I got back this week from a four week trip to Mexico and can relate to David Albahari’s experience of a foreigner thrust into Calgary. I’m still a little zoned out.

Continuing the Calgary in winter theme: Weyman Chan.

In the 1950s and 60s, anxiety was the most commonly diagnosed mood disorder in North America. People talked of the Age of Anxiety; The Rolling Stones sang about Mother’s Little Helper, a reference to a tranquilizer commonly prescribed to housewives.

Starting in the 1970s, anxiety became eclipsed by depression.  Today, prescriptions for anxiety are dwarfed by antidepressants, the most prescribed medication of our times.

Why this change? ask Allan V. Horwitz and Jerome Wakefield, authors of All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders.

And, furthermore, where is the line between natural anxiety and a disorder?

Their answers to this last question come from an evolutionary perspective. In the primitive world, where dangers were ever-present, anxious vigilence made sense.  Fear of strangers, status fears like making a public fool of oneself, fears of snakes, rhodents and heights increased your chances of evading disaster. Better to over-react every time, than to relax once and die. Those anxious genes of survivors were passed on to their modern descendents.

In today’s world, strangers rarely present a threat; if one group of friends hate you, you can find another group; city dwellers are unlikely to encounter snakes and in northern climates snakes usually aren’t poisonous. Yet such fears are bred into us and can seriously impact our lives. Fear of flying is a common anxiety because it combines several architypal fears – enclosed spaces, heights, loss of control. It wasn’t clear to me at what point the authors felt these fears should be treated by medicine or therapy, but they got across their view that these anxieties are rooted in human nature. It made me feel less odd about freaking at the sight of a mouse.

The authors’ first question interested me more. Many years ago, I watched a movie — I believe it was Starting Over (1979) — where a person had a panic attack at a large gathering of women and a character asked, “Does anyone have a valium?” Every woman reached for her purse. Valium was that decade’s most prescribed anti-anxiety medication, although by 1979 anxiety was already losing ground to depression.

People didn’t change in the 70s and 80s, Horwitz and Wakefield say, becoming less anxious and more depressed. Anxiety and depression have many overlapping symptoms. Sufferers often shift between symptoms of each that could arguably be treated as a single illness. What changed was the diagnosis. This happened for a convergence of reasons.

The anti-psychiatry movement of the 1960s and 70s heightened the psychiatric profession’s inferiority complex (my words) relative other medical specialties. Psychiatrists wanted to be viewed as scientific and, well, medical. They accomplished this by changing the focus of the 1979 DSM (Diagnostic and Statistical Manual) away from unproven causes  to symptoms, which could be clearly specified.

Major depression has always been recognized as a serious illness, one that might require hospitalization, like schizophrenia and bipolar disorder. Around this time, insurance companies were increasinging covering drugs that patients used to pay for on their own. The insurers wanted proof that applicants required treatment for medical reasons. The DSM lll defined depression as a mental disorder, with simple qualifications – two weeks duration and general symptoms that might be mild, moderate or severe. The manual eliminated general anxiety as a disorder, requiring the anxiety be specific (ie. Social Phobia, Fear of Flying) and that it continue for long periods of time, sometimes years. Diagnoses for general malaise quickly shifted to depression so patients could receive insurance payments.

In addition, by the late 1970s, anti-anxiety medications were getting a bad rap, due to claims of their addictive qualities. In the 80s, when the giant pharmaceutical companies developed Prozac and other new types of drugs, they marketed them as antidepressants, although they might as accurately have marketed them for anxiety. In fact, some of those medications have since been approved by the US Food and Drug Administration for specific anxiety disorders. In 1999 the FDA approved Paxil for Social Anxiety Disorder (SAD) and Zoloft for Post Traumatic Stress Disorder (PTSD). Horwitz and Wakefield predict more approvals will follow, breathing new life — and profits — into the tired antidepressants.

They also predict a shift in diagnoses from depression back to anxiety. They note that the same sort of attacks that happened to the anti-anxiety medications in the 1970s are now happening to the antidepressants, “with questions about their effectiveness, side effects, potential addictiveness and safety.”  In addition, the patents for the antidepressants will soon start running out, resulting in lower profits for the pharmaceutical companies. This should prompt them to develop newer drugs to treat newly-defined disorders.

The authors add that, “The diagnosis of depression is no longer as useful to psychiatry as it was over the past quarter-century. The profession’s scientific credibility is now far greater than it was in the 1970s, its diagnostic system is generally regarded as reliable, and its biological models are widely accepted.” As  a result, they expect psychiatrists to be more willing to diagnose anxiety. It will be treated by the pharmaceuticals’ new type of medication marketed to treat anxiety, now acceptable to insurers as a genuine disorder.

I would add that anxiety is becoming more socially acceptable. It used to seen as a women’s problem; now men are admitting to having it.

Which all means we might be entering a new age of anxiety.

Horwitz and Wakefield present this as a positive, since they favour viewing anxiety as a serious condition, but it left me wondering, do we want to keep letting fads and the  pharmaceutical companies call the shots?

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 nice 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.

Suzette Mayr’s novel Monoceros is a Calgary book that I found moving, challenging and memorable.

Who’s the world’s top earning writer? Clue: he leaves the rest of us in the dust. It’s in this month’s issue of Opal Point of View ezine along with tips for social media, blogging for fiction writers and writing accurate crime scene investigation.

Follow this link to view the February issue

http://www.opalpublishing.ca/wp-content/uploads/2016/01/Opal-Point-of-View-February-2016.pdf

You can download a copy of the PDF file from our website www.opalpublishing.ca

Copyright © 2016 Opal Publishing, All rights reserved.

Our mailing address is:
McKenzie Towne, Calgary, Alberta

Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list

“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.

Like the first psychiatry book I read, 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 with its portrait 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 # 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, Liberation 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 not as heavily as it is with the general public. 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. My next readings challenged the conventional point of view.

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 through the 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, he notes, 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 psycho therapy 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. Drugs are 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.

As I learned on the Internet, the the newer drugs developed to treat neurotic disorders like depression aren’t more effective than the older ones. They 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 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.

When I saw this picture on Calgary Through the Eyes of Writers I thought it was waves on a Mexican beach. Turns out it’s ice on the Bow River.