Mysteries of Mental Illness

a review of the PBS series

There were a bunch of artistic representations in ads for this series, but this was my favorite. I like the simplicity of the crumpled paper, and it’s actually a traditional way of representing the cortex in science classes, as a sheet of tissue that has to be folded or crumpled to fit inside the skull. Photo from https://www.tvinsider.com/show/mysteries-of-mental-illness/

First, to any of my summer students who might be dropping by, welcome! This piece is an extension to our various course readings, based on a new documentary series that I didn’t know about until just this past week.

Feel free to forward this to anyone you think might like it or benefit from it.

In the rush of summer teaching I had completely forgotten about this article ... first time my name has made a cover! Yay!

Second, I have a nonfiction piece out in the March issue of ParAbnormal Magazine.

It concerns synchronicities, those moments of odd significance when events in the world line up with internal events. It could be a song on the radio and a passage in the book I’m reading at the B&N Cafe. These moments feel, cognitively and emotionally, like more than simple coincidences, compelling in the same way that deja vu feels compelling, in that moment. Synchronicities are a regular feature of horror and paranormal literature, though they aren’t always labeled as such, and they sometimes feature in psychiatric diagnoses as well.

I mention the piece here because most of us have experienced weird things at at least once in our lives. Near the end of a long drive recently, I saw the white line on the left side of the road flicker very briefly between two images:

• a tall man, leaning into the road, with a white stripe down his pants; or

• a very large penguin.

Nothing else, just one of those two things, and then back to being a line on the road. More of a hallucination than a synchronicity, really.

I’m a neuroscientist and a meditator, so I know both from study and from personal experience that “reality” is a construction. I’m not much disturbed by moments when reality wavers a little bit. For me, those moments are rare and brief. Other people are not so lucky.

Mysteries of Mental Illness

This is a well-done series that intersperses interview clips of talking heads from psychiatry with profiles of people who are suffering from various maladies. These range from depression to obsessive compulsive disorder (OCD) to psychosis. To clarify, psychosis means a break from consensus reality into a personal reality of hallucinations and delusions — entirely different from the psychopaths or sociopaths so beloved of TV crime dramas. Any of us could have a psychotic break after a hundred hours or so of sleep deprivation. Psychotics might on occasion become violent, but generally not in a directed, sustained, serial-killer kind of way.

Schizophrenia is how we in the west label a chronic syndrome of persistent hallucinations and delusions that can lead to repeated psychotic episodes, illustrated in this series by the story of former astrophysics student and now activist Cecilia McGough.

OCD is represented by Houston native and flyweight boxer Ginny Fuchs, who just lost by decision to a Bulgarian boxer last month in the Olympics. It’s a feature of this series that extreme behaviors are shown in their extremity, but never played for laughs, the way Jack Nicholson played OCD in As Good As it Gets, or the way psychosis is portrayed in one of my favorites, The Maxx, a cartoon from the 1990s that I’ve used with students for many years now.

Another feature is the effort the series puts into context, showing how concepts and treatments have evolved over time, in response to technology and intellectual fashion.

Evil or Illness

This first episode opens with a quote from Hippocrates

“It is the brain which is the seat of madness and delirium, of the fears and frights which assail us, insomnia and sleepwalking, of the thoughts that will not come, forgotten duties and eccentricities, all such things result from an unhealthy condition of the brain.”

Most people at the time thought madness was a curse of the gods. Hippocrates and many other medics of the next 2000 years instead imagined four fluids, or humours, that had to be balanced through bleeding or purging (more on this in last week’s visit to the Country Doctor Museum). Women might also be driven crazy by their wombs moving around inside their abdomens, called hysteria, a diagnosis that lasted right up through the early 20th century.

Once Christianity came onto the scene, demonic possession was a common diagnosis, to be cured by exorcism, or by just beating the devil out of the patient. Even King George III of England was brutalized, as though consensus reality could be imposed through physical and social dominance (like the king was a wayward child who could be bullied into conforming). Or as though the mind was a complicated machine, full of gears that could get out of alignment, and be knocked back into alignment by banging on the skull with a hammer, or spinning the patient around, or shocking the patient with cold water. Metaphors were loose.

Some of my students this summer looked at a modern case in New Zealand, where a Maori woman named Janet Moses who was undergoing some kind of psychotic break was essentially waterboarded to death by her extended family over the course of five days while they tried to drive an evil spirit out of her. After her death, they continued on one of her teenage relatives, thinking the spirit had jumped into a new host. Eventually the police arrived, and the teenager was removed to a hospital, where she recovered. There’s a documentary on Netflix, called Belief: the Killing of Janet Moses.

This series, Mysteries of Mental Illness, never draws the distinction between a syndrome (a collection of symptoms) and a disease, which has an identified cause and effect, but it does emphasize again and again that we do not have reliable biological tests for any of these disorders. Which is more than most media do.

What I find annoying is that even the successes are presented as failures, because they’ve never been perfect successes. One quarter of all asylum patients were finally discovered to have syphilis, a venereal disease that is now easily treatable with antibiotics. One quarter. Millions of people saved from years of madness and suffering and eventual death. How is that not a triumph?

I was also fascinated to find out that Charcot, the most prominent neurologist of his time, used hypnosis in the treatment of hysterical women. Freud witnessed these demonstrations and combined that idea with Darwin’s hypotheses about the evolution of behavior (instincts) to create the concept of the unconscious mind. Another partial triumph, but one that quickly went off the rails in its applications.

Who’s Normal?

This second episode goes into more detail about the politics of de-listing homosexuality from the DSM than I’ve ever seen before, and also spends considerable time with Mike Yamamoto, a retired soldier who spent years in therapy “trying to figure out what was wrong with me,” before finally transitioning to become Mia Yamamoto.

“What is abnormal behavior? What is normal behavior? What is illness, and what is the sort of, you know, the broad swath of what it means to be human?”

-Susannah Cahalan, author of Brain on Fire

This episode also points out in a way I had never seen before how the two World Wars shaped the debate around mental illness, reinforcing Freud and his idiosyncratic developmental model of homosexuality.

“In the psychoanalytic worldview, the normal course of development was, you passed through your bisexual phase into your heterosexual phase. So that becoming homosexual meant there was sort of an arrest in the developmental process.”

- Ronald Bayer, public health researcher

It was actually the de-listing debate, starring the masked “Doctor Anonymous” that began to turn that tide, followed by the stunt / study that inspired another recent book by Susannah Cahalan, and the development of the first psychiatric drugs.

Or actually, the second wave of psychiatric drugs. The Germans pioneered the use of methamphetamine during combat, and according to another documentary from a couple of years ago, World War Speed (2019), the Brits tried using it to treat PTSD, which they called “shell shock” or “combat fatigue” at the time. Then they started using it to prevent PTSD, to boost morale, in tank crews fighting in North Africa, at a ridiculous dose of 20mg/day. Tweakers in tanks! 80% casualty rate during some of those battles.

This episode also follows a modern vet and sufferer of PTSD through a session of Cognitive Behavioral Therapy, trying to desensitize him to his memories.

The Rise and Fall of the Asylum

The Sheriff of Cook County jail states clearly in this episode that he did not know what job he was running for, as almost 40% of his prisoners have diagnosed mental illnesses, and 90% are people of color. In other words, our current asylums are not run by trained doctors but by whichever tough-on-crime candidate can get the most votes in a local election.

Dorothea Dix, the “Angel of the Madhouses,” took the idea of “moral treatment” from English Quakers and convinced state after state to build special hospitals for the insane, called asylums. North Carolina, despite its relatively large and influential Quaker population, was one of the last. Today the grounds are a park, owned by the city of Raleigh. There’s a virtual exhibit about the various historical stages of its development.

Tragically, the asylum network was almost immediately overwhelmed by the vast sufferings of the Civil War, and they became places where people just disappeared, and died, and were buried in unmarked graves. Treatments were experimental, but not peer-reviewed by other scientists, and there were no Institutional Review Boards who had to examine the ethics before they could be carried out.

And then of course, eugenics came along, and patients could be surgically sterilized without their consent. North Carolina was the last state to stop this practice, in 1974. The Winston-Salem Journal has some really excellent coverage of this horrific history, going back almost 20 years in a single online archive called Against Their Will (#againsttheirwill), after a multi-part expose in 2002.

We’re unsatisfied with our current crop of psychiatric medications, but the “chemical lobotomy,” thorazine, was an improvement over actual, surgical lobotomies, or dying in an asylum.

New Frontiers

This last episode was much more your standard hopeful science documentary, with descriptions of the latest versions of electroconvulsive therapy, psychosurgery, and psychedelic drugs (which were legally blocked from researchers for decades). The main difference is in the humility of the presenters, who are much more careful and conservative in their claims than previous generations tended to be.

Of course, this is PBS. They’re not in the business of sensation. But they do ask you to subscribe, so I will as well. This newsletter is free, though.

Finally, before we go, a nod to Nicky Case’s interactive Adventures With Anxiety!, in which you play the red wolf of anxiety, trying to keep your human “safe,” by preventing her from doing anything that might be “dangerous.”