I listened to the tail end of this interview and will listen to the rest of it shortly but I found what I heard disappointing. He really got tangled up trying to differentiate mild from serious mental illness in my view since he recommends drastically different treatment options for each and frankly it doesn't make a lot of sense as to how you draw the line in the sand about when things are allowed as appropriate and when they're not. Mild and serious mental illness are on a spectrum and treatments shouldn't suddenly change from being appropriate to inappropriate at some arbitrary point on the spectrum. Sorry to feel this way because so much of what he says about when treatments are inappropriate I just love. And I admit to being astonished to learn he's been on Prozac for years due to OCD -- don't think that was in the book. Sorry to say but it feels kind of fake to have him say the worried well shouldn't be on a/ds but he as a high functioning Yale prof can and it's somehow okay. Maybe I'm missing something. Please set me straight if I am.

Today was a big day on NPR because beside Charles Barber they had Richard Friedman on Talk of the Nation, the guy who wrote the NYTimes column last week on how maybe we should be worried about what it does to adolescents and young adults to grow up on a/ds. I really had high hopes for the discussion but just like the comments that appeared on the NYTIme website in response to Friedman's column the Prozac believers swarmed out of the woodwork and made calls into Neil Conan the host saying -- "Doubts be banished, these drugs have saved my life in no uncertain terms and the way I know is because when I go off them my "disease" comes roaring back and then I take Prozac again and it's sooo wonderful the way it stops it." I hope readers of this blog know enough to realize that is b/s and a perfect description of withdrawal and dependence. Did the shrinks even make a tactful, discrete attempt to set the callers straight? No way. They just sat smugly by and assented. NPR is promulgating the myths and doing nothing to further understanding of what's really going on.

Sara, I think you are missing the possibility that he wasn't so high-functioning before he went on Prozac. I haven't read the book yet but I'm guessing there is a big difference between what he means by the "worried well" and someone with full-blown OCD.

Right, Garth, that's true. It sounds like he had it pretty bad but he does not attribute getting it under control to the Prozac but to the steps he took in his life -- like leaving Harvard and turning outward to help other troubled people.

Yep Garth, the OCD hollywoodized by Monk and by Jack Nicholson in "As Good As It Gets" doesn't really exist anymore than the head injury in "Regarding Henry" really exists - I had a group of people with head injuries at Shepherd's Spinal Center walk out on that movie as they found it to be such a distastefully false betrayal of someone with a head injury, anymore than Sally Field's Sybill is a realistic portrayal of a "schizophrenic," or Girl Interrupted is a realistic view of a psych hospital.

Lot's of worried well get the ocd label, lots of severely mentally ill are differentiated from the folks Barber labels as worried well by their financial status and little else...in other words if you want to know the difference between yourself and a severely mentally ill person, try this experiment, first, imagine conditions in which you could lose your home and your money, in which your family, if you have one, is either deceased, abusive, or as poor as you and can't help, and then, for two days, leave your home on foot with no money (or credit cards fellow Americans;)and only as much stuff as you can carry on foot. If you can't imagine such circumstances, go to your local unemployment office to meet some recently laid off folk and get their stories. After two days of just pretending to be broke and unemployed, living that way, have your mental condition evaluated by a professional to see if poverty causes mental illness or vica versa.

Barber's belief in the efficacy of CBT, and the importance in his own life of "finding meaning," improving his social context, and empowering himself, sure seem to undercut claims that 'mental illness' are "biological." I doubt that having a rewarding vocation and an opportunity to help others would do much to lower the blood sugar of a diabetic. Yet in the interview he says, "severe and persistent mental illness, which is an obvious biological condition" with the stress on the word "obvious."

I must be missing something huge here, because the only 'evidence' I can find to support that claim is the hoary sophistry that 'mental illness' must be biological because it's just too weird and extreme to be anything else; that it must be biological because people with mental illness labels have brain damage after they're given brain-damaging treatments; or that it must be biological because that's what they say in the twin studies which any eight-grader can see are full of confounds and flaws and based upon absurd assumptions.

So someone, please enlighten me as to the actual, rigorous scientific evidence that 'mental illness' are biological so I can nominate you and Barber for Nobel prizes.

UnderTheThresher: Everything that goes on in our brains is biological - even if it's in constant interaction with the rest of the body and the outside environment - so I honestly don't understand what you or Barber are talking about. The idea that there is some hard and fast distinction between what is "biological" and what is not is just incoherent.

Garth, your right that everything that goes on in our brains, in fact, in our entire bodies, is biological. I believe that when UnderTheThreser, or Charles Barber for that matter, discuss mental illness as biological, they are referring to the idea that mental illness occurs purely through biology, independent of outside stimuli, which, even in cases of "extreme" mental illness, is of course absurd. The metaphor I found somewhere on the net is this, "to blame the brain for mental illness is like blaming the bat for a home run."

It's quite interesting that no one has any answers isn't it? I wonder when we ever will? probably never, considering the drugging of America via antipsyhotics going mainstream within the next year for anxiety, depression, social anxiety, etc. one will never truly know what we are dealing with any longer--the brain, the body and the minds of future generations will be in full blown chemical distortion.

I think the differentiation being made between the worried well and severe mental illness has to do with the er, severity, but oh, look -- something shiny!

Fuck this discourse, all praise to Barber's smackdown of the willful ignorance. Anyone who defines mental illness as the worried well, groovy eccentrics and people who can't cope with problems in living needs to be beaten with the cluestick. A normal person, seated in a restaurant, runs into the kitchen and accuses the chef of deliberately poisoning him, runs through the house babbling Revelations and ripping the sink off the wall to get the suicide out. Normal people running amok, that's the issue, that they are normal, intelligent, gifted, able, until these delusions and hallucinations inhabit them and they walk around town blowing bridges up with their mind. Do you people know nothing? At the end of his life Nick Drake, who could no longer play because he let his fingernails grow six inches long, refused to move his body for fear of hurting the air molecules. Daniel Johnston, who is still delightfully alive and living out loud, commandeered a cockpit, KO'd the pilot, and crashed an airplane because he was convinced the devil was manning the controls. People who continue to undermine inconvenient truths don't deserve to be taken seriously, don't deserve civil discourse and a reasoned response, the only hope for getting through to such types is unvarnished ridicule.

To me the exchange going on here is a large part of what makes mental health blogging so difficult. I partly agree with Phillip that Barber makes some very good points and I freak when I see FP come in and suggest that there are some people who are "worried well" and some who are "severely mentally ill," not because this is a false distinction but because it reflects a troubling way of perceiving human suffering.

Certainly some people at some times go crazy. When I say "go crazy" I mean become violent. I'm speaking outside of the DSM system. I'm speaking in terms we all understand. For example if I told you, "this guy I know came home early from work and caught his wife in bed with another man," and he just when crazy. Turns out he had a gun and all three are in the hospital. We would all understand what I meant by "go crazy" and have some empathy for the man. In fact in court he could use the temporary insanity plea, and maybe get probation or a short sentence. He wouldn't need to get a psych diagnosis because our society allows and even in some states codifies into law our belief that this kind of "going crazy" while ill advised is understandable. However, if I told you I knew a woman who came home and found her husband in bed with another person, and then explained that she went crazy, depending on your gender and your value system, you might feel she was entitled to the same defense, but generally the law doesn't allow the temporary insanity defense for a woman who catches her husband having sex with someone else. So she'd have to go with not guilty by reason of insanity, get a bipolar label and ngri treatment in a psych hospital. The point being some people are allowed to "go crazy" and it's considered a fluke, some, it's considered indicative of an inherent biological flaw and these folks are labeled forever. If you've ever been diagnosed with bipolar I, severe depression, schizophrenia, or various other diagnoses in this fluid category try and remember that when you are talking about the severely mentally ill, them, those people, you are in fact speaking of yourself.

At this point in my life there's only one delusional person I talk to on a daily basis, that I know of. He's a man that is a member of a support group I attend. When he speaks, he says things like "I went to the store to buy cigarettes and that lady wouldn't let me in the store because I had left my shoes in Bombay, and then they put me on this stretcher..." but he says his short piece and then is quiet and listens to other people. He lives in a halfway house. He's not "going crazy," he's not, because somewhat incoherent, dangerous to himself or others, in fact he's not nearly as much of a threat as someone who has caught their spouse in an adulterous affair, even if we understand and empathize with the person who caught their spouse, he's not even in particular distress about his delusions. I have no idea how he ended up in this condition, maybe he was born firing on different cylinders. I know he doesn't want any pills and I don't know of any pill that could get his thinking to be linear, pills would just "shut him up." If society really wanted to protect itself, it would confine everyone who caught their spouse in an adulterous affair for 72 hours, except we would never do so because we all know that not only is it not fair, but also it would only make that person angrier, exacerbate his or her already volatile dangerous state and again, we would feel it wouldn't be fair because the person is not that dangerous. Sure if someone in that condition is distraught and doesn't want to be alone until they calm down, I guess the could be allowed to be admitted to a psych ward, but to be legally forced, while it might actually be a good idea, we wouldn't want it. So instead we pick on those folks who's brains function in non linear ways, label them as different from us and restrain and drug them not realizing that doing so is abuse. Physically restraining someone who is not violent will make that person respond in a defensive way, but it's self defense.

But then what do you do about the Nick Drakes? Our current desire to other "them" out as severely mentally ill and drug, talk, confine and shock them back to who they used to be seems to do more harm than good. Maybe sometimes people do loose their (our)minds, this is no excuse for torturing these people. In other cultures people are allowed to work through their issues and their thinking usually comes back around to something we're more comfortable with.

What about the "worried well?" I do agree with the biopsych folks that experiencing severe emotionally distress is not a character flaw or a sign of weakness. I don't like the term "worried well" because it belittles the suffering these people experience. But I also agree with Barber that these people don't have medical diseases. I just go one further and argue that delusional folks also don't have medical diseases. Having a non linear way of thinking, experiencing auditory and visual hallucinations, are different ways of being, different ways of being normal if you must cling to that word. These ways of being do not automatically make a person "dangerous" and a person really does have a right to be however they are.

As Barber or someone recently wrote, "if everyone is mentally ill, then no one is." Suffering is part of the human condition. If you sometimes find your suffering unbearable, and you understand the risks, it's fine to get relief from medication. It's just that if the medication itself is going to exacerbate your suffering in the long run and may make it more likely that you "go crazy" i.e. become violent, then not only should you be told but maybe these drugs should be controlled a bit more. Has anyone here read Freud on cocaine? He thought it was a wonder drug, and initially it was for him, but when used over extended periods, it doesn't just lose its effectiveness, it actually causes extreme paranoia and physical deterioration. I fear these psych drugs, touted as harmless, have similar shortcomings.

Flawedplan, if you think that the discourse on this thread doesn't meet your high standards, why don't you try actually reading it? No one here is disputing the existence of the suffering, hallucinating, and all the craziness that gets labeled "severe mental illness." I know it exists, Szasz knew it exists, and as far as I can tell even the dumbest scientolgists don't dispute that it exists. The question is the validity of the explanation. But of corse, it's nearly impossible to question the party line that "mental illnesses are biologically-based brain diseases" without being accused of denying the reality of the thought, feeling, and behavior under the labels. I don't find any credible scientific evidence that even severe, suicidal misery constitutes a disease in any literal sense, or that it has a purely biological etiology (or a biologically-caused diathesis), so therefore I must be claiming that no one ever feels depressed and everyone is always happy all the time, right? I must need you, flawedplan, to set me straight with examples of people who were really, really miserable.

I for one am tired of your pettish proclamations that those whom you think disagree with you are wankers who are undeserving of even the most basic civility. Get your cluestick and go find zl0t and you two angry troglodytes can beat each other senseless.

I've been locked up several times with people considered to be among the 'sickest of the sick,' including one ward where more than half the people were accused of committing crimes and were there to be evaluated for competency. I met a lot of people who had gone crazy at least as severely as Drake and Johnston, yet every single person I talked to had a unique story and a unique context, and their actions made sense as reactions to their situations. Generally not reasonable, logical, or productive reactions, but comprehensible reactions none the less. Of course, the longer people undergo biopsych 'treatment,' the more detached they become from their own narratives, the harder it becomes to understand them in context.

It's totally illogical to assume that when we reject the moralistic explanation for suffering and craziness (that it's a moral failing/ character flaw) that leaves, "well then it just must be a biological failing/ genetic flaw" as the only other possible explanation. It's pseudoscientific, lazy thinking, and also totally dehumanizing, to assume because someone's thought, feeling, and action is very, very extreme and their situation is hard to understand that therefore the situation and context are irrelevant (or at most merely 'stressors') and they just have a biological disease.

I was speaking to Sally's facile explanation of poverty as etiology of mental illness, and invoked Nick Drake specifically because he lived his life in a castle with servants. Does that mean I deny narrative explanations of mental illness? Or does it mean I deplore facile argument?

I for one am tired of your pettish proclamations that those whom you think disagree with you are wankers who are undeserving of even the most basic civility.

I don't think you disagree with me, that's what I find annoying, when people create strawmen and lecture them. The wanking is in attempting to school people who have been channeling your narrative since you were in listserve.