A People's History of Mental Illness
From Beyond Mental Illness, 2015
The mere formulation of a problem is far more essential
than its solution . . . . To raise new questions, new
possibilities, to regard old problems from a new angle
requires creative imagination and marks real advances.
Albert Einstein
In his bestselling book, A People’s History of the United States,
Howard Zinn described US history from the viewpoint of the
common people, not the elites. This chapter provides a brief history
of mental illness from a similar perspective. To understand that
perspective let’s begin by discussing Meks and memes.
Meks and memes
According to a unique Travel Channel reality show, “Living with the
Tribes,” in remote regions of Papua New Guinea lives a stone-age
culture, the Mek tribe. Small clans live within agreed-upon
boundaries. Evil spirits live in areas of the primeval forests and
swamps. They, too, have their boundaries. Humans enter at their
peril. Trespass over the spirits’ boundaries and you may die, either
by man or a spirit called the Swangi. This spirit brings ill fortune
by possessing its victims. When bad things happen, anybody can
accuse anybody of harboring the Swangi. The leaders of the clan
take steps to remove the spirit from the village, whether by magical
incantations, exile, or death to those possessed. An article in the
London Telegraph tells of a young woman who was burned alive
in January, 2008. The country’s Post-Courier newspaper reported
that during 2007 more than 50 people were killed in Highlands
provinces, allegedly for sorcery.1 Those possessed are guilty with
no chance of proving their innocence.
The evolutionary biologist Richard Dawkins has given us a
perspective by which to view the Mek as well as our own culture.
In the 80s he coined the term “meme” (rhymes with “seem”). It is
a symbol, concept or artifact that spreads throughout a culture. A
meme can be shorthand for a reality believed to be true. Memes
self-replicate and evolve because their properties are perceived
to bring value to the culture. The ones that are useful remain and
evolve while those that are not eventually become extinct. Just as
the fittest survive in the animal and plant world, the fittest memes
survive in the world of ideas. In the animal world the dodo bird
didn’t survive. In the world of ideas, the beliefs of those in the
Cargo Cults of New Guinea didn’t survive after World War II. Their
life-size replicas of aircraft failed to get the deities to bring them the
cargo treasures they expected.
Swangi possession is a meme. As a meme, it explains
misfortune and provides a way to manage it, in this case by magic.
Its very existence in the 21st century suggests it confers some value
to the Mek culture. Some memes that appear barbaric and primitive
to us today seemed eminently reasonable in times past.
A new kind of possession
In her book, Disguised as the Devil: How Lyme Disease Created
Witches and Changed History, author M. M. Drymon discusses
historical writings in which a large round spot was considered proof
of possession by the devil. It was called the stigmata diaboli, also
called the witches’ teat or the devil’s mark. This red mark, which
looked suspiciously like the erythema migrans rash found in Lyme
disease patients, was often found in body crevices where ticks are
prone to attach themselves. Drymon hypothesizes that women,
who were most often accused of witchcraft, were targeted, in part
because of their greater risk of getting the disease. Women’s
petticoats touched the ground where the ticks were. Drymon
describes how people mistakenly saw “invisible pins,” probably due
to poor uncorrected vision. The ticks looked like the heads of brass
pins of that day and when they were removed there was blood,
which was presumed to be the result of being stuck with a pin.2
In my previous book I discussed how rye contaminated with
ergot mold provoked unusual behavior labeled as demonic. Given
the history of the devil’s mark, and the
existence of neuropsychiatric
symptoms from Lyme and associated
diseases, it appears that mold and
Lyme disease may have been
contributing factors in the witch hunts
in the early colonies and in Europe.
To prevent needless suffering,
written criteria were used by the
authorities to determine who was a
witch and who wasn’t. The famous
minister Cotton Mather, in his article,
“The Wonders of the Invisible World,”
advocated searching for devil marks
because he had read of the usefulness
of this. In a list of seven criteria, one
is written as follows: “If the party
Suspected be found to have the
Devils mark; for it is Commonly thought, when the Devil makes his
Covenant with them, he alwayes Leaves his mark behind them,
whereby he knows them for his own:—a mark, whereof no Evident
Reason, in Nature can be given.”3 That criterion was a paraphrase
of one of seven criteria written by William Jones, a deputy governor
of Connecticut and a member of some of the courts involved in the
Salem trials.4 Jones was likely inspired by Malleas Maleficarum,
a book on witches. Malleas Maleficarum is Latin for “Hammer of
Witches.” This book would probably have been number two on the
bestseller list, second only to the Bible, if such a list had existed
from 1468 through the Reformation.5 The culture accepted the
paradigms of that day as reflected in the Malleas Maleficarum. This
led to disastrous consequences for many.
In 1662 rural England, some four years before the Salem trials,
a woman named Amy Denny was hanged for witchcraft. Learned
scholars who were respected leaders in their communities presided
over her trial, providing justification for similar trials that would occur
later in such places as Salem, Massachusetts. One of her crimes
was accurately foretelling that a neighbor’s chimney was going
to collapse.6 Like Muslim fundamentalists who today execute
“infidels,” those in power were simply obeying God’s commands. As
the King James Version of the Bible says, “Thou shalt not suffer a
witch to live.”7
Similarly, Benjamin Christensen’s 1922 cult silent film
classic, Haxan, Witchcraft through the Ages, is a movie that is
part documentary and part grisly horror film. It tells a story about
a young attractive woman and her servant who accuse an old
toothless woman of being a witch after the woman’s husband
falls under some kind of dizzy spell. The old woman denies the
charges until clergy-orchestrated torture compels her to confess, at
which point she accuses her accusers, the wife and her servant,
of witchcraft. After both the old and young women had been
sufficiently tortured to the point of confession, both are burned at
the stake.8 The film suggests that in the “modern” culture of the
early 20th century, these women were not possessed by the devil,
but by a mental disease known as hysteria.
Compared to the consequences of the witch diagnosis, hysteria
must have been seen as a welcome innovation.9 Hippocrates
invented the term. He said that madness occurred in a woman
whose uterus had become too light and dry from lack of sex. This
caused it to float or move upward towards the heart and lungs,
causing symptoms. The symptoms, according to the French
physician Pierre Briquet, in his 1859 treatise on hysteria, included
not only moods, but a list of somatic complaints such as migraine,
abdominal pain, muscle pain, palpitations, restlessness, and
fatigue. One Victorian physician actually cataloged 75 pages of
possible symptoms of hysteria and then called the list incomplete.10
When Sigmund Freud came on the scene, psychoanalytical
thought became a foundation for understanding many forms of
dysfunctional behavior, including hysteria.
Olmsted and Blaxill, in their book, The Age of Autism, provide a
fascinating review of hysteria. They provide credible circumstantial
evidence that mercury treatments offer a more reasonable
explanation of symptoms than did Freud’s sexual interpretations
of dreams and behavior. One “hysteric’s” symptom of numbness
was more likely a result of handling mercury as she cared for her
syphilitic father than deep-seated unconscious psychodynamic
forces, as suggested by Freud.
They describe an interview with one of Freud’s much-cited
long-term patients, Sergei Pankejeff (the Wolf-man). Freud used his
psychoanalysis of “Wolf-man” to validate his methods and theories
about which he wrote extensively. For example, Freud claimed
that the patient’s need for a daily enema represented homosexual
strivings. In a recorded interview Wolf-man said that damage to his
intestines from mercury treatment for syphilis was the reason that
he needed the enemas.11 He denied having any homosexual urges.
Had Freud been confronted with this, he might have suggested that
Wolf-man was in denial.
In 1869 a New York neurologist, Charles Dana, used the term
“neurasthenia,” a term that had been used as early as 1829 to
refer to a mechanical weakness of nerves. His broader definition
included symptoms of exhaustion, malaise, muscle aches, sleep
disturbance, excitement and depression and a peculiar sensitivity
to noises, odors and light. Freud considered neurasthenia to
be a result of hereditary factors and excessive masturbation.
Neurasthenia was a precursor to “neurosis,” a diagnosis that is
today no longer used, having been replaced by anxiety disorders,
phobias and compulsions. Most considered neurasthenia a
psychological disorder.
In 2008, at the annual Orthomolecular Medicine Conference in
San Francisco, Albert Donnay, MHS, presented “Hidden in plain
view: the role of oxygen and carbon monoxide.” He proposed the
MUlti-Sensory sEnSitivity or MUSES Syndrome. Symptoms of
MUSES were similar to those of neurasthenia. He called it MUSES
because of links with famous artists such as Edgar Allen Poe, who
lived at a time when the neurasthenia diagnosis was commonplace.
Donnay says that some of Poe’s characters had symptoms
similar to neurasthenia that today might be called chronic fatigue
syndrome, fibromyalgia or various mental disorders. Poe wrote
characters with these symptoms into his stories and poems when
he lived in homes with coal gas lights such as his tiny house in
Philadelphia.12 These lamps caused low-level carbon monoxide
poisoning. Donnay researched the chemical composition of Poe’s
hair, and found exceptionally high levels of uranium, which would
be expected from the coal gas that was used to fuel the gaslights
of that era. Poe’s wife, Virginia, also had high levels. It appears
as if it wasn’t the “winged seraphs of heaven” that brought the
chilly wind that took away his Annabel Lee. The coal gas that lit
the lamps in their tiny house probably contributed to her demise.
The areas where “neurasthenia” was prevalent correlated with the
areas where coal gas was used. Even Abraham Lincoln complained
of various symptoms while living in the White House, which was
illuminated by this new technology.
Donnay points out that the number of articles written about
symptoms of neurasthenia during the 19th century parallels the
growth and decline of the coal gas industry. In his book, Carbon
Monoxide Toxicity, he demonstrates that his hypothesis linking the
use of illuminating (coal) gas with carbon monoxide exposure and
symptoms of neurasthenia satisfied Evan’s 10 unified criteria for
assessing the causation of disease.13
At the 2008 International Lyme and Associated Diseases
Society (ILADS) Conference in San Francisco, Deborah Metzger,
PhD, MD, quoted from a 1952 “scientific” article. The authors
described women with medically unexplained pelvic pain as
mostly “psychologically ill individuals, exhibiting conversion
hysteria, anxiety hysteria, obsessive-compulsive neuroses, reactive
depression and schizoid personality structure manifested by
emotional immaturity and strong dependency needs.”14 Contrast
that with Dr Metzger’s findings that among her patients with chronic
pelvic pain, late-stage Lyme disease existed in 90 percent with
endometriosis and 100 percent with abdominal wall neuropathy.
Other infections included Epstein-Barr virus and different viral-like
bacterial infections called mycoplasmas. Her conclusion was that
chronic pelvic pain cannot be explained by simplistic psychological
labels. They represent complex medical disorders, including
infections.
Depressed patients with somatic symptoms may have
mitochondrial disorders. A group of Swedish researchers found
that a positive answer to six items from a questionnaire called
the Karolinska Scales of Personality (KSP) could differentiate
depressed patients with somatization disorder who had
mitochondrial disease from those who didn’t. Those answering
positively to the six questions had low rates of Adenosine-5'-
triphosphate (ATP) in their muscles. ATP is a measure of energy
production in the body. Similar results were obtained in a larger
group.15 In the DSM IV, a mental health professional could make a
diagnosis of somatoform disorder by simply counting the number of
reported symptoms with no known physiological cause.
Researchers at the University of California, Davis, found that in
comparison with neurotypical children, autism syndrome patients
were more likely to have mitochondrial defects than were controls.16
17 Mitochondrial defects are not the same as a mental disorder.
Hysteria and neurasthenia, two widely accepted diagnoses
in the 19th and early 20th century, were relegated to a historical
footnote in a relatively short time, while the meme of devil
possession lasted for centuries and in some cultures still exists
today. For example, in late 2011, news reports out of Saudi Arabia
indicated that a woman had been beheaded for witchcraft.
From a 21st century perspective, the different cultural beliefs
and practices from a bygone era were archaic, if not barbaric.
How do our beliefs and practices of today measure up? How do
we know that our cultural beliefs about mental illness will not be
viewed by succeeding generations as we now view these historical
views of mental illness? It is true that we no longer torture and kill
those called the mentally ill. However, our beliefs and practices do
promote tardive dyskinesia, drug discontinuation syndrome, suicidal
and homicidal behavior, shortened life spans, and lifetimes of
chronic illness for all too many. If carbon monoxide poisoning, Lyme
disease with associated infections and mitochondrial dysfunction
produce “mental” symptoms, by what name shall 21st century health
care providers call symptoms associated with these conditions,
somatic symptom disorder or depression?
Our culture teaches us how to understand behavior that is
outside the norm. A health care provider who has demonstrated
competency, as defined by their professional association, and
who is approved by the state, uses written criteria to determine if
another person has (is possessed by) a mental disorder or, mental
illness. That person is not demon-possessed, but mentally ill. The
affliction is given a name and usually drugs are prescribed. From
an historical perspective, mental illness is a relatively new kind of
possession.
In Lewis Carroll’s Through the Looking Glass, Gnat is having
a conversation with Alice. “What’s the use of their having names
if they won’t answer to them?” Alice responds, “No use to them I
suppose, but it is useful to the people that name them, I suppose. If
not, why do things have names at all?”
How useful are these names? Do they help those with
biobehavioral syndromes? Do they help those who name them? Do
they differentiate those called the mentally ill by giving them a 21st
century version of the stigmata diaboli? How will the people of the
22nd century view the “mental” illnesses of the 21st century?
The DSM series, including the DSM-5, has been the
definitive word on “mental” disorders. Most of the diagnoses have
existed on the pages of the DSM series, but not in the world of
biology. The criteria of the DSM are used to assign names like
“schizophrenia” and “bipolar disorder” to what in this book we
are calling biobehavioral syndromes. Similarly, the criteria of the
Malleas Maleficarum were used to assign names like “witch” and
“possessed” in an earlier era.
Future historians may view mental disorders as memes that not
only prevented many from getting adequate care but, like the
Malleas Maleficarum, actually caused harm. These memes may be
viewed as having provided a way to categorize classes of people,
facilitate management of disruptive behavior and financially reward
those involved in such management. “Mental disorders” may simply
be perceived as a meme of no use to them (the patients) but useful
to the people (the culture) who named them.
A name is a symbolic representation that approximates with varying
degrees of accuracy something that exists. A meme is an idea,
belief, or expectation that, like a virus, spreads throughout the
culture via family, media, educational and religious institutions and
thousands of years of evolution. As the mental illness meme moves
towards obsolescence, our culture will be ready for new biomedical
names that move us beyond mental illness.