Resisting the Medicalization of Mental Illness

Back in December, a reporter for the Luther College Chips published an article bearing the title “A Look at Mental Illness.” Its purpose was to remind us that people with clinical depression are not crazy, but rather suffer from a biological illness, like cancer or diabetes. The reporter cites a statement from the website of the Stanford University School of Medicine declaring that “major depression is caused by an imbalance of certain neurotransmitters in the brain, such as serotonin, norepinephrine, and dopamine.” This Chips reporter accurately characterized the current orthodoxy of the mental health establishment, that emotional disorders like depression and anxiety are primarily caused by physical factors—what psychiatrist Elio Frattaroli has dubbed “the medical model” of mental illness. But is this the last word on the cause of our emotional miseries?

A growing number of mental health professionals are beginning to raise critical questions about the efficacy of this “medical model.” Elio Frattaroli himself has written Healing the Soul in the Age of the Brain to push back against the tendency to reduce the very human experience of deep emotional and spiritual crisis to the level of physical causation. Psychologist Gary Greenberg has written Manufacturing Depression and The Book of Woe, the latter a fascinating account of how the diagnostic categories making up the Diagnostic and Statistical Manual of Mental Illness (DSM) are the constantly shifting constructions of a psychiatric industry that is itself riven by ideological warfare so severe that the categories of the DSM begin to look almost ad hoc in nature. Even Dr. Thomas R. Insel, head of the National Institute of Mental Health, has pronounced the DSM  “not scientifically valid.” But perhaps the most damning indictment of the “medical model” has come from the pen of Robert Whitaker, who in 2010 released Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.

Whitaker set out to solve a puzzling enigma. Since the appearance of the antidepressant Prozac in 1988, an event which ushered in what he calls a psycho-pharmacological revolution, rates of mental illness have soared to near epidemic levels. Why is this? Shouldn’t a revolution in drug therapy lead to a reduction in the rates of mental illness? According to Whitaker’s research, no good scientific evidence exists showing that depressed people have lower levels of serotonin in their brains. He believes this is a myth perpetuated by the psychiatric establishment working in coordination with a pharmaceutical industry desiring to open up ever larger markets for the sale of psychotropic medications. According to Whitaker, the brain chemistry of depressed people is actually quite normal. But the medications designed to boost levels of serotonin (selective serotonin reuptake inhibitors [SSRIs] like Prozac and Paxil) actually create chemical imbalances that may make people more anxious and depressed in the long run. Hence, the rise in mental illness parallels the increasing use of medications.

This is a truly disturbing indictment, and not surprisingly many have simply dismissed Whitaker as an uninformed investigative reporter who fails to understand the science of the brain. But in 2008, even the venerable New England Journal of Medicine published an analysis of the clinical trials literature for a dozen popular antidepressants. Their conclusion? These clinical trials are presented in an intentionally misleading way by emphasizing positive results while ignoring negative ones. The fact is that antidepressants fail to outperform placebos in many clinical trials. SSRIs are not the wonder drugs the pharmaceutical industry would like you to believe they are.

But there is a deeper issue here. The “medical model” of mental illness rests on the philosophical foundation of scientific materialism. In this view, the human body is just a complex biochemical machine, and the experience of psychic depth is simply the side effect of enormously complex neural circuitry operating in a material brain. It is becoming harder and harder for modern people—even supposedly deeply religious people—to truly believe in the existence of an immaterial spiritual reality to which our psyches might be connected in their infinite depths. And someone who did believe the latter, like Carl Jung, is simply dismissed as a purveyor of superstitious poppycock. But what if Jung was right?

The philosophy of scientific materialism cannot itself be scientifically proven, and science itself rather than dispelling mystery has only served to sharpen the mysteries of the vast universe that surrounds us. The possibility of the existence of some kind of immaterial spiritual reality cannot be discounted, and its embrace may be a better solution to our mental woes. Do our epidemic levels of anxiety and depression result from a loss of deep spiritual connection? Do we suffer so because we have been forced to live in a purely materialistic, mechanistic, consumerist environment that emphasizes the superficial but fears psychic depth? This has been my experience (told in my book Radically Open) and, as I am learning, the experience of a growing number of people.

When other physical diseases reach epidemic proportions we often look for ways to prevent those diseases, not just treat them. But people rarely talk about prevention when it comes to mental illness. All the emphasis is on treatment (and increasingly medication is the treatment of choice). Perhaps it’s time to shift our focus away from treatment toward prevention. Perhaps we need to think deeply about the kind of society we have built, and have the courage to rebuild it in a way that enhances rather than denies the spiritual depths that ultimately make us human and that make our lives worth living.  

Headshot - Bob ShedingerRobert Shedinger is an associate professor of religion at Luther College. He is the author of several books, including "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 24 2014 at 9:27 am
    Tabita
    Your conclusion that it's time to shift our focus toward prevention is spot on. There is plenty of evidence that a number of factors (exercise, diet, sleep, experiencing nature, mindful awareness, spirituality, community, sense of purpose, coping skills, etc) greatly influence a person's opportunity to be mentally well. As you know, I have given this a lot of thought during the process of writing a book about child and adolescent mental health, and my conclusion is that we must start preventing mental illness—or, better yet, optimizing mental health—from the minute a child is conceived. And as you mention, our society is a big part of this. Thank you for giving your voice to this important issue!
  • February 24 2014 at 9:44 am
    Bob

    Thanks for your comments, Tabita. It really amazes me how we seem to take epidemic levels of mental illness in our society as normal and don't even raise the question about whether there might be things we can do to prevent it.