Saturday, April 09, 2016

Psychosis can be organic in origin

I have been struggling with a post by Vaughan Bell @vaughanbell on the Mind Hacks blog. He suggests that critical mental health writings implicitly demean people with brain disorders, but I don't think they do.

He gives four quotes to support his argument. However, they don't seem to support it. In fact, the first two aren't about brain disorders. The other two mention organic brain problems but are not demeaning of people with these problems. If you don't believe me, look for more detail about these quotes in the appendix to this post.

Essentially, Vaughan Bell does not want to make too sharp a distinction between mental health problems and brain diseases. He thinks critical mental health supporters do this because having a brain disease is demeaning. This is totally missing the point. This isn't the reason for the argument that functional mental illness is not brain disease. In fact, Bell himself acknowledges that there is "no evidence for consistent causal factors". But he goes on to speculate that these factors will be found in the same way as they have for organic brain disease.

Where Bell might have a point is that supporters of the critical mental health approach do not always explicitly state that psychosis can be organic in origin. He uses the example of the BPS report Understanding psychosis, which he says doesn't discuss organic psychosis, although I have already pointed out that, despite its strengths, there are deficiencies with this report (see previous post). To be clear, people can have psychotic symptoms in a toxic confusional state (delirium) and with dementia, such as Alzheimer's disease.

But not being explicit that psychosis can have an organic cause is not the same as being demeaning about people with brain disease. Functional mental health problems are fundamentally social and psychological. It's as important to combat the stigma of organic brain disease as mental health problems.

Attempts have been made to undermine the critical mental health argument by accusations of attacking a 'straw man' (see Guardian article and my response). It seems opponents of critical mental health are not immune to using this form of argument.

4 comments: said...

Hi Duncan,

Thanks for your response to my post. However, I'm very clear in my post that brain changes can lead to psychosis can indeed be understood differently in terms of their aetiology. In fact, I note dementia is likely the single biggest cause of psychosis.

However, the end result is still psychosis. If you are including people based on their lived experience, as critical mental health claims to do, everyone counts, but it seems critical mental health advocates are only keen to include people based on having a normal brain scan or EEG.

When we're considering psychosis and people with psychosis as whole, I see no reason to exclude people who may have measurable brain injury or alterations. In other words, psychosis includes people who have psychosis from all and every causal pathway. So when critical mental health writers say "there is no consistent biological basis for mental health problems" the only way they can be correct is to exclude people who do have a strong and identifiable biological basis to their experience.

Why? Do some people not deserve to be 'liberated' as critical mental health claims to offer? Or do they just fail to qualify?

So either critical mental health advocates should clarify - 'we are only talking about mental health problems with no consistent biological basis' or they should include everyone who experiences mental health problems. If they're doing the former, they should fess up to the circular argument: 'mental health problems with no consistent biological basis have no consistent biological basis'. I doubt the Nobel prize committee will be calling soon.

By the way, I don't say critical mental health advocates make the distinction between mental health problems and brain disease because they think the latter is demeaning. I agree mental health problems in the absence of brain disease isn't brain disease. But the fact they think brain disease is demeaning at all is a sign of troubling implicit prejudice. It isn't demeaning. Stop saying it is.

The quotes do indeed support my point, I've added a comment to your appendix post to this effect.

Duncan Double said...

Thanks, Vaughan.

I think what Peter means in his manifesto is that functional mental health problems are "fundamentally social and psychological issues". I'm sorry if I misunderstood what you were saying about the reason you think critical psychiatry makes a distinction between mental health problems and brain disease. However, you did say that the distinction was made "presumably based on the belief that being associated with the latter ['biological' disorders] would be dehumanising in some way". The point of my blog was to say that critical psychiatry doesn't demean brain disease. You keep saying it does.

Duncan said...

I think it doesn't intend to, but I think it encourages this way of thinking through an implicit and currently unrecognised bias.

I'm hoping this debate will get people to reflect on how they write about people with neurological conditions and how they consider them in terms of a wider understanding of mental health.

Which I think, is a very succinct way of saying what I intended to say before I wrote several thousand words on the topic!

Duncan Double said...


I do agree you have encouraged more of an emphasis on neurological conditions which I think is a good thing. Still, I think you're wrong about what critical psychiatry implies.