How is mental illness defined? What causes mental illness? How can a person be healed? Answering these questions will be influenced by our answer to the question of what a person is. Returning to the stratification of reality resulting from emergence, we see that there are social, psychological, neurological, physiological, and genetic dimensions to a person. To illustrate the complexity, I now take a brief tour of different university departments to get their unique perspective on mental health. Each represents a different tradition.
Biomedicine
The biomedical model for mental illness is based on the idea that brains are machines involving physical and chemical processes. Mental illness occurs when these processes do not function normally. Over the past few decades, brain imaging techniques have shown differences between the brains of healthy patients and those with mental illnesses such as depression, schizophrenia, and bipolar disorder. The best course of treatment is deemed to be drugs that target the parts of the brain or processes that are dysfunctional. Sometimes, physical interventions such as electrical shock therapies or surgeries are advocated. This biomedical model was embraced and promoted by most psychiatrists until relatively recently.
Antidepressant drugs have been widely prescribed, and now there are many studies examining their effectiveness, side effects, and biochemical mechanisms. I mention three scientific problems. First, there is a large placebo effect. This is found in studies where two groups of patients are told they are receiving an antidepressant drug. One group receive the actual drug, and the second group receives a placebo, a pill that, unknown to them, does not contain the drug. The proportion of patients reporting a significant improvement in mental health was about 25% for taking the actual drug compared to 10% for those taking the placebo. In other words, it seems that believing one will get better can lead to significant improvements in mental health.
Second, there is a large variation between patients concerning how effective the drugs are. Patients’ perceptions of change in their mental health range from getting slight worse to no change to large improvements. Third, the biochemical mechanism of the drugs has become controversial. When the class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs) were introduced, psychiatrists were confident that they knew how they work. Depressed patients lacked serotonin. SSRIs blocked the reuptake of serotonin into neurons, increasing the levels of this neurotransmitter in the synaptic cleft. However, a recent meta-analysis concluded as follows.
“The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration.”
In her book, Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness, Anne Harrington, a historian of science at Harvard, commented.
“Today one is hard-pressed to find anyone knowledgeable who believes that the so-called biological revolution of the 1980’s made good on most or even any of its therapeutic and scientific promises. It is now increasingly clear to the general public that it overreached, overpromised, overdiagnosed, overmedicated and compromised its principles.”
Psychiatry is a tradition, for better or worse. Its proponents persist in their faith that the biomedical model has the best answers to mental illness, even though the evidence for this belief is ambiguous. Science can involve faith.
The stakes are high. If a patient takes medication, they may get better, worse, or experience no change. If they don’t take medication, they risk missing out on healing.
Psychology
Psychologists present a multitude of theories of and treatment plans for mental illnesses. The focus is not on biology but on mental processes. Some focus on the subconscious and others on thoughts we are aware of and can articulate. Some focus on current life experience and thinking patterns, whilst others delve into the past, including unresolved childhood conflict or trauma. Sigmund Freud, the founder of psychoanalysis, claimed that depression was due to aggression toward the self. A century later, there is no empirical evidence to support his claim. Other psychologists claim depression is predominantly a loss of hope. Opinion is divided about the best method of psychotherapy, where a patient has regular sessions with a trained professional to address unhelpful thoughts, emotions, and behaviours. Names for different methods include Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), Psychodynamic Therapy, Humanistic Therapy, and Acceptance and Commitment Therapy (ACT). This diversity of perspectives and treatments highlights the level of scientific uncertainty about both causes and treatment.
I now mention three developments that are receiving increasing attention in psychology research and have a transcendent dimension.
Mindfulness practices. These involve training patients to focus their “attention on the present moment—thoughts, feelings, sensations, and environment—with an attitude of openness, curiosity, and non-judgment. It involves observing experiences directly, rather than overthinking or reacting impulsively. Key elements include breathing techniques, meditation, and bringing awareness to daily activities.” (Google AI overview).
Forgiveness. The American Psychological Association offers a continuing education article that cites studies showing that practising forgiveness can improve mental health.
Awe and wonder. Dacher Keltner has made extensive studies of the experience of awe and recounted them in a popular book. In a recent article with Maria Monroy, they: “review recent advances in the scientific study of awe, an emotion often considered ineffable and beyond measurement. Awe engages five processes—shifts in neurophysiology, a diminished focus on the self, increased prosocial relationality, greater social integration, and a heightened sense of meaning—that benefit well-being. We then apply this model to illuminate how experiences of awe that arise in nature, spirituality, music, collective movement, and psychedelics strengthen the mind and body.”
Integrated medicine
The past few decades have seen the rise of integrated medicine, which promotes the view that many diseases, both physical and mental, are best treated by a holistic approach that combines treatments from different specialists. For mental health, it proposes that treatments might include not just drug and talking therapies but also address lifestyle issues. This means considering the role of sleep, exercise, diet, stress reduction, connection to nature, and screen time. With regard to diet, this builds on recent research showing deep connections between what goes on in the gut and the brain. Perhaps this is not surprising because our brains are not disembodied. They are part of our bodies and are connected to our whole nervous system.
Sociology
Sociologists have investigated how mental illness can arise from social isolation. Emile Durkheim (1858-1917) was one of the founders of sociology. His book, Suicide: A Study in Sociology was published in 1897 and pioneered the scientific study of social phenomena. He proposed that suicide comes in four types, being distinguished by the level of imbalance of two social forces: social integration and moral regulation. Based on a detailed analysis of statistical data, Durkheim concluded that suicide was more likely in men than women, for single people than those who are married, for people without children than people with children, among Protestants than Catholics and Jews, among soldiers than civilians, and in times of peace than in times of war.
Since Durkheim, many more sociological studies suggest that social isolation and a lack of meaningful relationships can be a major contributing factor to depression. Some of this research has been reviewed in a popular book, Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions by Johann Hari. He was motivated by his own experience of being prescribed and taking antidepressants for many years without consideration of how his social isolation might be a contributing factor.
This short survey of the perspective on mental illness from a range of scientific disciplines illustrates the complexity of the issue, the multifaceted nature of reality, and scientific uncertainty.
Naturally, this survey of different scientific perspectives raises questions about my own experience. Why did the antidepressant drugs seem to work sometimes and not others? Did I experience a placebo effect? Why was mindfulness helpful to me two decades ago but not more recently? What was the role of stress, childhood experiences, social isolation, personal pride, or introversion in creating my mental illness? I simply don’t know the answers to these questions and don’t think I ever will. What does matter is that, somehow at different times, I did experience degrees of healing that allowed me to function, albeit sometimes at diminished levels. Regardless of which traditions you choose to guide your journey and whatever choices you make, trust (faith) is involved.
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