Reflections on attention, self-knowledge, and the mental health profession.
In this episode of the Integral Health Resources Podcast, I review an excellent article by Allen Frances in which he excoriates us all for turning a blind eye to those in our society who need mental health services the most.
Here is the article that was referenced in this discussion:
What Drives Our Dumb and Disorganized Mental Health Policies? by Allen Frances
In this episode of the Integral Health Resources Podcast, I discuss an important paper by Noel Hunter and William Schultz called A Response to the Hyper-focus on Brain-based Research and “Disease”.
Here are some other media resources that may be helpful/relevant to this discussion:
Here are the quotes from the white paper that I cited throughout this podcast:
The brain-based initiatives for clinical research rely on a disease model that is based on erroneous logic, a faulty reductionistic view of human nature, and a contradiction of the most robust research findings within the mental health field. The brain research conducted thus far actually appears to indicate that most of the conditions referred to as “mental illnesses” are likely otherwise healthy adaptive processes in response to extreme environmental experiences. So while it appears that such adaptive processes often do correlate with changes within the brain, and that they may lead to certain long-term problems for the individual, these changes do not necessarily signify biological disease. Furthermore, brain research has ironically reinforced the benefits of certain psychosocial interventions, such as yoga, meditation, and psychotherapy, thereby negating the assumption that the resolution of such distressing conditions requires psychopharmological or other related biological interventions.
But, is it really necessary to have “evidence” from brain scans to know that mediation, exercise, and eating healthily have beneficial effects on one’s wellbeing? The only thing this research really seems to show is how much the brain is constantly adapting to its environment. In fact, one could even interpret the findings of many of the brain differences in traumatized and distressed individuals as signs of adaptive functioning— the complete opposite of disease!
Three prominent negative consequences of focusing on biological, brain-based etiologies of “mental illness” are that it results in skewed research funding, biased treatment preferences, and clinically harmful impacts.
Many of the biological anomalies that one finds with chronic sufferers of “mental illness” are directly caused by the very biological interventions thought necessary to decrease distress.
So not only are brain-based etiologies of psychological distress unsupported by the evidence and related to the excessive use of dangerous medications, they also have powerful psychological impacts that can adversely influence treatment.
The resources available for mental health research and care are limited, and that every dollar and person-hour spent pursuing brain-based solutions to psychological distress comes at a direct cost to those resources available for psychosocial research and support.
When we consider the vast disparity between the predominant research and interventions within the mental health field on one hand, and the actual needs of distressed human beings on the other hand, we recognize that our mental health field is in dire need of a radical paradigm shift—from trying to make sense of psychological distress from a biologically reductionistic framework to one that is more humanistic and needs-based. This essentially involves shifting the general stance within the mental health field from “diagnosis and treatment” to one of “assessing needs and offering support.” This would mean focusing our resources on providing psychosocial support for individuals, families, and communities and working towards a social system in which meaningful and rewarding activity, education, and work is accessible to everyone.
Even in those cases in which the specific needs or other causal factors are unable to be identified, the evidence suggests that when a person’s basic needs are addressed, such conditions of psychological distress still naturally recede over time. And in those rare cases where such factors are unable to be identified and addressed, and in which the condition does not naturally recede over time, some psychoactive drug support may be beneficial, as long as it is used in minimal dosage for minimal duration and only with the individual’s fully informed consent.
I just finished reading HEAD CASE: Can psychiatry be a science?, an excellent article by Louis Menand in the The New Yorker. The article makes clear what I’ve already come to realize over the last twenty years studying and working in the field of mental health — namely, that the field is a freakin’ mess. My field, the one referred to on those degrees I spent so much time and money on, is almost hopelessly mired in conflict-of-interest corruption, bad philosophy, and wrong-headed (although often well-intentioned) approaches to alleviating human suffering. The situation is almost hopeless I say, but despite the sorry state of the field, I continue to consider myself a psychologist at heart. And I’m getting tired of wallowing in the muck and mire of it all, tired of hearing myself whine about how stupid everyone must be not see things the way I see them.
So I’m making a concerted effort to be more constructive in my rantings and ravings instead of merely tearing into whatever pushes my buttons. I don’t want throw out the babies with the bath water, so to speak, because there’s usually some truth to be found in most perspectives. That’s the whole point of an integral approach to health, to weave together what’s useful so that problems can be approached more effectively.
The challenge though, is to figure out exactly which perspectives are appropriate or useful in what specific contexts, to articulate how various partial truths fit together into a comprehensive plan of action. I’m hoping to rise to that challenge in the coming weeks by diving deeper into this integral inquiry through engaging others’ perspectives, reflecting on my experiences, and writing about whatever struggles and insights come along the way.
I’ll sign off for today with what I think is the most interesting part of Menand’s piece, where he ventures into this integral territory with some provocative reflections:
Mental disorders sit at the intersection of three distinct fields. They are biological conditions, since they correspond to changes in the body. They are also psychological conditions, since they are experienced cognitively and emotionally—they are part of our conscious life. And they have moral significance, since they involve us in matters such as personal agency and responsibility, social norms and values, and character, and these all vary as cultures vary.
Many people today are infatuated with the biological determinants of things. They find compelling the idea that moods, tastes, preferences, and behaviors can be explained by genes, or by natural selection, or by brain amines (even though these explanations are almost always circular: if we do x, it must be because we have been selected to do x). People like to be able to say, I’m just an organism, and my depression is just a chemical thing, so, of the three ways of considering my condition, I choose the biological. People do say this. The question to ask them is, Who is the “I” that is making this choice? Is that your biology talking, too?