Asking 'What happened?' instead of 'What's wrong?'

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This past January, I had the privilege of leading a group of eager and interesting young people through a critical analysis of two very different ways of thinking about mental illness in a First Year Seminar titled "Darwin, Drugs, and the Divine: Scientific and Religious Approaches to Mental Health." These two ways of thinking about mental illness are summed up nicely by psychiatrist Elio Frattaroli in his book "Healing the Soul in the Age of the Brain." When faced with a person struggling emotionally, Frattaroli says we can ask one of two questions: either "What is wrong with this person?" or "What happened to this person?"

When we ask "What's wrong?" we are thinking squarely within the boundaries of what Frattaroli calls The Medical Model of mental illness. The Medical Model is the current reigning paradigm that drives the majority of mental illness treatment as it is practiced in America. The Medical Model is based on the assumption that mental illnesses are primarily biological disorders caused by chemical imbalances in the brain. A person who is anxious or depressed has something physically wrong with them that must be corrected. And the best way to correct a chemical imbalance is to alter that imbalance with the use of medication. Thus, mental illness is treated in much the same way as physical illness.

But Frattaroli suggests we can approach the issue of mental illness differently by asking "What happened?" instead of "What's wrong?" This model assumes that anxiety and depression are responses to life experiences. In fact, Frattaroli would argue that anxiety and depression could be understood as a healthy response to an unhealthy situation. Treatment then would consist of trying to help a person understand what it is in their life situation that is making them anxious or depressed—to find the meaning and message of their symptoms so they can make positive life changes in order to relieve the emotional distress. This could be called a psychodynamic model.

These two ways of viewing mental illness could not be more different. One views mental illness as an unhealthy disease state needing to be cured. The other as the healthy response of a self-correcting psyche. Which approach is the right one? People will disagree, but Frattaroli sides primarily with the latter, as would I. These two models of mental illness are deeply rooted in fundamental philosophical perspectives, the Medical Model being deeply rooted in the materialistic premise that subjective conscious experience is the side effect of neurochemical processes occurring in a material brain. If our subjective experience is disturbed in some way, it must be caused by some type of physical disturbance in the brain. This materialistic view dominates today in fields like neuroscience, psychiatry and evolutionary psychology.

In the psychodynamic model, subjective conscious experience is treated as having its own reality not entirely reducible to underlying physical processes. Conscious awareness, which by definition is immaterial, is treated as a real feature of the universe, thus challenging the hegemony of materialist philosophy. In a religious sense, conscious awareness might be viewed as a manifestation of an immaterial soul.

While people will continue to debate these fundamental philosophical premises, it is important to realize that the common perception that science has proven the truth of materialist philosophy is unfounded. Materialism is a philosophical premise, not an empirical fact. And if so, the Medical Model of mental illness could be based on a faulty paradigm, a situation that has the potential to do great harm to large numbers of people.

We know now that there is no scientific evidence supporting the chemical imbalance theory of mental illness. Depressed people do not have lower levels of serotonin in their brains than non-depressed people. This is a myth perpetuated by a psychiatric industry trying to establish itself as a legitimate medical specialty along with a pharmaceutical industry trying to increase profits through the sale of psychotropic drugs. The modern psycho-pharmaceutical revolution was initiated in 1988 with the marketing of Prozac, but rates of depression and anxiety have only increased over the last 30 years despite the fact that anti-depressants are among the most widely prescribed drugs in America. Even clinical trials show that anti-depressants fail to outperform placebos in many instances. Fortunately, people like Robert Whitaker with books like Anatomy of an Epidemic and Psychiatry under the Influence are pulling back the veil on this tragic societal myth.

With rates of anxiety and depression at near epidemic levels on college campuses, it may be time to stop focusing so much on what is wrong with these young people and begin to ask what has happened to them. What aspects of modern life are driving them to anxiety and depression and how could these be changed? As my colleague Tabita Green argues so eloquently in her book "Her Lost Year," why don't we begin to focus on mental illness prevention, not solely on intervention? If we truly care about the emotional suffering of our children and young adults, we need to listen to the messages encoded in their pain and resist the temptation to simply medicate it away.

There is nothing inherently wrong with the emotionally suffering students who populate our college campuses. But there is much that is wrong with the society in which they are forced to live. Let us not become so enamored with a materialistic approach to the world that we fail to pay attention to the spiritual cries of our children and youth.

Robert F. Shedinger

Robert F. Shedinger

Robert Shedinger is a professor of religion at Luther College. He is the author of several books, including the 2015 "Jesus and Jihad," "Was Jesus a Muslim?: Questioning Categories in the Study of Religion" and "Radically Open: Transcending Religious Identity in an Age of Anxiety."

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Comments

  • February 29 2016 at 8:45 pm
    Jerry Johnson
    Well written and on target. If memory serves, Joseph Heller was telling the world 55 years ago, with the publication of his novel “Catch 22,” that in a world gone mad, there is no objective measure of sane vs, insane. A society that values material wealth above all else is a world gone mad. Are anxiety and depression mental illness in this society? Or are they are rational responses of people who perceive (consciously or subconsciously) that they are being forced to do mad, mad things in a mad, mad world. What happened to you? Dehumanizing things, every day.
  • March 1 2016 at 2:58 am
    Bryan Jordan
    Bob, Thanks for writing this! It's brilliant. Deserves publication and further development in a more popularized forum or comemrcial medium. Also, Jerry's above comment is frighteningly insightful.
  • March 1 2016 at 10:15 am
    Bob Shedinger

    Thanks for your comments, Jerry and Bryan.

    As long as we can locate mental illness within the person suffering, we don't have to take responsibility for the larger social context that might be the real cause. 

  • March 3 2016 at 2:36 pm
    Evelyn Norwood

    I can appreciate the intent behind this article -- to draw attention to the concept of how environmental factors feed into a person's mental state, and to talk about the need to do more than prescribe a single medication and call a person "fixed." (Which, as a future healthcare provider, I should mention is not actually how mental illness is treated, but that's a secondary concern at the moment.)

    But it asserts that mental illnesses like anxiety or depression are a "healthy response to an unhealthy situation." That is a gross oversimplification.

    Mental illness isn't rational. It isn't logical. It isn't healthy. In the experiences of those who have depression and anxiety, it isn't healthy to feel nothing, to feel shut down inside, to have nothing but a soul-sucking emptiness inside yourself. It isn't healthy to be stuck in an endless downward spiral of grief, to start crying for no reason when seconds ago you felt completely happy. It isn't healthy to be paralyzingly afraid of outside judgement or social interaction or making phone calls. That just describes two kinds of mental illness -- it doesn't even get into the many ways that different kinds of mental illnesses can manifest.

    Asking someone with mental illness "what happened" isn't enough. It just barely scratches the surface of the complicated nature of mental illness, of how sometimes brains just don't respond properly and send the right signals, regardless of whatever may be happening in someone's life. Concluding that all mental illnesses must not be based on irregular brain activity and thus nobody needs medications all based on one editorial is dismissive of the experiences and needs of mentally ill people. (I assume the article is referring to David Healy's work in the BMJ when it talks about depression and serotonin, though it's not cited, and if it is, this link may be of interest, since the topic is not nearly as simple as presented: http://goo.gl/56iRnM)

    If we are to advocate "paying attention to the spiritual cries of our youth," then we must also advocate listening, and closely, to what people with mental illness have to say. Respecting the individual's search for a way to overcome their suffering means listening both to those for whom medication does not work and those for whom it does. This approach ignores the latter voices and would let them suffer in silence.

  • March 3 2016 at 4:28 pm
    Bob Shedinger

    Thanks for your very thoughtful response, Evelyn. I know how hard it can be to think of the unspeakably difficult experience of anxiety and depression as in any way "healthy." I do not come at this topic from a purely academic perspective but from that of a sufferer myself who ran the gamut of the mental healthcare industry only to find relief when a psycho-dynamically trained therapist helped me see that my symptoms could be understood as a guide to my healing, not as symptoms of an illness (see my book Radically Open for more details). Of course as I say in the blog post, the idea that anxiety and depression can be understood as a "healthy response" is not mine, but comes from Elio Frattaroli, a psychiatrist with many years of working with patients under his belt.

    Your comment that "sometimes brains don't respond properly and send the right signals" is an interesting one. This idea is based on a basic philosophical presupposition that our subjective experiences are caused by brain function, but there are good reasons to question whether this presupposition is correct. It is the presupposition that forms the foundation of modern medical science, but that by itself does not necessarily make it right. We do need to pay more attention to the ways that science is influenced by networks of political and economic interest to make sure what we take as truth is really true, and not something that someone has a vested interest in convincing us is true.

    Again, thanks for taking the time to share your thoughts, which challenge me to keep reviewing my own.

  • March 23 2016 at 6:10 am
    John Campbell
    Hi Robert the best ways to prevent mental illness, e.g. depression, are (a) parent well), and (b) use CBT pre-emptively (http://www.sciencedirect.com/science/article/pii/S027273580900049X). Sadly the need to prevent grows; e.g. http://www.lfpress.com/2016/03/08/western-university-students-waiting-weeks-to-see-a-psychiatrist Maybe Luther College could lead. Best wishes John https://sites.google.com/site/mentalhealththinking/

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