Every month deserves a Blue Monday. For February, Psychology Month, here is my blog post written two years ago and revisited.

While researching a holiday to Provence, France, I stumbled upon The Van Gogh Blues: the Creative Person’s Path Through Depression by Eric Maisel, Ph.D.  My husband Will and I planned to spend a week in the town of St. Remy, Provence, where the painter lived in an asylum toward the end of his life. During that time, Van Gogh painted a number of his major works, including The Starry Night.

The Van Gogh Blues turned out to be less about the painter than about depression, the disease many believe he suffered from. Others claim schizophrenia or epilpsy might have been the problem that led Van Gogh to cut off his ear and ultimately take his own life.

Maisel’s premise in The Van Gogh Blues is that creative people suffer from depression more than the non-creative. He offers no statistics for this. His view stems from his observations as a family therapist with a PhD in counselling psychology, a creativity coach and a creative writer who regularly contributes to Writers Digest magazine. He concludes that depression arises from the creative person’s need for meaning and his or her clash with the facts of existence. He say non-creative people don’t seek as much meaning in their lives, either due to their personality makeups or the fact they already have enough meaning. For instance, the unwaveringly religious find enough meaning through their faith.

It follows that the collapse of traditional religion makes depression more common today than in the past, Maisel asserts this is true, but I wonder. I also question his statement that explorers, military personnel and professional atheletes have zero rates of depression. The reason, he says, is that these occupations contain built-in action and meaning.

Depression arises, he claims, when creative people fail to work toward the meaning they need. This can be due to procrastinating, taking a job that doesn’t answer their creative needs, drinking, eating too much chocolate, anything to avoid the blank page.

And those who put in the work are bound to bump against the facts of existence. A writer’s book can’t find a publisher or it does and fails to sell. This provokes a meaning crisis that, if not handled well, leads to depression.

Maisel does admit that biological or psychological factors might also contribute to depression. Therefore, people shouldn’t necessarily avoid medication or therapy. But he believes these factors aren’t the primary cause.

It almost makes depression seem a positive trait, since those disinclined toward it are non-creative (lesser?) beings.

For Valentine’s Day, let’s look at Evolution in relation to Psychology Month.

Psychiatric symptoms are manifestations of ancient adaptive strategies that are no longer appropriate, but can be understood and treated in an evolutionary and development context.

That’s the premise of the book Evolutionary Psychiatry by Anthony Stevens and John Price, published in 1996 & 2000 (2nd edition).

I find that premise not so hard to understand when I relate it to conditions like diabetes and obesity. Back in prehistoric times you couldn’t get too much sugar or store too much fat for the inevitable lean times. So a sugar-addiction or propensity to gain weight increased your chances of survival and opportunities to reproduce  and pass your diabetic- and obesity-prone genes to subsequent generations.

Unfortunately, this natural selection hasn’t caught up with our modern day abundance of sugary and fatty foods. People whose genes are too loaded toward handling scarcity suffer the consequences.

It’s the same with mental illnesses, evolutionary psychiatrists say. Genetic tendencies that let you thrive in the primitive world get distorted under modern conditions. They should be treated as natural, adpative patterns of behaviour that have gone awry.

This seems a more positive approach to mental illness than the old biological and psychological models, although I found that for most of the mental disorders discussed in Evolutionary Psychiatry the authors suggested the natural behaviours go awry due to faulty parenting. Can’t there be other causes?

In the primitive world where danger and scarcity were ever-present, group function was imperative for survival. Stevens and Price claim adaptive patterns were selected to optimize the group’s survival. They divide these patterns into two basic types: those that work toward group cohesion and those that work toward splitting the group when it becomes too large.

In general, traits traditionally defined as neurotic — depression, anxiety, eating disorders, phobias and obsessiveness — were selected to promote group cohesion. Primitive societies were hierarchical and depression, for instance, developed as a response to losing a competition. By withdrawing, rather than fighting back after a defeat, the loser allowed the group to return quickly to equilibrium. As with diabetics, modern depressives are people who inherited too much of that gene and apply it inappropriately or excessively to modern situations.

The book’s discussion of group splitting, or spacing, disorders is particularly interesting. The authors point out how risky it was to split with a primitive group and venture into the wilderness, but someone had to do it, since overly large groups would fall apart socially and put too much pressure on a region’s limited resources. Only someone with a vastly different vision and tendency toward belligerance would make that leap, and so schizoid and paranoid qualities developed. The authors note that history’s charismatic leaders have all been schizoid types, from Joan of Arc to Adolph Hitler to cult leaders like Jim Jones. Presumably, their followers might share those tendencies, without having such strong leader traits.

More often than not, the splinter groups would fail in their harsh new environment, but some would succeed and populate the wilderness with their group-splitting genes. A modern example that comes to mind is Mormon leader Brigham Young, who broke with conventional society and religion, led his people from the eastern USA to Utah and fulfilled his biological goal of producing numerous descendants.

Evolutionary Psychology also muses on the purpose of dreams, which interested Freud too. If there were no purpose to dreaming, the authors say, nature was wasteful in alloting so much of our time to it. They conclude dreams are used to process information, work out problems, and choose what to file in long and short term memory. Dreaming gets us in touch with the archetypes and reconciles us to nature. I’m not quite sure what this last sentence means, but it sounds good and is something to ponder.

The authors conclude that our treatment of mental disorders must involve confronting the meaning of symptoms. Mental illness should not be viewed as a disaster, like cancer or stroke. It is an ancient adaptive response that requires re-adaption to modern situations. Stevens and Price suggest, for instance, that we don’t necessarily have to change schizophrenics. Studies have shown they are happy in game-play with imaginary followers, becoming virtual Hitlers. This, rather than medication, might be the better treatment.

That’s a different way of looking at it.

“Psychiatry enables us to correct our faults by confessing our parents’ shortcomings.” (Laurence Peter)

Jeffrey A. Liberman includes this tongue-in-cheek quote in his book Shrinks: The Untold Story of Psychiatry. Published in 2015, Shrinks comes with Liberman’s strong credentials: Chairman of Psychiatry at Columbia University; Director of the New York Psychiatric Institute.

Shrinks begins with a reference to the profession’s ongoing tension between nature and nurture; the swings between the belief that mental illness is entirely in the mind and the belief that is in the brain. We must embrace both, Liberman says.

Shrinks continues with the history of psychiatry. An early practioner, Mesmer, believed the cure for mental illness was inducing crisis. He tried to provoke fits of madness in the psychotically ill and bring depressives to the brink of suicide.

Liberman calls Sigmund Freud a tragic visionary, far ahead of his time. Freud’s theories of conflicts between unconsious mechanisms defined mental illness. But Freud’s controlling ways alienated his followers and his theories and methods were unscientific and rigid.

The profession wanted a more solid, medical footing, especially after the anti-psychiatry attacks of the 1960s and 70s.

The  popular and acclaimed 1975 movie One Flew Over the Cuckoo’s Nest captured the public view of the psychiatric profession as morally and scientifically bankrupt.  Liberman doesn’t say this, but I suspect Cuckoo’s Nest played a role in the temporary abandonment of Electroconvulsive therapy (aka Shock Therapy), shown so gruesomely and cruelly in the film. ECT is back with us now as a treatment for depression when medication and/or therapy fail. 

Liberman takes us through the drama of the DSM III, released in 1979. Before reading Shrinks, I was only vaguely aware of  The Diagnostic and Statistical Manual (DSM), called the bible of psychiatry.  The DSM is periodically revised and 2013 welcomed the fifth release. But the big change occurred with release # 3, which drove the nail into Freudian psychoanalysis by defining mental illness by symptoms and courses of the illnesses, rather than by causes.

DSMs 4 & 5 made some minor changes, which included adding the only two disorders currently defined by cause: Post Traumatic Stress Disorder (PTSD) and Substance Abuse.

After reading about the debate, I can see why the DSM definitions matter.  Either a disease’s root cause is of vital importance to treatment or its cause is less important than its symptoms. Something is labelled a disease or not. Notoriously, homosexuality was a disorder in the original DSM.

Historically, Liberman says, biological and pschyodynamic theories of mental illness have fared equally well and, today, most psychiatrists address both. From my other readings, though, I get the sense the balance is weighted on the biological side, although the public probably leans stronger toward the biological view than professionals. Liberman might not see it so weighted because, despite his initial admiration for Freud, he seems to have landed closer to the biological argument and prescribes medication as a front-line treatment.  This isn’t surprising when his speciality is therapy-resistant schizophrenia.

Shrinks struck me as a knowledgeable book written by someone high up in the mainstream of the psychiatric profession, presenting a more conventional view than the authors whose books I reviewed earlier this month.

Catherine Ford’s Opinion column in today’s Calgary Herald newspaper reminded me of a radical book on mental health treatment that I read two years ago. Here’s the review of the book, which I posted at that time.

At 450 pages, Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex by Peter R. Breggin, MD is a big book. It’s not an easy read, which you might guess from the technical-sounding title. Breggin states at the start that his book is aimed at professionals, although he hopes it’s clear enough for non-professionals to understand. Partly for these reasons, I only read the first and last sections, along with the brief conclusions Breggin sometimes offered in the middle sections. This was still enough to convince me that of all the professional psychology books I’ve read and am reviewing this month, Brain-Disabling…is the most exciting, and the one that did the most to change my thinking on mental health treatment.

Breggin, age 79, has been a practicing psychiatrist in upstate New York for over 40 years.  He claims he has never prescribed medication and has never lost a person to suicide. He disagrees with the biological model for mental illness and avoids labels such as schizophrenia and bipolar disorder. His approach is to listen to a patient’s life story. That is, to treat him or her as a person and not as a problem to fix.

The part that threw me the most is his belief that psychiatric drugs are not only ineffective, they are harmful and work against recovery by impairing mental and emotional function. People’s  belief  these medications are helping them are due to the drugs’ spellbinding effect, much like the belief that you are witty and in control when you’re drunk.

The large middle section of Breggin’s book is devoted to proving his point for each current treatment, including psychotropic drugs, Electro Convulsive Therapy (ECT or Shock Therapy) and the medications for Attention Deficit Disorder. He especially opposes the current treatment of children for ADD/ADHD and depression. He claims there is an upsurge in diagnoses for bipolar disorder today because antidepressants have caused mania in people, who are then told by their psychiatrists that the treatment has unearthed this underlying condition.

I don’t feel qualified enough to know if his arguments against these treatments are solid or not. This is a second reason I skipped over the book’s middle. A third is that I don’t need his detailed arguments to be convinced, since I favour the nurture over nature view of mental illness and can easily accept a critique of medication. Breggin states that even if it is one day proven that some disorders are due to chemical imbalances — and there is no proof for this so far — our current drugs and shock therapy aren’t the way to go.

His extreme views made me Google him to find out if he’s a Scientologist, since they are notoriously opposed to modern psychiatry and its treatments. Breggin was associated with Scientology in the early 1970s. He wasn’t a member, although his wife was. Breggin broke with the the Scientologists partly because they opposed her marriage to an outsider. No doubt Scientology’s views on psychotropic medication were an attraction for him and the religion might have influenced, or at least reinforced, his thinking. Pharmaceutical companies have accused Breggin of being a Scientiologist to discredit him because he has been an expert witness in lawsuits against their products and vocal in his opposition to them.

Breggin wrote a defense of Tom Cruise’s rants on TV against psychiatry and medication. “The media would have liked to attack Tom on the grounds that he’s a Scientologist,” Breggin says. “Scientologists seem to share a number of views about psychiatry with me, including everything Tom said. In fact, I’d go further. Modern biological psychiatry is a materialistic religion masquerading as a science.”

Breggin’s credentials and clinical experience make it hard to dismiss him as a quack.  I was moved by the final section of his book, where he outlines his 20 tips for an empathetic psychiatry. He notes these guidelines could also be used in our everyday lives with colleagues and friends, and insists they have worked in his psychiatric practice, even with the most difficult and psychotic cases.

Psychosis, he says, is a “loss of connectedness to other human beings. The individual who withdraws into a fearful, self-protective, irrational fantasy responds best to being treated with kindness, respect, and the gradual building of rapport.”

It seems naïve and too simple, but could it work?

These findings are from a blog post I wrote two years ago, but the situation probably hasn’t changed much since then. 

On the internet, I found pages of information about mental illness, including this commonly quoted statistic:

One in five Canadians has a lifetime chance of mental illness, according to The Mood Disorders Society of Canada. 10.4 % of Canadians are experiencing a mental illness at any given time. This jibes with statements that one in ten Americans are taking antidepressants, the most prescribed medication in the USA. World-wide, depression is the leading cause of disability.

Other information surprised me:

Today’s antidepressants are no more effective than their counterparts in the 1970s, despite the billions spent on research and development during the past forty years. The newer drugs simply have fewer side effects, which makes people more inclined to continue taking them. Drug treatment is still hit and miss. No one really knows why antidepressants work. Many question if they work at all. A 2011 study published in the Journal of the American Medical Association found that, while meds appear to benefit severe depression (about 1/3 of cases), for mild to moderate depression they are no more effective than placebos.

Evidence suggests that some kinds of therapy, notably Cognitive Therapy, work better than medication, especially for preventing relapse.  Therapy combined with medication works best.

The rate of relapse for severe depression is 50-90 percent, depending on which website you read, with a lifetime average of four episodes per person.

Scans show that depressed brains look different than normal ones. It’s unknown if this altered brain chemistry causes depression or is an effect of it.

Is mental illness caused by biological, psychological, environmental or other facters, or a combination of these? The debate continues.

This preliminary research made me want to dig deeper, so I went to my library website and put holds on books about psychology and psychiatry that seemed relevant. Most of these books took me through the history of psychiatric treatment, which has been with us for less than two hundred years. They also provided different opinions on current treatments. Extremely different opinions in some cases. Which led the blog post reviews that I’m re-posting this February Psychology month.

Since the Government of Canada has established February as Psychology Month, I’ve decided to re-run my blog post reviews of psychology books, from two years ago. I’m finding it interesting to revisit the messages in these books. Here’s the first review:

Inside the Mental: Silence, Stigma, Psychiatry, and LSD by Kay Parley.

At 179 pages and not much larger than my hand, Inside the Mental offers an inside look at mental health treatment in Canada during the 1950s and 60s. In 1948, Kay Parley suffered a breakdown as a student at Lorne Greene’s Academy of Radio Arts in Toronto. She was admitted to the Weyburn Mental Hospital in her home province of Saskatchewan. The Weyburn was home to her in other ways, since her father and grandfather were long-term residents at the hospital. During her stay, Parley only saw them briefly due to the numbers of patients and wards and her doctor’s concern that meeting them could be disturbing.

Parley spent nine months in the Weyburn as a psychiatric patient. Today, she might not have been admitted at all. She wasn’t a threat to others or herself and, by her own account, was reasonably functional. She worked on the hospital newsletter and participated in drama activities. Upon release, she went on to a productive life with breakdowns every six years but no further hospitalizations. Parley was initially diagnosed as schizophrenic, although she says she might be bipolar or something else. In her view, the label doesn’t matter. She eschews treatment with medication, since her doctors at the Weyburn taught her to work through her problems.

The book’s big surprise for me was the enlightened treatment she received. Far from One Flew Over the Cuckoo’s Nest, most of the hospital staff showed the patients’ respect and a measure of equality. The Weyburn came across to me as less a prison and more a community that allowed people to thrive in a protective environment. This was misleading, as in the last chapter Parley states that life there was terrible for the majority of residents, who were deemed untreatable. Yet, her grandfather had an occupation as a hat-maker and she admits long-term patients able to work in the garden or other areas didn’t have it so bad.

During the 1960s, the Weyburn got into experimenting with LSD as a treatment for mental illness. Parley, now a nurse, became a regular sitter for those given LSD in the controlled environment. She says the drugs they used were purer than the later street forms. As often as not, the experimenters were hospital staff who viewed LSD as a way to understand their patients. Parley doubts that acid trips mimic schizophrenia, as LSD hallucinations tend to be more visual than auditory, but she feels LSD opened the staff’s minds to other consciousness. She believes these treatments worked especially well for alcoholics and might still be useful for treating addictions.

Inside the Mental challenges an assumption that medical treatment always represents progress. While reading this book, I found myself constantly wondering if today’s mental health treatment is better or worse than it was 60 years ago. It’s sad to realize I can’t answer that question. Parley’s book challenges us to not assume we’re on an improved track and to look at other possibilities.

Two-three years ago I read eight books on modern psychology as research for my novel, To Catch a Fox. I posted reviews of the books on my blog and now hate to see all that effort lost in cyberspace. Since the Government of Canada has established February as Psychology Month, I’ve decided to re-run my posts this month, with the odd updated tweak here and there. I’m finding it interesting to revisit the messages in these books. Here’s the first of the rebooted series:

I began my readings about modern psychology/psychiatry with Psychiatry: A Very Short Introduction by Tom Burns (Oxford Press 2006). The book is short, to the point and provides a good overview for not too much reading effort.

Burns’ introduction spoke to me when he remarked on the current preference to say that psychiatry is “just another branch of medicine.” The goal of such statements, he says, is to raise the status of the profession and reduce the stigma of mental illness. The problem is, psychiatry is different. There are real differences between mental and physical illnesses that won’t go away simply because we want them to.

In Chapter One ‘What is Psychiatry?’ Burns points out that psyche is the Greek word for mind (It’s also the Greek word for ‘soul’ or ‘breath of life’).

While the ancients pondered psychology (human thought and behaviour), the profession of psychiatry developed in the late 19th century with Sigmund Freud’s treatment of neurotic disorders, which he believed were caused by repressed unconsious thoughts.

Freud’s theories contributed much to twentieth century thinking — we still use the term Freudian slip, but his method of psychoanalysis has become increasingly marginalized in modern psychiatric practice. Today’s approach favours quicker and cheaper therapies that work at changing behaviours, with no need to understand underlying issues. Cognitive Therapy, with it’s goal of changing thinking, falls between behavioural and psychotherapy and has become one of the most successful and widely practiced therapies today. For better or worse, many turn to the self-help movement, a modern outgrowth of psychotherapy. Medication is the cornerstone of treatment for psychotic illnesses, the primary ones being schizophrenia and biopolar disorder.

What’s the difference between neurotic and psychotic? The latter involves a loss of insight into the personal origins of one’s strange experiences; an inability to reality check.

This led me to the internet, where I learned that the newer drugs developed to treat neurotic disorders like depression aren’t more effective than the older ones. Today’s drugs work better because their fewer side effects make people less inclined to discontinue them. The newer drugs are more expensive to develop and produce. Some critics claim this encourages pharmaceutical companies to push agendas to redefine conditions we once viewed as normal as an illness. While it is good to recognize certain conditions, Burns observes that the DSM (Diagnostic and Statistical Manual of Mental Disorders) definition of Oppositional Defiant Disorder sounds a lot like ‘difficult teenager.’

His book reminded me of the anti-psychiatry movement that was popular on college campuses in the 1960s and 70s. I never got past the title of Thomas Szasz’ book The Myth of Mental Illness, but discussed his message that the schizophrenia is just a different take on the world. Szasz, R.D.Laing and others battered the psychiatry profession during these decades and their views carry forward with the Scientologists. Burns suggests, in general, there is less opposition to the concept of psychology and psychiatry today, possibly due to an exaggerated faith in biological explanations.

The nature vs. nurture debate is inherent in psychiatry. Freud’s theories and approach shifted the focus to nurture, even though he believed that medicines would ultimately be the cure.  The nurture view prevailed from the 1940s to 1970s. The upside of nurture is the possibility of cure; the downside is blame, especially to parents.

Why do parents blame themselves? Because we need to believe we have influence in order to invest all that time in child raising. It’s evolutionary.

The conclusion of Burns’ book brings us back to the start: the mind is not the same as the brain. Psychiatry isn’t just another branch of medicine. When people can choose, they usually want a mixture of medicine and therapy.

Mental illness is still defined by its impact on the person’s sense of self and on his or her closest relationships. As Freud put it, his goal was to enable people to work and love.

For those who missed it, here’s my January 12th post on my publisher BWL’s website Author Blog.

Happy Holidays!

How better to enter into the spirit of the season than to reminisce about my trip last spring to the land of Beatrix Potter and Peter Rabbit. For those who missed it earlier this month, here is the post I wrote for the Dec 12th Books We Love Author Blog.

Beatrix Potter, author of The Tale of Peter Rabbit and other beloved children’s stories, grew up in London, England. Her family spent their summer holidays in the countryside, where she discovered that she loved animals and nature more than cities. The Lake District in England became the place of Beatrix Potter’s heart. Last spring I came to understand why she loved that region when my husband Will and I spent a week in The Lake District. One of our many highlights was a boat ride across Lake Windermere to Wray Castle, which the Potters rented for several family vacations.

Wray Castle – Beatrix Potter’s parents must have  had a fair amount of money to be able to rent such a large summer cottage. They were wealthy enough that they scorned working for a living.

Rambling Wray Castle is now a tourist site, its rooms containing an eclectic assortment of displays. Some depict the life of the woman who built the castle, Margaret Dawson, an early feminist. Other rooms show drawings and scientific studies made by Beatrix Potter. There are a large number of playrooms for children, which include replica scenes from Peter Rabbit and her other stories. A friend told me she and her family spent a fun rainy day at Wray Castle letting their children run loose.

Will steals cabbages from Mr. McGregor’s garden

I join Beatrix, her family and their guests for dinner

From Wray Castle, Will and I walked the path along Lake Windermere. At a beach we met a friend, who wasn’t shy.

Beatrix Potter studied animal habits meticulously to make her character’s actions realistic. We caught a ferry to the town of Bowness and visited The World of Beatrix Potter museum, which featured dioramas of Beatrix Potter’s stories.

In 1905 Beatrix used income from her books and a small inheritance to buy a farm in The Lake District. Eight years later, at age 47, she married a local solicitor. While she continued to write, her interests shifted to country life. She bred and raised Herdwick sheep, a breed indigenous to the region, and became president of the Herdwick Sheepbreeders’ Association. Some credit her progressive policies and methods for helping to save the breed from extinction.

Herdwick sheep are born black and grow lighter with age.

Beatrix Potter wrote her greatest works before she settled contentedly into the life she was meant to lead. No doubt she was happiest in her later years, but fans of Peter Rabbit and her other charming characters can be glad for her younger days when she struggled to find her place in the world.

Beatrix Potter and me in The World of Beatrix Potter

On Remembrance Day this year, I reflected on my trip to the Canadian battlefields of northern France in my post on my publisher’s website. Here is the post, for those who missed it.

Yesterday, November 11, marked the 100th anniversary of the formal end of World War 1. The occasion led me to remember my trip to Europe three years ago with my husband Will and our son Matt. We began our tour of Canada’s battlefields with a stop at the Canadian National Vimy Memorial in northern France.

Our approach led to an impressive sight. Sculpted of Croatian limestone, the Vimy monument features 20 human figures representing peace and the defeat of militarism.

Student guides conducted a tour of the preserved trenches and tunnels.

Moved by all we’d seen at Vimy, we drove to the Beaumont-Hamel Newfoundland Memorial. Newfoundland didn’t join Canada until 1949 and fought as a separate regiment in WWI.

Beaumont-Hamel caribou monument

On July 1 1916, the first day of the Battle of the Somme, the Newfoundlanders left the trenches to storm a ridge occupied by German forces. Most of the soldiers made it less than half way before they were mowed down by German guns and artillery. An Allied explosion set off earlier had warned the Germans of the impending attack. The Newfoundland regiment failed to take the ridge.

Plaque in Musee Somme 1916, in the town of Albert, France

Nearby, in Thiepval, we visited the Memorial to the Missing of the Somme, where graves of British Commonwealth and French soldiers represent the joint nature of the 1916 Somme offensive. The British Commonwealth headstones are rectangles made of white stone; the French headstones are grey crosses.

We left France and drove toward Bruges, Belgium, for several days of respite from war. But on the way we stopped at Ypres, the location of several WWI battles that virtually destroyed the city. After the war the city was rebuilt to its former style, attractively we felt.

Main square in Ypres

At the Ypres Memorial to the Dead, people were setting up for the weekend’s ceremony to commemorate the first poison gas attack, which took place in Ypres in April 1915. Lights shining on the stone monument’s list of war dead cast an ominous glow.