Should Psychiatry Test for Lead More?

Dr. Matthew Dumont treated a 44 year old woman with depression, body dysmorphia, and psychosis. She failed to respond to most of the ordinary treatments, failed to respond to electroconvulsive therapy, and seemed generally untreatable until she mentioned offhandedly that she spent evenings cleaning up after her husband's half-baked attempts to scrape lead paint off the walls. Blood tests revealed elevated lead levels, the doctor convinced her to be more careful about lead exposure, and even though that didn't make the depression any better, at least it was a moral victory.

The story continues: Dr. Dumont investigated lead more generally, found that a lot of his most severely affected patients had high lead levels, discovered that his town had a giant, poorly-maintained lead bridge that was making everyone sick, and – well, the rest stops being story about psychiatry and turns into a (barely believable, outrageous) story about politics. Read the whole thing on Siderea's blog.

Siderea continues by asking: why don't psychiatrists regularly test for lead?

Now, in my case, I'm a talk therapist, and worrying about patients maybe being poisoned is not even supposed to be on my radar. I'm supposed to trust the MDs to handle it.

Dumont, however, is just such an MD. And that this was a clinical possibility was almost entirely ignored by his training.

Dumont's point here is that while "medical science" knows about the psychiatric effects of lead poisoning and carbon disulfide poisoning and other poisons that have psychiatric effects – as evidenced by his quoting from the scientific literature – psychiatry as practiced in the hospitals and clinics behaves as if it knows no such thing. Dumont is arguing that, in fact, he knew no such thing, because his professional training as a psychiatrist did not include it as a fact, or even as a possibility of a fact.

Dumont's point is that psychiatry, as a practical, clinical branch of medicine, has acted, collectively, as if poisoning is just not a medical problem that comes up in psychiatry. Psychiatry generally did not consider poisoning, whether by lead or any other noxious substance, as a clinical explanation for psychiatric conditions. By which I mean, that when a patient presented with the sorts of symptoms he described, the question was simply never asked, is the patient being poisoned?

Dumont wants you to be shocked and horrified by what was done to those people, yes. He also wants you to be shocked and horrified by this: psychiatry as a profession – in the 1970s, when (I believe) the incidents he relates where happening, in the 1990s, when he wrote it in his book, or in 2000 when a journal on public health decided to publish it – psychiatry as a profession did not ask the question is the patient being poisoned?

And it didn't ask the question, because clinical psychiatry had other explanations it liked better, to which it had a priori philosophical commitments.

And that, when you think through what it means for psychiatry, is absolutely chilling.

And: