Copyright (c) 2022. All rights retained.

Dept of Education & Psychology, University of Bolton, BL3 5AB, UK.

MRCPsych MRCGP MA (Psychol), PhD(med computing), MBCS, DPM, MRCS

GMC speciality register for psychiatry – reg. num. 0400150

~~~o0o~~~

Chapter 5. in CRITIQUING THE MENTAL DISORDERS OF CHILDHOOD: Deconstructing ADHD, Autism, and the Psychiatric Paradigm of Childhood Mental Illness. Published by The Ethics International Press Critical Psychology and Critical Psychiatry Series https://ethicspress.com/pages/the-ethics-international-press-critical-psychology-and-critical-psychiatry-series

~~~o0o~~~

This chapter has four sections – (1) A Non-Verbal Scream; (2) Children Die From “Emotional Deprivation” For Reasons The Brain Disease Model Cannot Explain; (3) Hitler Verbalises His Own Psychopathy; & (4) The Deep MEDICAL Flaws In The Brain Disease Model.

~~~o0o~~~

1 – A ‘Non-Verbal’ Scream

As a family doctor, which I was for 20 years, you see a little bit of everything, sprinkled among a flood of the commonplace. So one morning, I’m sitting in my consulting room, wondering what to expect next, when in walks a short man with whose chest problems I was already well familiar. Chronic bronchitis featured regularly in my north of England medical practice, so I knew him of old. This time, however, he surprised me. He brought with him, not his breathing troubles, but his 6 year old grandson. Chest problems he could understand, but “Freddie”, as I shall call the little lad, had him foxed. And exhausted. “He’s up at 6 in the morning, and he won‘t go to bed before midnight – he’s wearing us to a frazzle. You must send him on to the hospital clinic, and soon”. Most children are well supplied with energy – but this was hyperactivity, and it was having a predictable and detrimental effect on the health of the whole family. As their family doctor, it fell to me to resolve it.

Happily this episode occurred a decade before the American Psychiatric Association had queered the medical pitch in 1980, with the third edition of their Diagnostic And Statistical Manual Of Mental Disorders (DSM-III), and Ritalin had never been heard of. More, my first love had always been psychiatry, so this time in general medicine on my part was but a detour in my medical ambitions. Accordingly, I had organised special appointments after my Wednesday morning sessions, where I could take my time, and meander through alternative pathways, hoping always to uncover where mental afflictions came from, and, if possible, how to remit them.

Since I was in sole charge of what happened in that small branch of the NHS, I took it upon myself to see what I could learn from this 6-year-old Freddie. I therefore managed to persuade a stressed grandad to let me speak to his troublesome grandson, in a session or two, before, of course, packing him off to the hospital. General practitioners are primary physicians, who were meant to act as filters and gatekeepers for the hospital or secondary service.

Both Freddie and his grandad agreed. So the next Wednesday morning, I sat alone with the little lad, and discussed what life was like for him – what he enjoyed, what he didn’t, and in general, getting to know more about him than you could in a brief medical consultation with anxious relatives overhearing every word. Now the other advantage of being a family doctor, was that I already knew the family background. He was the only child of a single mother, who was also a drug addict. She had recently overdosed on heroin, and died. These were facts that Freddie didn’t need to tell me – they were already there, in my knowledge of his family history.

The first Wednesday went well enough, so I asked him if he’d like to come again the following week. He said he would. We continued like this for a further two weeks. On the fourth session however, there was a marked change in his behaviour. Instead of joining in the dialogue, he was messing with the objects on my desk. I asked him what was different. “It’s over”, he said. Now I was the one to be foxed. “What do you mean?”, I asked him. “What’s over?” “You were the only one who told me that my mum wasn’t coming back”.

Bang – it all fell into place. Freddie’s hyperactivity was body-language for – “Where the Hell is Mum?” To a child, especially one with a single mother, there’s only one person in the world – the rest are hangers on. The whole infant-universe revolves around what that parent thinks, feels or does. Nothing else even comes close. Adults can generally fend for themselves – what to wear, what to eat, where to sleep – not so for 6-year-olds.

Without mum, your life-support system is kaput. You are bereft. At the mercy of whatever wind might blow you off course. And you know it. You may not be able to put it into words – but that doesn’t mean it doesn’t hurt. It’s agony. Only you can’t verbalise it. So you do the next best thing – you act it out, in whichever way comes to hand. In Freddie’s case, he powered through the house from dawn to midnight – not something he particularly wanted to do, but he could find no alternative.

Not only could he not verbalise – he couldn’t really see where the problem was coming from in the first place. In fact, the whole area of parental emotions was so fraught, it had become unfocussed. The more he thought about it, the worse the pain became – so he didn’t. Instead, he just rushed around – because that’s what he found he could most easily do.

Let’s look at how the Brain Disease Model (BDM) would handle Freddie. First – nothing would induce them to look at the surrounding context. Why bother? It doesn’t matter to Brain Disease orientated doctors what had triggered his overactivity. The last thing they think of is – “what is he trying to say?” The BDM view is that it all comes from within the brain – that’s to say from an adverse change in brain chemicals. What’s the point in asking questions? They don’t tell you which neurotransmitter is on the blink. Of course they don’t – and even if they did, it would be entirely secondary to the horrific circumstances in which Freddie suddenly found himself – something that to him, was utterly inexplicable.

Everyone, but especially doctors, should know that to a 6-year-old, what happens to parents plays a big, indeed the biggest role in the child’s life. Even as a medical student, my paediatric training included the redolent advice – “Pat the child on the head, and give the mother a sedative”. Not perhaps fully kosher nowadays, not with the benzo-horrors – but at least it was pointing in the right direction. Of course, with Freddie, there was no longer any mother around – and this was the root of his “psychiatric disease”. Such a perversion of medical thinking makes my blood boil.

And here we have the down-side of the Ritalin epidemic. The child’s behaviour is off beam – so you want to stop him or her behaving? What a travesty. “I can’t handle my child – please zombify him or her”. This is medical thinking for goats. Why can’t the medical profession appreciate that parenting is one of the most challenging occupations in the world – especially if your first exposure to it, in your own infancy, was not up to scratch. No, what anxious parents need is guidance, emotional support, explanations as to what is really going on underneath – then both parties will be satisfied. They will also be happier, not to say healthier. “A pill for every ill” – what rot.

Children of whatever age are people. Fancy having to put that in writing. BDM is medically flawed – it doesn’t make sense in ordinary medicine, let alone in psychiatry. Why, the whole thrust of the Model casts doubt on the very existence of minds. So let’s be ultra-scientific and look at the evidence. I submit as Exhibit One, a video clip showing a 5-minute-old baby deciding for himself. Yes, you read that right. Ethan in this clip has just been born – you can read that off the video clock. And his mother, as mothers will, offered him his first meal. He decides against. I’m not making this up. Watch the video yourself, before you dismiss the point. Search for – “Ethan on Social Baby”. The commentary says his mother offers him her breast, and you can see her doing this – but – “Ethan is far more interested in looking at his mother’s face”.

Now I call that deciding. I also submit that he can only do this if he has a mind in which to do it. You may not like to think that newborn infants have minds of their own – but I strongly advise you to do so. Not only that, ask yourself what they are trying to say. Their command of language is understandably poor, if non-existent – but this doesn’t mean they have nothing to say. It means they have to find other ways of saying it – and the first thing that comes to hand is body language.

More – Ethan is being social. Yes, by minute 17, he responds socially to his father. He can control very little – he won’t be able to smile for a few months yet – but he can control his tongue, else he wouldn't be able to suckle. So when John puts out his tongue, Ethan concentrates hard, and puts out his own. For the sceptics, he repeats this, a minute or two later. Watch the video, and then, hand on heart, deny that infants of all ages, communicate. It’s up to us to learn to listen.

2 - Children Die From “Emotional Deprivation” For Reasons The Brain Disease Model Cannot Explain.

Perhaps the worst medical aspect of the BDM is its gross neglect of the EMOTIONS. Granted, emotions are impossible to define, even to describe with any precision – it’s like trying to define the shape of a pint (or litre) of water – something no one in their right minds would attempt. But this doesn’t stop people drinking. Those who insisted on “first define your terms” with respect to liquids, risk dying of thirst, themselves. Something rather equivalent happens to those doctors, unfortunate enough to be lumbered with the Brain Disease Model.

And sadly, there can be little doubt that the attraction of the BDM to many, is that it does away with the emotions. Tricky things to handle – they float all over the place, and can drive people to distraction. Worse, since “Science” took over philosophy in a big way, introspection itself has been frowned on. And yet that’s where the emotions, all of them, are to be found. How are you feeling today? What do you feel? These are essentially subjective questions – they also happen to be quite essential medically – no clinician can get by without them. Just because you can’t measure, weigh, or quantify them, doesn’t mean emotions don’t matter. You could say the same about pain.

Accusing people of being unscientific, and excluding them from academic journals and elsewhere, just because they insist emotions matter, medically – this is a form of excommunication. And it carries immediate and crucial medical risks. Emotions, from a strictly medical viewpoint, are vital to life. Yes, that's true – and there are buckets of evidence to prove it – at least there are, for those willing to look. However challenging they may be to define, let alone describe – without taking emotions into account, which is what BDM sets out to do, life itself is jeopardised.

Indeed, if you ask any paediatrician, they will soon put you right on this point. Even scientifically speaking, there is solid SCIENTIFIC EVIDENCE that not only do emotions matter, they are even more significant, medically, than calories. Any and all medical textbooks (including especially psychiatric ones) which ignore what is commonplace in paediatrics are not worth the paper they are written on. Deficits in emotional support not only leads to stunting, to a failure-to-thrive, but can, if undiagnosed, and untreated, lead to death.

So where’s the objective, measurable data proving just how vital to survival, emotions are? The relevant points have been summarised in a recent paper by Rogol. He writes – “Refeeding programs at the end of World Wars I and II noted that some children did not thrive despite an adequate energy intake.” This needs spelling out. What it says, is that children who have been starved for a number of years, as they were in Germany during the First and Second World Wars, millions of them – even feeding them afterwards does not guarantee that they will thrive.

Adequate calorie intake does not compensate for lack of emotional support. If you are looking for solid scientific evidence that emotions not only exist, but matter – then here they play a life-saving role. It is clear that a scientific ‘definition’ as to what exactly an emotion is, or is not – can lead to some really controversial disputes. But it is beholden on everyone to tackle this verbal problem, to acknowledge the non-verbal part of every communication – and in the case of damaged children, to sort out ways of putting it right. You may not be able to say what “emotional needs” really are – but they matter. When you do, dramatic progress happens – as Rogol says – “It appeared … [that] taking care of their emotional needs, permitted super-physiologic (catch-up) growth.”

What this tells us is that once you do acknowledge the existence and medical importance of emotional support, then deprived children will catch up by way of weight and height gain, quicker than if you just replaced the calories.

Given the ubiquity of these medical facts throughout the entire paediatric profession, it is astonishing that in psychiatry, the very opposite holds sway. Rogol could not be clearer – it’s a pity more psychiatrists and others are not much more familiar with the data. Rogol writes – “Emotional deprivation can lead to growth faltering of infants and children. … The pathophysiology appears to be reversible hypopituitarism, at least for the growth hormone and hypothalamic-pituitary-adrenal axes. The review … moves to the issue of hospitalism, where young infants failed to thrive (and died) due to inadequate stimulation and energy intake.”

From a medical viewpoint, the pituitary is the master controller of hormones in the body. It is a small extension to the cerebrum, well in touch with the emotional circuitry, and it has a handle on virtually every hormone throughout. In particular, in this instance, growth hormone, and other “chemical messengers” which coordinate how the body responds. The term “hypopituitarism” means under performance of the pituitary – here in not putting out enough growth hormone.

What is fascinating is that if you restore these shapeshifting emotions – then this restoration has a direct, immediate, and beneficial impact on the whole body system. Rogol calls it reversible hypopituitarism. It cannot take place without emotional support. If you need more objective scientific evidence that emotions are vital for health, then this is so obvious, so irrefutable that if you overlook it, then something is wrong with you, rather than the other way around.

Rogol’s summary needs translating from its medical jargon. But it’s worth persevering with, since it provides irrefutable medical proof of the medical problems inherent in the Brain Disease Model. The Romanian Orphanages case is emphasised – again brain aetiology doesn’t begin to impact – it’s looking in the wrong direction, for the wrong reason, and is not therapeutic at all.

When this happens, children, and others, die. The parallel with the case of Freddie described above, is striking. Had I responded to him with chemicals to restore a putative, but unsubstantiated, chemical flaw in his brain, there is no reason to believe his hyperactivity would have subsided – indeed, scars from it could well have continued long into adult life. The same must be said of emotional deprivation, so clearly documented by Rogol. Here he is again –

“. . . clinical research studies are reviewed in depth to show that the hypopituitarism was relieved upon removal from the deprivational environment and occurred much too quickly to be due to adequate energy alone. These findings are then compared to those from malnourished children and adoptees from emerging countries, especially those from orphanages where their psychosocial needs were unmet despite adequate caloric intake. Together, these various conditions define one aspect of the field of psychoneuroendocrinology.” [emphasis added]

Take that last term “psycho-neuro-endocrinology”. It’s a bit of a mouthful, even for those familiar with medical terminologies. Yet take it apart, and it’s clear enough. What it combines is how emotions impact on hormones, via the mind, using neurological circuits. So if you wanted to stick, ruthlessly, to the Brain Disease Model, then, perforce, you must include this clear, reproducible, and irrefutable medical evidence that the mind (that’s the psycho- bit), does impact on endocrines (that's the growth hormone part), via the nervous system (the neuro- element). One of the problems with Science is that too many take what they fancy, and leave the rest – in effect, this is subjectivity run riot. Here there is no logical way out – emotions influence us all, and here’s the evidence. You can pretend otherwise. But you have to work pretty hard at it, and you have to shut your eyes very firmly against very solid paediatric evidence, as above.

(3) Hitler Verbalises His Own Psychopathy

How do you suppose the Brain Disease Model would “diagnose” Hitler? Badly, I would say. Hitler destroyed more in his life-time than most of the rest of us put together. Why? Were his brain chemicals at fault? Did he have too much, or indeed too little dopamine? What happened to all his serotonin? Well, I’ll tell you something, if we don’t get a better handle on violence and where it comes from, we can kiss tomorrow goodbye. Unlike in Hitler’s day, we are now fully equipped with thermonuclear weapons with which we can, as Putin nowadays does, threaten to annihilate the world as we know it.

I worked for five years in Parkhurst Prison, the flagship of the UK Prison System. I took with me a model of the long-term effects of childhood trauma. And the violence there, went down dramatically – not that anyone in authority took much notice. But again ask any paediatrician, or indeed any nursery school teacher, and they will convince you easily enough that childhoods matter. Oh yes. So let’s follow the pioneering work of that wonderful stalwart, Alice Miller. In 1980, she published unprecedented analysis of Hitler’s childhood, even including excerpts from Mein Kampf, showing in his own words where, precisely, his monstrous behaviour came from. You might think that Freddie’s grief reaction was a one off – not so if you delve into what Hitler has to say about what happened to him when he was even younger. He didn’t suffer from lack of parents – he had, as he cogently describes, too much of the wrong sort. Listen to him, verbatim.

Let’s start, where he does, at the age of three. Even he is appalled by the memory, so instead of saying “I was 3”, he puts it all in the third person – but the victim is undoubtedly Adolf himself.

“ . . . . in a basement consisting of two stuffy rooms lives a laborer’s family of seven. Among the five children is a boy of three years. This is the age when a child first becomes conscious of things around him. Gifted people carry memories of that period far into old age.”

If paediatricians fail to convince you that what you experience in infancy matters, learn it from Hitler himself. Look at the phrase I have put in bold. Even he makes clear that old age can be crippled by what happens to the young. And if you persist in insisting they only have brains – as in the BDM – in effect treating them as mindless unfeeling robots – then you can expect as many Hitler look-alikes as there are damaged children about. It’s worth hearing more from him. He goes on as follows.

“However, a daily battle between parents slowly teaches the children a lesson. The dispute may take the form of a father’s brutality to a mother, of drunken maltreatment. Any person who does not know of this life can hardly imagine it. By the time the boy goes from three to six, he has developed a working idea of the world which must horrify even an adult. Now, he is morally infected and physically undernourished, and the young “citizen” is sent to primary school with vermin living in his poor little scalp.”

“Morally infected” – where does that fit in the Brain Disease Model? It doesn’t. So must we just sit on our hands, and wait for the missiles to land? No wonder my blood boils when I see the damage the BDM does, not only to its recipients – but also to the hapless souls who have to go by the book.

“As he begins the more demanding parts of his life, he falls into the ruts he has learned from his father. He wanders about, comes home Heaven knows when, beats the tattered creature who was once his mother, curses God and the world, and finally he is sentenced to a prison for juvenile delinquents.”

You can read more, much more, in Alice Miller’s ground-breaking book “For Your Own Good”. Sadly the authors of the BDM had never heard of her– let’s make sure she didn’t work in vain.

(4) The deep MEDICAL flaws in the Brain Disease Model.

The Brain Disease Model has many unforeseen consequences, most of them disastrous, but perhaps oddest of all is the way it brings two pioneers in the study of the human mind together – Pavlov and Freud. These two are rarely seen in the same bracket – yet both were concerned to find a science of the mind – and both failed for exactly the same reasons – human beings have minds of their own. They take decisions, just as Ethan did, on the information available to them at the time, and they do so off their own bat. In medical terms, this is Patient Agency – what the patient thinks, believes or does. Or decides. If Ethan can decide, why can’t the rest of us? Yes, Patient Agency is here to stay.

Medically speaking, the doctor doesn’t do the healing – the patient does. The doctor may advise, prescribe or even operate – but any healing that occurs is done by the patient. This is obvious in surgery – the wound doing the mending belongs exclusively to the patient. Cure or healing is done off their own bat, or not, as the case may be. The mind is no different. Even if the doctor has the clearest possible view of what has gone wrong, this doesn’t help the patient, if this clarity is not conveyed to the sufferer. The clearer the better.

So a touch of medical humility is in order. If the patient doesn’t understand what you’re talking about, then they won’t incorporate it into their lives, using their ineffable Agency. The BDM says we’re machines, victims of our own chemical mishaps – with no control, no Agency, no healing, and therefore no chance.

Worse, the BDM has decided, off its own bat, with zero evidence to support it, that all mental disorders are neurological. Why bother looking for causative factors when you know, from your own dogma, that they all come from the brain, and none from anywhere else.

I’ve castigated the BDM in philosophical, theoretical terms elsewhere – it is simply a walking MEDICAL disaster.

In this chapter, I’ve highlighted the vital role that emotional deprivation and support play in mental health. None of this can be prescribed in a pill. The sooner this healthier view gets propagated, the better for all of us, both those treated and those treating.

~~~o0o~~~

References

Ethan – at

Johnson, B. (2021) Psychiatry Is Bereft—It Lacks a Workable Philosophy for Consciousness—Herewith a Three Pronged Escape Plan. Philosophy Study, November 2021, Vol. 11, No. 11, 797-809

doi: 10.17265/2159-5313/2021.11.001

https://www.davidpublisher.com/Public/uploads/Contribute/619f0119e0b56.pdf

Miller, A. (1981). For your own good. Farrar, Straus and Giroux.

Rogol, A. D. (2020). Emotional deprivation in children: Growth faltering and reversible hypopituitarism. Frontiers in Endocrinology. doi: 10.3389/fendo.2020.596144. https://www.frontiersin.org/articles/10.3389/fendo.2020.596144/full

[4000 words]