What If Everything We Think About "Mental Health" Is Wrong?

What if it has nothing to do with being successful, wealthy, happy, fit, liked and likable, sexily married with perfect children...?

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Two myths can prevent recovery from mental illness.

One says that mental disorders are primarily biological and genetic; the other that they’re caused by a chemical imbalance.

During the 1980s, 1990s, and early 2000s, despite the lack of concrete evidence, biopsychiatrists declared that our psychic and emotional struggles are “brain diseases.” Biopsychiatry researchers were never able to position the cause and development of psychiatric disorders primarily in the brain but kept promising that soon (soon!) they’d be able to. They fed the public potential findings, often overstating their results. Parts of the media helped with catchy headlines.

(Ironically, the push toward the mental-illness-as-a-purely-brain-disease model goes against the title of psychiatry’s only medical manual: The Diagnostic and Statistical Manual of Mental Disorders, or DSM. The definition of mental is “of or relating to the mind,” not the brain as a standalone organ.)

A vocal minority of psychiatrists and researchers pushed the biomedical model. That isn’t a crime; the crime is that they campaigned for hypothesized neurological explanations at the expense of other factors, such as environment, personality, trauma, and economic and social injustices. Doing so allowed them—and us—to shirk responsibility. If it’s all biology and genetics, then we can ignore everything else that contributes to mental distress: racial inequality, racism, economic inequality, transphobia, homophobia, misogyny, violence.

Psychiatry’s biomedical model was mostly well-intended. Certainly, some, if not many, clinical and academic psychiatrists wanted to help people. In some cases, selfishness, arrogance, and hubris got in the way. And conflicts of interest. Under the direction of one of psychiatry’s most prominent figures, Robert Spitzer, biopsychiatry aimed to (finally) establish psychiatry as a respected field of medicine. (Although some psychiatrists embraced a bio-psycho-social model of mental illness, biopsychiatry dominated the field.) Pharmaceutical companies funded research and plied academic psychiatrists and clinicians with kickbacks to find and tell the public that there could be one cause of mental illness to be remedied by psychotropic drugs.

Whether we know what the term biomedical model means, we, the public, practice it. The neuromythology surrounding mental illness is pervasive. Though no DSM diagnosis has been shown to be the result of genetics or caused by biology or a chemical imbalance, many believe that DSM diagnoses like depression, obsessive-compulsive disorder, schizophrenia, etc., are hereditary, permanent, and biological.

Nearly 80 percent of Americans think the chemical imbalance theory is true; it turns out the chemical imbalance theory, which I took as gospel, is little more than “an urban myth.” It proposed that mental health diagnoses result from high or low levels of chemicals (often referred to as neurotransmitters) like serotonin, dopamine, and norepinephrine. This included diagnoses like major depressive disorder, anxiety disorders, schizophrenia, obsessive-compulsive disorder, and ADHD. Originally called the chemical imbalance hypothesis, it was never proven. Today, many refer to it as the chemical imbalance myth or even the chemical imbalance fallacy. The myth offered patients a reason for their mental and emotional suffering; it also gave pharmaceutical companies a way to seize on a hypothesis, pretend it was factual, and make millions of antidepressants and anti-anxiety medications. Just those terms—antidepressant, anti-anxiety—are beyond misleading. Nothing about Prozac and Xanax and any other SSRI or benzodiazepine combats the diagnoses we call “depression” and “anxiety.” But pharmaceutical companies advertised that they did, and the media recycled the information. The circular reasoning went something like this: Psychotropic drugs affect levels of neurotransmitters, and people with mental disorders sometimes take and find relief from psychotropic drugs, so a chemical imbalance must cause mental disorders.

Why wouldn’t we accept the biomedical model? All those colorful brain scans seem to prove that schizophrenia must be caused by variations in grey matter, even though such variations can occur due to many factors, including prolonged insomnia, concussion, and smoking. The computerized renderings of neurotransmitters seem to offer scientific accounts of what’s happening when we have no interest in life, feel an intolerable heaviness in our bodies, and withdraw from others (i.e., depression).

Unfortunately, they prove nothing. Currently, fMRI technology can only rule out if a person’s symptoms are caused by an organic illness (brain tumor, Alzheimer’s), and that’s it.

It’s reasonable to want our disordered, confused, and troubling thoughts, feelings, and emotions to have a definite cause: chemical imbalances, misfiring neurons, depleted grey matter. Biogenic explanations of mental and emotional suffering—particularly the idea that this disorder is caused by that neuron or this gene—are tidy. We like the colorful photos of our amygdalae and the scientific jargon that goes along with them because they’re easy. We like and want to believe that our human experience can be understood through a neuroscientific lens. It’s comforting to think that our mental and emotional lives—ethereal and often indescribable—can be explained. But they can’t.

*

On alumni day at my high school, I’m asked to speak to a group of students who want to become writers or go into publishing. I enter the building and check in at the front desk. It’s strange to be there, even stranger to have been asked to play the role of the successful author.

In the classroom, my stomach sinks. My chest tightens less from my mental illness than from the feeling that, at any moment, we’ll be given a quiz.

I sit at the table across from the students. Their faces are eager. This high school grooms the best students in the city. Attending an Ivy League college—or a very good one—is the norm.

I speak, and everything I say sounds like a lie. Unmentioned go the pain and sense of cracking and mania and depression so deep I’ve thought they’d swallow me that have been the primary focus of my life since I graduated from high school. Unsaid goes the reality that my high school years were characterized by starvation, light-headedness, cracked skin, and thinning hair due to low body weight.

Today, whole swaths of young people with psychiatric conditions find community in their diagnoses and experiences (#stickysockvacations). When I was in high school, severe mental health issues weren’t discussed. The severely dysfunctional were ignored; we were outliers. Which is all to say that it was lonely and far from cool.

Why I made my mental illness my identity isn’t a mystery; it was all-encompassing. During my junior year, I attended an outpatient eating disorders program, which is the kind of extra-curricular activity that doesn’t exactly look good on a college application. (Time spent in group therapy sessions doesn’t get you into Harvard. If they only knew how much group therapy can teach a person about human nature and empathy.) I embodied the sociologist Erving Goffman’s theory of self-stigmatization. Goffman wrote that psychiatric hospitals are self-stigmatizing because the patient takes the institutional identity with him when he leaves. We can’t heal because we’ve become it and it’s become us.

Our mental health system is guided by the biomedical/maintenance model. Our suffering is internal and inescapable. It explains disruptive thoughts with neurons, distressing feelings with synapses, and undesired behaviors with brain mass. Some mental health professionals throw in a little of the psycho-social model, but services tend to be oriented toward illness, not wellness. Treatment is typically generalized, as if all patients are the same. Many clinicians fail to address the patient’s living environment, past trauma, financial status, and physical health.

The aim of the recovery model would change that. It goes against the idea that we have a permanent biological condition or a chemical imbalance and will always suffer. It looks at patients as individuals capable of healing and who deserve to have agency over their treatment. Recovery is achieved by tapping into a person’s strengths. One’s thoughts, opinions, and cultural beliefs establish the way toward recovery. It contextualizes our struggles within our lives: physical health, economic situation, medication, housing, purpose, co-occurring substance issues, and past trauma. The objective is to set goals and give people a future beyond triage, diagnosis, and lifelong illness. 

We don’t need to choose either the medical/maintenance model or the recovery model. Many in the recovery community want to see them combine, using the best aspects of each to serve patients. As one of the facilitators in a mental health peer support training put it, “The medical model saved my life; the recovery model gave me my life.”

*

The students ask questions. I answer them the way a successful, mentally healthy, non-mental-illness-suffering author would.

After my talk, I mingle with the other alumni in the cafeteria. I feel awkward and unworthy. Most of the men and women wear suits. I imagine their full lives and all that led them to be in that room, all these executives and successful entrepreneurs and academy-award-winning film directors.

I’m struck by all I missed out on by seeing myself as hopeless: opportunities, mainly, and relationships. Twenty-five years of my life gone.

And I was left with a skewed idea of what a mentally healthy person looks like—successful, wealthy, happy, fit, liked and likable, sexily married with perfect children—a misconception that will lead me down a very wrong path.

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For the comments:

• How do you think we misconceive “mental health”?

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The more we know, the more powerful we are.

Thanks so much for reading. To support my work, purchase Pathological: The True Story of Six Misdiagnoses(HarperCollins), the prequel to Cured. Both a memoir and a work of investigative journalism, it explores the ways we pathologize human experiences and ask, Is a psychiatric diagnosis a lifeline or a self-fulfilling prophecy?

You can also purchase a copy to donate to your local library or bookstore.