Many of these disorders are treatable with aggressive immunotherapy. “It’s a breakthrough,” Heather Van Mater, a pediatric rheumatologist at Duke who has cared for Sasha, told me. She and her colleagues treat people who, just 10 years ago, might have been given up for lost and locked away. “We can make them better,” Van Mater said. “It’s unbelievably rewarding.”
While each of these autoimmune conditions is rare, the field of autoimmune neurology is expanding, and may force a reexamination of mental illness generally. Some scientists now wonder whether small subsets of depression, schizophrenia, and bipolar disorder may be somehow linked to problems in the immune system.
High levels of bromide chronically impair the membrane of neurons, which progressively impairs neuronal transmission, leading to toxicity, known as bromism. Bromide has an elimination half-life of 9 to 12 days, which can lead to excessive accumulation. Doses of 0.5 to 1 gram per day of bromide can lead to bromism. Historically, the therapeutic dose of bromide is about 3 to 5 grams of bromide, thus explaining why chronic toxicity (bromism) was once so common. While significant and sometimes serious disturbances occur to neurologic, psychiatric, dermatological, and gastrointestinal functions, death is rare from bromism.
Bromism is caused by a neurotoxic effect on the brain which results in somnolence, psychosis, seizures and delirium. Bromism has also been caused by excessive soda consumption, due to the presence of brominated vegetable oil, leading to headache, fatigue, ataxia, memory loss, and eventually inability to walk in one case.
As a psychiatrist, I see this as the biggest challenge facing psychiatry today. A large part of the population – perhaps even the majority – might benefit from some form of mental health care, but too many fear that modern psychiatry is on a mission to pathologise normal individuals with some dystopian plan fuelled by the greed of the pharmaceutical industry, all in order to put the populace on mind-numbing medications. Debates about psychiatric overdiagnosis have amplified in the wake of the 2013 release of the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the so-called ‘bible of psychiatry’, with some particularly vocal critics coming from within the profession.
It’s true that the scope of psychiatry has greatly expanded over the past century. A hundred years ago, the profession had a near-exclusive focus on the custodial care of severely ill asylum patients. Now, psychiatric practice includes the office-based management of the ‘worried well’. The advent of psychotherapy, starting with the arrival of Sigmund Freud’s psychoanalysis at the turn of the 20th century, drove the shift. The ability to treat less severe forms of psychopathology – such as anxiety and so-called adjustment disorders related to life stressors – with the talking cure has had profound effects on mental health care in the United States.
In 1954, a prison doctor in Kentucky isolated seven black inmates and fed them “double, triple and quadruple” doses of LSD for 77 days straight. No one knows what became of the victims. They may have died without knowing they were part of the CIA’s highly secretive program to develop ways to control minds—a program based out of a little-known Army base with a dark past, Fort Detrick.
Suburban sprawl has engulfed Fort Detrick, an Army base 50 miles from Washington in the Maryland town of Frederick. Seventy-six years ago, however, when the Army selected Detrick as the place to develop its super-secret plans to wage germ warfare, the area around the base looked much different. In fact, it was chosen for its isolation. That’s because Detrick, still thriving today as the Army’s principal base for biological research and now encompassing nearly 600 buildings on 13,000 acres, was for years the nerve center of the CIA’s hidden chemical and mind control empire.
President Trump says yes, many in the mental health community say no.
Mental illness is commonly defined as an impairment that interferes with one’s ability to make decisions based on evidence. An obvious example is delusions of imaginary worlds that do not exist. A mentally ill person says that there is a monster in the closet but the average person can look in the closet and not see the monster.
But what about ideology? Strong views on an issue can cloud people’s perception of the facts. But what about a value system that values some evidence more than others? Are there bad values that a person can have? Mental health professionals generally try to avoid such topics because they don’t want to seen as picking sides in a political debate.
A person is generally viewed as not mentally ill if they take a course of action after analyzing the pros and cons of action. Even an action that could lead to certain death or a lifetime of incarceration might be worthwhile to a suicide bomber, who sees their death as a way to get to heaven. They may have fully understood the consequences of their actions and made a rational decision based on their ideology – and therefore are not mentally ill.