Psychiatrists, Sorcerers, and Transmissible Brain Disease

A Guest Blog by Pediatric Neurologist Dr. Peter Bingham

Posted Dec 06, 2016

(I am pleased to post this guest blog by my colleague Peter Bingham, MD, who is a pediatric neurologist and Professor of Medicine at the University of Vermont College of Medicine - DR)

Photo by Peter Bingham

Peter Bingham, MD

Source: Photo by Peter Bingham

A Gallup poll of people’s perceptions of the honesty and ethical standards of people in various occupations ranked psychiatrists relatively low, well below other kinds of physicians, not to mention pharmacists, nurses, teachers, and funeral directors. Of course one of the main drivers of the distrust stems from history: unproven, dangerous treatments that efface personality, excessive reliance on medications. Distrust of psychiatrists also stems from the kind of inscrutable, stigmatized problems that psychiatrists treat. Since the diagnoses can't be confirmed by laboratory testing, psychiatric assessment is imbued with subjectivity. Once made, the diagnoses remain fraught with overtones of hopelessness, or of evaded responsibilities, secondary gain. Such perceptions make psychiatrists, the ostensible healers, complicit in their patients’ problems.

At the same time, like many other physicians, psychiatrists may provoke an undercurrent of anxiety. What is this power to identify symptoms we hadn’t recognized in ourselves? There is the oft-repeated joke upon meeting a psychiatrist that he might identify our craziness. Like a sorcerer, they could point a finger, and so inflict us with the mental kind of brain disease.

The idea of brain disease via Sorcerer could remind us of the history of Kuru, a form of prion disease that caused an epidemic brain degeneration, so-called spongiform encephalopathy, among the Fore people of Papua, New Guinea. Until sometime in the 1960s, the Fore had a practice of eating the tissues, including brain tissues, of deceased relatives. Robert Glasse and Shirley Lindenbaum hypothesized that Kuru resulted from cannibalism, an idea that was eventually proven correct through the Nobel prize-winning work of Stanley Prusiner and Carlton Gajdusek. Gajdusek demonstrated the transmissibility of Kuru when he injected brain tissue from a deceased Fore into a chimpanzee, leading to neurologic symptoms and death in the animal. Prusiner later identified and named the infectious particle that could replicate in and destroy the brain--“prion.”

The epidemic was ended when, perhaps for moralistic rather than scientific reasons, Australian colonial officers—New Guinea was then a colony of Australia—forbade the cannibalistic practice. But many of the Fore people never assimilated the evidence of the infectious nature of Kuru, and they never gave up the idea that Kuru was the work of a powerful evil-doer. They believed that Kuru resulted when Fore sorcerers put together a bundle with something stolen from their chosen victim--clothing, a piece of discarded food, hair clippings--to which was added a poison. The bundle, bound with vines, was buried, with an incantation invoking slow death, where the intended victim was known to walk. The Fore believed that as the bundle disintegrated, the victim's symptoms would begin, ending with death. As their relatives deteriorated, desperate families’ tried in vain to locate and remove the bundles.

We look in horror, scurrying for some semblance of poetic justice—“I will never get that, because I will never be a cannibal.” And yet, every day, in our villages and cities, we face a transmissible brain disease that brings people in un-ceasing cycles to our emergency rooms with all manner of symptoms, that crowds our prisons, that kills: mental illness. Proximity to mental illness in childhood puts one at risk for a wide range of long term adverse health outcomes, including disorders of the heart, lungs, and immune system. The study of so-called Adverse Childhood Experiences shows that mental illness works very much like a contagious brain disease with long term, lethal, consequences.  Animal models support the interpretation that these epidemiologically identified associations are speaking to us of actual cause-effect relationships: experience of violence, abuse, or neglect in childhood leads to expensive, disastrous health outcomes, and early death.

The Fore, in the end, did not accept the scientific evidence that became available to them; they never perceived the long term effect of their funerary practice. And we, in the US, haven’t done much better in responding to the extraordinary social, emotional, and financial costs of psychiatric disease. We have yet to recognize, and respond to, the transmissible nature of mental illness, how it spreads through communities, exerting its effects on the organs even of those who were initially free of mental illness.

These enormous costs of mental illness may be the most horrendous consequence of the way we’ve separated psychiatric illness from other processes simply because our physiological understanding of them remains shallow. Yet we are beginning to overcome our societal mind-body problem, and to open our eyes to the manifold pathophysiological impacts of mental illness. Parity rules for insurers are one example of our progress in this direction. We need, urgently, to get over our sense of mystery, and our superstitions, regarding mental illness. There is no sorcerer.
 

Peter Bingham is a Pediatric Neurologist at the University of Vermont Medical Center.  Additional posts from Dr. Bingham can be found at his site, the Parpetsy Neuro-Log