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Wednesday, February 3, 2016

Infections Causing Mental Illness -- Madness?

Do you have a mental illness? Do you believe you genetically inherited your affliction? What if I told you that something may have infected your body and caused the disease? You would likely be ready to have me committed, right? Before you think I fabricated all of this, you may want to read this entry.

Harriet A. Washington is a Shearing Fellow at the University of Nevada's Black Mountain Institute. She has been a Research Fellow in Medical Ethics at Harvard Medical School and a senior research scholar at the National Center for Bioethics at Tuskegee University. She also has held fellowships at the Harvard School of Public Health, Stanford University and DePaul University College of Law.

Dr. Washington and a handful of researchers are researching whether mental illnesses are really caused by our immune system’s response to powerful microbial infections. Washington reports in her new book, Infectious Madness: The Surprising Science of How We "Catch" Mental Illness (2015) that some researchers in the field believe microbes may be responsible not only for clear-cut diseases like typhoid and tuberculosis, but also for mental illnesses such as anorexia, obsessive-­compulsive disorder and schizophrenia — but "in a less tidy manner."

(Meghan O'Rourke. "‘Infectious Madness,’ by Harriet A. Washington."
The New York Times. December 31, 2015.)

"Less tidy"? The findings support the germ theory, but, in no way, limit the causes of mental illness to microbes. Still, even if Harriet Washington's analysis accounts for only 10 to 20 percent of mental illnesses that are partly caused by pathogens, she believes it includes major afflictions such as autism. And, that belief represents a monumental paradigm shift that replaces psychosocial factors with biological ones as the cause of mental illness.

In her book, Washington relates research showing "that infections may shape us in utero and in our youth by triggering immune reactions our naïve immune system isn’t properly equipped to manage. This can lead to out-of-control inflammation or autoimmune responses, in which the immune system attacks the body’s own tissue."

We have long accepted that mental illness is caused by infection, as with paresis (in late-stage syphilis) and rabies. Yet, Washington is trying to show that a host of other disorders are caused by it too. This is a radical way of conceptualizing disease.

Among the most persuasive data she summarizes is evidence that obsessive-compulsive disorder, for example, can be triggered by strep throat practically overnight in a percentage of susceptible children.

Consider a study conducted by Susan Swedo, pediatrician at the National Institutes of Health (N.I.H.), who says ...

"Strep throat can trigger O.C.D., Tourette’s and anorexia in the genetically predisposed by way of a condition she calls Pandas, or pediatric autoimmune neuropsychiatric disorders. In other words, the infection triggers an outsize immune response whose consequences manifest as, say, O.C.D.

"They (researchers) found that these children tended to have an antigen — a molecule that causes the body to make immune responses to it — making them vulnerable to rheumatic fever. In another study, when they gave immune-modulating interventions to 18 kids with O.C.D., 16 of the children improved."

(Meghan O'Rourke. "‘Infectious Madness,’ by Harriet A. Washington."
The New York Times. December 31, 2015.)

And, even schizophrenia ... psychiatrist E. Fuller Torrey also noticed reports that schizophrenia rates rose in the United States the same year cat ownership became popular, a fact that has led researchers to look into Toxoplasma gondii, a parasite that cats transmit to humans. It’s not harmful to ­everyone — though it appears to make those who harbor it more sexually aggressive — but a pregnant woman can pass it to her child in the womb, where it causes damage. Washington quotes from a study in the American Journal of Psychiatry that found that “children of mothers who contracted T. gondii while pregnant did suffer higher rates of schizophrenia than other children.”

In Infectious Madness, Washington posits not only that many instances of Alzheimer's, OCD, and schizophrenia are caused by viruses, prions, and bacteria, but also that with antibiotics, vaccinations, and other strategies, these cases can be easily prevented or treated.

In the Kirkus book review for Infectious Madness, the site concludes ...

"In making the infectious pitch, Washington rightly argues that it strengthens the case for abandoning the Cartesian dualism that separates mind from body and leads to stigma and fear. It’s acceptable to study how infection and immunity affect the brain, but only as part of a larger agenda to understand the brain in all its plasticity and complexity.

"Conclusion: an unproven but undoubtedly provocative case. Expect dissent and discussion."

My Take

With her work, Harriet A. Washington shows that accepting the notion of “catching” mental illness requires blurring the line between afflictions of the mind and body. Before you scoff at her research, it would behoove you to remember that scientists began to accept germ theory only in the 18th century. Before that time, the "scientific community" blamed infections on causes such as sin and demonic influence.

And, think of the absurd beliefs held in past ages that mental illnesses were a mixture of the divine, diabolical, magical and transcendental -- times when belief in the four humors (black bile, yellow bile, phlegm, and blood) were common, and times when supposed cures like purges, bloodlettings, and whippings were applied to those who suffered mental health problems. 

Even the last fifty years have led to major changes in the understanding of mental illness and
substance abuse – from scientific knowledge about causes, to the shift from treatment in long-term care facilities (or “asylums“) to community-based care with short, periodic hospitalization.

I, like Washington, believe many illnesses are both mental and physical in nature. This is not to deny that more traditional causes of mental illnesses -- stress, trauma, genetics -- still apply. They do. But,
since infections and microbes are already solidly linked to certain mental disorders, I think much more research is needed in germ theory. Much of the public still has a stigma about mental illness that serves to stifle new scientific work in the field.

"Nothing defines the quality of life in a community more clearly than people who regard themselves, or whom the consensus chooses to regard, as mentally unwell."

--Renata Adler, American author and journalist

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