In order to get somewhere different, we need to know where we want to go. Is our goal to diminish symptoms of a “disorder?” Or is it to increase emotional and cognitive resilience and flexibility? Although these may not seem like mutually exclusive goals, they might betray very different ways of thinking about what mental wellness means. Moving from a “sickness” to a wellness model of mental health is not simply a verbal sleight-of-hand, or a marketing tool designed to hit the catch phrases du jour.
No, truly working to promote brain wellness is fundamentally different from “treating” a problem. But much of this difference is often left unsaid, for various reasons. Let’s unpack these different perspectives a bit.
If you go to most mainstream practitioners with a complaint about an emotional or cognitive challenge, there is a predictable chain of events you can expect. After basic introductions, you’ll be asked a series of questions designed to determine whether or not you have a “mental illness” (or cognitive “disability”). These questions may come in questionnaire format or be asked directly by a living, breathing human being. Either way they are designed to see if your experience can be labeled using the “Diagnostic and Statistical Manual of Mental Disorders,” version 5 (DSM V). If the answer is “yes,” and it almost always is, the practitioner can get reimbursed by the insurance industry to “treat” you.
The “treatment” will usually go something like this: you are prescribed one or multiple drugs which are given to reduce the “symptoms” you have reported. These drugs are called “anti-psychotics” or “anti-depressants” and you are often told they will help because they address “chemical imbalances” which are the root cause of your distress. And if you are getting the best that the standard approach has to offer, you will also be directed towards a psychotherapist (or “talk therapist”), for at least ten or so sessions.
Is there something wrong with this approach? From my perspective, virtually everything.
The DSM V has been criticized by many in the mental health field, and for many different reasons. But perhaps the most damning criticism comes from the former head of the National Institute of Mental Health (the top government scientist in charge of researching “mental illness”), Dr. Thomas Insel, who says the DSM V’s main weakness is its “lack of validity.” Now, that’s a pretty serious weakness. According to Insel, the essential problem is this: “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”
When you think about it, it is kind of strange. For virtually any serious medical complaint, some kind of objective measure, or imaging, is going to be used to determine the exact nature of the issue. But in the field of mental health, which deals with the most complex part of the human body, the diagnostic tool most typically used essentially amounts to “how ‘ya doin?”
But it gets worse.
It turns out that the model of mental illness as a result of chemical imbalances in the brain may be simply wishful thinking, and lacking in rigorous scientific support. Don’t take my word for it. This is what Dr. Ronald Pies, Editor-in-Chief Emeritus of “Psychiatric Times,” has to say about this issue: “In truth, the chemical imbalance notion was always a kind of urban legend, never a theory seriously propounded by well-informed psychiatrists.”
Say what? It makes me wonder in what world Dr. Pies has been practicing psychiatry. Virtually every person I’ve seen who has been through the mental health system has been told some version of this chemical imbalance story. If this turns out to be a falsehood, then the conceptual framework on which modern, medical mental health treatment has been promoted has been erroneous. Has it really been based on an “urban legend?”
This issue is obviously huge, and one we will unpack further in future blog posts. But for now, it should be telling enough that the most mainstream of mainstream psychiatrists now says that the chemical imbalance theory of mental illness is nothing more than a myth perpetrated by the drug industry and uninformed psychiatrists.
So where does this disquieting information leave us? Well, we’re certainly in need of a very different approach.
When faced with this information, many in our field tend to throw the brain out with the bathwater. That is, they claim that the medical model of mental illness is clearly broken and is focused in the wrong direction to begin with. They say more social interventions are needed, not approaches based on trying to understand the brain. As former Clinical Director of CooperRiis Healing Community, a leader in “relationship-oriented” care for emotional and psychological distress, I am very sympathetic with this impulse. Clearly the idea that true happiness is to be found in a pill is reductionist and dehumanizing. However, in my opinion, we truly need to work with the whole person, and if we ignore the physical brain, we are ignoring a pretty important feature of what it means to be human.
But how do we do this better than we’ve been doing it as a field? Stay tuned….