We love fighting demons.
And nowhere is that more apparent than in the current geo-political sphere.
Some of us fight them for meaning; others for clout. Bifurcating the world provides a sense of relief and one of structure, affording us the apparently correct knowledge of how to understand and navigate our lives. And it grants us the power of projection, the gift of disavowing our own darkness to alleviate our shame. Fanaticism is merely an easy remedy.
We discover Manichaeism and fanaticism in the anti-psychiatry and anti-psychology movement, at its more extreme end. These individuals are so-called enemies of the DSM and of Big Pharma, more broadly. In their straw-man perspective, the bio-psycho-social model is oversimplified and presented as the so-called medical model of psychiatry, wherein the patient’s brain chemistry is conceived of as the sole source of his emotional distress. Social Media platforms are full of these therapists; some are more obvious than others. They rail against evidence-based care, and tout individualized treatments, whatever those may be.
Modern Psychiatry and Psychology are, more or less, standardized fields. Their bio-psycho-social model informs us that the individual’s perceptions of themselves, the world, and others; their socio-economic status, surrounding environment, and history; and their genetic predispositions, indicated by a family history of specific symptoms and disorders all contribute to their clinical presentations. Mental illnesses are more than brain disorders, but our neuronal connections, nevertheless, play big roles. This means that, not unlike medicine, mental health fields have prescribed ways of treating psychological disorders. So, the opponents of medicalization will tell you that individuals need to be treated uniquely. But how? They can’t seem to say.
Individualized treatment appears to be a mere marketing ploy, meant to make prospective patients feel special. This isn’t to say that therapists and psychiatrists don’t adjust treatment based on specific needs. (e.g. Individuals with high degrees of anxiety require slightly different approaches.) But the argument that each person requires a unique treatment plan flies in the face of the necessity for accreditation. For, how can practitioners, beforehand, learn to craft extremely unique treatments? How does training work? Approaches may be nuanced, but are far from unique. Psychoanalyst Nancy McWilliams writes, “Despite the fact that we all need a general sense of what to do (and what not to do) in the role of therapist, and notwithstanding the time-honored principle that one needs to master a discipline thoroughly before deviating from it, the feeling that one is breaking time-honored, incontestable rules is the enemy of developing one’s authentic individual style of working as a therapist.” This is a distinction of style, rather than of the rules themselves. Rigidity and flexibility become enemies in their extreme forms.
These same individuals also argue that personalities can’t be boxed into categories, as in the DSM. They’ll also note that those categories are highly subjective. You can make the case that something like “five out of nine symptoms” appears to be an arbitrary criterion, but the opponents of the DSM often fail to note that most of the (formerly labeled Axis I) diagnoses require that the patient present clinically significant distress and/or impairment. This means that on the off chance that they’re not too preoccupied with their symptoms, they aren’t diagnosable. Yet, distress and severity often go hand in hand; the more symptoms you have, the more they negatively influence your life. This argument applies to personality disorders as well, minus the need to meet that diagnostic requirement.
The history of psychiatry is fraught with undesirable results. (Andrew Scull is one of the few in the movement whose work I recommend.) But to discount the field altogether or the evidence-based portion of it, especially when you’re marketing your own remedy, is ignorant at best and manipulative at worst. It’s a fact that psychotherapy and medication aren’t as effective for chronic conditions, and medication isn’t recommended in mild cases. It’s also a fact that various diagnoses (such as Autism and ADHD) are over-diagnosed. It’s also a fact that grief is an inevitable part of life. But if these disciplines help some people at some points, eradicating them, or replacing them with “individualized care,” is more than irresponsible. I often tell people that mental health care isn’t great, especially when compared to modern medicine, and the only thing we can promise is to try to learn from our mistakes. But to argue that most of the practitioners in these fields knowingly harm their patients or are merely milder versions of the Sacklers is frightening.
For a detailed discussion of mental health care around the world, check out our episode with Anthropologist Roy Richard Grinker:
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