My work for the National Alliance on Mental Illness requires me to endorse (in public, at least) the following quasi-creedal statement: “Major mental illnesses are biological brain disorders/diseases caused by chemical imbalances and electro-chemical malfunctions in the brain,” followed by vague references to dopamine, serotonin, neurons, receptors, and synapses.
“We ask people diagnosed with schizophrenia and those who love and care for them to adopt the brain chemistry narrative without consideration of the cost: the devaluing of the perceptions that make up the ill individual’s very sense of self. Indeed…the fact that healthy people do not dwell on the ‘brain chemistry’ story as an explanation for their own moods and feelings should be an indication of how unappealing and dehumanizing the idea is. When we fall in love, get jealous, feel the joy of playing with a child, or experience religious ecstasy we do not describe the experience to friends as a fortunate or unfortunate confluence of brain chemicals. Yet we continue to suggest that the narrative of brain chemistry will be useful in lessening the stigma associated with a mentally ill person. What could be more stigmatizing than to reduce a person’s perceptions and beliefs to the notion that they are ‘just chemistry’? It is a narrative that often pushes the ill individual outside the group, allowing those who remain in the social circle to…view the ill person as ‘almost a different species’.”
As a person diagnosed with, and under treatment for, a major mental illness, I confess to having my own doubts about the “brain chemistry” narrative. At best, that narrative oversimplifies the incredibly complex realities of mental illness, and in so doing it risks isolating the brain from the person and the person from his or her social context.
That is precisely the problem to which Ethan Watters calls our attention:
“The ideas [about mental illness] we export to other cultures often have at their heart a particularly American brand of hyperintrospection and hyperindividualism. These beliefs remain deeply influenced by the Cartesian split between the mind and the body, the Freudian duality between the conscious and the unconscious, as well as teeming numbers of self-help philosophies and schools of therapy that have encouraged us to separate the health of the individual from the health of the group. Even the fascinating biomedical scientific research into the workings of the brain has, on a cultural level, further removed our understanding of the mind from the social and natural world it navigates. On its website advertising its antidepressant, one drug company illustrates how far this reductive thinking has gone: ‘Just as a cake recipe requires you to use flour, sugar, and baking powder in the right amounts, your brain needs a fine chemical balance in order to perform at its best.’ The Western mind, endlessly parsed by generations of philosophers, theorists, and researchers, has now been reduced to a batter of chemicals we carry around in the mixing bowl of our skulls.
“What is certain is that in other places in the world, cultural conceptions of the mind remain more intertwined with a variety of religious and cultural beliefs as well as the ecological and social world. They have not yet separated the mind from the body, nor have they disconnected individual mental health from that of the group.
“With little appreciation of these differences, we continue our efforts to convince the rest of the world to think like us. Given the level of contentment and psychological health our cultural beliefs about the mind have brought us, perhaps it’s time that we rethink our generosity.”
In my experience, including twenty years of working with other individuals who live with mental illness, “recovery” is not a simple matter of neuro-chemical adjustment. Ideally, it involves a wholesale reorientation of the individual towards her or his own life, towards her or his social and cultural environment, and, in many cases, towards existence itself. What is ultimately “recovered” in this process is not just “normal” brain functioning, whatever that means; what is recovered, and restored, is the self, of which brain functioning per se is only one (necessary but not sufficient) element.
CRAZY LIKE US is troubling, provocative, and contrarian in the best possible sense of that word, combining skepticism and compassion in equal measures while avoiding the pitfalls of polemic. Whatever your views on the nature of mental illness, CRAZY LIKE US is worth reading with an open mind.