2011 NZPsS Conference
Can Poverty Drive You Mad?
'Schizophrenia', Socio-Economic Status and
the Case for Primary Prevention
New Zealand Journal of Psychology (2010) 39, 7-19
The Hunter Award Address
Professor John ReadUniversity of Auckland
Introduction: Poverty and Mental Health
Problems with Construing Madness as an IllnessDominance of the ‘Medical Model’The Pharmaceutical IndustryThe Bio-Psycho-Social ModelThe ‘Schizophrenia’ Construct
Summary of the Research
ExplanationsCan madness cause poverty?Poor people can’t deal with stressBiased diagnoses
Public Opinion
Treatment Bias
Therapeutic and Policy Implications
George Albee1922-2006
Past President American Psychological Association
Relative povertyWilkinson & Pickett ‘The Spirit Level’ (2009)
Drug company influence
• Research Funding
• Educational/training institutes
• Training for doctors
• Drug licensing bodies
• Lobbying governments (especially bad in USA)
• More recently, the internet…..
Drug Companies and the Internet
Significant Biological-Bias in Drug Company (D-C) funded websites
(% D-C Funded) Causes Treatments Total
Schizophrenia (58%) X X X(Read 2007)
Depression (42%) X X(de Wattignar & Read, 2008)
PTSD (42%) X X(Mansell & Read, 2008)
ADHD (37%) X X(Mitchell & Read 2011)
Erectile X X XDisorder (44%) (Mati & Read, in preparation)
Dr Steven Sharfstein – President,
American Psychiatric Association (2005)
If we are seen as mere pill pushers and employees of the
pharmaceutical industry, our credibility as a profession is
compromised.
As we address these Big Pharma issues, we must examine the fact
that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model.”
Professor Mike Shooter, President of the Royal College of
Psychiatrists (2005):
“I cannot be the only person to be sickened by the sight of parties of psychiatrists standing at the airport desk with so many perks about them that they might as well have the name of the company tattooed across their foreheads. It simply will not do.”
Epidemiologia e Psichiatria Sociale, 18, 4, 2009
“Time to abandon the bio-bio-bio
model of psychosis:Exploring the epigenetic and psychological mechanisms
by which adverse life events
lead to psychotic symptoms”
JOHN READ,
RICHARD P. BENTALL,
ROAR FOSSE
Introduction: Poverty and Mental Health
Problems with Construing Madness as an IllnessDominance of the ‘Medical Model’The Pharmaceutical IndustryThe Bio-Psycho-Social ModelThe ‘Schizophrenia’ Construct
**Summary of the Research**
ExplanationsCan madness cause poverty?Poor people can’t deal with stressBiased diagnoses
Public Opinion
Treatment Bias
Therapeutic and Policy Implications
No single cause.
As for other mental health problems - causes, usually in combination, include:
• Genetic predisposition ??• Brain differences – structural and
functional (can be caused by environment)
• Maternal prenatal health and stress• Birth complications• Rape and physical assault• War combat• Child abuse • Child neglect• Parental loss• Bullying• Urban living• Ethnicity (poverty, isolation and racism)• Heavy early cannabis use• Poverty - ‘the cause of the causes’
CHICAGO
Faris & Dunham, 1939
Pilgrim State Hospital had 14,000 patients, a bakery, a laundry, fire and police departments, a power plant, a church with a cemetery, a post office, a farm, and its own station on the Long Island Railroad.
Introduction: Poverty and Mental Health
Problems with Construing Madness as an IllnessDominance of the ‘Medical Model’The Pharmaceutical IndustryThe Bio-Psycho-Social ModelThe ‘Schizophrenia’ Construct
Summary of the Research
** Explanations **Can madness cause poverty?Poor people can’t deal with stressBiased diagnoses
Public Opinion
Treatment Bias
Therapeutic and Policy Implications
ISPS International Psychosis Conference - Dubrovnik 2011
Introduction: Poverty and Mental Health
Problems with Construing Madness as an IllnessDominance of the ‘Medical Model’The Pharmaceutical IndustryThe Bio-Psycho-Social ModelThe ‘Schizophrenia’ Construct
Summary of the Research
ExplanationsCan madness cause poverty?Poor people can’t deal with stressBiased diagnoses
** Public Opinion **
Treatment
Therapeutic and Policy Implications
Public believe mental health problems, including schizophrenia, caused primarily
by adverse life events (Read et al. 2006)
South AfricaChinaEgyptTurkey
FijiJapan
MalaysiaSwitzerland
EthiopiaGreece
BaliBrazil
EnglandIreland
Germany India
Australia Italy
MongoliaRussiaand …
New Zealand
Introduction: Poverty and Mental Health
Problems with Construing Madness as an IllnessDominance of the ‘Medical Model’The Pharmaceutical IndustryThe Bio-Psycho-Social ModelThe ‘Schizophrenia’ Construct
Summary of the Research
ExplanationsCan madness cause poverty?Poor people can’t deal with stressBiased diagnoses
Public opinion
Treatment
** Therapeutic and Policy Implications **
Similarities found in brains of severely abused children and adult ‘schizophrenics’:
• Overactivity of hypothalamic-pituitary-adrenal (HPA) axis
• Abnormalities in neurotransmitter systems (especially dopamine)
• Hippocampal damage
• Cerebral atrophy
• Reversed Cerebral Asymmetry
Read et al (2001)
Brain differences between two groups do NOT prove the ‘brain
disease’ hypothesis. The brain is designed to respond to
the environment