Global Health Asia-Pacific July 2020 July 2020 | Page 47

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to translate both understandable human feelings
and very severe or extreme forms of suffering into
the language of mental health and illness. Obviously,
people really do have extreme experiences such as
feeling suicidal, starting to hear voices or finding it
very hard to lead what many would consider normal
lives, but the idea that these reactions are symptoms
of medical illnesses like bipolar disorder and clinical
depression with causes in the brain has never been
demonstrated.”
In her view, the key disadvantage of the medical
approach is that it pathologises sufferers by turning
their problems into individual deficiencies, thus
obscuring the social roots that have led to them.
“At a societal level, we don’t say, for example,
why are so many people living in poverty feeling so
desperate and suicidal? We say, instead, that there’s
an epidemic of depression and we must give people
more pills,” she said.
At stake in this debate is whether we can identify
the causes of psychological problems, the appropriate
use of medication, and ultimately the most sensible
way to help people under the strains of their own
mind.
The biology of mental suffering: a constant but
elusive idea
In Western societies, attempts to trace psychological
problems to biological causes have a long and
disparate history.
In the 19th century, the belief in causal relationships
between brain damage and mental defects led
European neurologists to dissect the brain tissue of
deceased individuals from mental asylums with the
hope of identifying anatomical abnormalities that
could be matched to their mental issues.
The French neurologist Jean-Martin Charcot, for
instance, aimed to pinpoint the causes of hysteria, a
disorder that at the time was associated with easily
arousable emotions, paralysis, and convulsions
but is no longer recognised as a medical problem.
As Anne Harrington, Professor of the History of
Science at Harvard University, wrote in Mind Fixers,
“the postmortem microscopic observations of the
brains of hysterical patients showed no consistent
abnormalities. In fact, many did not look structurally
abnormal at all.”
In the following century, the discovery of the link
between general paralysis or paresis of the insane
(GPI) and syphilis, a common sexually transmitted
infection (STD), opened up another avenue of research
in the biology of mental illness.
Characterised by the progressive loss of voluntary
movements, including swallowing, bowel control,
agitated behaviours, and fullblown dementia, GPI was
a familiar sight in European asylums during the second
part of the 19th century. Fuelled by the observation
that many patients with ��I were also affected by the
dreaded STD, a series of experiments concluded that
The bacterium that causes syphilis can also lead to neurological problems
the bacterium Treponema pallidum not only caused
syphilis but in the late stages of the infection was also
able to invade the brain and lead to GPI.
If a pathogen could trigger a form of mental
illness, some clinicians thought, microbial infections
in any organ or body tissue, like the gut and teeth,
could be the source of mental disorders. As a result,
patients diagnosed with schizophrenia, a condition
often characterised by delusions and hallucinations,
had to endure the extraction of organs including the
appendixes, ovaries, testes, and colons.
One prominent supporter of this therapeutic
approach was Henry Cotton, the medical director
of the New Jersey State Lunatic Asylum in the US,
where more than 2,000 patients were operated on
from 1916. The surgeries, however, “far from curing
patients, were making virtually all of them worse than
before � if they survived at all. �ostsurgical fatalities
were estimated to be as high as 30 percent,” wrote
Professor Harrington.
Despite its questionable benefits, the idea of
using surgery for treating mental problems continued
gaining traction in the form of lobotomies.
First performed in 1935 by the Portuguese
neurologist Egas Moniz, the procedure involves the
destruction of brain tissue to sever fixed circuits
between the frontal lobes of the brain and the rest of
the organ and was originally intended as a treatment
of last resort for people with debilitating anxiety and
obsessive thoughts. With help of media headlines
touting its benefits, lobotomies increased in popularity
as an effective approach to schizophrenia, depression,
and compulsive disorders.
Some patients were reported to be free of their
previous anxiety and fears, but they also became
If a pathogen
could trigger a
form of mental
illness, some
clinicians
thought,
microbial
infections in any
organ or body
tissue, like the
gut and teeth,
could be the
source of mental
disorders
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