The Medical Model of Mental Illness
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Don't believe everything you thinkThe liminal space Veteran
I came across this video describing the way we've moved to a medical model of mental illness and how, though well intentioned, is showing down sides. I think I've been having this sense that the way I hear many people talking about mental illness these days that something was off. I've now spent more than half my life meandering along a spiritual path and learned time tested Buddhist approaches to addressing issues of mental health before being introduced to western psychological thinking.
Anyway, like the video, I'm not outright negating all of western psychology in its current forms. Its just saying that we're still learning and there is an unintended consequence of learned helplessness in the way people are relating to their mental illnesses. Rather than say you have depression or are depressed, say you are experiencing depression. The last option holds out the possibility for change and allows for positive growth.
Comments
I recently read the book "Lost Connections" by Johann Hari, which discusses this issue. Very interesting and informative, and offers different solutions.
Absolutely. Do you know the website Mad in America? There are a lot saner perspectives on mental health out there, rather than what psychiatrists are taught as medical doctors.
Also I’d point out that the “chemical imbalance” theory of mental illness has long since been disproved — basically when you ask a specialist whether they have ever found the chemical that is imbalanced, they end up admitting that no, actually they didn’t find that. It is just a short explanation that survives because it’s easy.
Again, diagnosis is just a shorthand for a bunch of symptoms. For a lot of mental health issues it is much more relevant to ask a patient about what happened to them. The story of what affected someone’s life can be much more revealing than just a list of symptoms.
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Seeing the video set me on a path and another good piece I came across is this one from the Atlantic.
Sorry if I pasted a lot of the article, it was hard to find an essence without taking it out of context. The article has more in the way of solutions and nuance.
The thing is, there are undeniably traumatic experiences, such as the suicide of a loved one. I don’t think you want to build a society that treats those kind of experiences as something to be learnt from. And every society that takes the stance “learn from it, toughen up” also inevitably has its casualties among the more sensitive people.
At the moment the social pendulum seems to have swung towards acknowledging the sensitive souls and seeing what we need to do to accommodate them. That is a good thing — society coming to terms with the sensitivity of its members. It will take some time and effort to find a good middle way, a position that encompasses both encouraging resiliency and allowing for sensitivity.
I'd adjust your point some an say we do want to build a society where people learn from those experiences, but we'd rather prevent them in the first place. This is samsara, pain and trauma are inevitable, lets build social and psychological structures that help people grow and thrive.
I wouldn't want to go back to some rougher past. I do believe in progress, in moving forward to something better. I think what I'm seeing in the video and this article are that our steps at doing that are leading to some unintended consequences that are making things worse in some ways.
I agree, it is a good thing. Valuing and understanding differing dispositions can be a strength when done right. I'd argue that there's a difference between accommodating and coddling though. It is proving to be unhealthy to prevent too much stress and discomfort, it seems a fact of our biology and psychology that people need challenges to grow. The human story seems to have a lot to do with seeking comfort in an unforgiving world, we're at a point in our history where it is becoming possible for some to live in a near constant state of comfort and we're beginning to see some of the downsides.
Hmm overpopulation, climate change and biosphere denuding may catch up with us before the majority of the human population lives permanently in comfort, I suspect.
My take written earlier this year:
I've had a couple of visits about my mental health with my PCP and a student clinical psychologist in the past week and have started buspirone to help with my depression and anxiety. But during those visits, I had trouble expressing some of the conditions and stressors that make it difficult, i.e., a combination of existential crises and material conditions under capitalism that make me feel constantly empty and anxious. As such, I'm both tentatively hopeful and chronically frustrated—hopeful the medication can help but frustrated that the world continues to be the way it is and creates so much unnecessary suffering.
My doctor recommended buspirone to help me weather the increased effects of the depression and anxiety I've been experiencing lately. And while I've been hesitant to take medications like this in the past, I've decided to see if it can help. But it's frustrating that many people, particularly in healthcare, don't seem to consider how our society contributes to the growing issue of depression and anxiety.
It seems like more and more people are struggling with these issues, some silently, some reaching out for help, and others taking their own lives. And while there are certainly physiological and psychological conditions caused by everything from chemical imbalances in the brain to the effects of trauma that healthcare professionals can help with in the form of medications and therapy techniques (e.g., cognitive behavioral therapy) that can be life changing, I think there are some deep-seated causes that have gone unaddressed and continue to feed into people's depression and anxiety—most of them being the external stressors weighing heavily on people stemming from the ways we organize our society.
It frustrates me, though, whenever I try to talk about the way I feel and see the world to healthcare providers. Most immediately assume my unhappiness with the world and ambivalence to existence mean I'm an immediate suicide risk, and I have to repeatedly try to express the experience of existential malaise and unsatisfactoriness with the world we've created in a way that they can understand differentiates the two. There's plenty of religious and philosophical vocabulary surrounding this, but little in the medical field because they often start with some general assumptions about society that I don't think are completely true, such as the world is inherently good and life inherently meaningful and worth living as is. If you're not happy with life as it is, it's you who has to change. But if the world and the life we've created are scrutinized in any serious manner, I think it becomes clear that there are material social conditions that actually have a negative impact on our health and well-being.
In this country, for example, which is arguably the wealthiest and most technologically advanced in the world, most people have to work for a wage to survive, or else hustle one way or the other, and oftentimes both. People often have to spend a great deal of time at work (the majority of our waking hours in fact) and commuting to and from work, keeping us away from friends and family and limiting the free time we need to exercise or relax and recharge. Workloads themselves are often full of stress. On top of that, wages for many aren't enough to do more than pay for rent, food, and other bills, and people feel like they're living to work (and this is exacerbated by things like inflation, which is designed to weaken the spending power of wages further and make borrowing harder to slow consumption, thereby lowering demand and prices and all that other stuff to combat inflation without at the same time overly hurting capital and overall market growth). They don't call it "the rat race" for nothing. As if that weren't enough, even more pressures come from trying to make due with what you get, forcing us to make tough financial choices between things like paying for food, rent, and utilities vs. healthcare, childcare, and car repairs. Over half of Americans alone live paycheck to paycheck in a state of perpetual precarity and the threat of unemployment and ruin around every corner. And if you want to gamble, you can put yourself into a lifetime of debt to get a higher education and piece of paper that might get you a little extra cheese, but there are no guarantees. It's also difficult to relax when at least five days are full of going full speed to make someone else rich and two days are left for you to try and do all your personal errands, spend time with friends and family, and do something enjoyable and meaningful. And when we don't have the time or money for that, we often find it easier to self medicate with drugs or alcohol or reality TV or whatever helps us through the day.
And the broader socioeconomic atmosphere across the globe isn't much better, often full of violence and uncertainty, from wars and food shortages to volatile stock markets and imperialist competition between nation states, many of which are trying to catch up to and compete with the hegemony of the US. Combined all of that with the ability to have constant stimulation from news and social commentary on TV, social media, etc., it's little wonder that people are seemingly suffering from depression and anxiety more than ever before.
Certainly not every mental health issue is caused by these material conditions, but a large number are, and the majority almost definitely exacerbated by them. If we want to truly address this growing mental health crisis, we must not only expand access to and normalize mental healthcare and our vocabulary around the experience of mental pain, unsatisfactoriness, and loss or absence of meaning, but also address the omnipresent material conditions giving rise to and exacerbating them. We need more free time. We need to have our basic needs met without having to work ourselves to death. We need more access to the things that make life worthwhile and enjoyable. And we need to share all of that with everyone instead of a system where a few profit disproportionately off of the labour of the many, while the many in turn benefit from the oppression and exploitation of the poor and marginalized. Capitalism is a pyramid of inequality, and the further down you are, the heavier your burden and its negative impacts.
I have some experience with mental health medication and how difficult it is to get off it once you’re on it. My take is, trying holistic options such as herbal supplements, mood enhancers like scents and candles, more relaxing baths, are all good things to visit first.
Further I’d suggest considering psychedelic therapy. They are relatively safe compared to the side effects of many so-called antidepressive medicines, and often work for a long period for depression, half a year to multiple years.
Which is why I select my social media with great care… I hang out on this forum and a few others for the lovely people and fellowship, but I have to admit that for a personality given to comparing themselves to others (unlike me) social media is highly corrosive. TV I take in very limited doses. But these are “first world problems”.
Mental health is affected by a large number of factors, but probably the foremost among them are childhood trauma and immigration, I remember seeing.
It seems to me that capitalism and materialism are systems that are bad for the mental health of the citizens, that’s true. The current mental health crisis is only the beginning, it’s something that’s working its way through the working generations. I had my own breakdown ten years ago.
I came across an interesting piece in a Dutch tv show called Everyone Enlightened, where they were talking about transcultural therapy. In parts of the Netherlands like around Amsterdam and Rotterdam more than 50% of young people have a parent from a non-Dutch culture, and so when they run into mental health difficulties, they need therapy which connects with their culture.
The founders of the transcultural therapy expertise centre found that there was a fundamental difference between “we”-culture and “I”-culture… that a lot of the people from Surinam, from Indonesia, and other places carried within them an expectation of “we”-culture where older people had an inherent authority and a supporting role, like the tribal elders of their homeland.
In modern western culture there was much more an independence, an “I”-culture. And this caused them many difficulties. In the transcultural therapy one of the first things they would do is set up a lineage chart, plotting family relationships against cultural backgrounds. I found it a fascinating direction of thought, because the support of one’s elders means different things in different cultures, and perhaps western culture is rather struggling with this.
@Jason Are you up for an experiment? I think it would help. For one week, do not read the news and do not discuss politics or cultural matters. Dedicate yourself to your ordinary daily life and your personal projects. Integrate into these activities your understanding of the Dharma. That's it. After a week, take note if this was helpful or not to your overall state of mind.
I propose this because - especially when I am in negative states of mind, but also in general - the news and political discussions are detrimental to my wellbeing. Dedicating myself to ordinary life, while trying for this ordinary life to be an expression of my deepest understanding of the Dharma - is supportive of my wellbeing.
Oh trust me, all of that had been done na y, many times over the last 20 years. And it is helpful, but not to the extent that I'm not still suffering or struggling with constant pressure from work and relationships and not making a living wage. But you're right that it can help relieve some of it, which is why I haven't been active here or much of anywhere. Everyday there is some regret that I didn't ordain when I had the opportunity. C'est la vie. Maybe in my next life.
Dear @Jason I should have written this immediately in my first post so I apologise for being "secretive": I confess that I proposed the "media-fast" because in your original post I saw a lot of "capitalism-blaming", which it seems you are using to vent your frustrations but then it is (imo) creating more frustration. I am not a political-relativist - and do believe there are better and worse political views and systems - but ultimately the state of society is not the main cause of our problems, nor changing it the remedy. We need to stand on our own two feet, do our practice, change for the better in a radical way, including changing our outer circumstances where possible.
""Which is why I haven't been active here or much of anywhere."
I read these Buddha quotes on spiritual friendship yesterday. They pull at the heart strings and seem so true to me. Feel free to post here more, seems to me NB qualifies in spades as a place of spiritual friendship.
"And it is helpful, but not to the extent that I'm not still suffering or struggling with constant pressure from work and relationships and not making a living wage."
Same here. What are we gonna do about it? Collapse and quit striving? Accept and continue the status-quo? Come out fighting guns a'blazin?
"Everyday there is some regret that I didn't ordain when I had the opportunity. C'est la vie. Maybe in my next life."
I have this regret often as well.
If my father ever said something wise and also embodied it it was to say that we cannot change the past but we can always do something right in the present and thus steer the future.
Ordaining is very helpful circumstances, but ultimately it is only circumstances. Would you consider "ordaining" in your present situation by treating yourself as a monk, your dwelling as a monastery, your job as work-practice, your relationships as Sangha relationship, your free-time as opportunity for deeper inner work? In a monastery, that's basically what you'd be doing, granted, with much more support.
Or maybe more practically and easier, would you consider initiating or deepening your relationship with a Sangha near you? There are many monasteries that allow people for extended stays.
A long-time Zen practitioner who ultimately resolved all of his questions had this same problem. He was a construction-contractor and while engaged in construction projects would often think: "If only I did not have to do this stupid construction, I could go off to a mountaintop, meditate, and get enlightened!". Then one day he saw clearly how such thinking removed him from the actual-factual present moment. So he dropped such thinking and from then on devoted himself fully to whatever he needed to do in the present moment. These days he enjoys asking people the question: "What should you be doing right now?". Where the answer is always what someone is doing right now (so, for me, for instance, writing this message to you).
Apologies if this was unsolicited advice. Just trying to be of help in the spirit of spiritual friendship.
It’s interesting Jason, that you are concerned with making a living wage, and at the same time thought seriously about ordination in the past. As a monk you’d have a lot less than you do now, you would have given up physical possessions and would be eating once a day and living off donations.
Considering life as a single person without a family, in a way the whole idea of stress is in the mind. I recently went through a period without any income and was confronted with losing my home, and so had to think about what would happen if I ended up living on the streets. I concluded I could still be happy, I could give up all my stuff, my home, my comforts, my coffee, and just let it all go. Luckily then the opportunity arose to go live with my mother and stepfather with Alzheimer’s for a while, and help them out.
But in India the Hindu sadhu’s and sannyasins, the holy men, also live in the streets and practice austerity. They have renounced, gone forth from the home, and live without possessions, health care or comforts, at most they have a copy of the Bhagavad Gita to read from.
My point is, it really is all in the mind. If they can live a happy and spiritual life like that, then so can we. If you can find the right things to let go of, the places where you still cling to comfort or to the things that society expects or to the idea I-am-the-body perhaps, then it is possible to be happy under nearly any circumstance, without stress and with ease.
Existential considerations too, in my experience, have been about not letting go. About wanting things to be other than as they were, or wanting there to be fairness and justice. These are things worth striving for, but we have to acknowledge that we can only do so much. At a certain point we have to let go.
Maybe we need a Mental Elf? We might even be one …
https://www.nationalelfservice.net/about-mental/
Thank you @lobster, this resource is fantastic.
I kind of regret saying anything as it's already causing me more dukkha. lol So just some general comments in reply to @marcitko and @Jeroen.
Namasté @Jason, it certainly wasn’t my intent to cause you dukkha. I had the good fortune to do well in my employment while younger, and perhaps not everyone is so fortunate.
When you have dependents there are stresses that come with that, for sure. It is a life choice to have a wife and children and provide for the next generation.
@Jason I sincerely apologise for my well-intentioned but obviously unskilful post. Good for you for standing your ground.
No worries, the amount of dukkha was minimal. It was mostly a joke re: the thought of responding to long replies. I know everyone means well.
In general, I'm doing better these days financial than I have at any time in the past, although I'm still not making what I'd consider a living wage in a city with unaffordable rents. And I find it very frustrating having worked in multiple states and industries, just not the right ones I guess. (And my dependents are my partner and 2 pets, no children. 👧🐕🐈⬛) My main point, though, was really about the impact of external/material conditions on our lives and mental health.
In Buddhism, there's a big focus on the mind and how it relates to experience with an emphasis on preventing the second arrow of suffering we experience due to painful bodily and mental feelings. And those techniques are quite effective. However, I've found that in my experience, the more involved/invested I am in worldly life, the harder it is for me to let go, practice equanimity, or any of the things that prevent myself being pierced by that second arrow. So I feel the weight of things moreso than when I had more time to practice and go on extended retreats. I just don't have the time or ability with the amount I work and all of the other things I'm responsible for. It's a trade off, but I've accepted that I'm a householder and not a monk, so more of my focus is now on working to make that life more materially comfortable and conducive to ease and happiness and the ability to practice for myself and others. And looking at the world, I think capitalism has contributed to an increase in depression and anxiety, environmental degradation, consumerist culture that feeds our greed, difficulties in monastic communities supporting themselves/being supported by the community, etc.
For those interested in mental health and developments in that field, here is the Mental Elf, part of the UK’s “national elf service”, a series of newsletters tracking the practice and state of medicine across the health industry. The name is a bit of a pun, I think…
https://www.nationalelfservice.net/category/mental-health/
Dear friends,
Be mad! Job done. Next?
Being the work horses/labor slaves for the haves in this country is mentally and physically exhausting and a struggle, to say the least.
No amount of meditation fixes that kind of shit. Period. Even the best of prayers go unanswered when it comes to someone making money at your expense.
If you know, you know.
@Jason …. I hear ya….and I feel ya. ❤️. Life IS short, don’t let ‘em get all of you. Find and make the moments that belong to you. Take care of you for me.
Its kind of hard to put myself in your shoes. I've been fully independent working for clients for a couple decades now, before then I was largely left alone to do my work. Even as a teenager I worked weekend mornings at a fast food joint with 2-3 other people where we ran the show.
I do sometimes work for people now, and have in the past, who want to micro manage what I do. Telling me how to do my work and what I'm doing wrong. This is very stressful and makes me not want to work for them and often leads to some sort of conversation to stop the behavior.
They say that one of the big factors in determining how happy one is at work is how much independence one has in how they conduct their moment to moment work. For example, janitors often score high on job satisfaction compared to other workers when companies are surveyed.
I have know people with shitty bosses or bad work environments who have changed work places and its made a big difference in their level of happiness.
So yeah, environment is important
My approach has always been to do what I love doing. Whether that’s been graphic design, engineering, software development, technical directing, as long as I’ve been able to find joy and enthusiasm in it I’ve done it with pleasure. Then as long as you get paid decently, it doesn’t matter so much whether you’re wealthy or not.