The economist: Many mental health conditions have bodily triggers

This came up as an advert on fb: The Economist - A revised understanding of psychiatry could have... | Facebook

Which I thought was interesting, given it is the economist

The line on the ad: "A revised understanding of psychiatry could have profound consequences for the millions of people with mental-health conditions that are currently poorly treated"

 

Link to article:
Many mental-health conditions have bodily triggers (economist.com)

I'm afraid this is paywalled for me so can only see the first few paras to see PANDAS is mentioned

then includes the following para:
"Ms Huitson is not alone in having a dysfunction in the brain mistaken for one in the mind. Evidence is accumulating that an array of infections can, in some cases, trigger conditions such as obsessive-compulsive disorder, tics, anxiety, depression and even psychosis. And infections are one small piece of the puzzle. It is increasingly clear that inflammatory disorders and metabolic conditions can also have sizeable effects on mental health, though psychiatrists rarely look for them. All this is symptomatic of large problems in psychiatry."

 

Non-paywalled link: https://archive.md/sPY0u

Not sure how I feel about ME/CFS being here given the focus on psychiatric disease, but I rather enjoyed the ending:

Some wonder whether these conditions are the tip of a much larger iceberg. The prize in finding out more will be better patient care and outcomes. Biology is coming, whether psychiatry is ready or not​

 

The BPS lot will take that as a direct physical threat

 

They can't. There are no physical threats, only predisposing, precipitating and perpetuating factors; and abnormal threat beliefs.

 

I'd be surprised if it was less than 90%, probably up to 99%.

Most of it depends on what mental illness even means, and this is where most of the problem lies. Probably by the middle of it the very concept will be unrecognizable, and different still by the end.

Not sure if it's a hot take, but I'm fully convinced that if all knowledge of mental health were erased, including from people's brains, and medicine started over from scratch today, things would be better off within a year. As in we would do much better overall by a year's end, by the simply fact of having removed a lot of harmful garbage. It'd be a bit chaotic at first, but would quickly level off.

I'd still give a good chance that harmful garbage would be produced anew, but it wouldn't have the weight of centuries of traditions and decades of practice, regulatory capture and financial gain, and that would be drowned out in the whole.

 

I could say so much about this issue.

Sort of leads back to an attitude of seeing people as objects like the old days circus exhibits to be described, vs Oliver Sacks style descriptions that could elicit findings that help with solutions too. And some parts have been better/worse than others.

One also has to wonder whether the fact that psychiatry sees itself partly as being there to protect society rather than really truly to make life happier for the ill, and there being a big old spectrum of what individuals land on here and how those two different aspects are catered for. You've a different imminent priority and 'when you are done and get paid' outcome, which is why I think its interesting this term of 'recovery' vs every other serious dept talking about prognosis and outcomes. I think we know that CFS was probably one of the first selling of their 'protecting the public good' claims of focus entering into health beyond infectious things. And BACME has finally put it as their reason for being.

THe BPS model is the nadir of this. Proper models in clinical psychology even, before this time when that model got nicked and warped into a big circle, were somewhat making headway by careful annotation to quite specific diagnoses based on what was at the nub of the issue (eg catastrophisation vs 'any depression'), and had arrows going from top down that made them testable. The real 'innovation' and very strange things, and I remember it being an emperors new clothes situation when writing about it in a BSc psychology exam not knowing if it was a 'test' and you could say it, was that it was this circular thing that didn't mean anything wasn't specific and you couldn't match diagnosis, cause and treatment nevermind test it as a model to see if it worked. Someone just drew a circle and wrote 'approx stuff' around it. It really was a total departure but not in any good or made sense way.

Of course it was just about a move to want to go to where they are trying to land things now of 'transdiagnostic' ... I mean what nonsense. All they've done is removed psychology and the science of it from the profession and renamed it 'mental health'.

There is another thread here going on where we are trying to describe what pwme have in common. It's become clear what a poor job - if they did it at all rather than it coming from 'make the round hole fit the square peg' - of even lowest common denominator describing ME the BPS did. You'd have no chance of working out a cause anyway so that was deliberate bucketing to lump and dump by priming anyone who might speak to them.

 

genius answer!

 

I remember reading that schizophrenia is exacerbated by common nutritional deficiencies. One of the nutrients mentioned is vitamin D. If a pregnant woman suffers from Vitamin D deficiency then the risk that the child suffers from schizophrenia also increases. It hardly ever gets mentioned when mental illness is discussed. And since vitamin D testing is apparently one of the more expensive deficiencies to test for many patients have been told that "Everyone is short of vitamin D, just go and buy a supplement" and the test is often refused.

I wonder if women who become pregnant or who plan to become pregnant find it hard to get tested or if it is a standard test.

Vitamin Supplementation in the Treatment of Schizophrenia

Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019

...

On the subject of depression...

I have been diagnosed with depression multiple times throughout life. SSRIs have been prescribed for me several times throughout life and they never did anything helpful. I also have problems with absorbing iron. I would occasionally get a prescription for iron supplements - enough to last me a couple of months. And I wouldn't get any more. It wasn't until I discovered, purely by accident, that iron supplements could be bought from pharmacies without prescription and I treated myself that I discovered that having sufficient iron in my body made a massive improvement in my mood. I haven't been depressed for several years now, whereas with low levels of iron I was depressed for decades.

But obviously... Iron pills don't add to the profits of pharmaceutical companies, and if lots of women are depressed it's all good for Pharma bank balances.

 

OK here is one for discussion. And it is important. There are so many of these articles where the main body of text makes sense and then the conclusion ends up seeming like a switch and bait that would embed things even more so.

I'd love people's input on this, but I think in the UK there is clearly an issue certainly with some parts of neurology being too close to psychiatry and not medical really unless it is their 'whatever niche they actually count as organic, but relates to the tiny area they will 'do'' and wanting to refer everyone else not back into medical tests, or doing said medical tests. So eg a patient lands on them (but could perhaps just as easily have ended up on another biomedical ward in another hospital) and they look for their list of pet areas, do no further eg blood tests or anything and then their only output is psych therapy (limited as they've removed psychologists normally and it is CBT) and rehab.

And it seems UK medicine has sort of headed that way with a lot of things, where there is a list of conditions and if it isn't one of those then there isn't further research and is seen as not existing, or even worse if it is an abnormal presentation so the standard pathway can't just be applied it's off to the biopsychosocial bin.

 

I agree. It was a bit of a weird crowbar, where I'm not sure before they tried to shove things that weren't under psychiatry before into a new term 'mental health' (like alzheimers wouldn't have been there before, autism wasn't) that you are talking very tenuous ideas of 'because they have concentration issues' - well then all ill people would be under psychiatry. AN untreated broken leg is going to find it hard to focus too

What a weird thing, after all that, to bring in a condition that might not fit under either - whatever the conceptualisation used here:

In order to try and 'bring together' your conclusion. It feels like the author either struggled for an ending, had to do it in a rush or had an agenda and couldn't resist to do this.

I'll take the line of 'new work suggests it is associated with both immune and metabolic dysfunction' but CDC have been saying that since 2018. And the author is inferring it sits under psychiatry or mental health with no good explanation for that. And worse seems to be using it as an example of why it should stay there and just be some flagship as to why neurology should become more psychiatry-trained. When it sounds like they need to clear out the bad side of both said departments.

I mean in this day and age, and even 20yrs ago, shouldn't anyone talking Freud and using the excuse of their psuedo-philophies about 'the mind can do strange things, woooo' as if it is persuasive science, just be shown the door? - even in philosophy journals, and certainly in any journal claiming what's in it is 'science', 'medicine' or 'OKayed' (because otherwise what are actually propaganda manifestos veiling as science by using dodgy correlations from biased designs, get given credit they aren't due and used to effectively brainwash and change people's beliefs).

 

Agreed. I will note that the economist often takes and publishes letters in responses to articles, in case anyone wants to write one.

 

I've just noticed the title too: "many mental health conditions have bodily triggers"

it seems at best incredibly dualist wording.

and given the 'finding': that it turns out ME/CFS always was a biomedical health condition, and has physical symptoms and isn't a mental health condition

it's all very strange. Hopefully most people won't read to the bottom, and when they do they'll also think it is a bit of a strange 'and also'?

 

I was just thinking a couple days ago: when will we see a huge push from the depression and anxiety communities to treat these things like biological disorders, in the way the ME community has impressively been doing?

Social anxiety affects 7% of the US population, and a few studies* have found biological abnormalities, yet researchers seem barely interested, and most of the papers on Pubmed are on behavioral/social/upbringing factors and different psychotherapy techniques.

Even if 100% of the cause was due to upbringing, there is so much overlap between people with similar environments yet have completely different mental health presentations, that it would imply there have to be important differences in the genes. If nothing else, do large DecodeME type studies with anxiety and depression too to guide treatment development.

* Two main studies I recall seeing
A preliminary study of buspirone stimulated prolactin release in generalised social phobia: evidence for enhanced serotonergic responsivity?

The immune-kynurenine pathway in social anxiety disorder

 

I agree that these things likely play huge roles in classic mental illnesses. Though I don't think one can be confident that there is not a very large contributing biological factor in all these diseases that could potentially prevent these societal factors from causing such enormous damage.

And there are so many subtypes of mental illness that one can't definitively say that "these things will not be solved by better pills". Sure, on one end of the spectrum, a perfectly healthy person can be subjected to weeks of terror during war, and develop PTSD, anxiety, and depression.

But on the other end of the spectrum, there are obviously "physiological" forms of mental conditions.

Drugs, like stimulants, hallucinogens, or drug withdrawal from opiates, can cause anxiety and depression in an otherwise happy person. 100% physiological.

I think I've read that numerous people have experienced post-infectious mental conditions such as OCD and tics.

These are just cases we've observed. We can't be sure there aren't genes we haven't found yet directly tied to a person's risk for depression or anxiety, where a pill can simply deactivate the protein causing issues. Or whether, like ME, pathogens lead to the majority of cases, the difference being the infections are caused by some virus that is barely noticeable as an illness and which happens in young children, so it seems like a lifelong condition.

Since ME happens so obviously after infection, there was an advantage there in motivating research into biology. But living with anxiety, I feel like this condition is something similar, but 50 years behind because there is no obvious infection. I'm trapped in here, with a deep understanding that there is something wrong with my body causing both ME and anxiety, and knowing that living in the most wonderful utopia possible wouldn't change a thing if my cellular environment was to stay unchanged. And like how people said/say of pwME they're "just being lazy" or "they're choosing to lay in bed, nothing wrong with them", and they're screaming inside, "you're wrong", that's similar to how I feel with generalized and social anxiety, or the OCD I once had, when people suggest therapy or a change of scenery will fix me.

 

Because it’s one thing talking drug treatment in medicine and another in psychiatry- where the history is not pretty of things like chemical coshes, ECT, lobotomy

So it’s more nuanced than that what they. Need to ask for

 

Eg published today —

Depressive symptoms and suicide attempts among farmers exposed to pesticides (2024, Environmental Toxicology and Pharmacology)