Nursing Book Club

Infectious Madness: The Surprising Science of How We Catch Mental Illness by Harriet A. Washington

Just enough science to make it dangerous

I must admit that it was the title of Infectious Madness that grabbed my attention. The book claims to discuss research “demonstrating how microbes influence our collective behavior, shedding light on issues that go far beyond individual mental health.” That’s a lot to take in and I was surprised I hadn’t heard it discussed before.

Author Harriet Washington is a science writer who has won a National Book Critics Circle Award, among other accolades. With Infectious Madness, she’s taken on an ambitiously large subject, including the nature of the human microbiota — all the microbes that exist within the human body — and its effect not just on the individual human in which it resides, but also on all of society.

Thin Research

We’ve all read about diseases that can cause neurological damage. We now know, for example, that end-stage syphilis — a contagious bacterial infection — can cause “rapid and complete mental decay, including frequent seizures, paralysis, incontinence [and] psychosis.” Similarly, we know that some infections can cause rheumatic fever, which can lead to brain inflammation and erratic behavior. This is not new or groundbreaking information.

What Washington is suggesting in this book goes well beyond such well-established cases, implying that much of the incidence of mental illness in our society is attributable to infections — or immune system response to infection.

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For example, she devotes a chapter to PANDAS, an acronym for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.” PANDAS syndrome includes a number of psychiatric disorders such as OCD, Tourette’s and anorexia occurring in children following a Group A streptococcal infection.

Susan Swedo, M.D., a senior investigator at the National Institute of Mental Health (NIMH), has studied PANDAS and written about it for the American Journal of Psychiatry. Swedo’s theory is that PANDAS is caused by cross-reactive antibodies produced in response to a strep infection, perhaps due to a genetic propensity in certain individuals.

Although the NIMH has a webpage about PANDAS (at, the syndrome is not included in the current DSM-V, the standard reference of psychiatric disorders. Washington remarks only, “The wheels of psychiatric epidemiology turn glacially slowly,” but I wonder what the omission really implies. Does the American Psychiatric Association have doubts about the research on PANDAS? Washington doesn’t say.

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Ammunition for Conspiracy Theorists

Infectious Madness has a lot of interesting material, but it’s also trying awfully hard to be “edgy,” mixing its science (much of which I already knew) with plenty of what feels like conjecture. It’s fascinating, but not always persuasive. Patients who are strongly invested in finding explanations for their disorders may latch onto the idea that their illness might be caused by pathogens, but I wonder how useful that idea really is.

Even if we know that a disorder occurred in connection with an infection, that might not provide new treatment or prevention insights. The NIMH page on PANDAS, for example, notes that there are no lab tests for the syndrome and its neuropsychiatric symptom can’t be treated with antibiotics. (NIMH recommends “standard medications and/or behavioral therapies” instead.)

I’m concerned that books like this could provide ammunition for naïve, misguided or unscrupulous providers and alternative therapy peddlers, who may seize on its mix of real research and provocative speculation, to sell dubious products to desperate patients.

After reading this book, I remain uncertain how much mental illness is really caused by infection. I suppose that if nothing else, Infectious Madness could inspire new interest in the nature and cause of mental illness, but the use of the word “science” in the title might attract additional readers that I’m not sure it deserves.

Infectious Madness: The Surprising Science of How We Catch Mental Illness by Harriet A. Washington (Back Bay Books, 2015).

Christine Contillo, RN, BSN, PHN, is a public health nurse whose 40-year nursing career has taken her from inner cities to medical missions in Central America. She turned to writing because she believes that everyone, not just nurses, needs to understand what nurses do.

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