It’s been several months since one of these blog topic requests came in. I got it on Good Friday (4/3) and am excited and trepidatious to attempt an answer: “Do you think there are ways the mental health system can be actually improved, not just botched with a feel-better patch, and how?” I am so grateful for this question. Let’s begin.
To think about direction, we first need to make like R.E.M. and “stand in the place where we live.” This, currently but only for the last thirty or so years, is the medical model of mental disorder – that is, these are chemical imbalances in the brain and are thus chronic and thus you need long-term medication. There is so much to say about this – from doctors basically being the new drug reps to 70% of the DSM-5’s committee having financial ties to Big Pharma (which is not unusual for the industry) to the ineffectiveness of antidepressants (which may be why even pharmaceutical companies are abandoning the chemical imbalance myth). I’ll let the psychiatric survivor’s/ex-patient movement speak for itself (one resource from this movement is complete with heavy-hitting cartoons even!). The point is that we’ve monetized suffering and are starting to label any sort of emotional experience or “difference” as possibly disordered, even though it’s in our (at least women’s) biology to be “moody.”
Our current paradigm is inaccurate and misleading. “Mental illnesses” are simply descriptors of behaviors or experiences, not established diseases and, as Professor Emeritus Allen Frances writes here, “The “mental illness” term also lends itself to a simple-minded biological reductionism that pays insufficient attention to the psychological and social factors that are crucial in understanding anyone’s problems.” And our current paradigm for treatment of “mental illnesses” is making things much, much worse. This shouldn’t be surprising, given that this system has survivors; not only are the present protocols and Best Practices stigmatizing and demeaning, but they are actually turning what in the ’60s and ’70s was researched to be self-limiting conditions like depression (so maybe something like this) into chronic conditions and leaving more people on long-term disability than ever before. The psychiatry, pharmaceutical and psychology industries profit hugely from this current scheme and have a lot of power. This is a deadly mess; is there hope?
I don’t know how realistic these are but there are a few ways to change the mental health system that I believe are morally imperative: first, just like in politics, we must rollback the influence of money (read: Big Pharma) in every level of care, from diagnosis to discharge. I don’t know how to do that but it must be done. Second, if we want to make any headway towards a system that is actually healing rather than dehumanizing and demoralizing and thus itself a cause of mental dis-ease, we have got to stop worshipping science and technology as all-mighty providers. I’m not saying they haven’t given us great gifts. I am saying that they will not save us, not even if science were an exact science.
Third, if we’ve got any hope of changing or improving the current mental health system, we have got to change how we talk about mental health. Fifteen years ago, we were scapegoating guns as the cause for Columbine; “mental illness” (and the drugs for it) were not mentioned until much later. Now, we’re talking about mental illness, but only to scapegoat again. If we didn’t so dehumanize, other-ize and distance ourselves otherwise so we can get tidy answers for our own pain, the current system would start to teeter under its own victim-producing, immoral, profiteering weight. Then real headway could be made. If we loved our mentally distressed neighbors as if they were us, we might not settle for “recovery” being lifelong meds with troubling side effects, getting back to work at some whatever job if you’re lucky and simply not dying (as is current protocol). But until we think that “mental illness” explains tragedies (rather than results from them, perhaps?), until we stop talking about the mentally ill as potential terrorists, we will not advocate for their help, care and dignity.
And actually, in Finland, the conversation has already begun to change, resulting in a different approach to treatment than the individualized, chemical-imbalance problem. It’s technically still an experimental program (as in, it has yet to be evaluated from the “outside”), but Open Dialogue suggests that acute mental distress episodes, psychosis and other mental/emotional suffering does not exist in the person experiencing the symptoms but between this person and their environment. Thus, “mental illness” is a social and not only a chemical disease. Fascinating stuff. Necessary stuff. As long as America’s current model of illness and treatment persist, we will be disabled – disabled from considering desperately needed structural, social, political, economic and community changes, disabled from truly connecting with others and ourselves and disabled from fully accessing our own humanity.
So, that was a lot. If you only click on one link in this whole post, let it be this one: the video quality of it’s not great but this presentation that researcher and writer Robert Whitaker gives to the Pennsylvania Friends is a great place to start thinking about how to heal the mental health system so that it supports and spreads mental health.