Brain Disease vs. Mental Illness [from THE BALTIMORE SUN, January 27, 2011]

–Richard E. Vatz

disease: n. A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.

— American Heritage Dictionary

I have been teaching and writing for decades on the topic of “rhetoric and mental illness,” arguing that “mental illness” has been a catch-all term of behavioral explanation that elucidates nothing and is often false; there is usually no “disease” in mental illness.

I have friends who are psychiatrists and neurologists who have argued with me that there is a neurological cause to some behaviors, and if that cause were called “brain disease” and proved, it would be an accurate accounting of why some violence is perpetrated.

Unlike some of my fellow critics of psychiatry, I am not an absolutist. I am convinced that Jared Lee Loughner, the accused shooter in the Tucson attack, may have had genuine brain disease; he may be a genuinely medically ill schizophrenic. His progression of predictable symptoms seems to emanate from the classic “physical, cellular defect or lesion in a bodily organ” necessary for inferring disease.

The problem is that in discussions of “mental illness,” most mental health professionals feel no constraint in helter-skelter diagnosing of mental disorders.

Two years ago, the American Psychiatric Association journal Archives of General Psychiatry provided the stunning estimate that “Almost half of college-aged individuals had a psychiatric disorder in the past year.” This should not have been surprising, for almost every decade the estimate of frequency of psychiatric disorders has gone up since the generally accepted percentage was 10 percent in the mid-20th century. Mental health fields usually measure morbidity using invalid, general population surveys — involving no medical diagnosing — conducted by lay interviewers.

Not all psychiatrists are comfortable with this outlandish methodology and/or the resultant inflating of the incidence of “mental illness.” A few years ago, when the National Institute of Mental Health (NIMH) estimated that more than 55 percent of the American population was suffering from some mental illness over a lifetime, Dr. Paul McHugh, the well-respected former chief of psychiatry at the Johns Hopkins School of Medicine, incredulously and famously stated, “Fifty percent of Americans mentally impaired — are you kidding me?”

Some mental health professionals who are contemptuous of the claims of hyper-increased incidence of mental illness try to differentiate between those “mental illnesses” which are and are not “severe.” But even these skeptics do not publicly argue that only a small percentage of even the “severely mentally ill” suffer from demonstrable brain disease.

The brutal fact is, no one knows with precision what causes most antisocial and criminal behavior: free will (perpetrator’s decision; increased responsibility), disease (less responsibility), drugs (never an exculpating factor), etc. But, indisputably, there are a few selected cases wherein no self-serving motive seems to exist, and there may be brain disease roiling the perceptions of the perpetrator.

A brain disease such as schizophrenia that can be a necessary and sufficient criterion for some violent actions should be a focus of those trying to prevent violent behavior. That well may have been the cause of Mr. Loughner’s violence. But some mental health professionals, while knowing that schizophrenia accounts for only a very small number of mental problems, will falsely diagnose larger numbers of patients with it.

If we are to successfully identify the tiny percentage of people with violence-producing schizophrenia, we must label it honestly as “brain disease” and end the myth of the mental illness pandemic.

Richard E. Vatz, a professor at Towson University, is associate psychology editor of USA Today Magazine and an editor of Current Psychology. He has been writing on rhetoric and mental illness issues for more than 30 years. His e-mail is

Copyright © 2011, The Baltimore Sun

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