The Mental Health Paradigm Shift; The importance of language and structure in social change.
As the eyes of politicians, psychologists, journalists and the general public turn to the social issue of our time, it seems odd to suggest that in the widespread campaigns and much needed dialogue around the importance of identifying and responding to mental health problems, that we have been barking up the wrong tree. Perhaps it seems even stranger to suggest that by supporting media campaigns focused on raising awareness of ‘mental illness’ we are perpetuating the problem and fuelling stigma. But, there is a conversation around mental health that has not yet entered the public realm. This conversation involves challenging the conceptual and scientific underpinnings of the system itself. This conversation threatens to shatter trust in not only one of the most engrained aspects of health care but to cause widespread public outrage.
In the media frenzy involved in bringing to public awareness the importance of these difficult and complex experiences, these experiences that we have communally agreed to call ‘mental health problems’, the momentum and search for more effective solutions has missed the importance of reflection and critical analysis of the past. If we are to move forward, we must recognize how the faults of the past have contributed to ineffective systems and invalid conceptual structures. We must be prepared to admit, honestly and frankly, how the systems created to promote healing have promoted disability, how a field that prides itself in evidence based approaches has turned a blind eye to the corruption taking place behind the scenes. We must recognize how social campaigns that are not well informed or educated can cause harm. We must recognize that this is happening everyday and we must recognize that by not examining the facts, we are taking part in it too.
So, to cut to the chase. Here’s the conversation that you may not have heard.
It begins with a book. The DSM, colloquially termed as the ‘Psychiatrist’s Bible’ or de-acronymed as the ‘Diagnostic and Statistical Manual of Mental Disorders’. It is a thick, heavy and Tolkein-esque literary masterpiece. Sadly, for all the wrong reasons. If you have ever received a ‘diagnosis’ or a label related to your mental health, it came from the pages of this book. Your label was chosen from a list of 172 others. Some of which include ‘Mathematics Disorder’ and ‘Other Disorder not otherwise specified’ a.k.a ‘I’m not sure what’s wrong with you so take this one so we can carry on our process’.
Until 1973, if you were gay, you would have been given a diagnosis of ‘sexual orientation disturbance’ or be described as suffering from ‘ ego-dystonic homosexuality’ and given appropriate ‘ pharmacological treatment’. As public perception of what is or isn’t abnormal changed, psychiatrists were forced to remove this category from their book. The fact that these ‘conditions’ and ‘disorders’ can be erased by social opinion shines an obvious spotlight on the fact that these are not categories supported by science or underlying biological causes, they are categories that are created to make social judgements on what is or isn’t socially ‘normal’ behavior. Psychiatrists believe abnormal behavior can be treated with drugs and this is exactly what they have been doing at an increasing rate for the last few decades. Disturbingly however, as the rate of antidepressants issued to the public has increased, so have the rates of long-term disability. This poses the question. If these drugs do what they claim to do, why are we seeing more, longer-term episodes of depression, not less? This question takes us to the truth behind the illusions of the medical model that has spread like a virus across western society.
Once somebody receives a diagnosis such as ‘ General Anxiety Disorder’ or ‘ Major Depressive Disorder’ they are administered a course of psychiatric medication. This makes sense, assuming that these ‘Disorders’ operate in the same way as other medical pathologies. The problem is that they don’t.
David Kupfer, is a man who chairs the DSM committee. He choses what should or should not be considered normal. This man recently released a statement to the psychological community.
‘In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients
for several decades that we are waiting for biomarkers. We’re still waiting’ (Kupfer, 2013).
Translated into everyday language, this means that a Professor of Psychiatry, a medical role from which he pathologises mental distress as a disease, is admitting that there is to date, no evidence of a biological or genetic cause of any ‘mental illness’ that he proposes should be treated with drugs. What this also means is that the chemical imbalance theory was just that, a theory, ruthlessly and cleverly marketed as the truth. The drugs you are given may make you feel different, sometimes better, sometimes save your life by altering your mental state through sedation or stimulation. However, they are not working on a neurological system to repair it, only alter it.
Another crucial, but relatively unsurprising aspect of this story is the shockingly apparent links between the inventors of the DSM and pharmaceutical companies. A research article produced in 2006 found that ‘Of the 170 DSM panel members 95 (56%) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies. ‘(1). Put plain and simply, the system we have been given to understand our most intimate and human experiences of suffering have been not only unscientific and lacking evidence but the result of clear and power-hungry corruption.
So what does this mean for anybody looking to conceptualise and seek help from our mental health system during times of extreme distress? Well, it means be careful. You may wish to use these categories to help think about your experience but be aware that the drugs you are given are not fixing the underlying problem and in many cases may producing long term side effects. Your brain is uniquely yours and not a hydraulics system. The psychiatric system has been playing a guessing game with millions of people’s, including young children’s, most delicate and complex system for too long, cleverly disguising it as a valid medical approach.
The obvious issue that emerges in this recognition is, if this ideological system is so engrained in the framework of our current understanding of the experiences themselves, then how are we able to come to a more accurate and communal understanding that respects, values and promotes a deeper insight, a more truthful representation? The answer to this question requires an overhaul of the current framework, refreshed and renewed by the real evidence. This evidence exists and Clinical Psychologists, who work alongside those suffering from the most extreme experiences of distress have been working to build a conceptual framework that honours the more subtle, gradual and cumulative nature of experiences that to many, look like abnormal behaviour. They work in what is in many ways an antithesis of the approach taken by psychiatry. Instead of asking what is wrong with you, they ask what has happened to you. They use the unique stories of a person’s life, explored gradually and gently, to piece together the moments or elements that may have taken them away from a sense of equilibrium, into a space where life becomes troubling, painful and frightening. They give time and space to understand complexity, without viewing complexity as a disease.
Clinical psychology has worked alongside psychiatry as a sister system, in many cases using the ‘diagnosis’ as a guide but working in a way that ideologically opposes the idea of a faulty brain. It recognises the intricacy of human behaviour in relation to the systems that surround us. The families we are born into, the way we grow to see ourselves, the opportunities and people that we may have lost, the ways we learn to respond to internal pain. This storytelling model fundamentally changes the messages of psychiatry into one that honours how these experiences grow out of understandable events that subtly affect our perceptions and responses to the world around us. Often, these behaviours that appear as abnormal were once useful ways of surviving in traumatic environments or threatening situations. It makes sense to withdraw from the world when we are frightened, it makes sense to lose trust in people if they have repeatedly failed to provide a sense of safety and understanding. Depression makes sense if our internal world has not been recognised throughout our lives, listened to but not really heard. This approach recognises that no two human experiences are the same, yet we can respond to and understand mental distress by recognising the uniqueness of these stories.
This shift in ideology has powerful implications for not only how we understand mental health problems as a society but how we view the world around us. If we move into this new realm of thinking, we enable ourselves to move from judgement and separateness into a space of intrinsic connection. Suddenly, when we see somebody talking to themselves, shouting at different voices in their head, we might be given a new space in our minds to replace the label and judgement that so often accompanies the word ‘Schizophrenic’ with a gentle and curious enquiry into this persons life. A sense of how this person, like us, grew from a state of pure potential and limitless opportunity into an adult whose traumatic experiences have become personified as voices. How maybe if we were less fortunate, we could hear those voices too. How our response, even a silent narrative in our head, promotes the continued sense of separateness and rejection that most vulnerable and maltreated people have experienced for so long.
Part of the problem is that this storytelling process is hidden from the public view. The insights and transformations that take place in the process of healing can be communally shared in a process of collaborative reflection, given the opportunity and without fear of their exploration. The final question and perhaps the most important one, is how can we adopt a new language. One that makes sense, one that allows us to explore and convey these parts of our lives that have lay hidden for so long. That exist intimately and intensly deep within us. How can we develop space in our society to explore curiously, without fear, these aspects of human experience that fundamentally manipulate and colour our view of the world. The answer to this question holds the energy that will allow us, as individuals and as a society to move from meaninglessness, dullness and despair, into a new sense of connection and opportunity for transformation.