This is the original draft of the Physics World article: A physicist’s experience of the mental health system (which then lead to the 24th February podcast)
I sent this draft to the editor around August 2021, when I was quite a lot sicker than I am now. I am proud of what I wrote given I could barely make breakfast at the time. So bear this in mind if some of it doesn’t make sense!
I entered my experimental physics PhD way out of my depth. I, like many others, was taken aback by just how much rigour goes into the experiments. “Did you check this?” my supervisor would say “Or that?” he would continue, as I stood there with a feeling of dread knowing that my answer was going to be an inevitable, “No”. “Well, we will have to redo the experiment then” he would say, knowing full well that by “we” he meant “me”.
Over the course of four years, I was lucky enough to mess up on one of the most precise and accurate electron microscopes in the world. I would mess up continually until I finally had data worthy of publication. This is where it got interesting. You would think that with nice pristine data revealing the secret of the universe we desired, that we would be able to interpret it with consummate ease. The reality was that we couldn’t make heads nor tails of it. Undesirable secrets (Noise), complexity or just plain ignorance prevented us from seeing what was right in front of our eyes. It took plenty of wrong simulations, wrong hypotheses and wrong ideas before we were eventually right. 99 percent of science is not shown to the public. Only the pretty and flattering end result.
So, I am absolutely astonished that no one has taken a single measurement, not a single concrete test during my fight against the mental illness caused by a severe reaction to the antidepressant Sertraline 6 years ago1. In its place have been interviews, questionnaires, bias and opinions. I have seen 5 clinical psychiatric professionals, who in the space of half a decade have given me the following formal diagnoses:
- Previous serotonin syndrome on SSRI
- Recurrent depressive illness
- Most probably on the bipolar spectrum
- Current presentation does not meet criteria for affective disorder
- Chronic nature of low mood since childhood
- Possible features of ASD2
- Mixed Anxiety and Depressive disorder
- Traits of highly anxious personality with Alexithymia
- Severe depressive illness
- History of rTMS induced hypomania
The diagnoses coloured green have turned out to be likely associated with my mental illness, and the ones coloured red, unlikely. Unfortunately, after years of explicitly telling clinicians about my generalised anxiety symptoms, I have yet to receive a formal diagnosis. In fact, I diagnosed myself with generalised anxiety disorder, looked up the NICE guidelines on treating the condition and asked my psychiatrist to prescribe me Pregabalin. The Pregabalin has had, by far, the greatest impact on my generalised anxiety and ongoing recovery.
I am terrified of having to use my defective brain in a field I feel completely lost in. I had spent so many years of treatments not working or making my condition worse that I felt forced to take control. The people that were supposed to help me were driving me towards death and, well, I don’t want to die! But when I, a mentally ill physicist with no medical training, started to be seemingly doing a better job than the professionals, I became pretty concerned about the state of mental illness treatment. Despite this, my exasperation is not directed at any individual within the mental health system. Instead, I return to the fundamental question that has played over and over in my head:
“Why has no one taken any measurements of my brain?”
I had something the clinical experts didn’t: a direct (though poor, and subjective) measurement of the workings of my brain. Pretty much every clinical expert I have seen has told me their view of how my own brain worked, and they were stupendously wrong. My measurement wasn’t great, but at least I didn’t have to argue with myself that over 300 hours of therapy3 (involving most modalities) probably means my remaining problems are primarily physiological, not psychological.
From my experience in experimental physics, the more accurate, precise and direct the scientific instrument is, the greater the understanding that can be derived from that measurement. When I was writing my PhD thesis, I had the pleasure of searching for images of the very first diffraction patterns from the technique I was using. It was a mess. You could not tell where one blob of intensity began and another ended! Their initial research was therefore mostly qualitative, filled with generalisations and guesswork.
The refinement of this technique over the best part of 80 years meant that I could now see all sorts of weird and wonderful features in the diffraction pattern. Not only did this mean that a lot more physical phenomena could be studied, it meant the technique could now become quantitative. These intensities were accurate and precise enough that meaningful numbers could be attributed to them. No more guesswork – we could apply simulated models to the patterns. So, while I am much less gifted than these earlier physicists, I am able to understand a lot more of the physics than they did! Put simply, they were literally not able to see it.
I was therefore greatly disturbed to discover that the nature of my treatment was entirely generalisations and guesswork. Surely, I thought, neuroscience would have sussed that a measuring device capable of non-invasive direct detection of action potentials in the human brain would revolutionize the field overnight? Instead, all I found was, well… this . The original BRAIN initiative  paper with an underwhelming total of fewer than 300 citations in nearly 10 years. Compare that with this paper  unveiling the stunning revelation that the darknet is used for crime with over 200.  And it has had 3 fewer years to gather those citations.
How can it be that we can land a rover on Mars with a jetpack (twice), yet do not have a single quantitative measure of any mental illness? Why is it all still blobs? Further, the current measure of effectiveness for the entire psychiatric research field is no more complex than the survey used in an episode of Family Fortunes. The HAM-D  for instance, one of the many rating scales used, has been generally agreed  to be the ‘gold standard’ for objective measurement of the severity of depression. Therefore, from the perspective of a physicist, it looks like psychiatric research is based on social science. i.e. patterns can be shown, but no definitive conclusions can ever be drawn. The best that can be hoped for is associations, with no way of proving causation.
This is concerning to a currently mentally ill physicist for two reasons. Mental health conditions are inherently complex , and more importantly, relative. I’m not able to give an objective measurement of how severe my condition is. I only know the things I can no longer do and the symptoms I currently have.
As sad as this statement is, and perhaps hard to understand, I can confidently say I do not know what remission feels like. I have learned that my mood is the ground that my internal reality is built upon. When my mood became corrupted, my reality changed with it. I think this is the most tragic thing about mental illness. Spend a long enough time in it, and you believe that this is all there is and ever will be. Brainwashing from within. This is why, on a personal level, I believe measurement is so important. A number, a scan, whatever it may be, showing that something is not right. A reminder that you are actually sick, in a world that doesn’t understand why.
My personal delusion only broke once I had significant improvement in my severe condition. This contrast provided me with the understanding of how far my own personal reality could shift. In my opinion, contrast is vital in the study of various physical phenomena. Examining what appears to be an exception to the rule allows progress in defining the rule. Through these vast differences, the underlying laws that define nature are much clearer for physicists to see. Take black holes for instance. It is an extremely rare cosmic object that packs in a heck of a lot of mass into something perhaps infinitely small. It would be by far the best place to test theories of quantum gravity (if it were accessible; spoiler: it isn’t). From taking measurements4 inside the black hole and just outside, theories of quantum gravity can be tested as fully as possible. The contrast provided through measurements of these extreme conditions and ordinary ones allows us to see the holes in our theories (pun unintended!). It has been apparent since the inception of science, that the laws that govern the exceptional must also govern the normal. The very reason physics instruments have become so ridiculously precise and accurate is to allow us to discern more and more subtle contrast out of our observations of the universe.
I do not see this contrast in most psychiatric treatment research trials. In fact, I see intentional blurring of contrast. This is the problem with statistics. While it may be possible to spot objective trends out of a group of trial participants, it cannot tell you anything about any one participant within that group. If my recovery were not dependent on this system, I would find this obsession with statistics rather odd. Surely the ultimate aim of psychiatric treatment is to ensure that when a specific patient is given a treatment (or combination of treatments) it achieves remission of all their symptoms? Whereas the best case scenario resulting from current methods is a solution that partially works for the greatest number of people? At least that is what it looks like from my ignorant position. It is like the old joke, about the man who dropped his keys in a dark underpass, then climbed up and started looking for his keys under a lamppost because the light was better. Except in this case, the man also used a torch just to make sure it is bright enough.
And yet, I have read of countless missed opportunities to examine this contrast, walking in and out of hospitals. In the medical literature, there are thousands upon thousands of case studies where they write about the strange, the extreme and the weird (conditions or reactions to medicine etc.). But I have not yet read about a single measurement being taken once the patients were better. There seems to be bias in clinical research to stop scientific inquiry once a patient is better. Why not ask them if they want to contribute to science? A DNA sample, EEG, an fMRI, anything! My physics brain is telling me that these people, these extremely unfortunate yet wonderfully odd people, might hold the key to countless conditions5. For my specific case, the contrast could be found between two people with direct opposite reactions to low dose Sertraline. One who had a panic attack induced  by it and one who achieved remission  of their panic disorder with it. This is the type of contrast not found in trial after trial of carefully selected patients with the ‘average’ presentation of the condition in question.
I think there is this idea that the scientific method must always be carried out in a certain well-defined way. But this was not my experience. Physicists are trained to think from the ‘bottom up’: to use our imaginations to question previous fundamental assumptions and methodologies. We are taught to fail forward; that is, to try something outside of the box in order to find where the walls lie.
As Richard Feynmann puts it in the first of his lectures on physics : “The principle of science, the definition, almost, is the following: The test of all knowledge is experiment. Experiment is the sole judge of scientific ‘truth.’ But what is the source of knowledge? Where do the laws that are to be tested come from? Experiment, itself, helps to produce these laws, in the sense that it gives us hints. But also needed is imagination to create from these hints the great generalizations—to guess at the wonderful, simple, but very strange patterns beneath them all, and then to experiment to check again whether we have made the right guess.”
 ‘NIH BRAIN Initiative – Google scholar citations’. https://scholar.google.com/scholar?cites=5530391697256397887&as_sdt=2005&sciodt=0,5&hl=en (accessed Aug. 24, 2021).
 T. R. Insel, S. C. Landis, and F. S. Collins, ‘The NIH BRAIN Initiative’, Science, vol. 340, no. 6133, pp. 687–688, May 2013, doi: 10/gmkh2p.
 D. Moore and T. Rid, ‘Cryptopolitik and the Darknet’, Survival, vol. 58, no. 1, pp. 7–38, Jan. 2016, doi: 10/gfkmjn.
 ‘Cryptolink and the Darknet -Google Scholar citaations’. https://scholar.google.com/scholar?cites=3919773215528629019&as_sdt=2005&sciodt=0,5&hl=en (accessed Aug. 24, 2021).
 M. Hamilton, ‘The Hamilton rating scale for depression’, in Assessment of depression, Springer, 1986, pp. 143–152. [Online]. Available: https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-DEPRESSION.pdf
 R. W. Iannuzzo, J. Jaeger, J. F. Goldberg, V. Kafantaris, and M. E. Sublette, ‘Development and reliability of the HAM-D/MADRS Interview: An integrated depression symptom rating scale’, Psychiatry Res., vol. 145, no. 1, pp. 21–37, Nov. 2006, doi: 10/dztq2v.
 M. Pandya, M. Altinay, D. A. Malone, and A. Anand, ‘Where in the Brain Is Depression?’, Curr. Psychiatry Rep., vol. 14, no. 6, pp. 634–642, Dec. 2012, doi: 10/f4dwrq.
 C. E. Schwartz and R. E. Stevenson, ‘The MCT8 thyroid hormone transporter and Allan–Herndon–Dudley syndrome’, Best Pract. Res. Clin. Endocrinol. Metab., vol. 21, no. 2, pp. 307–321, Jun. 2007, doi: 10/bfkgpb.
 G. Catalano, S. M. Hakala, and M. C. Catalano, ‘Sertraline-induced panic attacks’, Clin. Neuropharmacol., vol. 23, no. 3, pp. 164–168, Jun. 2000, doi: 10.1097/00002826-200005000-00007.
 H. Orenstein, ‘Two Cases of Panic Disorder Responsive to Low-Dose Sertraline’, Clin. Neuropharmacol., vol. 33, no. 4, pp. 215–216, Jul. 2010, doi: 10.1097/WNF.0b013e3181e1612e.
 ‘The Feynman Lectures on Physics Vol. I Ch. 1: Atoms in Motion’. https://www.feynmanlectures.caltech.edu/I_01.html#Ch1-S1 (accessed Aug. 24, 2021).
- At time of writing
- I scored 4 in the ASQ
- Which was great as an educational tool. Building self-esteem, resolving panic symptoms and becoming aware of when and how my emotions come and go.
- I have no idea what measurements would have to be taken to test theories of quantum gravity. It is well beyond my remit as an electron crystallographer!
- I think a good example is the discovery of the action of the MCT8 transporter in the brain