Why We Need A More Nuanced Understanding of Mental Health
The biological model of psychiatry is the dominant model of present mainstream treatment. Medicine, with its focus on symptom reduction, has perpetually propounded the notion of mental illness as a brain disorder, being organic in nature and fixed through chemical means, such as the use of SSRIs (the standard form of current treatment). Throughout our history, it seems, it’s been much easier to explain away mental illness in the same way we describe the sources of cancer, or even black lung if you’re a Republican; we shroud each in its own veil of mystery and sweep away environmental influence into a void of irrelevancy.
Depression, anxiety, mood swings, we posit, exist within the distressed and within them alone; anything else is peripheral, linked only in some limited way. And much as with our cultural view of cancer, it’s all too convenient for us reduce the mind to the processes of the brain, eliminating subjective experience and any responsibility for our roles in the maintenance and foundation of mental illness.
Medicine sustains its satisfaction with this view, maintaining its simple solution to treating a complex problem: just give them a pill. And this perspective is in line with medical history, as in prior times, it was the lobotomy, and before then, an asylum; we shipped away the hysterics whom men no longer wished to deal with, those whose difficulties were believed to be purely internal, separated from the patriarchal dominance of a chauvinistic culture. It appears that we’d do anything to repel the experience of empathizing with those in distress, even to the point of deluding ourselves into the marginalization of their trauma, doing this most extensively with children.
It continues to baffle me that parents, and even some psychiatrists, insist that “certain” children are somehow broken through organic means, needing outside treatment for help; it’s as though they exist in a vacuum or some biological bubble in which their brain organically becomes dysfunctional, through no fault of their caregivers. And our culture works hard to push this view, effectively negating accountability while engendering serenity in the process, for the parents, of course. And as we quiet their minds, their circumstances remain: those children return to their chaotic homes, but with a diminished desire to fight back and a curtailment of their spirits.
To hear, really hear, about another’s experience is to empathize with their circumstances, and to acquaint oneself with their pain. This appears to be the most difficult aspect for medical professionals, parents, husbands, friends, family, etc… to encounter. The absolute one thing that we can give someone who’s struggling with mental illness is the thing which we deny them: genuine connection. For it is through listening, and I mean really listening, that we create the power for change; but to precipitate that change, we first need to care, and few of us care to listen, few of us allow ourselves to hear their stories. And thus, their suffering is prolonged through silence and their assessments of inherent defect, reinforced by an outdated medical view that refuses to allow experience into the fold.
In his recent, Steve Rathje discussed the practical, and psychosocial, downside to framing depression as a purely chemical, brain illness. The author maintained:
Researchers at the University of Melbourne conducted a meta-analysis of 25 different studies that looked at the impact of the “brain disease” framing of mental illness. They concluded that this framing is a mixed blessing: While some studies showed that this way of framing mental illness leads to a decreased sense of blame, many also showed that it leads to a stronger desire for social distance and an increased perception that people with mental illness are dangerous.
With respect to a solution, the writer argued for a more nuanced understanding by factoring in several elements, stating:
What are some better ways to talk about mental illness? One study found that talking about how genes and biology are malleable and interact with the environment led those with mental illness to have less pessimism about recovery. Another study found that talking about how there is a continuum between mental health and mental illness, rather than a strict dichotomy, decreases perceptions that people with mental illness are different and leads to greater social acceptance. And a meta-analysis of several studies found that some of the best tactics to reduce stigma against those with mental illness involve increasing contact with those who are suffering from mental illness and dispelling common misconceptions about having a mental illness.
In my work as a therapist, the most important thing I’ve learned is to listen, believing the act to be the greatest gift that one can ever give another. And what I’ve heard in response were tales of trauma, suffering, recovery, and resilience: harrowing stories which undoubtedly precipitated each “clinically significant” symptomology. For clarity, I want to state that it isn’t my goal to negate the effectiveness of medication or to defend a dualistic perception of the brain/body, but it is my goal to promote the diathesis-stress model, and to help others learn that one’s circumstances greatly affect one’s health, whether it be physical or emotional. And to devalue the subjective is to devalue another, reducing them to being nothing more than a set of biochemical factors. It is my perpetual hope that we’ll continue to improve on a model lacking in humanity and begin to emphasize the subjective experience of one’s environment, in addition to one’s underlying biology, for one will always be tied in with the other.
As Bessel van der Kolk, the prominent trauma therapist, noted
I wish I could separate trauma from politics, but as long as we continue to live in denial and treat only trauma while ignoring its origins, we are bound to fail. In today’s world your zip code, even more than your genetic code, determines whether you will lead a safe and healthy life. People’s income, family structure, housing, employment, and educational opportunities affect not only their risk of developing traumatic stress but also their access to effective help to address it. Poverty, unemployment, inferior schools, social isolation, widespread availability of guns, and substandard housing all are breeding grounds for trauma. Trauma breeds further trauma; hurt people hurt other people. – The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma