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Wednesday, February 18, 2015

Are “Mental Illnesses” Really Potentially Helpful Tools?

psychiatry2If your behavior, thoughts, or feelings become a concern, for a fee, many psychiatrists, psychologists, and social workers are eager to translate your experiences into a language of symptoms, diagnoses, psychopathology, and mental illness. In earlier posts I provided negative criticism about this type of name-calling from several different angles ((see here, here, here, here and here).  Today, we focus in on an additional problem with the pathologizing approach.

Psychiatric Name-Calling Simplistically Devalues What William James Referred to as “Exceptional Experiences”

toolsTools can be used for good or evil.  A hammer can be used to drive in nails in the construction of a life-preserving shelter or to bludgeon an innocent person to death. A car can be used to rush a child to an emergency room so that life-preserving treatment can be administered, or it can be used to tragically end a prom night. Are experiences that are oftentimes referred to as pathological really tools, and is it up to each one of us to use them either for good or evil?
William James
William James
The first time I came across this question occurred while reading about William James’s 1896 series of lectures on “Exceptional Mental States.”  Harvard psychologist, Eugene Taylor, had reconstructed these lectures from James’s original handwritten lecture notes, newspaper reports, letters, and a variety of other sources.
At the very beginning of the lectures, James argues that experiences that are commonly viewed as unhealthy or morbid are really “an essential part of every character,” and give life “a truer sense of values.” To support his contention, James first provides three examples of famous individuals who suffered from melancholy, a term that corresponds closely with what modern pathologizers call “major depressive disorder.” St. Paul, the religious figure of the New Testament, Cesare Lombrosa, a late 19th-century Italian criminologist, and Immanual Kant, the 18th-century German philosopher, became, according to their histories, better as a result of their troubling experiences.
psychiatry4Not only is melancholy far more normal and potentially beneficial than the pathologizers would like us to believe, so too, James argues, are delusions and hallucinations. James tells us that the belief in the possession by demons, which is often viewed as a delusion by pathologizers, is remarkably common. “[It] is the one most articulately expressed doctrine of both Testaments, and . . . reined for seventeen hundred years, hardly challenged in churches.”
James then goes on to tell his audience about Buddhist sects in Japan that have priests who believe they can put themselves into a trance so that a god can speak through them. These people seek to cultivate these experiences, apparently believing that they provide some benefits to their sect.
Hullucinations3Although hallucinations can be construed as a symptom of mental illness to some, James presents the case of Socrates who “once stood motionless for many hours in the cold and spoke of having a guiding demon.” Attempting to counter the association between pathologies and hallucinations, James states,
Even if this demon [of Socrates] were really meant hallucinations of hearing, we know now that one in eight or ten of the population has had such an experience and that for insanity we must resort to other tests than these.
psychiatry1Like melancholy, delusions, and hallucinations, the “symptoms” of obsessions and manias are treated in James’s lectures as experiences that are normal and potentially beneficial. Thus, James states that there is no end to the possible types of obsessions that we see all around us. And what about “the anti-slavery mania?” obsessionsIs this to be viewed as pathological? What benefit can such experiences have? James tells his audience about Henry Borg, founder of the American Society for the Prevention of Cruelty to Animals; Charles Henry Parkhurst, a Presbyterian clergyman and reformer who launched a furious attack on organized crime in state government that led to an official investigation; Dorothea Dix, a mid-19th-century humanitarian who visited the insane asylums and successfully advocated for legislation to improve the care for those now labeled mentally ill; General Booth, founder of the Salvation Army; Frances Willard, a suffragette; and others. “These persons,” said James, “are not insane, not maniacs, not melancholics, not deluded.”
individualsLater, he states, “Individuals are types of themselves and enslavement to conventional names and their associations is only too apt to blind the student to the facts before him.”
As Taylor (1984) closes his reconstruction of the lecture series, he quotes James as follows:
There is a strong tendency among these pathological writers I have cited… to represent the line of mental health as a very narrow crack, which one must tread with bated breath, between foul friends on the one side and gulfs of despair on the other. Now health is a term of subjective appreciation, not of objective description….There is no purely objective stanHullucinations1dard of sound health. Any peculiarity that is of use to a man is a point of soundness in him, and what makes a man sound for one function may make him unsound for another…. The trouble is that such writers . . . use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with. . . . The only sort of being, in fact, who can remain as the typical normal man, after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity . . . Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all?

William James and the Leo Tolstoy Example

A few years after this series of lectures, James wrote one of his classic works, The Varieties of Religious Experience.  There he tells us about the great Russian writer Leo Tolstoy’s 2-year period of despair.
Leo Tolstoy
Leo Tolstoy
In his painfully personal book, My Confession, Tolstoy relates how, at about the age of 50, his life had become “flat, more than flat: dead.”
I felt that something had broken within me on which my life had always rested, that I had nothing left to hold on to, and that morally my life had stopped. An invincible force impelled me to get rid of my existence, in one way or another…. Behold me then … hiding the rope in order not to hang myself from the rafters of the room where every night I went to sleep alone; behold me no longer going shooting, lest I should yield to the too easy temptation of putting an end to myself with my gun.
All of this took place at a time when Tolstoy’s outer circumstances seemed excellent.
I had a good wife who loved me and whom I loved; good children and a largeproperty which was increasing with no pains taken on my part. I was morerespected by my kinsfolk and acquaintances than I had ever been; I was loaded with praise by strangers; and without exaggeration I could believe my name already famous.
Tolstoy quote2Tolstoy goes on to explain how his melancholy stimulated a gnawing questioning that eventually led to one insight after another. His trouble had not been with life in general, not with the common life of common men, but with the life of the upper, intellectual, artistic classes, the life that he had personally always led, the cerebral life, the life of conventionality, artificiality, and personal ambition. He had lived wrongly and had to change. Then, one day in early spring, while he was alone in the forest listening to its mysterious noises, he was filled with a sense of deeper meaning. “After that,” he wrote, “things cleared up within me and about me better than ever, and the light has never wholly died away.”  According to Tolstoy, his suicidal feelings disappeared, and he went on to live a productive life until he passed away at the age of 82 of natural causes.
Tolstoy4Now, as we look over the information provided, much of it in Tolstoy’s own words, we see that no pathology words are used, and yet we have enough detail to get a pretty clear picture of Tolstoy’s experience.
When James uses a brief phrase to refer to Tolstoy’s experience, he chooses “an attack of melancholy,” rather than “mental illness.” Melancholy serves us well. It is an experience that is familiar to us all. To me, it evokes the beautiful words from the Joni Mitchell song “Hejira”:
Joni Mitchell
Joni Mitchell
There’s comfort in melancholy where there’s no need to explain. It’s just as natural as the weather in this moody sky today.
In our Tolstoy example, his melancholy appeared at first to come on him as if out of the blue. Later, Tolstoy came to understand it as having been due to living wrongly. Only by questioning deeply and repeatedly the meaning of his despair did he come to this understanding.  Thus, Tolstoy’s experience, it seems to me, is far more aptly construed as a tool for personal growth than a mental illness.

The Review of the Evidence

Robert Whitaker
Robert Whitaker
It may seem a fanciful theory that the experiences now referred to as mental illnesses can be potentially helpful.  However, in 2010, Robert Whitaker published a book titled Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness. To write the book, he pored through the scientific literature for the past 50 years and found a dramatic increase in the number of people who are pathologized, which led to an astonishing increase in psychiatric drug consumption.  And more people then ever before became disabled for longer and longer periods of time.
Whitaker's book coverHere is just one of many such studies that Whitaker describes.
In the 1980s, Martin Harrow, a psychologist at the University of Illinois, began a long-term study of 64 newly diagnosed schizophrenia patients. Every few years, he assessed how they were doing. Were they symptomatic? In recovery? Employed? Were they taking antipsychotic medications? The collective fate of the off-med and medicated patients began to diverge after two years, and by the end of 4.5 years, it was the off-medication group that was doing much better. Nearly 40% of the off-med group were “in recovery” and more than 60% were working, whereas only 6% of the medicated patients were “in recovery” and few were working. This divergence in outcomes remained throughout the next ten years, such that at the 15-year follow-up, 40% of those off drugs were in recovery, versus 5% of the medicated group.
Whitaker also found studies that compared cultures, like our own, that employed the pathologizing model with cultures that framed exceptional experiences as potentially beneficial.  Countries infected with the pathologizing approach had outcomes significantly poorer.
These findings lead me to conclude that it is time to have a reasonable discussion about embracing other models of care.
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence.