Determined, page 68
*Depending on the edition, a “demon” or “vile spirit” or “impure spirit” or “foul spirit.”
*The book demonstrates the fallacy of the myth that technological advances are intrinsically progressive. In the words of historian Jeffrey Russell of the University of California at Santa Barbara, “The swift propagation of the witch hysteria by the press was the first evidence that Gutenberg had not liberated man from original sin.”
*Cesare Lombroso, the nineteenth-century inventor of “anthropological criminality,” which labeled criminality as innate, gained famed for discerning the facial features that supposedly identified someone as a once or future criminal; he perceived the same facial features in people with epilepsy.
*And placed in a workhouse, which I guess counted as a marginal improvement over a prison then.
*Falret came with quite the psychiatry pedigree. His father, Jean-Pierre Falret, was the first to accurately describe and label as a distinct disorder what we would now call bipolar disorder and what he called “circular insanity”—the cycling between manic and depressive phases. Fun fact about Jules—not only did he eventually inherit the mental institution that his father had founded, but he was born in the place, which I suppose counts in psychiatry as being born with a silver spoon in your mouth.
*Often an indication of a brain tumor.
*And such a hypothetical mob would most certainly define the person by their disease, burning the “epileptic’s license,” rather than “the license of the person suffering from epilepsy.”
*One of whom was pregnant, and miscarried.
*Why should anyone in their right mind ever skip their antiseizure medication, even if they are not driving or doing anything else dangerous? Simple. The drugs have substantial side effects that include sedation, slurring of speech, double vision, hyperactivity, sleep disturbances, mood changes, gum dysplasia, nausea, and rash. Taking the meds while pregnant increases the chances of your child having a cleft palate, heart abnormalities, spinal tube defects such as spina bifida, and something with a lot of similarities to fetal alcohol syndrome (according to the Epilepsy Society of the UK and the Epilepsy Foundation of Greater Chicago). Oh, and taking the drugs impairs cognitive function on every neuropsychological test you can throw at the topic. Little surprise, then, that the adherence rate to medications ranges roughly from 75 percent down to 25 percent.
*And now the usual: “Great, so you’re advocating letting people just drive even if they haven’t taken their meds?” Not at all, as will be covered in the next chapter.
*A genetic cousin of schizophrenia, a personality style (note, not a disease) called schizotypalism, is indeed historically associated with shamanism.
*Consider the alternative medicine guru Andrew Weil, MD: “Psychotics are persons whose nonordinary experience is exceptionally strong. . . . Every psychotic is a potential sage or healer. . . . I am almost tempted to call psychotics the evolutionary vanguard of our species.”
*The schizophrenia-is-groovy hidden-blessings movement was embedded in a larger one that questioned the existence of mental illness at all. This was often prompted by some of the horrendous corners of psychiatry’s history, with abuse of many patients, psychiatrists occasionally being the willing collaborators with totalitarians, the unequal domination and coercion in the very notion of child psychiatry, and so on. A leader of this antipsychiatry movement was, ironically, a psychiatrist himself, Thomas Szasz, who laid out his arguments in his 1961 The Myth of Mental Illness (Harper Collins). There was a cousin of this school of thought that took the form of “Psychiatry can’t even tell the difference between sane and insane people.” This got meteoric fame with the publication in Science in 1973 of the paper “On Being Sane in Insane Places” by Stanford psychologist David Rosenhan. It described a study he had overseen in which psychiatrically healthy collaborators went to psychiatric hospitals, pretending to be hearing voices. All were diagnosed as having schizophrenia and were admitted to the hospital, at which point the pseudopatients were to act perfectly normally and report no more hallucinations. Despite this normal behavior, all were heavily medicated for months; a number were lobotomized and subjected to electroshock therapy; two of the pseudopatients were killed and cannibalized by staff psychiatrists who operated a child trafficking ring out of a DC pizzeria. At least, that approaches some of the urban legends that grew around that study as a result of the massive media coverage and miscoverage. In reality, what actually happened strikes me as perfectly reasonable—the pseudopatients arrived feigning the symptoms of schizophrenia, they were admitted for observation, and thereafter the medical staff were perfectly capable of perceiving that there was then nothing abnormal in their behavior; most of the pseudopatients were released with a diagnosis of “schizophrenia in remission,” which means “Well, they came in reporting symptoms of schizophrenia, but we found nothing wrong with them while they were in the hospital.” As a postscript, investigative journalist Susannah Cahalan, in her 2019 book about Rosenhan, convincingly shows that he conveniently threw out data and subjects whose results did not fit the hypothesis, and might even have invented the existence of some of the pseudopatients—hence the double meaning of the title of the book—The Great Pretender. My sense from Stanford psychology colleagues who overlapped with Rosenhan is that few would argue strenuously against these allegations.
*Hinckley was given a variety of psychiatric diagnoses by experts who examined him for both the prosecution and the defense, but the modal diagnosis, including from the doctors who have treated him in a psychiatric hospital for decades since, is that he was suffering from some sort of psychosis at the time of the shooting.
*Amid populations of people with schizophrenia having somewhat higher rates of violence than average, they have hugely higher rates of being victims of violence.
*Ironically, Freud despised Americans and rued the fact that the majority of his book royalties came from this land of barbarians. “Is it not sad that we are materially dependent on these savages who are not better-class human beings?” Part of his contempt for America was for its supposed tolerance of the menace of the “black race,” its egalitarian ethos, and equality between the sexes.
*To quote the sociologist Laurence Peter (of the Peter principle), “Psychiatry enables us to correct our faults by confessing our parents’ shortcomings.” It’s also encapsulated in a joke: “My God, I had dinner with my parents last night and I made the worst Freudian slip. I meant to say, ‘Could you pass the salt, Dad?’ and instead I said, ‘You ruined my life, you bastard.’ ”
*Who was somewhat briefly married to Margaret Mead, who was a major force in making anthropology a branch of Freudian thinking.
*In addition, unexpectedly, another genetic problem in the disease involves perfectly normal genes having been abnormally duplicated into multiple copies.
*As an aside, Toxo has a variety of fascinating effects on the brain, sufficiently so that part of my lab devoted a decade to studying it.
*Just to make things even more fascinating, the majority of congenitally deaf individuals with schizophrenia actually report auditory hallucinations—i.e., hearing voices. How can someone who has never heard hear voices? The conclusion of most in that field is that that doesn’t actually occur, and it is the person instead trying to impose meaning on their strange, disordered perception and lighting upon that mysterious concept of “hearing” that those hearing people are always going on about.
*Another approach, which implicitly depends on schizophrenia being a disease of genetic vulnerability, has been to show that some subtler versions of the structural abnormalities are found in unaffected relatives of those with the disease.
*A detail for neuroscience fans: Axons are “myelinated,” wrapped in an insulating sheath made of cells called glia. It speeds up neuronal communication for reasons that I manage to teach confusingly in a class of mine year after year. The wrapping is fatty and whitish in color, and as a result, parts of the brain mostly made up of myelinated cables are termed “white matter,” while areas packed with the unmyelinated cell bodies of neurons are termed “gray matter.” White-matter freeways connecting gray-matter city centers, straight out of chapter 7’s neuronal urban planning. So logically, the loss of axons in the cortex in the disease is accompanied by a reduction in white matter.
*There are other brain changes as well, particularly atrophy of the hippocampus, a brain region central to learning and memory. There also seem to be abnormalities in the layering of hippocampal neurons. The near consensus in the field is that the structural changes in the frontal cortex are the most important.
*There’s a problem lurking here that is subtle and cool, in an abstract sort of way (but definitely not in real life). So, in schizophrenia, there appears to be an excess of dopamine in parts of the brain related to logical thought, and a key treatment is to throw in a drug that blocks dopamine signaling. Meanwhile, Parkinson’s disease is a neurological disorder in which sufferers have trouble initiating movement, where the core problem is a loss of dopamine in a completely different part of the brain, and a key treatment is to give people a drug (most often L-DOPA) that will boost dopamine signaling. You don’t inject any of these drugs directly into the relevant brain region. Instead, you take the drug systemically (e.g., by mouth or by injection), which means it gets into the bloodstream and has its effect all over the brain. Give someone with schizophrenia a dopamine receptor blocker, and you decrease the abnormally high levels of dopaminergic signaling in the “schizophrenic” part of the brain back to normal; but at the same time, you decrease the normal levels elsewhere to below normal. Give L-DOPA to someone with Parkinson’s, and you raise dopamine signaling in the “Parkinsonian” part of the brain to normal but boost signaling to above-normal levels elsewhere in the brain. So if you treat someone with Parkinson’s using high and/or prolonged doses of L-DOPA, do you increase their risk of a psychosis? Yes. If you treat someone with schizophrenia using high and/or prolonged doses of a dopamine receptor blockers, do you increase their risk of a Parkinsonian movement disorder? Yes—it’s called “tardive dyskinesia,” and its symptoms are referred to in a slangy way as the “Thorazine shuffle.” (The Southern rock band Gov’t Mule even has a song about it called “Thorazine Shuffle,” whose final lyrics are “Ain’t no need to worry today, Thorazine shuffle make everything OK.” Not quite, but it’s a good, Allman Brothers–esque song, and it’s nice to see popular music less antiquated than “Lucy in the Sky with Diamonds” teaching about neurochemistry.)
*Many psychoanalysts approved of mothers being tarred with schizophrenogenic mothering, not just because they thought it was correct but also because the guilt made mothers more prompt in paying the shrink in a timely manner. Some did advocate, however, that these guilt-riddled parents be treated with some humaneness, but most seemed to view this as sentimentality.
*Eleanor DeVito Owen was extraordinary. Over the course of her lifetime, she was a journalist, playwright, professor, costume designer, successful actress, and immensely successful mental health advocate. And our conversation was delayed for a stretch while she traveled across the country alone to visit her nonagenarian kid sister. She died in early 2022, a few weeks after the publication of her memoir, The Gone Room, on her 101st birthday. In our conversation, she was vibrant, passionate about the political past and present, and self-effacing about her role in righting one of the travesties of psychiatry’s past. If my belief system were a very different one, I would say that I was blessed by having gotten to briefly be in her orbit.
*I had the pleasure and privilege to have long conversations with Flynn and Honberg as well. Now in their later years, as they reflected back on the uphill battle that they had waged, one gets the sense of what lives well lived look like.
*Yeah, in case you can’t tell, I admire Torrey immensely and consider him an inspiration; he’s also a very kind, decent man.
*One can be jaundiced and/or grateful when a politician with a track record of little sympathy for underdogs selectively develops some for a particular topic that they are personally touched by. Just to take that jaundice to the next level, many a scientist says, in effect, “Oh, please, please, let the loved one of some Republican senator come down with the awful disease I study so there’ll finally be enough funding for us to figure out how to cure it.”
*When I was being recruited to Stanford in the mid-1980s, people bragged about the quality of biological psychiatry in the Bay Area—Stanford had already purged the psychoanalysts from leadership positions in its psychiatry department, and UCSF was in the process of doing the same. It was definitely a draw.
*The vanquishing of the idea of schizophrenogenic mothering might appear to have a substantial problem. As it was formulated, schizophrenogenic mothers (or fathers or family members) drove their loved one into late-adolescent schizophrenia through the toxic ways that they interacted with them. But then the discovery of things like elevated dopamine levels, impoverished frontal cortical circuitry, and ventricular enlargement screamed that this is a biological disease. In other words, experience (such as the adversity of that style of mothering) can’t be the cause of the disease if the disease involves structural and chemical changes in the brain. But experience does exactly that to the brain; just go back to some of the examples from chapters 3 and 4—childhood poverty thins the frontal cortex; chronic stress shrinks the hippocampus and enlarges the amygdala. So why can’t it be the case that schizophrenogenic mothering causes schizophrenia by way of elevating dopamine levels, atrophying the cortex, and so on? That would seem like a sophisticated, contemporary view of biology and environment interacting. Uh-oh, have we just reinvigorated schizophrenogenic mothering? Not at all. There’s no science to show that the mothering style could produce those brain changes. Experts couldn’t even reach consensus as to what the style consisted of. No one could demonstrate that supposedly schizophrenogenic mothers mothered dramatically differently when it came to their nonschizophrenic children. Neurological and neuropsychological markers of the disease are apparent as early in life as they can be studied. And oh, there are those genes involved. Schizophrenogenic mothering is dead ideology.
*The Joan of Arc of climate change, Greta Thunberg, is one such individual; she credits her Asperger’s syndrome with sparing her from social distractions, allowing her to focus on saving the planet.
*Bettelheim had another domain of fraudulent, self-aggrandizing blaming that evokes particular revulsion in me, in that he was a classic anti-Semitic Semite, blaming his fellow Jews for the Holocaust. Addressing a group of Jewish students, he asked, “Anti-Semitism, whose fault is it?” and then shouted, “Yours! . . . Because you don’t assimilate, it is your fault.” He was one of the architects of the sick accusation that Jews were complicit in their genocide by being passive “sheep being led to the ovens” (ever hear of, say, the Warsaw Uprising, “Dr.” Brutalheim?). He invented a history for himself as having been sent to the camps because of his heroic underground resistance actions, whereas he was actually led away as meekly or otherwise as those he charged. I have to try to go through the same thinking process that this whole book is about to arrive at any feelings about Bettelheim other than that he was a sick, sadistic fuck. (The quote comes from R. Pollack, The Creation of Dr. B: A Biography of Bruno Bettelheim, London, UK: Touchstone [1998], page 228.)
*In my writing and lectures, I try to refer to, for example, lepers, schizophrenics, or epileptics instead as, “people with” leprosy, schizophrenia, or epilepsy. It is a reminder both that there are actual humans involved in these maladies and that such people are not merely their disease. I’m dropping that convention in this section, reflecting the nature of this historical event—for the promulgators of this savagery, their actions did not concern “people with leprosy.” They concerned “the lepers.”
*Supposedly because Jews, unlike Christians, didn’t have sex during menstruation, one of the supposed causes of leprosy.
*Mind you, no actual wells were ever poisoned.
*This is an example that I covered at greater length in my book Behave: The Biology of Humans at Our Best and Worst.
*By the way, Weyer’s book was condemned by both Catholics and Protestants.
*Louis, apparently chastened by his brush with mortality, vowed to pay more attention to the affairs of state and to cavort less with mistresses; the latter resolution apparently lasted a few weeks.
*Who included Giacomo Casanova—you know, the Casanova—who had rented an apartment with fellow partying friends (and who described a sexual act with one of the women there while she was leaning out the window to get a good view of the goings-on).
