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

www.isps.org

ispsnz@gmail.com

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