Mad in America: Rethinking Mental Health

On the Mad in America podcast this week, we hear from the co-authors of a paper published in the journal Ethical Human Psychology and Psychiatry which documents the mass murder of a quarter of a million people, mostly diagnosed as “schizophrenic” in Europe during the Second World War. Later, we hear from Dr. Jeffrey Masson, who is an author and a scholar of Sanskrit and psychoanalysis. But first, we talk with professor of psychology John Read. Regular visitors to Mad in America will know of John’s work. For those that don’t know, John worked for nearly 20 years as a clinical psychologist and manager of mental health services in the UK and the USA, before joining the University of Auckland, New Zealand, in 1994, where he worked until 2013. He has served as director of the clinical psychology professional graduate programmes at both Auckland and, more recently, the University of Liverpool. He currently works in the School of Psychology at the University of East London. John has many research interests, including critical appraisals of the use of psychiatric drugs and electroconvulsive therapy. Jeffrey Masson has had a fascinating career in which he studied Sanskrit and psychoanalysis and became director of the Sigmund Freud archives. A prolific author, he has written more than 30 books and has become an advocate for animal rights. He is currently an Honorary Fellow in the Department of Philosophy at the University of Auckland in New Zealand. We discuss how John and Jeffrey came to write a paper which examines a grim period in psychiatric history.

In March 2022, a new grief-related disorder was officially adopted into mainstream mental health diagnosis nomenclature. Prolonged Grief Disorder (PGD) is a recent addition to the Diagnostic and Statistical Manual fifth edition text revision (DSM-5-TR). A PGD diagnosis is to be used when a person is grieving too long and too intensely. In this interview, Kaori Wada, Psychologist, grief researcher, and Associate Professor and Director of Training at the University of Calgary, builds upon her recent paper on the Medicalization of Grief in conversation with MIA Science News Writer and Psychologist Zenobia Morrill. Wada articulates a history of institutional tensions and financial conflicts behind the creation of this new PGD diagnosis. She also discusses the ways PGD could shape how we collectively understand and respond to those grieving. Wada’s work demonstrates that the creation of PGD was not based on scientific findings but appears to be entangled in long-standing arguments between camps of mental health professionals with different stakes in whether the diagnosis became legitimized. Further, PGD, as with other diagnoses, represents elements of mainstream psychological theory that tend to render deviations from Western cultural norms as “unhealthy.” Is diagnosis needed to provide support and care? If so, those most likely to experience marginalization, violence, and unjust loss are also most likely to be classified as having PGD, a mental illness. At a time when the world is fraught with tragic loss—owing to causes ranging from political failures, state violence, and the COVID-19 pandemic—grieving has been transformed into a mental health disorder. But the complicated question of what a mental disorder is continues to be glossed over. The opportunity for psychiatric professionals to embrace humility seems to have reverted to the familiar “diagnose-and-treat” response. Will pharmacological intervention become the dominant “treat” response to a diagnosis of PGD? A new grief disorder is a clear departure, however, from the way grief used to be described in the field as an example of something that is clearly not a mental health disorder, Wada shared. She exclaims: “To me, the medicalization of grief is controversial because it may fundamentally shake up the concept of a mental disorder, [how it has] been defined and understood.” Wada and Morrill explore what this new PGD diagnosis may mean, reflecting on the ways the “diagnose-and-treat” logic seems to of experiences formerly considered part of the territory of being human. The need to pathologize experiences in order to address them represents a paradox. A new ethical and moral quandary befalls professionals tasked with determining when grief is an illness and when expressions of grief are inappropriate. Will the public embrace this new disorder? Will the medicalization of grief be resisted? Will a pandemic of PGD diagnoses follow a global pandemic? Wada speaks to the personal and professional influences that shaped these curiosities and her approach to researching how grief is being construed in the mental health field.

Our guest today is sociologist and author, Doctor Andrew Scull. Andrew is a professor of Sociology and Science Studies at the University of California, San Diego, and recipient of the Roy Porter Medal for lifetime contributions to the history of medicine and the Eric T. Carlson Award for lifetime contributions to the history of psychiatry. The author of more than a dozen books, his work has been translated into more than fifteen languages and he has received fellowships from, among others, the Guggenheim Foundation, the American Council of Learned Societies and the Shelby Cullom Davis Center for Historical Studies. In this interview, we discuss his latest book, Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness, published by Harvard Press in May 2022. Dirk Wittenborn, the screenwriter and novelist, described the book as "A riveting chronicle of faulty science, false promises, arrogance, greed, and shocking disregard for the wellbeing of patients suffering from mental disorders. An eloquent, meticulously documented, clear-eyed call for change." *** If you find this podcast valuable, rating it 5 stars and leaving a review on iTunes or Spotify or sharing it on social media helps us to get the word out about these important conversations. Thank you.

On our last podcast, Mad in the Family covered the effect of climate change and extreme weather events on children’s and mothers’ mental health. This one continues the conversation on environmental links to emotional distress: emerging research showing that pollution in the air and water can affect our minds and emotions, and that children are especially vulnerable, both while they are young and later in life. Kristina Marusic is a Pittsburgh-based investigative reporter for Environmental Health News, an award-winning, non-partisan organization dedicated to driving science into public discussion and policy. Last fall, EHN collaborated with Allegheny Front on a five-part series, “Pollution’s Mental Toll: How Air, Water, and Climate Pollution Shape Our Mental Health.” They found that residents throughout western Pennsylvania were likely suffering changes to their brains due to pollution in the surrounding environment, even at levels below federal limits. Prior to joining EHN in 2018, Kristina covered issues related to environmental and social justice as a freelancer for a wide range of digital media outlets including The Washington Post, Slate, Vice, Women’s Health, and MTV News, among others. Her reporting on environmental health for Public Source won first place in the Keystone Society of Professional Journalists’ Spotlight contest in 2017. Kristina holds an MFA in Non-Fiction Writing from the University of San Francisco and a bachelor’s degree in Creative Writing from Hofstra University. She is the co-founder and chair of the Pittsburgh chapter of the Association of LGBT Journalists. *** If you find this podcast valuable, rating it 5 stars and leaving a review on iTunes, Spotify or Facebook helps us to get the word out about these important conversations. Thank you.

Our guest today is Jessica Taylor, author of Sexy But Psycho: How the Patriarchy Uses Women’s Trauma Against Them, which was published in March by Little, Brown and quickly hit the London Times bestseller list. Based in England, she is a chartered psychologist with a PhD in forensic psychology and more than a dozen years of experience working with women and girls subjected to abuse and other trauma. She's the founder and CEO of VictimFocus, a trauma-informed UK organization that challenges the blaming and gaslighting of victims—and advocates for change in how they're treated. She's also the author of the 2020 book Why Women Are Blamed for Everything: Exploring Victim Blaming of Women Subjected to Abuse and Trauma.  *** If you find this podcast valuable, rating it 5 stars and leaving a review on iTunes, Spotify or Facebook helps us to get the word out about these important conversations. Thank you.

On the podcast this week, we hear from Dr. Niall McLaren. Niall, known to many as Jock, is an Australian psychiatrist who worked for 25 years in the remote north of the country. Also an author, Jock's latest book is entitled Natural Dualism and Mental Disorder, the Biocognitive Model in Psychiatry, and it was published in December 2021. Recently retired after 47 years, Jock joined me to talk about his experiences working in psychiatry and explains why the models that purport to guide psychiatric diagnosis and treatment are not what they seem.  

Tara Thiagarajan is founder and chief scientist of Sapien Labs, a nonprofit organization that runs the Mental Health Million Project and its annual Mental State of the World Report, which uses an online survey to track mental wellbeing among internet-enabled populations around the world. The 2021 report, just published, was the project's second annual effort. Authored by Thiagarajan and lead scientist Jennifer Newson, it surveyed more than 233,000 internet users in 34 countries. The overall objective, write the authors, is to “provide an evolving global map of mental wellbeing and enable deep insights into its drivers.” Its results have considerable implications regarding mental health and the factors that contribute to it.

Dr. Bruce Cohen is an Associate Professor of Sociology at the University of Auckland. His career spans over thirty years where he has time and again used empirical research to tackle the numerous shortcomings of the psy-disciplines. With his upcoming book series, The Politics of Mental Health and Illness, he continues to expose how the psychiatric discourse “doesn’t work for us” but instead greases the wheels of a neoliberal capitalist society. In this interview he talks about how the psychiatric discourse has left the clinic and entered workplace, how the DSM has been feminized to the detriment of women, how and why the ADHD diagnosis has shifted shape, and lastly, how the global move towards “mental health” and away from “mental illness” might not be positive or benign.

Note: To find out more and to register for the 26th International Network Meeting for the Treatment of Psychosis 2022, click here. *** May is Maternal Mental Health Month, and although we tend to hear a lot about postpartum depression, as our guest today has pointed out, perinatal distress is really a spectrum of reactions. Childbirth and new parenthood are major life transitions that involve many physical, psychological, and practical changes. These changes may interfere a little or a lot in a mother’s ability to function optimally and, in turn, affect her relationship with the child and the child’s development. Today’s global crises, including climate change, the pandemic, and war, can add an additional layer of stress so normalizing the experience is more important than ever. Our guest is public health expert Jennifer Barkin, Ph.D., M.S., a Professor and Vice Chair of Community Medicine and Obstetrics and Gynecology at the Mercer University School of Medicine in Georgia. A biostatistician and psychiatric epidemiologist, Dr. Barkin was formerly an analyst at the University of Pittsburgh’s Epidemiology Data Center, where she designed the Barkin Index of Maternal Functioning (BIMF), the first patient-centered wellness assessment tool focusing on mothers’ daily lives during the first year after giving birth.  She is a peer reviewer for journals including Archives of Women’s Mental Health and serves on the Board of Directors for Postpartum Support International, Georgia Chapter.

The Visible Hands Collaborative in Pittsburgh, Pennsylvania is run by Alice Fox Thompson and Kenneth Thompson. Together, the father and daughter team is bringing a novel form of community healing developed in Brazil, called Integrative Community Therapy (ICT), to the United States for the first time. Alice Fox Thompson is currently in her fourth year of medical school at Geisinger Commonwealth School of Medicine. Before medical school, Alice worked in community organizing and advocacy. She is interested in solidarity-based approaches to community and population mental health. Kenneth Thompson is a psychiatrist trained at the Boston University School of Medicine. He has served as faculty at Yale University and the University of Pittsburgh and has been the director of many different psychiatric clinics. Ken currently serves as the Chief Medical Officer of the Pennsylvania Psychiatric Leadership Council, a unique state-level education policy and advocacy organization that he helped found. Ken’s focus as a psychiatrist has always been on social medicine and community psychiatry, having written, consulted, and lectured extensively on issues of public service, whole-person treatment, primary health services, health equity, democracy, human rights, and more. In this interview, Alice and Ken describe how they both came to Integrative Community Therapy and what they've learned in adapting it to their context in the Visible Hands Collaborative in Pittsburgh. They also discuss the connection between the emotional literacy and community support developed in their groups and broader processes for political change and social justice.