The Little Red Blog

Food for Thought

In his brief essay, “Infernal Bore,” Sam Buntz suggests that Satan is in charge of “Netflix Original” programming:

As the desire to be “self-raised” without relation or obligation progresses in people who really believe in it, it produces art of a significantly lower quality. Or, perhaps of no quality. Quality ceases to matter, and all that is left is the quantitative enumeration of identities, the checking of representation boxes. Eventually, the “Dark Satanic Mills” start to churn out the same, boring, repetitive, pandering Netflix shows. 

Modern individualism is apparently a Satanic dead-end that turns us into zombies or, worse, “coomers”. ¹ Buntz bemoans a culture that has been so diminished and a humanity that has been so reduced:

[Satan] has settled for making people watch lousy Netflix original programming. That is atomized Satanic “individualism” at its terminus, a sad and numb person opening tabs in Google Chrome and then slamming the laptop shut when Mom unexpectedly walks in the room.

More seriously, Buntz notes how “individuals” are formed not in a vacuum or through social isolation, but in contact and interaction with the external world, including other persons:

The curious thing about individualism is this: one needs to consider oneself in relation to the universe and its inhabitants to bring out individuality. The isolated, individual self, without any greater contact with reality, is like a seed that goes un-watered. Nothing stimulates it to break its boundaries.

We face a paradox: by trying to completely self-determine being, we are ultimately plunged into slavery under our darkest compulsions. Alternatively, becoming interested in other people and in the surrounding world liberates individuality to shine forth through this relation. One develops an authentic inner life by means of this vibrant connection with a wider world.

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 Infernal Bore: The Satanic Pose of False Individualism (athwart.org)

¹ From the Urban Dictionary: “A coomer is someone who excessively masturbates for the dopamine rush and the sense of fulfillment. Usually masturbates up to seven times a day.” You learn something every day, or at least I do.

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Writing at Aeon, Satsuki Ayaya and Junko Kitanaka explain the workings of orthodox psychiatry:

In psychiatry, only experts make diagnoses. They do this by referring to detailed lists of criteria in technical guides, such as the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM-5; 2013). With this manual in hand, a psychiatrist can determine whether a person is experiencing trichotillomania (hair-pulling disorder), schizophrenia, antisocial personality disorder, autism spectrum disorder, narcolepsy, childhood-onset fluency disorder (previously called stuttering), selective mutism, rumination disorder, or any of the myriad other disorders in the DSM-5.

Even when the experts get the diagnosis “right,” the diagnostic process itself is a two-edged sword:

Being given one of these diagnoses can sometimes change a person’s life for the better. It can validate their struggles and allow them to finally receive the professional support and medication they need to live a fulfilling life. But being diagnosed can have a dark side, too. It can take over a person’s identity. A psychiatric diagnosis is not only descriptive, it’s also prescriptive – it contains a narrative about what progress or recovery should look like. And, as this prescriptive narrative begins to dictate a person’s sense of self, a diagnosis can intrude so deeply into their identity that it may be difficult to imagine an alternative way of being.

Is there any alternative? The authors suggest there is:

In Japan, a radical approach called tōjisha-kenkyū has emerged to challenge the prescriptive narratives that dominate mainstream psychiatry. In tōjisha-kenkyū, which roughly translates as ‘the science of the self’ or ‘self-supported research’, people with disabilities and/or mental illness learn to study their own experiences. During the past few decades, this approach has grown from a grassroots movement created by people with schizophrenia and other mental illnesses in a small Hokkaido fishing town, to a revolutionary method for moving beyond psychiatry – a method that is being embraced across the strata of Japan’s rapidly ageing society.

According to the authors, “Tōjisha-kenkyū offers a hopeful vision of coexisting worlds. It’s a vision in which those affected by physical and mental differences have a meaningful place in the future, including a communal and open understanding of ailments, and an optimistic view that society can become more inclusive. Imagine what would happen if experts stopped only defining and diagnosing patients, and instead taught people to study themselves.”

Maybe the inmates should run the asylum.

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Japan’s radical alternative to psychiatric diagnosis | Aeon Essays

Wednesday with Pascal: Siberia USA!

{Pascal the existential Russian blue cat has asked to have the last word on Mental Health Awareness Month. He is, as he points out, qualified for the task.}

Since today is the last day of this year’s “Mental Health Awareness Month,” I thought it would be appropriate to recall an occasion, nigh on to seventy years ago, when patriotic Americans were able to prevent a “diabolical plan” to inflict mental health on unsuspecting citizens. ¹ Talk about dodging a bullet!

In 1956, the Alaska Mental Health Enabling Act was passed unanimously by the U.S. House of Representatives and sent to the Senate for what was expected to be uncontested approval. Alaska at that time was not yet a state but a U.S. territory, and it had no mental health facilities of its own; Alaskans needing psychiatric care were taken to Oregon instead. The proposed bill would have funded construction and operation of psychiatric facilities in Alaska; it included provisions to set aside a “land trust,” revenue from which would provide an ongoing source of funding. Crucially, the bill would also have established both medical and legal criteria for involuntary commitment, which was, at the time, a widely accepted procedure for securing treatment for recalcitrant individuals. ²

Once the bill drew public attention, concerned patriots sounded the alarm; this was, after all, the Fifties, and though Senator Joseph McCarthy had been publicly disgraced, the Red Scare he had helped create (with the help of Richard Nixon, among others) had not abated. A California “superpatriot” group calling itself the “Keep America Committee” had already, back in 1955, drawn a line in the sand on this issue, publishing a pamphlet denouncing "mental hygiene" as “part of the "unholy three" of the "Communistic World Government”. The pamphlet declared: "Mental Hygiene is a subtle and diabolical plan of the enemy to transform a free and intelligent people into a cringing horde of zombies".

Another California anti-communist group, “Minute Women of the USA,” which claimed a membership of 50,000 women nationwide, took notice of the threat posed by the Alaska Mental Health Enabling Act. In January 1956, “Minute Woman Leigh F. Burkeland of Van Nuys, California issued a bulletin protesting the bill.” The bulletin was distributed across the country. “On January 24, 1956, the Santa Ana Register newspaper reprinted Burkeland's statement under the headline, "Siberia, U.S.A." ³ The headline was an accurate reflection of Leigh Burkeland’s fears:

“Is it the purpose of H.R. 6376 to establish a concentration camp for political prisoners under the guise of treatment of mental cases? The answer, based on a study of the bill, indicates that it is entirely within the realm of possibility that we may be establishing in Alaska our own version of the Siberia slave camps run by the Russian government. This legislation will place every resident of the United States at the mercy of the whims and fancies of any person with whom they might have a disagreement, causing a charge of 'mental illness' to be placed against them, with immediate deportation to SIBERIA, U.S.A.!”

And so, the God-fearing forces of righteousness rallied “to torpedo the Alaska Mental Health Bill.”  Those forces included the notorious anti-Semite and white supremacist, Rev. Gerald L.K. Smith; a group called “Women for God and Country”; the “For America League”; right-wing agitator, conspiracist, and former FBI agent Dan Smoot; and L. Ron Hubbard’s fledgling Church of Scientology, founded only two years before.

The accusations made against the Alaska Mental Health Enabling Act were ominous. Dan Smoot told subscribers to his newsletter that the bill “fits into a sinister pattern which has been forming ever since the United Nations was organized." A Dr. George A. Snyder “sent a letter to all members of Congress in which he demanded an investigation of the Alaska Mental Health Bill's proponents for "elements of treason against the American people behind the front of the mental health program". The Keep America Committee of Los Angeles similarly called the proponents of the bill a "conspiratorial gang" that ought to be "investigated, impeached, or at least removed from office" for treason.”

Nor was the US military ignorant of the dangers facing the nation. In March 1956, “Retired brigadier general Herbert Holdridge sent a public letter to President Eisenhower, in which he called the bill "a dastardly attempt to establish a concentration camp in the Alaskan wastes". Holdridge went on:

‘This bill establishes a weapon of violence against our citizenry far more wicked than anything ever known in recorded history — far worse than the Siberian prison camps of the Tsars or the Communists, or the violence of the Spanish Inquisition. The plot of wickedness revealed in this bill fairly reeks of the evil odor of the black forces of the Jesuits who dominate the Vatican, and, through officiates in our Government, dominate our politics.’

One final example: the Daily Oklahoman printed a letter in May 1956 summarizing arguments against the bill. The letter was obviously written by an expert on mental health, Alaska, and geopolitics:

“The advocates of world government, who regard patriotism as the symptom of a diseased mind, took a step closer to their goal of compulsory asylum 'cure' for their opponents when, on January 18, the U.S. House of Representatives passed the Alaska Mental Health Act.

The Act was prepared by the U.S. Department of Justice, Department of the Interior, and the socialist-oriented Department of Health, Education, and Welfare. It closely follows the ‘Model Code’ drafted by the American Psychiatric association, which has been working with the World Health Organization, a specialized agency of the United Nations. All of you who don't want members of your family railroaded to an asylum had better start writing your senator, now.”

After discussion by slightly bewildered senators in Washington, an amended version of the Alaska Mental Health Enabling Act was passed, shepherded through by Senator Barry Goldwater (R-Arizona), who had the sections on involuntary commitment procedures removed from the bill, thus satisfying at least some of the opposition. The amended bill couldn’t satisfy everyone, of course; for instance, John Kaspar, a White Citizens’ Council leader from Tennessee, complained that “almost one hundred percent of all psychiatric therapy is Jewish and about eighty percent of psychiatrists are Jewish. One particular race is administering this particular thing [and trying] "to usurp American nationality". That argument probably did not resonate with Senator Goldwater, who, although raised Episcopalian, was of Jewish heritage.

My point in all this is that mental health has always been a contentious issue in America, entangled as it has been with eugenics on the one hand and with right-wing paranoia on the other, embroiled as it has been with disputes between medical practitioners and psychoanalysts, and plagued as it has been by controversies over psychiatry’s links to the pharmaceutical industry.

A secondary point, of course, is that a surprisingly substantial percentage of Americans seem to be—and, historically, to have been—undiagnosed lunatics whose symptoms include incoherent political opinions and a susceptibility to conspiracy theories so bizarre that they wouldn’t pass muster on a psychiatric ward—and I should know; I’ve been on several myself.

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Alaska Mental Health Enabling Act - Wikipedia

¹ My source for this article is Wikipedia. However, I first learned of the Alaska Mental Health Enabling Act from Arthur Goldwag’s 2012 book, The New Hate, about the durability (and monotonous consistency) of right-wing American populism.

² By “recalcitrant individuals,” I mean people suffering from anosognosia, a mental disorder characterized by the individual’s inability to recognize that he or she is ill. (BTW, involuntary commitment is also an increasingly popular option for dealing with the homeless mentally ill.)

³ You will recall that Siberia’s (and Russia’s) proximity to Alaska was immortalized by Sarah Palin, who claimed she could keep an eye on Putin’s shenanigans from her perch in Wasilla, Alaska. Why she failed to warn us of Putin’s 2022 invasion of Ukraine, I cannot say.

 

Three Dimensions of Wellbeing: "Self, Society, and Space"

{In all likelihood, this will be my last post this month on the topic of mental health. I'm not sure what more I have to say on the topic; besides, I have so many other axes to grind.}

In 2022, the World Health Organization released what was billed as its most comprehensive report ever on mental health. The report highlighted the alarming rise in serious mental health issues and the glaring inadequacies of our systems and modes of treatment. It concluded with three broad suggestions that, if taken seriously, would require rethinking and restructuring our entire society.

Dr. Tedros Adhanom Ghebreyesus, the WHO’s Director-General, made it all sound eminently reasonable, explaining that “Everyone’s life touches someone with a mental health condition. Good mental health translates to good physical health; the inextricable links between mental health and public health, human rights and socioeconomic development mean that transforming policy and practice in mental health can deliver real, substantive benefits for individuals, communities, and countries everywhere. Investment into mental health is an investment into a better life and future for all.”

So, what were the WHO’s three basic recommendations?

1. Deepen the value and commitment we give to mental health. For example:

Stepping up investments in mental health, not just by securing appropriate funds and human resources across health and other sectors to meet mental health needs, but also through committed leadership, pursuing evidence-based policies and practice, and establishing robust information and monitoring systems.

Including people with mental health conditions in all aspects of society and decision-making to overcome stigma and discrimination, reduce disparities and promote social justice.

2. Reshape environments that influence mental health, including homes, communities, schools, workplaces, health care services, natural environments. For example:

Intensifying engagement across sectors, including to understand the social and structural determinants of mental health and intervening in ways that reduce risks, build resilience and dismantle barriers that stop people with mental health conditions participating fully in society.

Implementing concrete actions to improve environments for mental health such as stepping up action against intimate partner violence and abuse and neglect of children and older people; enabling nurturing care for early childhood development, making available livelihood support for people with mental health conditions, introducing social and emotional learning programs while countering bullying in schools, shifting attitudes and strengthen rights in mental health care,  increasing access to green spaces, and banning highly hazardous pesticides that are associated with one fifth of all suicides in the world.

3. Strengthen mental health care by changing where, how, and by whom mental health care is delivered and received.

Building community-based networks of interconnected services that move away from custodial care in psychiatric hospitals and cover a spectrum of care and support through a combination of mental health services that are integrated in general health care; community mental health services; and services beyond the health sector.

Diversifying and scaling up care options for common mental health conditions such as depression and anxiety, which has a 5 to 1 benefit–cost ratio. Such scale-up includes adopting a task-sharing approach that expands the evidence-based care to be offered also by general health workers and community providers. It also includes using digital technologies to support guided and unguided self-help and to deliver remote care.

The necessary investment and coordination of resources envisioned in the WHO’s plan would be staggering—not to mention the shift required in public understanding of, and attitudes toward, mental illness. But will anything less suffice, and can we justify not even making the effort?

Along the lines of WHO's recommendations, an organization called “citiesRISE” is promoting and trying to create “mental health friendly cities”. According to the website:

citiesRISE aims to improve mental health and wellbeing by connecting leading mental health practitioners and community members to:

Drive change through city- and community-based alliances and initiatives that bring innovative mental health education, prevention, treatment, and recovery support to millions of people currently underserved. With their inherent connectivity, density, creativity, and entrepreneurial capacity, cities have the potential to spur countrywide action.

Adopt evidence-based strategies for tackling the most pressing problems in mental health and wellbeing — especially stigma, the incidence of suicide, shortcomings in support for young people, and the prevalence of mental health problems affecting vulnerable groups.

Scale up proven tools and approaches through helping communities learn from each other and working with innovations that bring services to where people are.

In an academic paper elaborating on the “mental health friendly cities” concept, the authors explain:

Some components of Mental Health Friendly Cities include:

• Educational institutions with programs on hope, resilience and life skills; spaces for learners to deal with psychological distress or just ‘hang out’; youth-led organizations promoting mental health; linkage to mental health clinical services;
• Urban environments that have youth gathering spaces with a variety of youth-designed activities (sports, arts, theater, peer support activities) that promote mental health; physical design that promotes physical and mental health (green open spaces, relaxation spaces and benches, pedestrian walkways, cycling lanes, safe road designs, environment-friendly building designs); youth-led organizations connected to existing systems (media, education, governance, mental health professional associations) and promoting mental health; youth-friendly mental health services and improved access to health care;
• City governance systems with youth membership of legislative and policy-making institutions; mechanism for collecting youth feedback during decision-making; adult allies working with youth-led organizations to influence policy and legislation; clear focus on youth needs and mental health underpinning all decision-making.

Traditional approaches to mental health and mental illness either focus exclusively on the individual or, at most, on the family. The recognition that mental health is a social issue, and that mental illness has social roots as well as social consequences, is critical:

This framework is based upon a conceptualization of mental health as involving nurturing three dimensions of human wellbeing; self, society, and space.

Mental health is based on an individual self which experiences a complex and unique journey, parts of which can be observed or described to others, but most of which takes place beneath the surface of day-to-day life. This self then links the emotions, thoughts, and behaviors of an individual to a vast constellation of past experiences and future aspirations. However, humans are social beings relying on others from birth (and even before) to grow strong and resilient. Society plays an essential role in the mental health and wellbeing of individuals right from infancy. All of this takes place in the space of structural and intermediary determinants of health such as housing, play space, and physical work environments.

It would be nice if some nationwide organization—the National Alliance on Mental Illness, let’s say, or Mental Health America, or the National Institute on Mental Health—were to come up with a set of rubrics for measuring the mental health of various cities, and then award the designation of “Mental-Health Friendly City” to cities that measure up. ¹

The task is daunting, but so is the prospect of continuing what we’ve been doing and expecting different results—which, as we know, is one popular definition of insanity.

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WHO highlights urgent need to transform mental health and mental health care

Home - citiesRISE (cities-rise.org)

Full article: Towards mental health friendly cities (tandfonline.com)

¹ NAMI does a “rate the state” evaluation, using standard measures (suicide rates, licensed psychiatrists per capita, number of psychiatric inpatient beds, crisis centers, accessibility of services, etc.). Broader criteria could be added: percentage and distribution of urban green space, public benches for resting, “quiet” zones, automobile-free areas (or days), active neighborhood associations, civic engagement, lighting, crime rates, quality of schools, rates of volunteering, etc.  

Wednesday with Pascal: Maps of Our Pain

{Pascal the existential Russian blue cat insists on leaping into the ongoing discussion of Gabor Mate’s ‘The Myth of Normal’. Pascal brings to the issue his usual feline sagacity and his own history of being decidedly not normal.}

Stop me if you’ve heard this one: “Neurotics build castles in the air, psychotics live in them, and psychiatrists collect the rent.” Or this one: I told my psychiatrist I’m thinking about suicide. He said from now on I’ll have to pay in advance.”

Now wait just a goldarn minute.

Aren’t we being unfair to the psychiatric profession and to mental health experts in general? How can psychiatry’s critics deny the substantial evidence that psychotropic medications work, that unruly kids calm down, and that depressed people recover their interest in life? What do those critics have against helping people feel better? Forget about, if you will (and as many clinicians do), the diagnostic categories themselves; but 50,000,000 Prozac users (more or less) can’t be wrong!

Or can they? Granting for the sake of discussion that the pills work; setting aside, for the moment, their common and undesirable side effects, both immediate and long-term; and overlooking for now the dangers of misuse and abuse of medications, of overdoses and addiction, and of withdrawal difficulties; even if you choose to frame the argument as favorably as possible to the medical approach, there remains, according to Gabor Mate, an inherent problem with it. Our overreliance on medications, he argues, not only encourages us to turn a blind eye to social and environmental factors, but it leads us to mistake symptoms for causes—because, although medications can certainly alleviate the former, that proves nothing about their relevance to the latter.

“We have to avoid the fallacy of inferring from medication’s (in some cases) observable benefits,” Mate explains, “that the proven origin of mental illness rests in the biochemistry of the brain, let alone that physiological disturbances are genetically caused. That a medication has a certain positive effect reveals nothing about the genesis of a symptom. If aspirin eases a headache, can the headache be explained by an inherited brain deficiency of acetylsalicylic acid, the pill’s active ingredient? If a shot of bourbon relaxes you, is your tense nervous system suffering from a DNA-dictated whiskey shortage?” ¹

Neurologists insist that the human brain is the most complex thing in existence; that may be a mere anthropocentric conceit, but, taken at face value, it suggests that perhaps we not jump to conclusions about how that admittedly complex organ works. After all, writes Mate, “There are numerous neurotransmitters in the brain whose complex interactions we are only now beginning to explore, not to mention the almost infinite possibilities inherent in the lifelong intersection of experience with the biology of body and brain. Once again, the physiology of the brain is a manifestation and a product of life in motion and in context.” ²

Further, as Bruce Perry writes, “The brain is a historical organ. It stores our personal narrative.” Since it does so in the form of its chemistry and its neural networks, it is no wonder that difficult experiences may result in disturbed neurobiology. Even when brain scans show certain abnormalities—as they do, for example, in many traumatized people—these do not prove that the “disorder” has a neurochemical source.

The brain is a scrapbook, a photo album, a treasure chest, and a junk drawer; things get lost, forgotten, misplaced. The recognition of “neuroplasticity”—the fact that the human brain changes and can even be intentionally changed with cognitive and behavioral (that is, non-chemical and non-surgical) techniques—complicates medical approaches to “mental illness”: are brain abnormalities the cause of mental disorders or are they the result of life experiences?

There is research that suggests the latter:

A recently published thirty-year study followed people from early life to age twenty-nine. Poor quality of care in infancy was, nearly three decades later, associated with a higher volume of the emotionally key brain structure, the hippocampus, as well as with an elevated risk for “borderline personality” features and suicidality. In other words, the brain’s genetics did not “cause” either the “illness” or the neurophysiological differences: all were the result of life experiences.

Mate cites one of my favorite recent books:

In his work Lost Connections, Johann Hari relates his own experience of devastatingly low moods, followed by his initial elation at the depression diagnosis that, at last, “explained” his disturbing mind states. “This will sound odd,” he writes, “but what I experienced at that moment was a happy jolt—like unexpectedly finding a pile of money down the back of your sofa. There is a term for feeling like this! It is a medical condition, like diabetes or irritable bowel syndrome.”

Naming is power; naming demystifies (to some extent); naming offers hope. Christian exorcists have long known the efficacy of making demons reveal their names, the better to cast them out. Sometimes, though, the demons, even after being named, don’t leave:

Hari’s first experience of medications was positive. “It was only years later,’ he relates in Lost Connections, “that somebody pointed out to me all the questions the doctor didn’t ask that day. Like: Is there any reason you might feel distressed? What’s been happening in your life? Is there anything hurting you we might want to change?” The answers would have been yeses all around: Hari was carrying both past trauma and present stress that he took to be part of his “normal.” Over time, he came to recognize that the narrow medical model that had helped him manage his symptoms was also leaving him far short of healing. He is not entirely jaded about the biological approach, but he notes with sorrow that “it has crowded out the much more common-sense insights that people have about why they become distressed and how to resolve their distress. Really— how do I put it—it’s given us an inaccurate map of our own pain.” ³

There is nothing wrong with taking pills, but medication is merely and at best a stabilizer. For anyone looking for more than that, for anyone looking to go beyond tinkering with their brain chemistry, and for anyone looking to get at the roots of “mental illness”; Rainer Maria Rilke—a poet, not a psychiatrist—said it best: “You must change your life.”

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¹ Yes, almost certainly, and it’s about time someone pointed that out.

² Consider that statement: "The brain is a manifestation and a product of a life in motion and in context.” Thank you, Dr. Gabor Mate; you have made my day.

³ And thank you, Johann Hari; yes, the brain is also, among so many other things, a “map of our pain”.

Science Marches On: Demystifying the Brain

Send in the Canaries?

{We continue our focus on Mental Health Awareness Month and on what are now called “mental health conditions” or "mental health issues," previously known as “mental health disorders,” and before that just plain old-fashioned “mental illness”. Crazy, isn’t it?}

Although he is an outspoken critic of what he considers the over-diagnosing and over-medicating of children for mental health issues, Dr. Gabor Mate (The Myth of Normal) does not have his head in the sand. He does not dismiss contemporary children’s behavioral and learning difficulties. He does not say that the kids are alright; rather, he acknowledges that “We are witnessing a sea change in children’s mental well-being.” Unfortunately, however, our medicalized mental health system is ill-equipped to navigate, much less to alleviate, that sea change: “Diagnoses,” writes Mate, “reveal nothing about the underlying events and dynamics that animate the perceptions and experiences in question. They keep our gaze trained on effects and not their myriad causes. There could be multiple reasons why a child may have trouble paying attention or be restless, disengaged, and fidgety: anxiety, stresses at home, boredom with material she finds uninteresting, resistance to the constraints of sitting in a classroom, fear of bullying, an authoritarian teacher, trauma—even birth month, believe it or not.”

Mate concludes, “The world into which kids are being born these days might as well have been designed to promote disruptions of cognitive function and emotional self-regulation.” To paraphrase Cormac McCarthy, 21^st-century American culture is no country for children, whose behaviors reflect (as they have always done) the increasingly fragmented, lonely, and dysfunctional adult world around them.

Writes Gabor Mate:

Consider the DSM-5 diagnosis of oppositional defiant disorder (ODD), often tacked on to ADHD and other “diseases.” “If your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder,” advises the Mayo Clinic. The clue is in the word “toward”: oppositionality, by definition, can arise only in the context of a relationship. I can suffer symptoms of a cold in isolation or break my ankle on my own. I cannot oppose anyone or be angry or irritable with anyone unless that “anyone” is in some relationship with me.

In other words, it takes two to tango:

Given that a child develops in the context of relationships, her behavior will be intelligible to us only if we look at the relational environment. Seen this way, these so-called ODD kids turn out to be ones who lack sufficient connection with nurturing adults and have a natural resistance to being controlled by people they do not fully trust or feel close enough to. This aversion, furthermore, is only magnified by all attempts to shame or cajole it into submission. To call this “disordered” says nothing about the child’s inner experience; it reflects only the perspective of the ones who find her recalcitrance inconvenient. It is also completely obtuse about how emotional power dynamics work: there is nothing disordered in resisting authority figures with whom, for whatever reason, we do not feel confident in and safe.

If we are today seeing more youngsters in automatic resistance mode, the question we must return to is, how does this culture disrupt healthy adult-child relationships? Why are we diagnosing children with a disorder, instead of diagnosing—and treating—their families, communities, schools, and society?

The answer is obvious: it is easier to diagnose, and to treat, “difficult” individuals, whatever their age, than to overhaul an entire culture. If x percent of children misbehave in school, it must be the children who are to blame and not the school, much less some unknown combination of social influences. Of course, today’s preferred option is to blame not the individuals themselves but their brains, their neural networks and neurochemistry, their flawed synapses, transmitters, and receptors. Put the blame on the brain, goes the conventional wisdom. Mental health professionals try to guess what's gone wrong inside our heads; meanwhile, as Bob Dylan put it, “Life outside goes on all around you.” Mate writes:

It is known beyond controversy that the greater the degree of childhood adversity, the higher the risk of mental disturbances, including psychosis. One study found that people who had suffered five types of maltreatment in childhood were multiple times more likely to be diagnosed with psychosis than those who had not experienced such traumatic events. A major review in 2018 in the Schizophrenia Bulletin concluded that the severity of childhood traumas was correlated with the intensity of delusions and hallucinations. Richard Bentall, a clinical psychologist, summed up the science a few years ago: “The evidence of a link between childhood misfortune and future psychiatric disorder is about as strong statistically as the link between smoking and lung cancer,” he wrote. “There is also now strong evidence that these kinds of experiences affect brain structure, explaining many of the abnormal neuro-imaging findings that have been reported for psychiatric patients.” This mirrored a Harvard study that concluded, “These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex.”

How can so many children of America’s affluent society have suffered “childhood adversity” and “childhood misfortune”? Is Gabor Mate trying to indict American culture as a whole? Maybe:

It is manifestly evident to many clinicians working with mental distress that overt maltreatment is not necessary to exert negative impacts on the neurobiology of the brain or the functioning of the mind. Neurobiology is a continuum, as are “mental illness” and health. Emotional injury during development can have physiological consequences, even without abuse or neglect. As Bruce Perry explains, adverse childhood experiences—of the big-ticket kind that merit the official ACE designation—are of consequence, but “not as determinative as your history in relationships. The most powerful predictor of your functioning in the present is your current relational connectedness and then the second most powerful component that we see is your history of connectedness.”

Think of our kids—kids in general, really—as canaries in our socio-cultural coal mine. If the canaries start to sicken and even to perish in droves, should we develop more ingenious medicines and mechanisms to help them survive; or should we shut down the damn coal mine?

Saturday Lecture: The Name Game

"Our inner lives are too important to leave in the hands of doctors: because they don’t know as much about us as they claim, and because a full account of human nature is beyond their ken." (Gary Greenberg)

Gary Greenberg (from The Book of Woe):

By the turn of the twentieth century, doctors were stalking disease like Sherlock Holmes stalked criminals. Under the magnification of their microscopes, syphilis, diabetes, and streptococcus, to name just a few, soon yielded their secrets and their terrifying hold on us. With their newfound ability to parse suffering, to track it down to the bodily processes causing it, and then to dispatch it with a potion or a surgery, doctors gained prestige—and with it, money and power. They were rewarded as much for their prowess in relieving suffering as for the promise they now embodied: that they could use science to give a name to someone’s suffering and then, having named it, to relieve it.

This revolution in medicine accounts in part for the immense appeal of considering craziness to be just another disease. If scientific understanding and cure were possible for the suffering of the body, then why not for the suffering of the mind? If a patient’s delusion is some kind of metaphor, if the content of his delusion brims with meaning, then it is out of reach of the microscope and the X-ray. It requires what ancient doctors offered: interpretation and the invocation of metaphysics, of something beyond the symptom. But if the delusion is only another symptom, if it is not, in principle, different from the malaise and relentless thirst of an untreated diabetic, or the narrowing of vision of a glaucoma patient, or the fever of someone with malaria, then it can be brought under the physician’s purview. It doesn’t need to be understood in itself any more than fever or thirst does. It can be explained, it can be treated, and it can be cured.

You know the lure of this promise. If you’ve watched your child descend into psychosis or your husband spin out into mania or if you have struggled to get out of the bed into which depression has laid you, you know it even better. On the other hand, if you’ve been involved with the mental health industry, then you probably also know that the promise is not always fulfilled. Even if doctors can settle on a name for an individual’s illness—and this is not a sure thing—they will not be able to scratch out a prescription, tell him to take two and call back in the morning. The person may end up taking a drug indicated for a different diagnosis, or a cocktail of pills—one to quell his hallucinations, one to temper his agitation, one to relieve his depression, and one to help him sleep—and the combination may change monthly or even weekly, or it may work for a while and then stop.

No one will be able to explain why that happened, any more than they will be able to explain why the drugs worked in the first place. No honest psychiatrist will claim that she cured anyone’s mental illness; and while she is being honest, she may acknowledge that, for the most part, her treatments are targeted at symptoms, not diseases, and that she selects those treatments as much by intuition and experience as by scientific evidence.

But psychiatry’s appeal is not just about the possibility of cure, which is why the profession continues to flourish even when it cures nothing and relieves symptoms only haphazardly. The appeal is in the naming itself. What Wallace Stevens called ‘the blessed rage to order’ is so deep in us that it is in our origin story: the first thing the Bible’s authors have Adam and Eve do to establish their dominion over Eden is to name its flora and fauna. That story doesn’t have a happy ending, but the rage itself is surely blessed, or as blessed as we humans can be, and as noble. Give a name to suffering, perhaps the most immediate reminder of our insignificance and powerlessness, and suddenly it bears the trace of the human. It becomes part of our story. It is redeemed.

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Gary Greenberg, The Book of Woe: The DSM and the Unmaking of Psychiatry (2013)

Gary Greenberg (psychologist) - Wikipedia

Is Our Psychiatrists Learning?

{Feeling it necessary to make up for the frivolous tone of Pascal the existential Russian blue cat’s recent post, I have turned to an esteemed British medical historian, the late Roy Porter, much of whose work focused on insanity and on treatment of, and treatments for, the insane.}

Roy Porter, Madness: A Brief History

As the twentieth century dawned, the British Medical Journal sounded an upbeat note: ‘In no department of medicine, perhaps, is the contrast between the knowledge and practice in 1800 and the knowledge and practice of 1900 so great as in the department that deals with insanity.’ Not so the specialist (and hence more authoritative?) Journal of Medical Science. Pointing in the very same year to the ‘apparent inefficacy of medicine in the cure of insanity, it seemed depressed: ‘Although medical science has made great advances during the nineteenth century, our knowledge of the mental functions of the brain is still comparatively obscure.’ Lancet for its part managed to look in both directions at once, claiming in an editorial in 1913 that only then, and belatedly, was ‘British psychiatry beginning to wake from its lethargy.’

At the dawn of the twenty-first century, a similar confusion of tongues may be heard regarding the psychiatric balance sheet. For some, the twentieth century brought Freud’s revelation of the true dynamics of the psyche; for others, psychoanalysis proved a sterile interlude, before neurophysiological and neurochemical understanding of the brain finally advanced and bore fruit in effective medications. Psycho-pharmaceutical developments certainly allow psychiatry itself to function better, but pacifying patients with drugs hardly seems the pinnacle of achievement and any claim as to the maturity of a science of mental disorders seem premature and contestable—witness the wholesale comings and goings of disease classifications from the Diagnostic and Statistical Manual.

The psychotropic revolution, the patients’ rights movement, and the scandal of crumbling asylums fused to launch the ‘de-carceration’ policies favored since the 1960s. The difficulties that followed are all too familiar. Controversy rages, within and beyond the psychiatric profession, about the success or failure of deinstitutionalization and community care, leading to calls (from both the profession and the public) to bring back the traditional asylum as a safe haven for the insane. ¹ In such circumstances, psychiatry itself must seem somewhat disoriented. Meanwhile, whether treatment of the mentally ill actually became more humane in a century which gassed tens of thousands of schizophrenics is a question permitting no comforting answers about rationality and sanity.

Once under siege from anti-psychiatry (a la Laing), the discipline has undoubtedly weathered that storm. But it still lacks the cognitive and professional unity enjoyed by general medicine and remains torn between bio-psycho-social medical models both of its object and of its therapeutic strategies.

Meanwhile, partly because of the proliferation of psychiatric options, more people are said to be suffering—indeed, claiming to be suffering—from a proliferation of psychiatric syndromes, in a ‘victim culture’ in which benefits may appear to lie in buying into psychiatric paradigms. More people than ever swallow the medications, and perhaps even the theories, which psychiatry prescribes, and attend various sorts of therapists, as the idioms of the psychological and the psychiatric replace Christianity and humanism as the ways of making sense of self—to oneself, one’s peers, and the authorities. Yet public confidence in the psychiatric profession is low, as is evident from the ubiquitously distrustful images in the arts and reports in the popular press. ^{2 / 3}

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Roy Porter - Wikipedia

¹ As Roy Porter certainly knew, asylums were never “safe havens” for anyone.

² To be fair, public confidence in every profession is low. It’s almost as if scoop-hungry mass media, scandalmongers and rumormongers, ideological spin doctors, and internet conspiracists have conspired to make us into a nation of cynics. On the other hand, old adages like “Caveat emptor” and “In God we trust; all others pay cash” suggest that cynicism has a long history.

³ I recognize that--allowing for differences in tone, felicity of expression, and levels of education and of authority--Roy Porter’s conclusions (published in 2002) are alarmingly similar to those of Pascal the existential Russian blue cat.

Wednesday with Pascal:

{Pascal the existential Russian blue cat could not find the correct tone for today’s post about mental health/mental illness. Still, today is his turn to blog, and he will not relinquish it. I will therefore apologize on Pascal’s behalf if the following does not seem suitable to the subject matter. What, after all, can you expect from a cat?}

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“When it comes to mental health, you could say my family had issues—actually, it was more like a lifetime subscription.” (Overheard at a NAMI presentation)

I have been doing research into the subject of mental illness, from which 50% of Americans suffer directly and the other 50% suffer indirectly. Mental illness is so prevalent and so prominent in America today that, considering the state of our governments and our courts, it is no exaggeration to say that the inmates are running the national asylum, or at least the ward that contains the Republican Party.

As I say, I have done some research, and I have learned some things. For instance, I have learned that nine out of ten mental health professionals agree: Most mental illnesses don’t have just one single cause. The subject is very complicated.

There are lots of factors which contribute to mental illness, including genetics, family environment, poverty, poor nutrition, overprotective moms, neglectful dads, stressful events, loss of a loved one, exposure to violence, reading comic books, playing violent video games, masturbating, social media, and demons, to name just a few. You name it—if it’s something that happens to human beings, it probably drives at least some of them crazy. The main risk factors for mental illness amount to (a) being alive and (b) having a brain.

On the other hand: It’s plain ‘insane’ is mainly in the brain.¹

Somewhere in the complex tangle of neurotransmitters and receptors, and in the balance of neurochemicals like dopamine and serotonin, lies both sanity and madness. Not that psychiatrists measure the levels of such chemicals in patients’ brains, before or after treatment; nor do they monitor the functioning of neurotransmitters and receptors. Such measures are either unavailable or insanely expensive. Instead, subjective reports and observations of thoughts, feelings, and behaviors (including speech) are assumed to have objective neurological causes that would be revealed by brain scans, functional MRIs, and neurochemical dipsticks (Yep, just as I thought—your serotonin’s a quart low), should such things ever be available. In the meantime, brain research is a multi-billion-dollar industry: no research grant is left behind.

For all that: Mental illness is perfectly normal.

It’s so normal that almost everybody has it at some point in their life, even if it’s never diagnosed. In fact, the single most common mental illness is something called ‘anosognosia,’ which means that you’re insane, but you don’t know it. Hey, wait, you protest, I don’t have a mental illness, but of course that’s what someone afflicted with anosognosia would say. Anyway, mental illness is just like heart disease or diabetes, except those latter diseases can be caused by irresponsible lifestyle, overwork, poor diet, etc., while mental illness, as we have seen, is nobody’s fault, unless it stems from Adverse Childhood Experiences, trauma, or from being hit in the head by a baseball deliberately aimed at you by an oversized Little Leaguer who didn’t like the way you were crowding the plate.

So, it’s mostly no one’s fault, but still: One of the major risk factors for mental illness is you.

Let’s face it: if you don’t eat right, don’t exercise, don’t have good sleep habits, isolate yourself, dwell on the negative, bombard yourself with critical self-talk, belittle yourself, blame others for your problems, abuse drugs or alcohol, stop going to church, spend all your time staring at screens, reading comic books, or listening to heavy metal—you can’t very well expect not to go crazy, can you? Conversely, if you make your bed, clean up your room, put your house in order, follow the rules, work hard, pray to some Power even higher than yourself, show up on time, salute the flag, bend the knee, speak when spoken to, keep your head down, respect authority, stop whining, keep a clean nose, watch the plainclothes, stay away from those who carry around a fire hose—well, that’s a formula for mental health if I ever heard one!

None of this is intended to take lightly the subject of mental illness. Rather, I only want to suggest, since this is Mental Health Awareness Month, that (a) even the experts don’t know how to define mental illness; (b) even the experts don’t know what causes mental illness; and (c) even the experts don’t know what to do about mental illness. Those three considerations, taken either separately or together, do not augur well for the future of our mental health system.

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¹ Lerner and Loewe: “The rain in Spain stays mainly in the plain.”

Mental illness: it's all in your head.

Sunday Sermon: The Demonic Factor

{“Mental illness is not funny,” Philip Dick noted somberly in one of his novels. At the same time, explanations for mental disorders are frequently hilarious. In the following excerpt, Rodger Bufford, a Christian psychiatrist, discusses Satan’s role in madness, while dodging the obvious question: what would psychiatry have to say about a patient who claims to be the Son of God and who tells his followers to eat his flesh and drink his blood?}

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“Demonic influence and mental disorders are conceptually distinct phenomena, but in view of the extensive overlap among symptoms, it may be difficult in a given instance to make a firm conclusion regarding which phenomenon is present.” (Rodger Bufford)

Rodger Bufford, from “Demonic Influence and Mental Disorders” (1988):

Demon possession was a widely accepted explanation for disturbed behavior from antiquity through the middle of the nineteenth century. The scientific revolution and the adoption of naturalistic reductionism around the close of the nineteenth century left no room for the supernatural or spiritual. Consequently, what had formerly been viewed as demonic influence became "nothing but" mental illness or mental disorders.

In exploring the relationship between demonic influences and mental disorders, we must remember that the question is not whether Satan is involved in mental disorders; rather, it is a question of how he is involved. Mental disorders, like any other human malady, came with the Fall and the entrance of sin into the world. All human suffering can be traced, in part, to that momentous event. Satan's role in the Fall, and thus in all earthly ill, must be acknowledged. Discerning the means of his involvement in mental disorders is the issue at hand.

Historically, the predominant view has been that demon possession and mental disorders are alternative explanations of the same phenomena. We need first to ask whether, on the basis of their respective symptoms alone, we can tell the difference between demon possession and mental illness. As we examine the relationship of demonic influence and possession to mental disorders, it is important to keep in mind several considerations. The first consideration must be that of distinguishing among spiritual, psychological, and physical problems.

Second, given our assumption that mental disorders and demon possession both occur, we must realize that a given person may show any of the following conditions: 1) physical disorder alone; 2) demon possession alone; 3) mental disorder alone; 4) a combination of physical disorder, demon possession, and mental disorder. Demon possession is understood to be a spiritual problem, while a mental disorder is a psychological problem.

Third, it is important to remember that Satan was involved in the entrance of sin into our world, and thus in the many changes that resulted. Whether the problem is spiritual, psychological, physical, or a combination of these, Satan is nonetheless involved.

Even in the time of Christ there appears to have been confusion regarding the distinctions between mental illness and demonic influence (and these were both confused with signs of the power of God). [Donald] Bloesch proposes a distinction in terms of the mind and the will. Examination of mental disorders suggests that in some mental disorders the will may be affected; examples include severe depression and perhaps alcoholism and drug dependence. In other mental disorders the primary disturbance is one of affect or emotion, as in the major affective disorders, and most neurotic disorders. In practice, however, people function as wholes, with a continuous interplay among mind, will and emotions in a manner that makes it impossible to sustain the functional distinction required by Bloesch's formulation.

In practical terms we must observe the person who shows disturbed behavior and determine whether or not a demon is present. Demons do not readily reveal their presence for analysis and treatment; if we knew beforehand that the person had a demon, then there would be no difficulty in distinguishing demonic influence from mental disorders. Comparison of the two conditions reveals that virtually all the symptoms associated with demonic influence are duplicated in at least one mental disorder as defined by DSM-111-R.¹ Supernatural knowledge is often claimed by individuals with the hallucinations and delusions of psychotic disorders, especially paranoid schizophrenics. Exploits of unusual strength and endurance may be observed in manic episodes and in catatonic conditions (where normal fatigue reactions seem to be absent). Nakedness or deterioration of dress and appearance is common in [those with] psychotic disorders, especially schizophrenia.

Speaking in a different voice, and even the appearance of two or more distinct personalities are classified as Dissociative Disorders (e.g., Multiple Personality Disorder). Bizarre behavior is characteristic of all the psychotic conditions. Finally, violent behavior is found in certain psychotic conditions, especially Delusional (paranoid) Disorder, as well as in Intermittent Explosive Disorder, Antisocial Personality, and Conduct Disorders of Childhood and Adolescence. Those who are demon-possessed sometimes admit that fact. Claims to be demon-possessed are specifically included as a consideration in the diagnosis of Multiple Personality Disorder. Finally, persons who are demon-possessed often show involvement in occult practices; while this activity is not a defining symptom for any specific mental disorder, it seems likely that it could be observed in persons diagnosed with a number of disorders. ²

In general, it seems safe to presume that demonic influence is relatively independent of biological causes. If this is true, it follows that as evidence of organic cause increases, the likelihood of demonic influence as an explanation for behavioral disturbance is correspondingly decreased. It is noteworthy that those mental disorders that are characterized by the most prominent disturbances of thought and behavior are also the conditions to which biological factors have been most strongly linked. This suggests that psychotic manifestations—mental disorders in which disturbed religious ideation is quite common—are unlikely to be the result of demonic influence because of the high probability of organic causes such as senile dementia. Thus, the deranged person who claims to be Jesus Christ, Napoleon, or Satan is more likely to have a severe organic brain disorder or schizophrenic disorder than a demon.

Two important cautionary notes must be sounded here. First, because all aspects of the person interact, it is possible that malfunction in one of them may result in greater vulnerability to stressors that could interfere with functioning in other dimensions. Just as a physical illness makes a person more prone to depression, depression may make a person more likely to become demonically influenced. The fact that one problem leads to another does not negate the value of distinguishing among the conditions, both for conceptualization and treatment. Second, we have seen that Satan is able to produce even physical disorders, as well as physical healings. Thus, while the presence of physical factors often makes the probability of demon possession seem less likely, it cannot clearly rule out the demonic factor.

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Demonic Influence and Mental Disorders - Chapter 8 of "Counseling and the Demonic" (georgefox.edu)

¹ “DSM III-r” refers to the Diagnostic and Statistical Manual, often known as “the psychiatrists’ Bible,” possibly because psychiatrists, when dealing with especially difficult patients, will sometimes thrust the DSM at them while chanting “The power of psychiatry compels you! In the name of Freud, Jung, and all the saints, I command you!”   

² Can a demon-possessed person who has been dispossessed by means of an exorcism subsequently be repossessed?

“Does your head sometimes slowly rotate 360 degrees on your neck while you hover three feet above your bed? You might have a demon!”

Saturday Lecture: Framing Mental Illness

“We don’t understand any major mental disorder biologically.” (Anne Harrington)

Gabor Mate (from The Myth of Normal):

While mental ailments certainly exhibit some features of illness—the brain seeming to function like a disordered organ —mainstream psychiatry takes the biological emphasis too far, reducing everything mostly to an imbalance of DNA-dictated brain chemicals. Psychiatrist Kay Redfield Jamison, one of today’s most eloquent authors on manic-depressive illness, also known as bipolar disorder, wrote the memoir Unquiet Mind. This book is essential reading for anyone wanting to appreciate the experience of an exquisite consciousness oscillating from episodes of hyper-elation to immobilizing despair. And yet, embedded in Dr. Jamison’s gorgeously rendered recollections are faulty assumptions that exemplify the simplistic genetic narrative to which psychiatry still clings. Here she recalls a manic episode: “My mind was flying high that day, courtesy of whatever witches’ brew of neurotransmitters God had programmed into my genes.” In truth, neither God nor genes have much to do with it.

In her Touched with Fire, an equally poignant book, Jamison puts it more explicitly, asserting that “the genetic basis for manic-depressive illness is especially compelling, indeed almost incontrovertible.” Twenty-five years on, we know that the hard, scientific evidence is not only not compelling; it is nearly nonexistent.

The term “mental illness,’ even as it describes real phenomena, focuses our attention centrally on brain physiology, analogous to how, say, anginal pain connotes a restriction of oxygen supply to the heart muscle, owing to narrowed cardiac arteries. It also implies that the problem necessarily falls within the domain of medicine. Despite whatever partial truths they contain, these assumptions are highly questionable and limit our understanding. Worse, they generate harm, both in the sense that they leave many people subjected to inappropriate treatments and in that they displace perspectives that could be far more complete, humane, and helpful.

In its predominantly biological approach, psychiatry commits the same error as other medical specialties: it takes complex processes intricately bound with life experience and emotional development, slaps the “disease” label on them, and calls it a day.

Little in the training of doctors prepares them to wonder about their patients’ lived experience, much less to seek the sources of their malaises therein. Simplistic explanations, which require little time or emotional energy, are an attractive fallback position. Many doctors are intensely uncomfortable facing their own hidden sorrows and wounds—what Carl Jung called our shadow side. And not only doctors: as a well-known colleague told me, “Patients play into this as well. They don’t want to look at their lives, either. It would involve getting into recovery, changing something. It’s enormous work to recover from our childhoods.”

The gospel of genetic causation shields us from having to confront our hurts, leaving us all the more at their mercy. If anything, this limitation is especially calamitous in the realm of mental suffering, and even less justified. Unlike in cancer or rheumatoid arthritis, no physical findings, blood tests, biopsies, radiographs, or scans can either support or rule out psychiatric diagnoses. That statement may surprise many readers, so it bears repeating. There are no measurable physical markers of mental illness other than the subjective person’s description (of their own mood, say) and the behavioral (sleep patterns, appetite, etc.).

Like all concepts, mental illness is a construct—a particular frame we have developed to understand a phenomenon and explain what we observe. It may be valid in some respects and erroneous in others; it most definitely isn’t objective. Unchecked, it becomes an all-encompassing lens through which we perceive and interpret. Such a way of seeing can say as much about the biases and values of the culture that gives rise to it as about the phenomenon being seen, whether a religious concept like “sinful” or a biomedical one like “mentally ill.”

Other than modern culture’s typical, left-brain materialist bent, how did we arrive at this view of mental illness as an essentially biologically rooted phenomenon? In part, it seems to be a holdover from a once tantalizing aspiration in medical science, a mission unaccomplished. “Psychiatry today stands on the threshold of becoming an exact science, as precise and quantifiable as molecular genetics,” wrote the journalist Jon Franklin in 1984. As with the ultimately unfulfilled promise of the genomic revolution to explain health and illness, the initial enthusiasm for the prospect of a science-based psychiatry was virtually unbounded. Nearly forty years later we are no closer to crossing this imagined threshold; if anything, we are further away.

When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published by the American Psychiatric Association in 2013, Dr. David Kupfer, head of the task force responsible for it, acknowledged as much. “In the future,” he stated in a press release, “we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

A diagnosis like ADHD or depression or bipolar illness explains nothing. No diagnosis ever does. Diagnoses are abstractions, or summaries: sometimes helpful, always incomplete. They are professional shorthand for describing constellations of symptoms a person may report, or of other people’s observations of someone’s behavior patterns, thoughts, and emotions. For the individual in question, a diagnosis may seem to account for and validate a lifetime of experiences previously too diffuse or nebulous to put one’s finger on. That can be a first and positive step toward healing.

The dead end comes when we assume or believe that the diagnosis equals an explanation—an especially futile view when it comes to illnesses of something as inherently abstract as the mind. As the British psychologist Lucy Johnstone said, “In physical illness you have, in principle, a way of checking it out. You can say, ‘Let’s look at the blood test or the enzyme levels.’ And you could, in most cases, confirm or disconfirm it. But in psychiatry, it’s simply a circular argument, isn’t it? Why does this person have mood swings? Because they have bipolar disorder. How do you know they have bipolar disorder? Because they have mood swings.”

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Gabor Maté - Wikipedia

Mental Health: Is There an App for That?