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Mental health: United we stand, divided we fall

by Guest Author on 13 Mar 2017

Developing better approaches to treating and preventing mental illness is one of the greatest challenges we face. But by sharing ideas and working together we can make progress, says Professor Sir Michael Owen, Director of the MRC Centre for Neuropsychiatric Genetics and Genomics at Cardiff University.

Prof Mike Owen

Prof Mike Owen

 

Mental health is never far from the headlines these days, and this is as it should be. One in four of us will suffer from some form of mental ill health in any given year. Mental illness affects people across the lifespan from children to the elderly, and the burden imposed on individuals and society is immense.

It is widely acknowledged that we need more investment in care provision, and research into the causes and prevention of mental ill health and into the development of new treatment approaches.

We need new thinking about care and treatment, causes and prevention. We also need to hear from a wide constituency, including those with direct or indirect personal experience of mental illness (virtually all of us), healthcare professionals and academics.

I am an academic psychiatrist and have spent my professional life caring for patients with severe mental illnesses such as schizophrenia and bipolar disorder, and researching the causes of psychiatric disorders and dementia. Also, like most of you, I have encountered mental illness and dementia in my personal life.

Many of you will know that mental illness can be a controversial area. Stories in the media often give the impression that there are widely held fundamental disagreements about whether mental illnesses are disorders of the brain or mind, caused by nature or nurture, and whether they should be treated by drugs or psychological approaches. These polarisations may make good copy but I sincerely hope that we can move away from them.

First, they are profoundly misleading. They assume, implausibly, that mind and brain are separate independent entities rather than different aspects of the same thing. They also fly in the face of a large body of evidence indicating the importance of genes and altered brain states in contributing to disorders of mental health, and equally compelling lines of evidence that psychological and social adversity impact on mental health.

There is also strong evidence that drugs, psychological therapies and social interventions can be effective and often work better in combination than when given separately. Most mental health workers, researchers, and those with personal experience of mental illness recognise that mental health disorders reflect a complex interplay of social, psychological and biological factors, and that the relative balance of these varies from person to person.

Providing treatment consists of working out for each individual the optimal combination of social care, psychological therapy and drugs as well as management of any concurrent physical illness, and is delivered by a multidisciplinary team of nurses, psychologists, social workers, occupational therapists and doctors (both psychiatrists and GPs).

The second reason I hope we can move away from these polarisations is that not only do they misrepresent the evidence and the views of the majority, but they also misleadingly suggest that there is widespread disagreement among mental health workers about how mental illness should be treated and researched.

Surely, if we wish to bring much-needed resources and innovation into mental health, we need to present a coherent and unified case for greater investment and a positive image of the many exciting possibilities for progress whether in genomics, neuroscience, social sciences, psychological treatments, early intervention, public health measures and so on.

While understanding mental illness and developing better approaches to treatment and prevention represents one of the greatest challenges we face, there are grounds for optimism. Many voices are calling for change; the need to integrate social, psychological and biological approaches to both treatment and research is widely acknowledged; and new research approaches are making this increasingly possible. What we need to do now is share ideas and work together to make this happen.

Mike Owen

Mike speaks in his own capacity and his views do not necessarily reflect those of the MRC.

This article has been re-purposed from an article published originally on Cardiff University’s blog.

Comments

author avatar by Duncan Double on 13-Mar-2017 19:29:35

Replying to Duncan Double

For clarity, I’ve copied the post from my website

I have mentioned Mike Owen in a previous post. In a recent blog, he argues for less polarisation in the debate about the nature of mental illness. I couldn’t agree more.

However, Mike does need to represent his opponents correctly if there is going to be a rapprochement. He says, “They assume, implausibly, that mind and brain are separate entities rather than different aspects of the same thing”. This isn’t true. The argument being made is not Cartesian. As Steven Rose says, “That brains enable minds is uncontroversial. That they ‘are’ the mind is a reductionism too far” (see Lancet article).

Similarly, Mike also says “They also fly in the face of a large body of evidence indicating the importance of genes and altered brain states in contributing to disorders of mental health”. Again, not true. The critiques are evidenced-based. Genes, of course, set the boundaries of the possible but environments define the actual. More caution is needed in interpreting so-called altered brain states.

It is important that Mike understands what people are saying who are critical of his view. As Steven Rose says, people like Mike should not “dismiss without a backward glance not only millennia of philosophical debate but also a huge current literature on mind/brain relationships”. There is a “conceptual innocence” about his position, although he is, of course, trying to dismiss any criticism. Despite what he may think, modern psychiatry has not solved the mind-brain problem.

author avatar by Duncan Double on 17-Mar-2017 17:10:33

Replying to Duncan Double

Dear Duncan, Thanks for your comments; I agree with you. I read Steven Rose’s excellent book “The Conscious Brain” as a student and am aware of the dangers of arguing for causation across levels of the hierarchy of organisation (forgive me if I have the terminology wrong but it was 40 years ago!). Like you I am materialist but not reductionist. You say I don’t represent my opponents correctly, but you misunderstand the purpose of my piece. It was not to argue that psychiatric disorders can only be understood in biological or genetic terms. Rather I was suggesting that both types of extreme view, biological or psychosocial, are incorrect. Moreover setting the issue up as a dichotomy between the two views, as some do (see other comments on my blog), contributes to the lack of investment in mental health services and research.
All the best, Mike Owen

author avatar by ibaker on 20-Mar-2017 08:53:26

Replying to ibaker

I agree there should be “critical friendship”, as Nikolas Rose (Steven’s brother) calls it, between critical and mainstream psychiatry.

author avatar by Duncan Double on 21-Mar-2017 08:47:12

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