Medicinal Fear of Biblical Proportions

I was recently directed to a blog post via a parent that discussed whether or not mental pharmaceutical treatment was preventing modern prophecy. This interesting perspective is brought by Vironika Tugaleva, a self proclaimed life coach who has authored two self help books. Now, setting aside the obvious differences in Religious beliefs that are likely to come up, the arguments she gives in this post have some clear issues, both factually and, if I'm going to be honest, ethically. Let's dive in to them.

Let's begin by looking at the context given for the discussion. An individual named Ken Dickson and his book, detailing his personal experience in dealing with his mental illnesses, that lead her to some interesting conclusions. She makes three observations about Ken's experience:

1. Everyone around him thought he was crazy and dangerous while Ken gained abilities that some people vie to access with daily meditation and ceremony
2. Our current mental health care system hasn’t progressed since the asylum days as much as we’d like to think (physical straitjackets replaced by chemical ones)
3. Mental illness is a dream so bad that, if you’re lucky or well-supported, you might just realize you’re dreaming and wake up in a world where everyone else is still asleep

The first issue I have with these observations is there are some heavy religious connotations overshadowing them. Now, I don't have a problem with any one persons religious beliefs, most beliefs are in a philosophical grey area (where science is concerned) that renders it untestable. Because of this I leave individual beliefs that make no testable claims alone. However, if you plan on evaluating something scientific, say the efficacy of mental health treatments, testable arguments are required. Therefore, beginning your assessment with religious justification is not appropriate. Furthermore, the statement on the progress of mental healthcare is blatantly false. By "asylum days" I assume she means since the drop in institutionalization in the mid 1960's. It is actually a bit ironic that this is her metric as the drop was made possible in the first place by anti-psychotic medications. PBS has a good timeline that overviews the improvements in mental health that have been made. And there's been no shortage of them. There are regular updates to the Diagnostic and Statistical Manual (DSM) which is now on its 5th edition (as a side note, a great piece of evidence that psychiatrists are not "owned" by pharmaceutical companies is in the fact that the DSM-IV was much larger that the DSM-5 due to removing many editors who had industry connections). There is also constant investigation into new, more effective drugs with less side effects. The field is by no means static.

She then goes on to list a couple "examples" of the mental health system failing,

An old friend of mine, whose art is so captivating you could stare at it for hours, was put on Ritalin for drawing in math class.

This seems like a brilliant observation; that ritalin was squashing his creativity. But it is just a non-sequitur. I know the effects of stimulants on the body, both through education and experience via having ADHD myself. There is nothing to suggest that ritalin effects creativity in any qualitative manner, as is suggested. And it is not as though suggesting someone should pay attention in math is a huge atrocity; math class is for math, not drawing. If he has a problem switching gears to the point it's causing trouble then maybe an ADHD evaluation is necessary. In all fairness it could very well be the case that he is not in need of the meds; he could be bored because he's unchallenged for example. But randomly taking a child off medication because of logic like this is a recipe for disaster. You need to work through the changes with a doctor.

My first vivid hallucinations when I was 18. ... What if I took the pills I was offered? Would I still be here?

That's an excellent question. It is not at all uncommon to hear people taking anti-psychotics note a "fog" of sorts. Though it has been suggested that this subjective analysis, while internally consistent, is not strongly correlated with other measures.

A woman who reached out to me to tell me about keeping her son, clearly exhibiting symptoms of schizophrenia, away from doctors and pills—the son recovering fully a year and a half of sleepless nights later.

This is a blatantly absurd, unethical statement. If you think your child may be better off without pills that is one thing; there are always other methods like talk therapy. But to keep a child away from doctors because you, "think they're wrong," is dangerous.

Sam Shelley being diagnosed with bipolar and, after engaging in frequent and dedicated meditation, coming forth symptom-free and ready to help heal the world.

I'm going to be up front here and say I'm a practicing Secular Buddhist. I truly believe that meditation can help people in a similar manner as talk therapy. That said there is a distinct lack of quality evidence for meditation's medical benefits. This includes a lack of an operational definition of "mindfulness meditation." No one seems to be able to agree what is under the umbrella of "meditation." Current literature also fails to control for the central claim of meditation proponents; namely that mindfulness is a distinct mental state that can be differentiated from, for instance, relaxation. With that in mind, Sam here could very well be an example of meditation success. Or it could be that simply setting aside time to relax is the real culprit. With the currently available evidence there is no way to know for sure. This also illustrates why anecdotal evidence, lacking any form of control, is one of the weakest forms of evidence.

Ms. Tugaleva then goes on to conclude three things with a bit of discussion:

Our mental health care system is breaking people. We have no room for the sacred, only normal.

The argument she is making here is that modern medicine has created an arbitrary concept of "normal," typified by "fitting-in" as she puts it, that when we deviate from it society demands we "fix ourselves." This is a very blasé oversimplification of how mental disorders and illnesses are defined, delineated from typical behaviour, and diagnosed. Firstly, the concept of "normal" is not arbitrary nor based on "fitting in". If it were, Every other high school teen would feel as though they are suffering from some condition. It is based, in part, on the distribution of specific behaviors in the population and on whether or not your position in that distribution causes difficulty functioning in society. A common example I like to give is intelligence. It is equally likely, 2.1%, for a member of the population to be diagnosed with an intellectual disability (having an IQ under 70) as it is for one to be considered "gifted" (having an IQ above 130). Both of these two conditions do not "fit in" with the mean. The latter of them, however, does not cause difficulty in life and therefore is not a mental disorder. She also gives the existence of villages that "praise" conditions that we would consider disorders or illnesses as evidence for this conclusion. Anthropologically you need to judge a society by its own internal logic and therefore it is improper to judge us by any villages standards. Setting that aside, this is also an appeal to antiquity fallacy. Shamanism, the medical practice of the village in question, is not valid evidence simply because the culture is old.

We’re weeding out our geniuses. We’re killing off our prophets. We’re drugging our messiahs.

Here she makes what I like to call the van Gogh fallacy. It goes something like this: Vincent van Gogh had a mental illness; his mental illness influenced his work; therefore, putting him on medication would reduce the quality of his work or eliminate it completely. This is a bad assumption for a number of reasons. Primarily because we have absolutely no idea how van Gogh, or any other historical figure, would've responded to medication. So her use of Sylvia Plath, Salvador Dali, Beethoven, Issac Newton, and Jesus Christ as illustrations are absurd. It also makes her statement that even if we prevented suicide in any of them (though of the figures she gives Plath is the only one who actually committed suicide) they would have "...extended their lifetimes while they would have faded into the background, known by few, remembered by no one," a reach at best. Putting Newton on medication, for example, likely wouldn't have effected his genius. Furthermore, there is no justification to claim that hallucinations are actually divine prophecy. Aside from being insulting to any religion you apply it to, for every benign "message from god" you'll likely find one that is the source of some dangerous and/or violent behaviour. So how then would we even try to separate the two?

How can we recognize the healers in those who are, themselves, healing?

Her final thoughts given under this heading repeatedly ask, somewhat rhetorically, how we can get all different forms of thinking (science, spiritualism, religion, philosophy) to work together to help the mentally ill. Though I understand that in many cases religion is a source of strength for people, it should be, by no means, the basis of treatment or understanding. The only way to understand these diseases is through science; the only way to treat them is through understanding. Psychiatry is just coming out of its infancy, gaining real traction in understanding and treatment. But just because we don't have all the answers yet doesn't mean we should risk letting our children suffer at the hands of pseudoscientific belief.