Exporting Mental Disorders: Ethan Watters
First Aired: 01-02-2011 -- 22 comments | Add comment
How did pharmaceutical giant Glaxo Smith Kline create “depression” in Japan — and a billion dollar market for its anti-depressant drug Paxil? Why do people diagnosed with schizophrenia recover more in Tanzania than they do in the US? Can western-style psychotherapy help tsunami survivors in Sri Lanka?
Ethan Watters, author of Crazy Like Us: The Globalization of the American Psyche, discusses how mental disorders are cultural products, defined in the US and then exported around the world.
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Hi Marian, I like your comments, but I do think that some of Anonymous’ meaning and intention has been missed because of the way in which specific word choices can lead to unintended interpretation and because of the way the internet tends to make it hard for people to communicate.
Something you wrote did catch my eye, where you said “instead of being seen as a reaction to the individual’s surroundings and life experience.”
I think the nature of pain and suffering is more mysterious than to see it as a reaction. I am wondering if you have thoughts about this, because seeing it as a reaction might cast the sufferer in a passive victim status that does not convey agency, choice, or responsibility? I don’t think it’s either/or, but even physical pain, as people who meditate can often attest, has a deep mental influence that can be shaped by choice and practice. I wonder your thoughts about this.
I wish there was some way to talk about experiences we do potentially have control over, we’re not just reacting to or victims of, without reversing responsibility and making it complete control and choice. There is a big discussion going on in addiction research right now about this very issue. It goes to the heart of what it means to be human, what is the self, and what is free will.
When it comes to abuse our legal system for example makes it very hard to create a blur around issues of abuse and violence, because one party has to be guilty for punishment to take place. I recently had a client who was violent towards their partner. I made it clear that the violence was 100% their responsibility and had to stop. At the same time I helped the client see things that could change in the relationship to make violence less likely, including changes in what the victim was doing and how they were communicating. The violence and the suffering it causes are not just simply a reaction in my mind but part of a complicated relationship. I’m interested if you have thought about this, because victim status can itself be a trap, though we tend to talk in the media and widely in the society in these terms, that people are victims of circumstance and deserve sympathy and support for this reason.
Interesting questions! Before I answer with a whole thesis, here a few thoughts.
I wouldn’t say pain or suffering are a reaction, other than on an emotional level, but that they may cause a reaction.
I think that what is called “mental illness” is a state of actually being a victim — of one’s past, and one’s, unconscious, reactions to it. The labelled people I know, were never really given the opportunity to take responsibility for themselves. They were constantly victimized. When then, at some point, the self protests against this oppression, i.e. someone experiences “symptoms”, they’ll perceive their self as the oppressor, i.e. the “symptoms” are just happening to them, without them being able to do anything about it. The self becomes the “illness” (so much for “you are not your diagnosis”… ) that no one can be held responsible for. Once again people are victimized, this time on a whole new level. “Meta-victimization”. And I see many people actually asking for it. In a way, I did ask for it myself, in turning to a professional, and, although I’ve also always felt kind of trapped (= pain, suffering), and repeatedly had made half-hearted, and actually deemed to fail attempts to liberate myself (= reaction), freedom, and the responsibility I knew inevitably comes along with it, also scared me to death. All I knew was how to be the victim. Take away the oppression, and I wouldn’t have known how to be. The death of the victim, i.e. of me. Or so I thought, and more or less expected the professional to take responsibility for me. The professional did the opposite, quite like you did when you were asking your client to take responsibility for their violent behavior. — And someone once told me that, after trying again and again unsuccessfully to get in control of their violent behavior, they finally accepted their shrink’s explanation that they couldn’t get in control of it, since it was caused by a chemical imbalance in their brain, which they had no control over in terms of free will, and all they could do was to take drugs that would suppress the violence. This person also said, it was a huge relief to accept this explanation, Of course. It confirmed them in what they saw as their only way of being able to be: being the victim. — That wasn’t necessarily the death of the victim, but certainly a major blow to her, while I had become more alive than ever in taking responsibility for myself/my self/-s reactions. And it wasn’t the end of “mental illness”, but it was the beginning of becoming aware and more in control of myself/my self’s reactions, of being able to choose whether to act on a given emotion, or not.
“Mental illness” is not being able to choose, because you’re not given a choice. It’s a vicious circle, because people believe, being “mentally ill”, you can’t make a responsible choice on your own, so that they would have to make it for you. And so you get trapped in “mental illness” for life. While, basically, all it would take to free yourself from “mental illness”, from being the victim, would be to have you become consciously aware of your free will, and it’s potential to control yourself. All it would take is to have you become consciously aware of the fact that you’re not “mentally ill”, but can take responsibility for yourself. The way to do this is to give you responsibility for yourself, not to take it from you, respectively deny you your own choices, and to have you become consciously aware of your-self, your reactions, to have you understand, or know, them in context with your life story, to own them. Because no one can take responsibility for what they don’t know what it is, for what just happens to them, like the above mentioned person thought, the violent behavior was just happening to them, that behaving violently wasn’t something they themselves did. That was why they couldn’t get in control of it.
In a broader sense, “mental illness” also is being human, lies at the far end of the being-human continuum, since a certain extent of being unconscious, of being the victim of our-selves, is what distinguishes us from being God, i.e. pure consciousness, pure free will.
And, Anonymous, I am aware that I do have strong opinions, and I’m certainly not the type that voices them in an “excuse me for existing” kind of style. “Vitriol”, however, would look different.
“Without pain/suffering there can be no change and growth, and life is change/growth.” Is your quote, verbatim, which can reasonably be interpreted as pain/suffering = life. I found that an extreme interpretation which is why I asked you if that was indeed what you meant. Your response is, “yes, I believe that existential suffering is intrinsic to the human condition.”
I had been having trouble understanding what precisely our point of disagreement was until you defined your view of the type of pain we are discussing as “existential”. Though how my beliefs deny pain or silence anyone in pain is still a mystery. No where have I scapegoated “those who get labelled with this construct (mental illness), and shut(ting) them up with consciousness-reducing drugs.”
I’m not even sure what you are trying to say with the rest of the paragraph. “Under these circumstances it is certainly convenient for everybody too frightened to face their own pain, if the individual who keeps on confronting them with this pain, and won’t let him-/herself be silenced (= is “treatment-resistant”), chooses to state his/her pain of having been made the victim of everybody else’s denied one in the ultimate way, and commit suicide, which then, also very conveniently, can be explained away as a result of “mental illness”, instead of having to be listened to and understood. Acceptable it is not.” Is this an expression of your dislike of the western medical views on psychiatry and psychology? If western medicine has failed you, I can understand your vitriol, but not why it is directed at me. I perceive that you are in pain, but not how my words can have caused all, if any of it. I’m just working through some ideas. Discussions like this help in clarifying thoughts on a subject. This one of the purposes of a blogs.
There is a divide when it comes to defining what existential pain is among people providing pastoral or spiritual care and those providing medical relief from pain. For the non-medical (pastoral, spiritual) professional, pain is often used as a metaphor.
Existential pain refers to guilt, isolation, religious questions, daily discomforts (too hot or cold, disliking rain or winter, mild indigestion), why am I not where I want to be in my career, what is the meaning of life?
In this sense, pain would be a metaphor. This is what pastoral and spiritual advisers and possibly life coaches mean by existential pain or suffering. This kind of pain is quite serious to the person experiencing it.
While all pain can technically be considered as existential, most people consider things outside the scope of the above paragraph as pain that may warrant treatment. For example, a person with a compound fracture can be said to have pain as a result of existing with that injury, but a doctor will administer anesthesia during the any necessary surgery to repair the damage and pain medication for at least part of the recuperative process. I hope we can at least agree on that.
I think where we disagree may be that I consider pain as a result of, for lack of a word we can agree on, depression can be severe enough to require treatment to alleviate the pain. That treatment can include psychotherapy, treatment of underlying medical problems (hormone imbalances, certain infections, and other conditions), diet changes, sleep pattern changes, lifestyle changes (new job, retirement from work, moving to a different climate) physical or mental exercises (video games can help build up one’s ability to focus and problem solve), nutritional supplements, and medications.
If a person has exhausted all available treatments to alleviate severe, unbearable pain, then yes suicide is an acceptable option. This statement in no way says or implies that all forms of suicide, including sepppuku are the result of mental illness.
I will grant you that for our purposes the brain and mind can mostly be considered equivalent. That being said, brain disorders do exist. While psychiatry is a young science, it is technologically advanced enough so that there are tests that show some brains act differently than the average and that some of these differences are pathological in nature. The choice of the term is purely semantic. It is not a judgment on the person’s character or worthiness. A large part of society, unfortunately are uneducated enough to make value judgments about people with these conditions. This could be said to be part of the existential suffering of a mental illness. The condition itself however is outside of the definition of existential pain.
Anonymous, yes, neurological disorders do exist. Alzheimer’s is an example. The rest of what you state in the last paragraph of your comment is wishful thinking. No brain pathology, nor any genetic basis has so far been established for what is called “mental illness”, and that psychiatry keeps on clutching at straws, and desperately tries to convince everybody that there is no doubt about the genetic, biological nature of existential suffering, and that the research findings to, once and for all, prove the biomodel true are right around corner — which they, btw, have been for several decades by now, if we are to trust psychiatry… — doesn’t turn this model into anything else than what it is: a so far unproven hypothesis.
In philosophy, existential suffering refers to a lot more than what you choose to list. Basically, all pain, or suffering, that is not of physical nature, is existential. “Mental illness” is an artificial construct created to turn meaningful, understandable existential suffering into meaningless, not understandable “insanity” whenever a culture, a society, or an individual (cf. phrases like “This is crazy!” or “You must be crazy!”) can’t or won’t understand the meaning of a reaction (to it/him/her). — Actually, you’re doing it, right here, right now, in this comment thread, when you assume I would be in a pain that would need “treatment”. What makes you jump to that conclusion? — The divide between existential suffering and “mental illness” you refer to is an artificial, culturally determined one. It is not a natural one. That “most people” (in our culture) subscribe to the validity of this divide doesn’t make it more universally or scientifically valid.
The scapegoating takes place the minute someone’s existential suffering is ascribed to an individual, either biological, genetic (biological psychiatry), or psychological, developmental (Freudian psychoanalysis), flaw, instead of being seen as a reaction to the individual’s surroundings and life experience. That is, the minute the individual is isolated from his/her social and historical context. Do human beings exist in a social and historical vacuum? Because this is the only place where “mental illness” does exist.
What I am saying in the rest of the paragraph is that viewing suicide as an acceptable solution for someone whose suffering was isolated, ascribed to their own, diseased biology, and then tried to be silenced, borders to the ideology of euthanasia in Nazi-Germany. The only difference is that accept of the suicide of someone, whose discomfort in our culture, and protest against its violence isn’t recognized, but denied and tried to be silenced, is the passive version of actively murdering these people.
“…a person with a compound fracture can be said to have pain as a result of existing with that injury, but a doctor will administer anesthesia during the any necessary surgery to repair the damage and pain medication for at least part of the recuperative process. I hope we can at least agree on that.”
Of course, we can agree on that. Although it also should be mentioned that physical pain due to physical injury or real illness, just as existential pain/suffering, is neither meaningless, nor without purpose. And this is exactly where your analogy doesn’t hold, because in telling people their pain is caused by “mental illness” what we’re telling them is that their pain isn’t real, that it is imagined, the figment of a chemically imbalanced, or otherwise malfunctioning, brain, and not a very appropriate reaction to very real “injuries”, respectively the sign of a healing process from such injuries to take place. Fact is that the vast majority of labelled people provenly have suffered “injury” in their past (cf. Hammersley and Read’s meta-study; one of numerous research results showing a strong correlation between trauma and “mental illness”). What entitles anyone to, by diminishing or even denying the reality of the pain it has caused, diminish or even deny the reality of this injury, and the harm done by it?
I am glad you brother survived his suicide attempt. Suicide is not a logical choice for a child. Human brains don’t mature until about the mid twenties. This is why children must be carefully nurtured through painful times.
Child and teenage suicide is very frustrating to me. They can be overwhelmed by things an adult knows how to handle with ease. Suicide as the result of bullying makes me particularly angry. The adults present (teachers and principals) need better psychological training and just plain human decency and compassion.
I was referring to suicide as a choice for an adult who has exhausted all available treatment options. There are a surprising number of people whose depression is treatment resistant. These people can find life unbearable. I wouldn’t second guess a person’s choice for suicide under these conditions.
Marian,if pain/suffering = change/growth and change/growth = life, are you concluding that pain/suffering = life? If so your logic is massively flawed. Pain has been very useful to our development and evolution. Pain signals teach us to avoid things that can harm us in our changing environment because humans experience pain as bad. Pain was probably involved as our immune systems developed and individuals with poorer systems died off. The successive generations would experience less pain because of improved immune responses. The developement of higher intelligence levels likely involved similar pain. Pain avoidance has developmental advantages. Another influence of equal power and value to humans is pleasure. Pleasure seeking drives evolution as much as pain avoidance – consider the pleasures of sexual procreation.
As individuals, pain and pleasure also influence our change and growth. It’s not all no pain, no gain. There are many change and growth situations that don’t involve pain and are actually pleasurable. This isn’t cultural, all humans develop through a combination of pain avoidance and pleasure seeking.
As for your being offended, you have to take responsibility for that yourself. I did not say that all who commit suicide are mentally ill. I didn’t even imply this. In my first post I stated that political suicides were a common means of expression in Japan. In my second post I posited the possibility that the suicides were not caused by mental illness, but pain. Pain can occur outside of mental illness.
As for your definition of mental illness being that a person “must have a mind that doesn’t work as it should, and be unable of decision-making”, I’m afraid that’s inaccurate too. That is not my definition and I argued that the DSM is not useful in discussing what we call depression in cultural terms.
When defining mental illness the mind has little to do with it. The modern concept of mental illness is that it is a brain disorder. The mind is a fuzzy concept that is hard to define as is consciousness and ego. That is why terms such as the brain, its structures, its chemical and electrical reactions, and observable behavior are more in use today. Psychiatry and psychology are still very new sciences and there is a lot of work to do in the field. It isn’t all about medication either, plenty of mental health professionals recommend other ways of influencing the brain. If you prefer to live in and get treatment from cultures closer to nature, go for it!
That a person can’t make decisions when mentally ill is also your definition. The majority of people with mental illnesses make good decisions in their every day lives at work, home, and as members of their communities. That is why I think society and mental health professionals should not second guess a person’s choice of suicide. Each individual should be able to decide at what point the pain is unbearable. If all available options for alleviating the pain have been exhausted, ending the pain by suicide is an acceptable option to some.
Anonymous, yes, I believe that existential suffering is intrinsic to the human condition. The equation life = pain is yours, though. To me, that’s far too simplistic. Just as it is far too simplistic IMO to write off the mind as a “fuzzy” concept, and ascribe the human experience to the brain. Anyhow, whether you see someone’s mind as “broken”, or their brain, doesn’t make a difference. In both cases the person’s pain is denied (sic). I agree that everybody should have the right to make their own decisions, also in regard to their death. What i take issue with is that you say a decision to commit suicide, because the pain of “mental illness”, of being “mentally ill”, becomes unbearable, should be respected. Those are the words of a culture that is too frightened to face it’s own pain, why it projects this pain into the artificial construct “mental illness”, scapegoating those who get labelled with this construct, and shutting them up with consciousness-reducing drugs. Under these circumstances it is certainly convenient for everybody too frightened to face their own pain, if the individual who keeps on confronting them with this pain, and won’t let him-/herself be silenced (= is “treatment-resistant”), chooses to state his/her pain of having been made the victim of everybody else’s denied one in the ultimate way, and commit suicide, which then, also very conveniently, can be explained away as a result of “mental illness”, instead of having to be listened to and understood. Acceptable it is not.
In your above comment you wrote: “In fact it would be nice if western society would respect a mentally ill person’s choice of suicide like they used to in Japan.”
What you’re saying is that the Samurai ritual of Seppuku, which is the formerly in Japan respected form of suicide, is an expression of “mental illness”.
Just want to say that I agree with you, that our world can be a place of brutal pain, that maybe it seems when we feel overwhelmed that we’d just like to leave… to be done with the world the pressures and the terrible sadness, the trouble with suicide is the foreverness of it. Can a rational person want to die, maybe so, we do know though that not everyone who contemplates, or even attempts suicide truly would have been satisfied with the outcome. One of my relatives at the age of 13 swallowed an entire bottle of pills and nearly died, was given last rites… but survived. He was experiencing a great deal of grief over many losses when he took that unexpected action. He went on to become an accomplished musician, got his PhD, served in the military… he was unhappy when he awoke, having survived, in a hospital all those years ago though. At 13 he wasn’t able to cope with life as he was experiencing it, in that moment, right then. I can’t imagine life without my older brother. I am so grateful he failed at something, he succeeded at so many other things over the decades that followed, it is amazing he thankfully did not manage to take his own life. Today, he doesn’t want to die, he needed more support than he had growing up. We never really finish growing up if suicide interrupts. And suicide isn’t one of those choices that you can reverse. I think of it often as a straw that broke the camel’s back, that on another day, in a different state of mind, something that seems wholly unbearable… just might have proven bearable, given time, and a brighter afternoon.
Anonymous, pain, or suffering, doesn’t need to be a bad thing. Without pain/suffering there can be no change and growth, and life is change/growth. Cultures closer to nature than to what we call modern western civilisation acknowledge this.
I find it offensive that you imply a person who commits suicide must be “mentally ill”, i.e. must have a mind that doesn’t work as it should, and be unable of decision-making.
Is it death with honor or death from pain? How did you determine this? Shame and humiliation involve emotional pain. Has any one done a study on the amount of pain people who commit suicide in this culture endured before the act? Cultural differences considered, it may be that identification of pain is more relevant than a specific DSM diagnosis. Is pain a cultural construct? Do you know of any good studies about this?
You’d have to ask the Japanese people about their change in attitude toward depression since it’s their attitude. Your reference to popping pills indicates that you feel that western cultures are worse that other cultures, a judgment just as wrong as the one you accused me of making. I am not assuming the western way is always better. In fact it would be nice if western society would respect a mentally ill person’s choice of suicide like they used to in Japan. It might alleviate a great deal of pain.
Anonymous, you’re contradicting yourself. The Japanese have a culture that embraces what we westerners call “depression”. Which their culture also embraces is death with honor. Those are two different things. Bankrupcy, losing one’s face, divorce, etc. are all regarded a threat to one’s honor. “Depression” is not. It can’t explain the country’s high suicide rate, as it isn’t true that “depression” automatically leads to suicide, and as embracing a “depressed” state of mind as a meaningful, desirable experience actually can render suicide an undesirable action, since it would end a desirable state of mind. IMO, “depression” as such is not a valid, causal explanation for suicide. But if a “depressed” state of mind is viewed as undesirable in a specific cultural context, that may well be an explanation.
Also, when you say that the Japanese people maybe simply started to see some aspects of their culture as undesirable, and consequently abandoned them, replacing them with concepts borrowed from modern western civilization, such as popping pills to avoid an experience that formerly was seen a desirable one, you’re implying that the universal, and not just the cultural, truth about this experience is that it is an undesirable one that has to be avoided. You’re implying that our western culture is superior to the Japanese culture, at least in this regard. How can you know this for sure? Actually, it is what every culture fancies to believe about itself. That it is superior to all other cultures. That’s not an objective truth. It’s a cultural belief.
Japan’s attitude of not “fearing” or “running away” from depression certainly explains that country’s high suicide rate. You’re analysis that depression is something to “embrace” in terms of spirituality as a cultural aspect of Japanese society may be true, but so is suicide as an acceptable solution to many of life’s problems. Bankruptcy? Suicide. Lose face? Suicide. Husband divorced you? Suicide – frequently women tied their children to themselves and walked into the ocean. Emperor dies? Suicide – officials tried to stop people killing themselves at the death of Hirohito, not always successfully. In the past, suicides at the death of the emperor were common as were political protest suicides. It is not surprising that people would embrace depression by committing suicide in this culture.
During the second half of the twentieth century, the Japanese people were becoming familiar with the culture of western Europe and America. Maybe,just maybe, the Japanese people started seeing some aspects of their culture as undesirable. In this case Glaxo Smith Kline may not be the major cause of Japan’s change in attitude about depression that Ethan Watters contends. Just a thought.
Ethan writes about how shame, not depression, is behind the high suicide rate in Japan. People’s identity there is very group focused and about how people are expected to behave.
Assuming depression must be behind suicide is making the assumption that other cultures are like the US, which is exactly the point of the book.
So, basically, what is seen as a “mental illness”, and what is seen as “normal” is a question of culture. I agree. Which nevertheless is a little disturbing to me is that, while Ethan Watters seems to acknowledge the crucial role culture plays in not only defining, but even creating “mental illness”, he also uses the term “mental illness”, and the numerous different labels of “mental illness” as if they were not only culturally, but universally real. Ethan Watters seems to me to, in part, be able to see the phenomenon of what modern western civilization calls “mental illness” from a perspective outside of culturally conditioned, and limited, thought, while he also, on the other hand, obviously to a certain extent still is caught/trapped in our culture’s thought pattern that defines “mental illness” as real illness, also beyond our own culture.
Now, the term illness applied to the mind means that something with the mind isn’t quite as it should be. An ill mind isn’t functioning as we’d expect it to — and here we have the cultural expectations again, which Ethan Watters talks about in the beginning of the interview, and which indeed are the only measures we have at our disposal to distinguish “healthy” from “diseased” when it comes to the mind, i.e. to thoughts, emotions, reactions, perception, etc. The question is, whether it is advantageous for the individual, or not, to define his or her mind as diseased, i.e. as not quite as it should be, “malfunctioning”, and consequently his or her thoughts, emotions, reactions, etc. as “wrong”, or whether this maybe rather is disempowering, possibly even re-traumatizing (I know that it was for me… ), and thus actually complicating, or even preventing the healing process, and whether cultural norms and values are enough to justify such a the healing process complicating or even preventing practice.
IMO, it doesn’t make such a big difference whether we define “mental illness” as brain diseases(= being “possessed” by defective genes and/or an imbalanced brain chemistry), or whether we define them as being possessed by demons. Although the latter belief means a lot less “stigma”, i.e. discrimination and marginalization, in a culture where it is “normal” to be possessed by demons, and although the demons can be send back to where they came from, so that the individual is no longer possessed by them, while allegedly defective genes never will be “normal”, and while the illness they cause can’t be cured, only “managed”, resulting in life-long illness, so that it probably is wiser to believe in demon possession than to believe in defective genes and an imbalanced brain chemistry. Still, in both cases the individual is the victim of something undesirable.
Which makes a decisive difference is whether we define the individual as diseased, or possessed, i.e. as the victim, at all, or whether we manage to let go of our culturally conditioned, and thus always more or less narrow, limited, expectations, and dare to define his or her mind as perfectly healthy, no matter how extreme the thoughts, emotions, reactions, etc. it generates.
It seems to me that we resort to this kind of cultural constructs, which both “mental illness” and demon possession are, whenever we can’t or won’t (out of fear) understand a certain state of mind. Both “mental illness” and demon possession then relieve us from the necessity, or responsibility, to understand these states of mind in relation to ourselves. But this relief comes at a cost. It victimizes not only the “mentally ill”, or possessed, individual, but also ourselves. And victims don’t grow.
Absolutely fascinating and crucial research! Will, I love your program. Thank you so much.
Paxil in Japan !
now U.S. Eli Lily are stepping up effort to sell Zyprexal ? ( similar or same drug as antipsychotic Zyprexa ? to people who STUTTER (many young people ) !! in China where “off Label ” laws for drug/medicine are not as straight ,a huge market.
Science has no clear definition or understanding of how mind emerges. Your statement “brain disorders do exist” is not scientifically accurate with regard to psychiatric diagnosis like schizophrenia, depression, bipolar, etc. Mind remains a scientific mystery: science does not support your claim that brain and mind are equivalent, and all mental disorders remain without clearly demonstrated causality. Many interviews here on Madness Radio discuss this, I suggest you start with John Horgan.
Similarly there is no scientific consensus or consistent research showing that what are diagnosed as mental illnesses are “brain disorders,” again many interviews on the show talk about this, such as the interviews with Paula Caplan, Alisha Alli, Christopher Lane, and Joanna Moncrieff. This is a commonly held belief, promoted by the medical research industry and pharmaceutical funded advocacy groups like NAMI, and helps sell a lot of medications. It also obscures other possible explanations for and ways of helping people in emotional and mental distress. Without a scientific consensus or demonstrated research, mental disorder diagnosis is a subjective decision made without benefit of objective tests. This is why so many people get different diagnoses at different times and why diagnosis is so inconsistent between doctors.
It is important to question the assumption around brain disorders because we need to open up the field of mental health to treatments that actually help people. Our current focus on presumed brain disorders drives a medical model and pharmaceutical approach that is mostly failing and mostly doing more harm than good. It removes attention from social and political issues. Focusing on non-existent brain disorders is bad science and has created lousy outcomes for treatment. This is also true of healthcare in general: it is social inequality, not medical interventions and spending, that determines the overall physical health of a society, and until we stop focusing on genetics and a strict medical model approach we will never be able to truly provide a healthy society to all.
I do believe that improving physical health can often help people who have mental health diagnosis. For example I am diagnosed with schizophrenia and I no longer eat gluten, which I believe has helped my brain and body become more healthy. My “symptoms” have gone down as a result. That does not mean that gluten sensitivity is the “cause” of schizophrenia — many people with the same diagnosis are not going to be helped by stopping eating gluten. It just means everyone is different and that yes improving physical health can sometimes help people who have diagnosis. Working and having friends were also vital parts of my recovery, as was my spiritual practice — and unlearning the myths I was told about brain disorders, chemical imbalances, and genetic predispositions.
I do like your idea of focusing on pain or suffering as the issue that needs to be addressed, there is no need to put people in DSM boxes to help them, knowing they are in pain and need help is enough. As a counselor I am more interested in how the person experiences their suffering as a way of understanding what might be useful to helping them than I am in making any kind of diagnosis.
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It isn’t à sign of good mental health to be well integrated in a society that is ill.