NEW VISTAS IN MENTAL HEALTH

...In less technical language, they have been described as the ivory-tower and red-brick schools of psychiatry...

...He felt that psychotherapy was better suited for treating the neuroses, the milder mental conditions, and that other methods were needed for psychotics...

...One thing, however, should be made clear...

...The disruption of thoughts and emotions may be caused by an excessive amount of some chemical substance released into the blood by stress or by the abnormal susceptibility of brain tissue to such a substance...

...A natural chemical substance known as serotonin also has been figuring prominently in the investigation of mental disease in the last few years...

...The new concept of mental disease does not rule out the importance of such psychological elements as damaging emotional experiences during childhood and other environmental stresses...

...The concensus of some of the keenest investigators is that mental illness basically involves chemical disturbances in the brain...

...Sigmund Freud, the father of modern psychiatry, once said that "behind every psychoanalyst stands the man with a syringe...

...New Vistas in Mental Health by SELIG GREENBERG OF ALL the enigmas confronting man, none seems so unfathomable as the mystery of the caverns of his own mind, of how the fantastically complex machine which is the human brain functions normally, of what happens to this immensely delicate mechanism to cause the terrible disorganization of thought and behavior that is mental disease...

...Now it finally has...

...Any attempt to understand what is happening in the research battle against mental disease must take into account the deep schism that has rent psychiatry for years...

...Few people now dispute the overall validity of Freud's theories...

...No other psychiatric disease is as devastating in terms of incidence, duration, suffering, and economic waste...

...What makes the outlook for the future so hopeful is that at long last we appear to be on the trail of the enormously subtle interrelationship between the brain and the rest of the body...

...The controversy between the psychiatrists who lay stress on the psychological factors in the genesis of mental disease and those who attribute such disorders primarily to organic faults will undoubtedly continue for quite some time...

...They believe that seemingly unrelated lines of investigation are starting to converge and to form a pattern that may before long explain the causes and the mechanisms of the ailments of the mind...

...What Freud meant by this was that the analytic method of psychotherapy he himself had devised—whereby the psychiatrist attempts to resolve the mental patient's deeply buried anxieties by talking them out and bringing them to the surface—was not a panacea that would work in every case...

...After injecting a compound isolated from the blood of such patients into monkeys and inducing in them what resembled the behavior of schizophrenics, Dr...

...He believed that the inner conflicts originating in childhood often lead to a failure of adaptation and maladjustment in adult life...

...But the connection is certainly suggestive...

...But with the mounting tempo of research and its concentration on the chemistry of the brain, the trend is more and more away from the obfuscating theories and terminology of the extreme psychogenists and toward a broader concept which seeks to integrate some of the conflicting viewpoints with regard to the causes of mental disturbance...

...But researchers regard it as highly significant that a drug which blocks serotonin can cause temporary insanity and that another drug which releases serotonin can temporarily relieve insanity...

...When this is done, there is no reason why it should not be possible to correct the chemical faults in the brain at least to some degree with drugs, just as defects in other organ systems are now being corrected...

...The pendulum is now swinging the other way, toward a concept of mental disorder in which there is a close interaction between organic mechanisms and the effects of upbringing and environment...

...Another point made by this group is that regardless of whether mental disorders are wholly organic in nature or partly also psychological, the harsh reality is that psychotherapy cannot possibly cope with the huge burden of psychiatric illness...

...This school of thought has espoused the concept that mental and emotional disorders are solely or primarily the result of deeply buried tensions and anxieties which go back to the patient's early years and can be resolved only by bringing them to the surface through psychotherapy...

...Out of the insights scientists are gaining into this disorder is emerging a new concept of psychiatry...

...Instead of antagonizing serotonin as LSD does, reserpine releases this chemical from its inactive state in the brain and nervous system...

...Measures of the progress being made by scientific investigation are the hopeful signs of a gradual rapprochement between the warring schools of thought, which should eventually lay the basis for a unified theory of the causation and treatment of mental illness...

...Much of the most encouraging current research is concentrated upon schizophrenia, the most widespread and severe of all mental ailments...

...ahead of the problem of mental illness instead of lagging decades behind it...

...The term schizophrenia actually covers a group of psychotic conditions...

...What a tremendous accomplishment this would be may be gauged from the appalling fact that mental patients now fill nearly 800,000 hospital beds in this country, accounting for more than half of the nation's hospital population, and that perhaps five times that many men and women who manage to escape hospitalization lead tortured lives because of varying degrees of emotional disorder...

...In people who are born with such a susceptibility, emotional distress can precipitate mental disease by triggering off chemical disturbances in the brain...

...But it is the glory of man that his brain—as the repository of thought, emotion and imagination—is also more than merely another bodily organ...

...Robert Heath, chairman of the department of psychiatry at Tu-lane University...

...But the fact that these drugs can block off even temporarily the intensity of distorted emotions demonstrates that what has gone wrong is basically an organic process...

...Some scientists believe that serotonin acts on the multitude of switching points which control the transmission of impulses to and from the brain through the pathways of the nerves...

...Another tack in the attempt to link mental illness with some physiological deficiency is being pursued by Dr...

...In doing so, they have tended to neglect the fact that thought and behavior are dependent upon biological processes and that the brain is a part of the body...

...Even this dark domain is gradually being illuminated by intriguing research leads of great promise...

...I think that for the first time we shall catch up with and get SELIG GREENBERG, writer on medical problems for the Providence Journal and Evening Bulletin, has twice been honored by the Lasker Foundation for distinguished writing on medicine...

...If such knowledge could be gained, the prospects for devising Jul antidote would be vastly enhanced...

...Whether this biochemical upset is the cause or merely the effect of mental illness is still a matter of dispute...

...This means that such imbalances are measurable and that it is only a matter of time before their precise nature is established...

...If you will stand by us for another decade and help make possible the research that we know must be done, help us train the personnel we need so desperately, help us establish the community facilities we must have—if you will do these things, then I feel confident in predicting that within ten years you will witness a truly impressive decline in admission rates to mental hospitals and a firm increase in the speed and number of hospital discharges...

...But now that psychiatry is increasingly being put back into the realm of medicine through concentration on chemical abnormalities as major factors in mental disease, the picture is rapidly changing...

...All in all and despite the immense complexity of the research problems still to be solved, the outlook in psychiatry is bright with promise...

...Franz Kallman of the New York Psychiatric Institute has found in a series of studies of identical twins extending over a period of 30 years...

...Although numerically this group is not large, its spokesmen are among the leaders of the profession and wield great influence...

...It merely holds that these influences constitute just one of the factors figuring in the bieakdown of the mind...

...Just as the tranquilizers turn off psychotic symptoms in the mentally ill, so the hallucinogenic compounds do the same thing in reverse...

...In addition to the tranquilizing drugs, there have been a number of other research developments in recent years which strongly point to a disturbance in the physiology of the brain as a major villain in mental illness...

...The theory now gaining general acceptance is that the psychological elements come into play only when an individual suffers from an hereditary vulnerability to mental illness...

...In the opinion of leading authorities, this concept of an interplay between physiological and psychological forces in a person's make-up opens up highly encouraging possibilities for both cure and prevention...

...The psychogenic school is largely made up of psychoanalysts and some other psychiatrists in private practice...

...And it also suggests that the body itself may sometimes produce a chemical, similar to the hallucinogenics, which causes mental disease...

...What these and other research leads point to is the hypothesis that in persons who are physiologically vulnerable and whose relations with other people become progressively impaired through various environmental circumstances, psychosis is precipitated by some metabolic disorder which interferes with the normal functioning of the brain...

...One such clue is provided by...

...The various theories of an organic factor in mental disease tie in with what Dr...

...distortions of perception that ultimately develop into hallucinations...

...The very fact that they can do so through their chemical effect on the brain is another indication that mental derangement stems from the chemistry of the mind...

...The tranquilizers do not cure mental disease...

...Second, psychotherapy is immensely costly and time-consuming...

...As long as psychiatric theory tended to regard mental disease as something almost entirely divorced from the functioning of the body, the researcher had to deal with bafflingly elusive ideas defying precise scientific investigation...

...Equally suggestive is the discovery that reserpine, one of the two major tranquilizing drugs, apparently achieves its calming effect by doing the opposite thing...

...Francis J. Braceland, the retiring president of the American Psychiatric Association, told a U.S...

...His great discovery was that every one of us is, in effect, two persons and that the subconscious personality has a tremendous effect on everything we do and think...

...Heath performed the same experiment last year on two volunteers at the Louisiana State Prison...

...Nor does their calming effect last when the medication is discontinued...

...Individuals with such a defect, he maintains, are more prone to lack the inner hardihood to adjust to life's trials...

...This hope is bolstered by the fact that the gist of Freud's ideas—that the child is the psychological father of the adult and that we are all governed by the attitudes fostered in us in early life —has already permeated deeply not only all of medicine but much of our culture...

...There is no other explanation, medical scientists say, for the ability of the tranquilizers to interrupt through their chemical action the abnormal flow of anxieties in the mind...

...The soothing effect of the tranquil-izing drugs on the frenzied agitation of schizophrenia furnishes striking confirmation of the view that mental disorder is fundamentally an upset of the chemistry of the brain...

...The aim of such experiments is not only to discover how schizophrenics feel but to try to establish exactly what defect originating in the body makes them feel the way they do...

...There is nothing in all of medicine quite so intricate as is mental illness...

...Psychological factors undoubtedly play a vitally important role in the genesis of psychosis...

...The organic school holds that while environmental factors may contribute to the development of mental illness, such disease is fundamentally the result of some physiologic disturbance in the brain which must be treated medically...

...Senate appropriations subcommittee a few months ago...

...Impairment of the normal function of serotonin may thus upset the brain's communication system and produce a distortion of the message it sends out and receives...

...Whether a breakdown in the body's serotonin mechanism would in itself cause mental disease is still an unanswered question...

...In no disease is there such a complicated range of factors—involving the biology of the brain, the psychology of the mind, and the effect of social environment on both—which appear to contribute to it...

...Without a doubt, we are now in the most exciting period that psychiatry has ever known," Dr...

...The Freudian method of psychotherapy tries to uncover this hidden part of the patient's make-up which gets in the way of his normal functioning...

...They temporarily produce psychotic symptoms in normal people...

...He reported that the two prisoners promptly developed the classic symptoms of schizophrenia for about two hours...

...Freud himself had never lost sight of the biological factors underlying mental illness...

...The basic symptoms are a progressive disorganization of thinking and feeling, so that the patient eventually becomes overwhelmed by emotions and anxieties which misrepresent the external environment: delusions of persecution and omnipotence...

...Whether this in itself enables LSD to induce the symptoms of schizophrenia in normal persons is still to be proved...

...First, there is the difficulty of communication between the psychiatrist and the deteriorated chronic patient who usually speaks in incomprehensible gibberish, if he talks at all...

...the so-called hallucinogenic drugs...

...When the full nature of this interrelationship is finally clarified, we shall not only be able to spare immeasurable suffering but we shall have opened dazzling new vistas for human happiness and achievement...

...What he had done, largely as a reaction to the narrowly organic concept of such disease which had prevailed during most of the Nineteenth Century, was to emphasize the tremendous influence of early experience and of environmental stress upon behavior and personality...

...He is the winner of the Associated Press Managing Editors Association Award for his series of articles on the problems of the aged...

...In trying to tackle the riddle of human personality and to explain how it cracks under stress, one authority has said, medical science is faced with a "highly complex and most individualized physiochemical system which reflects the totality of constitution plus the storehouse of past experience mingling in the arena of present awareness...

...Heath has for some time been investigating what he considers chemical peculiarities in the blood of schizophrenics...

...Mental illness is not one but a group of diseases with a • common thread—the inability of the victim to function satisfactorily as a person...

...and, finally, an almost complete withdrawal from the world of reality, various phases of cataconic stupor or excitement, and a breakdown of the ability to communicate comprehensibly with other people...

...In the professional literature the contending psychiatric factions are referred to as the psychogenic and organic...

...The possibility that this chemical helps keep us sane and that mental disorder may be connected with a deficiency of serotonin or with some defect that upsets its function appears to be supported by several research findings...

...By talking to the patient at length, the psychotherapist attempts to lay bare the origin of the patient's difficulties, so that he can understand them and try to live with them...

...Until the tranquilizing drugs became available three years ago, medicine had nothing to put into the psychiatric syringe...

...These studies have shown that mental disorders occur most frequently in families with what appears to be a constitutional vulnerability to such disease...

...When medical science is able to understand fully the why and how of mental illness, a cure and a preventive will have become an attainable goal...

...Lysergic acid diethylamide, an hallucinogenic drug which is called LSD for short, blocks the action of serotonin in the brain...

...The red-brick school, whose proponents are concentrated on the staffs of the big state mental hospitals, argues that since everything a human being does is clearly influenced by some organic function in his brain, it is obvious that there can be no twisted thought without some twisted process in the brain...

...While they are laying their bets on the physiological school of thought as the one most likely to produce a cure for the plague of the mind, thoughtful observers hope that the pendulum will not swing to an extreme in this direction...

...We can never get enough psychiatrists to tackle the problem with psychotherapy alone...

...Kallman believes that the high incidence of mental illness among certain families, regardless of their income level and of the environmental stresses to which they are exposed, strongly indicates the inheritance of some kind of metabolic defect...

...The only trouble is that some of his disciples have gone far beyond the teachings of their master and have built up an exclusively psychological theory of the origin of mental disease...

...Freud's teachings underscore the great importance of subconscious inadequacies and hostilities shaped in the formative years by unsatisfactory child-parent relationships and the role these feelings play in mental breakdown...

...The brain is obviously subject to the body's ills...

...The hallucinogenic drugs have enabled many volunteers to take a brief but terrifying journey into the private hell of schizophrenia and to bring back a report of its horror...

...Some of the top experts in the field are convinced that patient probing on many fronts, integrating a variety of disciplines ranging all the way from biochemistry to psychology, and accelerated by the research push of recent years, is beginning to pay off...

...But tremendous progress will have been made when, as it now looks increasingly possible, scientists manage to pinpoint the noxious chemical agent involved in the breakdown of the mind...