Removing the Disease from Mental Health
When hitting, catching or throwing a ball in a sport there is an easy link made between action and effect. We can declare rather simply “I did that” and depending on the skill level, feel a greater or lesser degree of personal pride. This mentality bleeds over into much of what we do as human beings, our ego as the “I” of our personal narrative or story, constructing each and every situation from that mind’s eye view. Events happen “to” us, we “do” things, the happenstance of positive or negative confluences are always concerned with helping or hindering us. While this self-centered focus is most pronounced in the positive thinking movement, such did not simply arise out of nowhere. The social power of positive thinking is due to its inherent resonance with how we usually go about our lives.
This billiard-ball mental construct of causation becomes linked with mental health through the common disease model of psychiatry. Illnesses happen “to” us, as if they are invading organisms, and while there is certainly truth to this when it comes to germs and viruses, the distinction loses its validity when it comes to mental health. Just where does the mind start and end? The common belief is there is an “I” and then an “other” that encompasses everyone and everything else that makes up experience. Attempt for a moment to think only of an “I” in complete isolation from anything and anyone else and the futility of doing so should, if being honest, lead to the stark conclusion that such easy boundaries are anything but.
The difficulty with viewing mental health through a disease or illness model is compounded and promoted by the common understanding of drugs. As Peter Kinderman says:
…while it is clear that medication (like many other substances, including drugs and alcohol) has an effect on our neurotransmitters, and therefore on our emotions and behavior, this is a long way from supporting the idea that distressing experiences are caused by imbalances in those neurotransmitters.
Were such a direct relationship to exist between drugs and behavioral change, there’d be no variation. We’d never have to worry about negative side-effects because we’d know exactly what y-behavior will result from x-drug. Thankfully most psychiatrists, when more openly discussing this, are well aware that such a simple explanation is patently false, but the lack of focus for dispelling this myth only contributes to the already prevalent American mentality concerning “better living through pharmacology.”
The interconnectivity of lived reality positions us, our individual “I’s” as one variable among many in the building of experience. It is only hubris and the continued disconnection from our social relationships that pushes us to believe we can pick and choose what and how events and people effect us.
We learn as a result of the events that happen to us, and there is increasing evidence that even severe mental health problems are not merely the result simply of faulty genes or brain chemicals. They are also a result of experience — a natural and normal response to the terrible things that can happen to us and that shape our view of the world.
I remember in Boy Scouts, in the Pine-Wood Derby, where using a kit we’d create with the assumed minimal help of our parent(s) a small car that would then be placed on a ramp and timed in races. Placed ever so carefully at the top of the ramp, I had a healthy understanding that the result was not entirely up to me, but the sense of failure upon not winning remained all mine. The same can be said for mental health. We can place our lives through our perspective at the top of the ramp of life, but this by no means is the only determinant of whether we will succeed in our projected goals. The structure of the car (our genes and familial history), the friction of the ramp itself (our continued relational dynamics) and the proximity of other cars (natural and social effects outside our immediate control) all play major roles in the race. To look at mental health through the lens of a disease model is to assume the only thing that exists is our perspective and whether something “out there” forces itself upon us.
We need to place people and human psychology central in our thinking. Psychological science offers robust scientific models of mental health and well-being, which integrate biological findings with the substantial evidence of the social determinants of health and well-being, mediated by psychological processes.
Much is being said recently about whether there can be a scientific means of determining well-being or human flourishing. Michael Shermer and Sam Harris, among others, have sought to explain how morality and therefore positive human community can be developed through the skeptical and steady inquiry of scientific study. Whatever the particulars of such endeavors may create, the central view cannot be ignored: we cannot come to a legitimate, helpful understanding of mental health and well-being without beginning with the study and appreciation of the human organism. Doing so means seeing humanity as an integrated organism within the holism of reality, not as something set apart.
We must offer services that help people to help themselves and each other rather than disempowering them — services that facilitate “personal agency” in psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions.
A medical understanding of humanity is only one perspective, but it fails if it seeks to remove all others. This does not mean any and all perspectives are equal in validity, only that a full and proper articulation of human flourishing will be found when looked through a holistic lens. This means an integral model, multi-disciplinary studies and an appreciation that the psychology cannot be removed from the social anymore than either can be removed from the material biology of our being.
© David Teachout