Dr James Alexander, PhD- Psychologist

 This week has seen my favourite broadcaster, the Australian Broadcasting Commission (ABC), run a range of discussions and programs to coincide with mental health week. in Australia We have been inundated with the statistic that nearly 50% of the population are suffering from one form of mental illness or another. I can’t help but wonder what are the motives behind such an alarming (and alarmist) statement? Does it actually reflect reality, rather than reality bending driven by big-pharma who are seeking more and more customers? Or is it a desperate attempt for public sympathy and relevance by the ABC to withstand budgetary and ideological attacks from a hostile government? Is one in every two of us really mentally ill? Surely this statement requires some analysis.

It is just two years since the death of civil libertarian psychiatrist Thomas Szasz, and it appears that his basic message (see 'The Myth of Mental Illness') again needs restating. Psychiatry, a profession now almost entirely dependent on funds from big-pharma, has been pushing back the definitions of mental illness for decades. The latest edition of the Diagnostic & Statistical Manual (the DSM- psychiatry's ever growing list of 'mental illnesses') attracted howls of criticism long before it was published, with former contributors warning that it had been rendered useless due to its apparent desire to define an ever increasing amount of human experiences as ‘illnesses’. While the net of what is captured under the term ‘mental illness’ has been broadened to the point of absurdity, it will come as a shock for many to learn that there is still no consistent neurological basis demonstrated for even the major ‘mental illnesses’, such as schizophrenia, bi-polar disorder, major depression, etc, let alone the raft of other human experiences which are now described as illnesses. Further, there are still no proven genetic bases for what are presumed to be ‘mental illnesses’. This reality stands in stark contradiction to the claims which psychiatry has maintained for decades that ‘mental illnesses’ are brain disorders (with genetic predispositions) and are comparable to any other medical condition.

One of the essential points Szasz made is the fact that medicine already has a speciality dedicated to brain disorders, ie. neurology. If a brain basis to ‘mental illness’ is ever found, this will simply result in an addition to the list of neurological disorders and a reduction from the list of ‘mental illnesses’. As such, what are referred to as ‘mental illnesses’ by psychiatry are essentially human experiences for which no neurological basis in known.

The term ‘mental illness’ is merely a metaphor. However one wants to define the ‘mind’, whether one be a materialist or idealist, a dualist or monist, the term does not mean brain. Materialists refrain from the serious use of the term ‘mind’, and instead prefer to acknowledge only the reality of the brain. If they use the term ‘mind’ at all (as in Ian Hickey’s Brain & Mind Research Institute), they are using it metaphorically as a concession to a public which is not ready to concede the unreality of the ‘mind’- what they really mean is the brain. As opposed to psychiatrists, it is more likely to be some philosophers and psychologists who still use the term mind in any genuine manner, to refer to an aspect of the human organism and functioning not synonymous with the brain.

What is it that is 'ill' in ‘mental illness’? The ‘mind’? However the mind be conceived, it is not a physical entity. As such, ‘minds’ can only be viewed as ill or diseased in the same way that an economy or a joke can be seen as sick, ie. metaphorically. No one suggests that a joke can be made healthy via the administration of drugs, as that would be straining the metaphor beyond a workable limit. Yet, this is precisely what psychiatry (and the ABC) are doing- treating a metaphor as a literal reality. None of this is to say that many people who are called ‘mentally ill’ are not experiencing very real problems in living (although not all of them are upset by their beliefs and circumstances). I am only disputing how we are to make sense of their experience, not that their experience is real.

If the use of the term ‘mental illness’ were only a case of poor semantics, it would hardly matter. However, what follows from the use of this medical metaphor for human problems in living is both the forced incarceration and treatment (an invasion of civil liberties which is usually not permissible within criminal law), and the neurological damage which can accrue to people from the physical treatments of psychiatry. Stigma is another inevitable and damaging consequence for people whose identity has been ruined by labeling. Stigma is the inevitable consequence for a categorical way of classing human beings- you are either mentally ill or mentally healthy. The reality is that what are referred to as 'mental illnesses' are usually human responses to adverse experiences which differ only by their degree, not by kind. As long as psychiatry sticks with its categorical view, humanity is divided between the 'ill' and the 'healthy'- rather than seeing the common humanity between all of us. A dimensional approach (barely affected/moderately affected/extremely affected) has a far better chance of not resulting in stigma.

Most of us are aware of psychiatric disaster stories, such as the ‘deep sleep therapy’ of the Chelmsford Hospital in Sydney, wherein many psychiatric patients were killed (several of whom were pregnant to the chief psychiatrist). Or the primitive forms of psychosurgery in which the patient was partially murdered the by destruction of their personalities and memories, changing their sense of self. But how many people are aware of the permanent neurological damage caused by equally destructive modern approaches to psycho-surgery, or to people on anti-psychotic drugs (Tardive Dyskenesia)? Or that an ever increasing amount of Australian children are being put on these drugs each year- this includes primary school aged children. What does Patrick McGorry intend to do with those who his early psychosis detection centres identify as being susceptible to psychosis? Contemporary psychiatry offers nothing other than psychiatric drugs (not entirely true- psychiatry is still enthusiastic for ECT, which simply kills off enough brain cells so the person temporarily forgets what was depressing them).

British professor of psychiatry, David Healy is in no doubt that the skyrocketing of suicide rates in the Western world over the last 30 years is not just a random fluctuation, but has followed the radical increase in prescription of SSRI antidepressants (and he cites compelling statistics in support of his case). The list of well demonstrated brain damage from psychiatry goes on. Suffice to say that the breadth and range of well argued critiques against the widespread use of psychiatric drugs is too large to be detailed here.

The medical model requires that we talk in terms of ‘illnesses’- rather than being a reflection of psychological reality, this is merely a convention of language within the medical world. But is this sufficient reason to use the same language, or is it incumbent on psychologists to be ‘cleaner’ with our use of language, given what we know of the many serious consequences when medical language is applied to psychological phenomenon? While some psychologists have always seen themselves as vassals to psychiatry (adopting both its language as well as its world view and assumptions), most psychologists have found it difficult to both speak and think in psychiatric terms. Being social scientists as much as we are behavioural scientists, we simply know too much about social learning, the power of contexts, cultural/social/political differences, the history and philosophy of science and the sociology of illness/medicine/treatment to play dumb. How can we blindly resort to still unproven (in fact, largely discredited) theories of serotonin deficiencies when we are well aware of Seligman’s theory of Learned Helplessness of depression? How can we ignore what superficial psychiatric scrutiny of a person does to distort perception when we know of Rosenthal’s study of ‘Being Sane in Insane Places’? How can we settle for simplistic chemical imbalance theories when neuroscience is telling us how complex the brain is? How can we use psychiatric terminology when we know of studies which show that the label applied to a person’s suffering has no positive impact on the outcome of the intervention? Are we really able to maintain a silence when we read of research which demonstrates the brain damaging effects of antipsychotics, minor tranquillisers, antidepressant drugs, mood stabilisers, and ADHD drugs? How do we ignore our knowledge of the placebo effect, as it has been well demonstrated with such drugs? Can we really ignore what we know of damage to sense of self for people who have psychiatric labels applied to them, or the damage to self-efficacy for people who have been ‘saved’ by physical interventions extraneous to themselves from which they develop no life skills or valuable learnings?

These are the problematic issues which I think of whenever I hear the non-sense statistic that 50% of us suffer some form of mental illness. Yes, we know that there is suffering in the world- but clearly, not all suffering is evidence of a medical/psychiatric condition which requires chemical ‘correction’. Racism, unemployment or overemployment, sexism, abuse of children, and poverty all cause psychological suffering. We already know this. As psychologists, we need to stand confident in the wisdom of our own discipline and resist the invitations to join the great psychiatric enterprise of chemically altering an ever increasing chunk of humanity. Psychiatry is terminally joined to big-pharma. Psychology is not. Our language needs to reflect the humanities legacy of our discipline, and reject the promise of status from adopting the medical model. Disease mongering is alive and well- soon, there will be no form of human distress not considered an illness. I expect more from the ABC, which is staffed by smart people who have been able to use their critical thinking skills with a broad range of issues in the past- why not with this issue?