Guest post by Andrew James Archer, author of Pleading Insanity
I think one of the main reasons American’s mental health is so impoverished has to do with the dominant perception on “mental illness” being similar to physical diseases or infections. We are culturally dependent on psychotropic medications partially due to viewing “mental illness” as an external concept or a tangible and separate entity from the individual.
Consider aspects of the website for the National Alliance on Mental Illness (NAMI). It lists a series of disorders (e.g., ADHD, Autism, Bipolar Disorder, Borderline Personality Disorder, Depression, OCD, PTSD, Schizophrenia, etc.) under the column heading “Mental Illness.”
The website defines “mental illness” as “a condition that impacts a person’s thinking, feeling or mood and may affect his or her ability to relate to others and function on a daily basis.”
This implies that the “condition” is separate from the individual and has an impact on how they are able to function.
As a psychotherapist, I frequently hear people describe their experience using diagnostic language. It is common for someone to say “my ADHD” or “my depression” or “my bipolar” that is the culprit for how they feel and behave.
The NAMI site goes on to say that mental health conditions “go beyond these emotional reactions and become something longer lasting.” The description did not offer a specific differentiation from emotional responses and disorders, but it notes that these are “medical conditions that cause changes in how we think and feel and in our mood.”
Think about this for a second.
Imagine you have a disease. You need to go to an established practitioner in order to confirm the diagnosis. The diagnosis is based on a set of criteria (i.e., symptoms). Once this is verified, an intervention is presented.
The intervention is meant to address the symptoms of the disease for eventual elimination.
Now, imagine this process as a road. Within the road you have these three paths: the disease, the illness and the intervention.
At some point, the intervention is supposed to relieve the symptoms and if you do not have symptoms then the disease is gone. There is no longer a need for the intervention. However, with mental health concerns there is no clear disease.
There are no objective medical tests such as blood draws or brain scans that are able to identify “mental illness.” Instead, practitioners are forced to discern and interpret subjective experience while formulating a diagnosis. In fact, one cannot even identify the mind scientifically. Oxidation levels in various areas of the brain are detectable, which tend to represent thoughts, but the actual mechanism for how neuronal firings create the mind is a mystery.
What we are able to do is correlate brain activity with perceived mental states (usually constructed in research laboratories).
Without a tangible test, it is not clear the trajectory of the course. And, if you take away the intervention and symptoms resurface, it could be interpreted as: (a) the disease was never cured (b) that the intervention was working or (c) the intervention created a disturbance. This uncertainty around cause and effect is the chink in Psychiatry’s armor.
For example, say Joe is depressed and is prescribed an antidepressant medication. Joe’s ostensible disease is “depression” and the symptoms are what make up the criteria for a major depressive episode (e.g., pervasive sadness, insomnia, anhedonia, etc.). The intervention is the antidepressant medication. If the person has less symptoms of depression while taking the medication then the intervention tends to confirm the disease (i.e., the person was depressed). Now that the person is no longer experiencing symptoms of depression, one avenue to travel could be titrating off the medication.
However, if depression symptoms return after the titration, Joe is left with a tricky interpretation.
Are the symptoms returning because the person “needs” the medication? Is this a return of the “disease”? In other words, does the return of symptoms seemingly confirm that the person needed the medication?
Another scenario is that the intervention (e.g., the antidepressant) creates a dependency over time. The idea that the brain starts to compensate for alterations in serotonergic pathways (i.e., from SSRI medication). The imbalances due to these changes leads to a more chronic course of depression that builds immunity to medicinal cures.
This would be considered an iatrogenic process, whereby the treatment or intervention relates to the actual illness it is trying to eradicate. The road to a cure begins to look like a circular track or habitual pattern.
And if that is true, then we might all soon be sick.
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Books by Andrew James Archer
Pleading Insanity ~ View on Bookshelves | View on Amazon