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All in the Mind? Three Controversial Mental Health Conditions

By Edited May 21, 2015 3 1

The mind is the most complex part of the human anatomy and, like the body, is prone to illnesses of varying degrees of validity. Here are three of the most contentious mental health issues known to psychiatry.

Sexual Addiction

Unless we count ourselves as asexual (as many people do), then our sexual urges are fundamental to our experience as human beings. Yet some find those compulsions so overwhelming they harm their daily activities, personal relationships and even their jobs. As celebrities such as Tiger Woods, Kanye West and Charlie Sheen have discovered, sexual addiction can wreak havoc with their professional life and public reputation, while the legacy of President John F Kennedy, a serial womanizer, diminishes with accounts of behavior that these days would classify him as suffering from sexual addiction.

unmade bed
Just how bad can this addiction get? In 2011, Time reported on the case of a 57-year-old man who recognized he had a problem back in 1987 when he stopped on the way to pick up his wife from the airport to pay for the services of a prostitute. As soon as the man returned home with his wife, the couple made love in the bed he’d used to have sex with three different women in the short time of his wife’s break. As with all addictions, no amount of sexual activity could quench this individual’s thirst for physical gratification, putting all he held dear at risk, despite his knowledge of the possible negative consequences of his actions. Indeed, one definition of addiction the inability to stop such behavior, despite knowing the ruin it could cause.

However, medical authorities such as the American Psychiatric Association do not recognize sexual addiction; nor does it feature in the APA’s latest Diagnostic and Statistical Manual of Mental Disorders. Unlike substance abuse, such as alcoholism and drug addiction, the general consensus holds that as compulsive sexual behaviour comes from ‘within’, and doesn’t cause physical harm, it can’t be considered a medical addiction in the true sense. Put simply, it is easy enough to tell when a person has consumed too much alcohol, not so easy to tell if someone’s sexual activity is excessive. The same problem occurs with gambling addiction; it can ruin your life without actually making you physically unwell.

This view is changing however, just as societal and medical opinion changed their view of alcoholism during the last century, as something other than weakness of character. Earlier this year, medical researchers based at the Wolfson Brain Imaging Centre, Cambridge, UK, studied the effects of addictive behaviour on the brain and found the more the pleasure center of the brain received a certain type of stimulant, the more it needed of that stimulant to receive the same amount of pleasure.

Long known in the case of substance abusers (the more you drink, the more you need the drink to get a ‘buzz’), the researchers found this ‘wearing down’ of the pleasure center also afflicted behavioral addicts, who needed the hit of sexual activity more often, be it through pornography, cybersex, conducting multiple affairs or visiting prostitutes (even if they had a healthy sexual relationship with a partner at home). In short, the neural mechanisms within the brain of a behavioural addict reacting to appropriate stimuli were the same as those of a substance addict ingesting their preferred stimulant.

Today, a sex addict, depending on seriously how his physician views the subject, can seek a cure through Cognitive Behavioural Therapy, counselling, group therapy or medication. There remain skeptics though, who consider sex addiction either a cultural condition stigmatizing those with high sex drives or a self-labeling by the depressed treating themselves with sex as it were a medication. Behavior addictions, they believe, turn ordinary people into profitable patients for drugs companies and rehab clinics. Time noted one such clinic in La Jolla, California, charged $2000 a day for their services, at a minimum stay of one week. 

Dissociative Identity Disorder 

A spurious existing condition is as difficult to remove from the DSM at it is to admit a new,

Dr Jekyll & Mr Hyde
valid, disorder. Be it through the various adaptations of Robert Louis Stevenson’s The Strange Case of Dr Jekyll and Mr Hyde (1886), the influential 1957 hit film The Three Faces of Eve, or the surprise bestseller of 1973, Sybil, the condition once known as Multiple Personality Disorder is arguably the most misunderstood, and controversial mental health condition found in the DSM. By the 1990s, Multiple Personality Disorder had become so discredited, practitioners changed its name to Dissociative Identity Disorder (DID) to maintain credibility in the field.

The Three Faces of Eve showcases the classic scenario most imagine of DID, that of several personalities occupying the same mind; in this case, a woman splits into three characters, one wild, one timid, the other stable, with Eve unable to recall account for the actions of the others when they take over her personality. It is this amnesia effect, more than proliferating selves, which is of real interest to psychiatry. A study conducted in 2012 by the University of Gronigen in the Netherlands however appeared to disprove such memory gaps existed, with a test which showed certain words which should have meant nothing to a patient’s ‘false’ self actually registered as pertinent to the ‘real’ patient. Richard J McNally, Harvard Professor of Psychology, who assisted the Dutch team, believed this proved the lack of evidence in the amnesia between different character states, and so disproves DID itself.

This is not to say those who claim to suffer from DID are malingering, but are using a well-known condition as a cover or retreat from problems or a different mental disorder, such as depression. The researchers at Gronigen compared it to the ‘swoons’ of Victorian women, their only ‘acceptable’ recourse when faced with a situation they found difficult or overwhelming.

Of the three conditions discussed in this article, DID has the longest history, with its original term of Multiple Personality Disorder coined by Morton Prince (1854 – 1929), one of the foremost psychologist in America of the time, in his 1906 work The Dissociation of a Personality. In this, Prince described the case of Christine Beauchamp (a patient whose real name, Clara Fowler, kept hidden to keep anonymity), and their hypnotherapy sessions during which Prince ‘brought out’ Sally’s conflicting personalities. Since then, MPD/DID has enjoyed sporadic waves of popularity, with Sybil sparking off an epidemic of cases through the 1980s; the professional backlash against the book in the following decade, followed by law suits from patients further damaged by quack therapists, saw the diagnosis fall almost totally from favour.

Now seen not as conflicting personalities, but a sole, fractured self, treatment of DID focuses on dealing with other possible mental ailments first, such as depression and Post-Traumatic Stress Disorder. If troubled by difficult memories, such as a childhood trauma, a psychiatrist will help the patient to deal and live with those memories without the need to switch to a character who cannot remember the initial event. Hypnosis is often used, not to bring to the surface repressed memories (themselves a hugely sensitive subject in psychiatry), but to relax the patient and help them sleep – insomnia is a classic symptom of a patient presenting themselves with DID.

Today, the field of psychiatry is, ironically enough, split on the issue of DID. Those who believe in the condition see the problem as fourfold: the trauma triggers amnesia within the patient, who then enters a fugue state when they change personality for a time. Next comes a spell of depersonalization, where the patient feels as if their life is happening to someone else, resulting in a fourth state of switching between identities as a way of dealing with the problem. Those who discredit DID feel it is a cultural phenomenon, with patient and therapist ‘colluding’ (as with Morton Prince, albeit inadvertently), to name a series of recognizable symptoms to produce a safe zone in which the patient can act out certain psychological conditions, as a protective, yet self-defeating, distraction from the core ailment.

Multiple Chemical Sensitivity 

Long dismissed as the overworked imaginings of the hypochondriac, Multiple Chemical Sensitivity, as with Sexual Addiction, has gained credence in recent years thanks to advances in brain scanning technology. A classic case would go as follows: a person exposed to a new environment such as a remodeled office, or a freshly painted room at home, develops a range of symptoms such as nausea, migraines, ‘brain fog’, swollen joints, sleeplessness and fatigue. Convinced the chemicals present in the altered environment have caused a physical disease, the patient finds he is considered mentally ill by their doctor, who prescribes treatment for anxiety or depression, to which the patient suffers a further unpleasant reaction. Finally, the sufferer retreats to a specialised environment away from the city, high in the desert mountains. The patient adopts MCS as ‘their’ illness, cursing the day new carpets were laid at their office, or when they had their old home redecorated. Living in isolation, unable to tolerate indoor living, they become more prone to depression than ever before.

MCS is triggered by a host of common products, such as food additives, pesticides, cleaning products, solvents (such as paint or nail polish remover), perfumes, gas fumes and fabric conditioner. Synthetic mattresses and wood preservatives can make an ordinary home inhospitable to a MCS sufferer. Gulf War Syndrome, a condition affecting up to 250,000 veterans, caused by exposure to anti-nerve gas pills, oils spills and pesticides, is a similar condition, also once discredited by the medical establishment.

First proposed in 1950 by pioneering allergist Theron Randolph (1906 – 1995), MCS still finds itself on many a skeptic’s list of quackery, but the work of Dr Claudia Miller of the University of Texas School of Medicine suggests otherwise. In her research, Dr Miller used EEG machines to monitor the brain activity of MCS victims, in the same way as they diagnose epilepsy. Instead of sensitivity to flashing lights acting as a trigger, it is certain manmade chemicals, or toxicants, which cause the response, inhaled through the nose straight into the olfactory center of the brain, the limbic system. Many of us, perhaps a quarter of the population, so Dr Miller proposes, are born with a more pronounced sensitivity to such chemicals, and this is gradually worn down through life-long exposure to low-level toxic fumes.

An event overloading a vulnerable system (such as the redecorated office) results in a kind of ‘seizure’ taking place, permanently damaging the brain’s tolerance to chemicals. From then on, the tolerance grows less and less, until the sufferer lives in a near-permanent state of illness, where even using a computer becomes impossible, with its negligible emissions, once unnoticed by the victim, now intolerable to their neurologically damaged brain.

Again, the condition is difficult to diagnose, even for those medical practitioners convinced Dr Miller’s research is valid. To the disbeliever, MCS is still the preserve of the self-absorbed, recommending the same treatment as would be prescribed the depressive or clinically anxious. Of course, both sides could be correct; MCT may have its genuine cases, as well as those who find it a convenient cover for their neuroses. But at last, there is hope for the people who find modern life itself bad for their health. 



Jan 15, 2015 3:07am
Excellent article. So interesting. I definitely think sexual addiction shud be a recognized disease
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