Mind the Science: Saving Your Mental Health from the Wellness Industry

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Yves here. This post addresses a pet peeve of mine, and I suspect of many readers. While engaging in physical and mental health maintenance is a good idea (and some physical practices like exercise have a positive effect on mood), a whole industry of wellness providers has sprung up to exploit this desire. Their promotional efforts have even resulted in not just “wellness” schemes being covered by some health care plans but even pressure by employers for employees to sign up and be monitored by wellness specialists (in the US, they can’t be required to participate because ERISA). Recent surveys show employers are keen about these schemes, employees markedly less so.

KLG’s overview:

Wellness is one of the “keywords of the day,” along with its cognate, mindfulness, with intentional, holistic, artisanal, and deliverable only slightly lower on my list. While wellness was a useful concept when first described in the late 1950s, it is now basically a racket designed to separate people from their money and to assuage the conscience of large employers who have no real feeling for their employees.

In his recently published Mind the Science: Saving Your Mental Health from the Wellness Industry the clinical psychologist Jonathan Stea of Calgary dissects what the Business of Wellness has become, accompanied by recommendations and warnings for the unwary. It is doubtful that many of these unwary souls will find Dr. Stea’s book in their Barnes & Noble beside the works of the one and only Medical Medium, but they should!

Dr. Stea provides excellent advice on avoiding the pseudoscience of Mental Health and by extension Physical Health, which are not separable and are too important to be left to the whims of this particular “market.” True wellness has a deeper history that can carry the day, but only if we are intentional and mindful in what we do while remembering that the whole body, mind included, is the subject and object of healthcare.

By KLG, who has held research and academic positions in three US medical schools since 1995 and is currently Professor of Biochemistry and Associate Dean. He has performed and directed research on protein structure, function, and evolution; cell adhesion and motility; the mechanism of viral fusion proteins; and assembly of the vertebrate heart. He has served on national review panels of both public and private funding agencies, and his research and that of his students has been funded by the American Heart Association, American Cancer Society, and National Institutes of Health

Wellness is everywhere these days, but what does it really mean?  Jonathan Stea, a clinical psychologist and therapist in Calgary, entered that swamp and has emerged with answers in Mind the Science: Saving Your Mental Health from the Wellness Industry, which was published earlier this month by Oxford University Press.  It is a brisk read, with the foundation of his arguments well supported by a deep engagement with the relevant literature.  Dr. Stea also regularly confronts “Wellness” on social media.  He is doing essential work there and in Mind the Science, which begins with a description of “The Evolution and Seduction of Pseudoscience.”

What is pseudoscience as applied to health?  Its beginnings lie in Clark Stanley’s “Snake Oil Liniment,” which really existed in the early 20^th-century, with thousands of iterations to come, as noted below.  According to Dr. Stea, pseudoscientific practices in mental health include Ayurveda [1], Biosound Therapy, Chelation Therapy, Energy Medicine (Therapeutic Touch), Thought Field Therapy, Naturopathy (Acupuncture, Homeopathy, Orthomolecular medicine  [2]), Hyperbaric Oxygen Therapy, Ozone Therapy, Past Life Regression Therapy, and the Narconon Program of Scientology.

This is an incomplete list.  Many of these therapies sound plausible to the layperson, which is a key to their popularity.  Chelation therapy, for example, is used to treat heavy metal poisoning (e.g., lead, cadmium) with compounds that bind to heavy metal ions, most of which have a net positive charge of +2 or +3.  When bound to a chelator, these poisons can be excreted in urine.  Hyperbaric oxygen can be used to treat wounds infected with bacteria that are killed by oxygen.  But there is no evidence that this or any other of these high-sounding practices will have any effect on mental illness.  No, chelation therapy will not flush unnamed “toxins” out of the brain and the body and restore mental and physical health.  Moreover, ozone is toxic.  We have no past lives to which we can regress.  There is, however, much evidence that in the hands of self-described “therapists” these “therapies” can be dangerous.  For example, Mind the Sciencerecount the sad story of Kirby Brown in Chapter 5: Falling for Fake Scientific News.

According to Dr. Stea, the only protection against quackery is to “become literate in science and mental health.”  He begins with one Bill Maher being interviewed by Larry King [3] on December 15, 2005.  The substance of Maher’s argument was that Western medicine is toxic, from pain relievers to vaccines.  On his own show Real Time with Bill Maher earlier in 2005 Bill Maher had stated:

I don’t believe in vaccination either…That’s another theory that I think is flawed, and that we go by the Louis Pasteur theory (the germ theory of disease), even though Louis Pasteur renounced it on his own deathbed and said that Béchamp was right; it’s not the invading germs, it’s the terrain.  It’s not the mosquitoes, it’s the swamp they are breeding in.

Here Maher is referring to the 19^th-century argument about the “germ” and the “terrain” theories of disease that is now perfectly understandable in the (unfortunately seldom made) distinction between the cause of a disease and the agent of a disease. [4]  In the case of malaria, it is the “swamp and mosquitoes” (together the cause of the disease) and the species of Plasmodium (agent of disease) the mosquitoes transmit when feeding on humans.  Another example is the distinction between the agent of tuberculosis (Mycobacterium tuberculosis) and the cause of tuberculosis.  The cause of the White Death that killed millions was removal of rural people to overcrowded, fetid tenements in big cities such as London and Manchester as an “economic necessity” required by the Industrial Revolution.  A more recent example is the distinction between the cause of AIDS in the Global North, centered in the United States, and the agent of the disease (HIV), which was transmitted through distinct but complementary behavior in the Global South (e.g., sub-Saharan Africa).

According to Dr. Stea, “(T)o become literate in science means adopting the intellectual humility that is associated with the scientific spirit while at the same time constantly learning about science and finding a balance between trusting expertise and remaining skeptical about scientific claims.”  Our current scientific leadership could follow this lesson a bit better, but I digress.  An example from real life has appeared from Dr. John Turner, a chiropractor who developed a proprietary protocol called Quantum Neuro Reset Therapy (QNRT™) that “initiates a quantum shift in the nervous system by resetting the brain’s response to emotional triggers for both past and present emotional trauma and stress.”  Quantum is a protean word, but “science literacy involves knowing just enough about quantum physics to understand that the alternative medicine practitioner trying to sell (keyword) you a therapy apparently based on quantum physics doesn’t understand quantum physics” [5].  Mind the Science is filled with other examples just as distant from any reasonable conception of science and scientific evidence as QNRT™.

The Wellness Business [6] had its origins in the work of John Harvey Kellogg, yes, of Battle Creek, Michigan, at the Battle Creek Sanitarium (established in 1878), which was a medical center/spa/grand hotel that attracted “celebrities” of the late-19^th century.  Kellogg was an advocate of “biologic living,” in which every health condition could be treated with “physical exercise, adequate sleep, and a diet replete with fruits, grains, vegetables and milk”. [7] Kellogg was followed by Bernaar Macfadden, perhaps the first well-known health “influencer” (there is very little new under the sun) and his magazine Physical Culture.  Kellogg and Macfadden “brought 19^th-century ideas of health moralism into the new era of mass marketing and celebrity culture, championing the fantasy that your health could be controlled with a virtuous lifestyle” (see Michelle Cohen; virtuous is doing heavy lifting here).  Kellogg and Macfadden have a multitude of successors, especially in anti-psychiatry and wellness movements of today.

Ambivalence about psychiatry dates to its beginnings in the opposing views of the German psychiatrist Emil Kraepelinand the Austrian neurologist Sigmund Freud.  According to Kraepelin, psychopathology is the result of abnormalities in the brain.  The much better-known Freud was the “Father of Psychoanalysis.”  As illustrated by the first two editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I, DSM-II), psychoanalysis was the ruling paradigm in the beginning, but with DSM-III the Kraepelin thesis largely supplanted psychotherapy and neuropsychiatry has dominated for the past 60 years.

It was easy for many to dismiss psychotherapy through the middle of the 20^th century, just as it has become easy to criticize neuropsychiatry, which can sometimes be reduced to “Yes, we have a pill for that” (Bill Maher was not entirelywrong).  The psychiatrist Thomas Szasz became a leader in the mid-century antipsychiatry movement with his publication of The Myth of Mental Illness (1960; still in print), in which he argued there is no such thing as mental illness.  As late as 1996 he wrote:

I believe viewing the schizophrenic as a liar would advance our understanding of schizophrenia.  What does he lie about?  Principally about his own anxieties, bewilderments, confusions, deficiencies, and self-deceptions.  He pretends that he is not confused, impotent, and insignificant; he is confident, powerful, and supremely significant.

This is nuts nuts incorrect.  The causes of schizophrenia are not known, yet, but it is certain that both Kraepelin and Freud would have had something useful to contribute to the understanding and treatment of schizophrenia.  The condition is certainly not due to the patient lying about himself, not now and not in 1960.

So, where are we today in the Wellness Business?  According to Dr. Stea, far down the rabbit hole of pseudoscience.  Perhaps the best example is one Anthony William Coviello, known to his followers as the Medical Medium. Following John Harvey Kellogg and Bernaar Macfadden of one hundred years ago, the Medical Medium has built an empire on his view of wellness, which began when he was a 4-year-old and an elderly man spoke into his right ear, “I am the Spirit of the Most High. There is no spirit above me but God.”  This has continued to the present day, as “Anthony continues to tell us that he has been greeted by the man’s voice every morning from that day forward as he’s provided with paranormal information about the health status and necessary treatment of anyone he encounters.”  Medical Medium operates now with endorsements from these (and many other) “A-Listers”: Dwayne “The Rock” Johnson, Sylvester Stallone, Robert De Niro, Hilary Swank, Novak Djokovic, Liv Tyler, and Gwyneth Paltrow (of another famous wellness empire called Goop).

Medical Medium covers it all, with canned answers to virtually every human illness, from anxiety and depression to cancer, autoimmune disease, and blood clots.  I have tutored medical students in Hematology for the past 15 years, so I downloaded the Medium’s 2-pager on Blood Clots.  I was greeted by this:

• When you have elevated blood fats from a diet too high in radical fats (this applies to all fats, whether they are healthy fats or not) and proteins – whether from animal or plant sources, such as butter, milk, yogurt, cheese, eggs, chicken, beef, pork, lamb, oils, nuts, seeds, soy products, fish, ghee, chocolate or any other–your blood will become thick. Thick blood has trouble carrying ample amounts of oxygen and macro minerals such as magnesium and trace mineral salts.  This can prevent proper blood flow.
• One way someone can form blood clots is from pathogens such as viruses and bacteria, or poisons such as toxic heavy metals, pesticides…and countless other toxic chemicals. Pathogens and toxins trigger an alarm that prompts white blood cells and other immune cells to attack and consume these invaders.  If the pathogen or chemical invaders are not completely consumed, more immune cells will join in and cluster around these invaders. As this clump of immune cells flows into smaller blood vessels and capillaries an obstruction is created.  This is one variety of blood clots.

Lots of medical words, but this is nonsense from start to finish that never describes an actual blood clot.  And no, an aggregation of immune cells, which would be unusual in the blood, is not “a variety of blood clot.”  Nevertheless, in this healthcare guide you can “Find out more about how to heal blood clots, including more on the foods to avoid (plus additional foods to watch out for), foods to eat, and supplements with dosages in the NYT best-selling book, Cleanse To Heal,” which is a paean to one of the most common tropes in the alternative medicine of the wellness business: “Flush out the toxins!  And by the way, we will show you how to detox if you will only buy this book!  And several companion volumes.”

Which brings us to the question “Why alternative medicine?”  Mind the Science addresses this question throughout the book by distinguishing difficult science from attractive pseudoscience.  While one may think the dividing line is clear, this is not always the case.  QNRT™ has nothing to do with the quantum or the brain.  Light therapy for Seasonal Affective Disorder may work for some but the mechanism remains obscure.  Dr. Stea is somewhat contradictory about the chemical imbalance theory of mental illness but does point out that the simple model associated with serotonin is a gross oversimplification but may be valid for some even if the exact mechanisms are unknown.  “Science versus pseudoscience” is beyond the scope of discussion for now.

The most convincing answer to “why” is that people seek alternatives when conventional practice does not serve their needs.  This is true in psychology, medicine, and political economy.  In each of these the sense of touch writ large, therapeutic and otherwise, has been obliterated as community has been thoroughly alienated and commoditized under Neoliberalism.  However, we should always keep in mind the distinction between traditional medicine and alternative medicine.  Traditional medicine often works.  Tu Youyou was awarded a Nobel Prize for her discovery of the anti-malarial drug artemisinin.  Her search was motivated by ancient Chinese medical texts that recommended tea from wormwood as a treatment for malaria.  The active ingredient in this tea is artemisinin. [8]  Ethnobotanists the world over have learned much about the utility of traditional medicine.  Much to the astonishment of our current Professional Managerial Class (PMC), humans have been good at inductive reasoning and engineering for a very long time.  The definition of “alternative medicine that works” is “medicine.”

Perhaps the most useful approach to wellness is to go back to the first use of “wellness” as a clinical term by a physician who focused on public health.  Halbert L. Dunn published a paper in the Canadian Journal of Public Healthin 1959 entitled “What high-level wellness means.”  I have not been able to gain access to this paper but his related paper “High-level wellness for man and society” (1959) from the American Journal of Public Health and the Nation’s Health is here.  It addresses how mental health and wellness are dependent on one another and are the normal state of being only when people live in a healthy society.  We do not live in a healthy society.  Nor did everyone in the United States or Canada 65 years ago, but that is not the point.

Halbert Dunn begins this paper with (emphasis added):

The awakened interest of public health circles in full-time local health departments and in the family and community programs of health maintenance is an indication that health workers are becoming more “health oriented.”  This shift in emphasis is in accord with the frequently quoted fundamental objective expressed in the Constitution of the World Health Organization, “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity…

It is my thesis…that both medicine and public health must undertake a multiple and thoroughgoing exploration of the factors responsible for good health.  Without prejudice to the importance or the continuation and support of existing medical and health programs involving preventive, curative or rehabilitative research and activities, it seems clear that many of today’s and tomorrow’s problems call for the stimulation and development of a new major axis of interest directed toward positive health – one strong enough to activate physicians, health workers, and others in devoting a substantial segment of their time, resources and creative energies toward understanding and culturing good health in a positive sense.

This is illustrated in Figure 1: The Health Grid, Its Axes and Quadrants (redrawn for clarity).  Sixty-five years later one is struck by the assumption that public health is a real concern of the people, through a native, functional public health system that includes healthcare providers across the spectrum, accompanied by the natural assumption that public programs will be devoted to such.  Wellness is attainable only in a favorable environment through social and cultural institutions.  Those of us of a certain age do remember this imperfect but perfectible pre-1978 world before the Neoliberal Dispensation.  And therein lies the minor weakness of Mind the Science.  Although Dr. Stea does recognize that he is a practicing psychologist in a city that provides mental healthcare as a right, his situation is rare.  Mental health care is not widely available, especially for those at the greatest risk.  And for most people, environment is probably the critical factor determining mental health.

This simple diagram from Halbert Dunn also addresses the Kaepelin-Freud argument.  Mind is a function of the brain.  It is reasonable to expect that poor physical and mental health are often caused by a poor environment and that the agent(s) of psychopathology lie in insults to the brain in that poor environment.  Some of these are reparable, by therapy and/or therapeutics, despite what the wellness and anti-psychiatry movements say.

But it would be much better for all, rich and poor alike, if we lived in an environment that –through the intermediation of social and cultural institutions – virtually everyone has enough to eat, a safe and comfortable place to live, a school to attend for as long as desired (within reason), a rewarding job at a living wage, and expectation that in the case of an unlucky accident the necessary healthcare, mental and physical, will be readily available.  Dunn has been criticized as the founder of “The Wellness Movement,” but his view of wellness as dependent on community is far removed from wellness as a commodity to be purchased, often at great cost, by solitary, alienated individuals.

When social and cultural institutions provide what is needed, through the active contributions of citizens instead of consumers (the Neoliberal word for citizens), virtually all of us can live in the upper right quadrant of high-level wellness and those who cannot due to illness live in the upper left quadrant with their poor health protected.  Very few will live in the two lower quadrants.  And those with the wherewithal can still Goop all they want, while the Medical Medium eventually withers on the vine for lack of business.

Notes

[1] The “Science of Life” in Sanskrit, 5000 years old and generally experienced in a completely denatured form outside of South Asia, as are other most other forms of traditional medicine.  This vitiates any value they may have.

[2] Quackery involving mega-dosing on water-soluble vitamins (e.g., vitamin C) as a key to health, Orthomolecular Medicine was introduced by Linus Pauling in the 1950s.  Pauling was awarded the Nobel Prize in Chemistry 1954 for his many contributions to chemistry and the structure of molecules (e.g., his classic text The Nature of the Chemical Bond and the alpha-helix).  Pauling was also awarded the Nobel Peace Prize in 1962 for leading the early anti-nuclear movement and became the only single Nobel Laureate with two prizes.  People tend to listen to Nobelists, even when they speak nonsense.  This is especially true for the ersatz Nobel Prize awarded by the central bank of Sweden, Elinor Ostrom excepted.

[3] For our international readers, Larry King was a radio and television talk show host in the United States for over fifty years beginning in the 1950s.  I began listening to him very late nights in the laboratory in the late-1970’s.  His Larry King Live on CNN was “must-see TV” from 1985 until 2010.  He was quite good at his job.  Bill Maher is a comedian and political talk show host for the past thirty years.  He is also quite good at his job.

[4] Agent versus cause (reviewed here) has been presented most effectively by Richard C. Lewontin, who was a pioneer in molecular evolution.

[5] And there is this, from a mashup of Richard Feynman and Niels Bohr that any undergraduate who got to the end of calculus-based physics will appreciate.

[6] Dr. Stea refers to this as the Wellness Industry, but I think “business” in the sense of the third entry in the Oxford English Dictionary is more appropriate: mischievous or impertinent activity. This usage goes back to 1466 in the Paston Letters: “Ther ys but few within oure plasse but they know how yt is with her, and al by her awne bessynes of her tunge.”  This is Late-Medieval English that is easily followed.

[7] There is also a good case that Kellogg based his advice on his rather severe Seventh Day Adventist faith: “He warned against sedentary lifestyles, meat, sugar, caffeine, tobacco, alcohol, sex, and obesity – the latter of which was considered both a slight against physical attractiveness and a health hazard.  He referred to masturbation as ‘self-abuse,’ advising that it could lead to mental illness, cancer, and moral destitution.”  He recommended barbaric treatments for both boys and girls to prevent this “self-abuse.”  One can only wonder at what happened behind his closed doors.

[8] Tu Youyou shared her Nobel Prize with William C. Campbell and Satoshi Omura, whose work led to ivermectin as treatment for elephantiasis and river blindness.