This post is being reposted after many readers requested I do so.
This is a hard post to write. I know before I start I am probably not going to say things as well as I would like, and some people will get mad. So with apologies said upfront here goes:
I have a friend who once told me she was like the Al Gore movie. She was she said “…an inconvenient truth…” Philosphically she bought heavily into the ideas of the “mental health survivor movement.” On a philosphical basis she was strongly against the use of psychotropic meds. She could quote study after study that showed that they didnt work and indeed did positive damage. She had been diagnosed with bipolar disorder, but once told me that no one had even proved it even existed.
But there was major problem. Even after multiple efforts she simply wasnt stable without medication. Her depression had bought her to the edge of sucicide multiple times. Her manias had left her in legal trouble from the some of the things she had done.
She finally decided to stay on meds, but was really unhappy about the decision. I remember one time telling her she had a choice– “be right or be real.” She is stable now, for a little over a year. As crazy as it sounds though I still think that somehow she feel like she let people down.
There is an ideology of mental illness I think. At its extreme ends it has people that are totally convinced that they are right and that their views make perfect sense and have been adequately proven to anyone with an “open mind.” The problem is that if they are right many people are left as my friend. They are inconvient truths.
- Mental illness is a brain disease and the best and most effective way to deal with it is through the use of medication.
- There is no proof, no test, no biological markers that prove that mental illness is biologically based, or that in fact, it even exists.
Both of these statements are normally said with a lot of passion. The people who believe them see them as self evident. Those who dont, at best, view the people who hold those beliefs as innocently stupid and , at worst, as positively dangerous.
- Both of these positions have assumptions about what is really real that are just that — assumptions.
- The biological people assume that the brain is the most real thing. That is a philosphical assumption and not a scientific fact. People are more than the chemical forces that make them up. They are creatures of meaning, in a social and cultural context, with a history, and beliefs and as sense of purpose that charts their future. To reduce people to any one dimension of their reality is to create a ‘straw man” that does little justice to the real thing.
- Medication, despite assurances, doesnt work real well for some people. For others, it doesnt seem to work at all. For others, it seems a cornerstone of any chance they have of leading a stable and productive life. It seems to matter somewhat on what conditions and what medications are being talked about, but it is a mixed verdict at best. Furthermore as anybody who has taken meds can tell you, most of them have side effects that can make life tortuous. And I know people who honestly question rather or not the gains are worth the costs. I know people who take meds when they “are in trouble,” but refuse them “when things are good.”
- Even when meds “work” by themselves they are inadequate. If you dont give people the tools to deal with the impacts that their issues have on their lives you havent done much.
- People are much more magic than pills.
- Diagnosis are labels or maps to describe people. They are not people. They are not true or false. They are either helpful and effective or a waste of time.
- The diagnosis you are given depends too much on the person doing the diagnosis and not enough on the person being diagnosed.
- The argument that their is “no proof” that it even exists is in my opinion a weak one. It is the argument that many Christians made about evolution. And look where that argument has went.
- To me, it seems self evident and common sense that everything has a biological basis and that biology has a substantial impact on who we are and how we live. Just because it may not be more real than other aspects of being human does not mean it is not real. And it seems clear to me that the thrust of medical science is in discovering how our biology impacts what kind of people we are. And anyone who thinks they know what the future will bring is either a lot smarter than me, or a lot more foolish.
- There are many problems with the medical model. But denying the biological side of who we are just seems to me to substitute one inadequacy for another.
- To say it doesnt exist because their are no “brain tests” is, in my opinion, like saying you cant prove you’ve been in a car wreck unless you know what model hit you. Sometimes you just have to look at the destruction it leaves in its wake. For a myth it is causing one lot of people one lot of misery, unhappiness, and death.
- The criticism that psychiatry does not know it all, or even, that is knows nothing is not proof there is nothing to know.
- And finally too many people are too obsessed with being right and not enough with being real. The real question is what works and what helps. Personally I dont think we know enough for anybody to be right. I hope we know enough to be real and to find ways to bring help to people badly needing help.