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BMJ. 2001; 322:937 ( 14 April )

Personal views

Time to abandon the term mental illness

When we use the term "mental illness," not "brain illness,"
do we put our patients in harm's way? This is an appropriate
time to ask, because it has become apparent in recent years
that disorders of the brain and nervous system are among the
most serious and prevalent health problems globally.

It is harmful to millions of people to declare that some brain
disorders are not physical ailments.

By 2020, diseases arising from nervous system disorders will
make up 14.7% of all diseases worldwide (up from 10.5% in 1990),
according to the Global Burden of Disease (GBD) Study recently
carried out by the World Health Organization and other institutions 

[Fred A. Baughman Jr., MD:
"diseases arising from nervous system disorders"...
What does that mean. All who have gone to medical school--all
physicians--know a disease is an abnormality; an objective, demonstrable
abnormality. What is a "nervous system disorder"? The authors need to
define a "nervous system disorder" or a liver "disorder" or a spleen
"disorder" before they move on. Dr. Menken is a neurologist, he knows,
as I do what a nervous system disease is and is not. I am not sure what
Dr. Baker is, and, therefore cannot speak of what she should

Although nervous system disorders

[Fred A. Baughman Jr., MD:
What do they mean "disorders"?]

 comprise only 1.4% of all
deaths, this study estimated that they account for a remarkable
28% of all years of life lived with a disability. Moreover,
much of the burden of illness due to road traffic incidents,
violence, war, and falls is a consequence of nervous system

[Fred A. Baughman Jr., MD:
Here is yet another term left undefined. Why the
confusion of terms? Why not a simplicity and consistency in their
lexicon. Either one has a disease, a physical abnormality of the nervous
system or some other system or one does not. Nothing is more fundamental
to the scientific practice of medicine]

. The president of the 
World Federation of Neurology,
James F Toole, has highlighted brain dysfunction among world
leaders as one of the greatest threats to global peace, and
therefore the health of populations

[Fred A. Baughman Jr., MD:
And here we have the authors
taking to yet another term: "brain dysfunction"]

In making their estimates, the GBD researchers took into account
that chronic illnesses differ in their impact on people,
including the differential impact resulting from the way friends,
coworkers, and society at large react and respond to each illness.
For example, there is little doubt that people with nervous system
disorders are more likely to be subjected to discrimination and
stigmatisation than people with, say, disorders of the heart and

[Fred A. Baughman Jr., MD:
having had a bona fide neurological disease
(poliomyelitis) with tangible sequelae, I am not so sure of this.
Furthermore, I very much object to attempts to lump bona fide
neurological diseases with psychiatric diagnoses, bringing them all
under the term "neurological disorders." To try to do so is a perversion
of neurology, science, and medicine]

. Employers try to avoid 
hiring people with a history of
nervous system disorders

[Fred A. Baughman Jr., MD:
Again, Drs, Mencken & Baker, how are you
defining "nervous system disorders" and how do you distinguish them from
demonstrable "nervous system diseases" those which all neurologists are
medico-legally responsible for delineating in our patients]

, and 
otherwise compassionate people may
avoid contact with such individuals in social settings. Health
ministries or private insurance companies may deprive some people
with serious brain disorders

[Fred A. Baughman Jr., MD:
definition needed; actual disease or
not; it makes all the difference in the world]

 of the opportunity 
to consult with a psychiatrist or neurologist

[Fred A. Baughman Jr., MD:
a neurologist in the case of
suspected real disease, a psychiatrist in cases where all organic
diseases have been ruled out and are not thought to exist]

Our reflections upon the stigma and prejudice that apply
differentially to people with nervous system disorders have led us
to conclude that the mental health and mental illness labels
traditionally and commonly used to characterise certain brain
disorders contribute to these twin sources of unnecessary suffering.
We propose that these terms be abandoned in favour of "brain health"
and "brain illness."

The concept of mind and mental effort is deeply woven within the
western intellectual tradition as a fundamental concept of philosophy.
Metaphysics is that branch of philosophy that studies the nature of
matter (ontology), of mind (philosophical psychology), and of the
ways that matter and mind interact in sense perception and the
acquisition of knowledge (epistemology). "That in the soul which
is called mind," Aristotle writes, is "that whereby the soul thinks
and judges." Philosophers, theologians, and children wonder whether
mind is a uniquely human possession, whether other animals have minds,
or whether there is a transcendent intelligence, an absolute mind, in
the universe. However, in proposing that we replace the mental illness
label with the brain label, we are arguing not from a philosophical
position but within the domains of public health and clinical medicine,
as an essential step to promote the improvement of human 

[Fred A. Baughman Jr., MD:
in proposing that replacement of the mental illness
label with the brain label, Baker and Menken are, knowingly, I think,
doing the work of the psychiatric-pharmaceutical cartel that would have
us believe that all of the invented, and yet-to-be invented psychiatric
diagnoses (of the DSM of the Am. Psychiatric Association) be called
diseases so as to justify their medical/drug treatment, if not
voluntarily, then forcibly]

Last week's World Health Day 2001 commendably highlighted nervous
system disorders. Although the six disorders underscored in this project
were all brain disorders (depressive disorders, schizophrenia, dementia,
alcohol dependence, epilepsy, and mental retardation)

[Fred A. Baughman Jr., MD:
a favorite stratagem of their's is to co-mingle actual
diseases, with non-diseases, referring to them all as "brain disorders."
Neither schizophrenia or depression is a demonstrated, demonstrable
disease of the brain. The dementia, alcohol addiction, epilepsy and
mental retardation (all kinds) are--and Drs. Baker and Menken know it,
and know they obfuscate and deceive in writing thusly]

 the event was
widely known as World Health Day 2001 on Mental Health. Advances in
neuroscience during the past 50 years have left us not knowing how or
where to draw a line between brain and mental problems, or between
psychiatric and neurological disorders, as is customarily done. From
our angle of vision, there are only brain disorders that psychiatrists
prefer to treat and other brain disorders that neurologists (and
neurosurgeons) prefer to treat. 

[Fred A. Baughman Jr., MD:
Dr. Baker and Menken know very
well the indelible line; the disease vs. no disease, line that separate
neurology on the "disease" side and psychiatry on the "no organic
disease" side. They are purposely trying to obliterate that line of that
their can be no doubt. What is their motivation. Who might have
solicited their attempt to obliterate this line. Someone is paying
someone. I have seen similar attempts to obliterate this line from the
World Health Organization. Why? Who? How much? These are a few of the
questions that must be answered]

To be sure, there are many social problems and problems in living 

[Fred A. Baughman Jr., MD:
a few things might be at work that they would agree do not need

most healthcare workers would agree do not reflect brain disorders.
We frequently meet people with complex presentations, leaving us
uncertain whether any brain disorder is present. We should honestly
admit this uncertainty, and await the results of further research
without retreating into the ambiguity of the "mental" paradigm.

We suggest that it is unscientific, misleading, and harmful to millions
of people worldwide to declare that some brain disorders are not
physical ailments

[Fred A. Baughman Jr., MD:
It is essential to practice neurology and
every single medical specialty that it first be determined whether or
not an organic disease/physical abnormality is present. If yes, then it
must be determined which one. No psychiatric diagnosis is known to be
due to an organic disease of the brain having a demonstrable
macroscopic, microscopic or biochemical abnormality. To urge eradication
of this line between neurology and psychiatry, between disease and
absence of disease, is a duplicitous, anti-scientific endeavor, one with
an ulterior motive. It is not about scientific or medical disagreement
at all.]

 Neurology and psychiatry must end the 20th century
schism that has divided their fields. There must be closer collaboration
in neuroscience research and clinical practice. And we must build
partnerships with our patients and with societies at large. Only
then will we advance the prevention and treatment of brain and nervous
system disorders.

Mary Baker, president of the European Parkinson's Disease Association,
Matthew Menken, World Federation of Neurology liaison representative,. 

[Fred A. Baughman Jr., MD:
Dr. Menken is a neurologist, and understands perfectly the
scientific divide between all organic medicine (neurology included)on
the one hand, and psychiatry/psychology/mental health on the other. Only
his motives for seeking to smudge the line between the two remains
unclear. Just what Mary Baker's credentials are, I do not know. It is
commonplace for disease organizations to do the work (propaganda
included) of the pharmaceutical industry generally, and of the
psycho-pharm-federal government cartel, in particular. Clearly the World
Health Organization here, as elsewhere is busily trying to portray all
psychiatric diagnoses a "neurological" and therefore "medical" so as to
justify the automatic prescriptions for every one, not always so easily
justified, especially not in entirely normal infants, toddlers,
preschoolers and children of all ages. ]

World Health Organization

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