A Pathological Lie
What if everything you have been told about mental health is wrong?
We all recognise that sadness is a normal reaction to significant loss, such as the death of a loved one. And we understand that stress and anxiety are common experiences in situations of pressure and threat. So what’s the difference between a healthy brain responding normally to adversity, and a disordered brain suffering from a mental illness? At what point do we determine that psychological difficulties are no longer attributable to one’s circumstances, but reflect some sort of abnormality in brain function?
Most mental health professionals will tell you that psychological issues cross this threshold when the collection of “symptoms” with which a person presents meet the checklist for a particular diagnosis in the DSM-5, which is the official compendium of mental health disorders. According to this view, if you feel down, but display only four DSM symptoms of Major Depressive Disorder, you have a healthy brain and are simply experiencing a normal, understandable reaction to your life events. But if you display five, this is a completely different scenario. Suddenly, your sadness is no longer attributed to external life events, but to a malfunction in your brain. You are assumed to be suffering from a biomedical disorder, and can be diagnosed with a mental illness. You may be told that your symptoms indicate a medical disease, just like any other. In the same way that people with diabetes suffer from a lack of insulin, you have a “chemical imbalance” characterised by a lack of serotonin in your brain.
Thousands of people receive this explanation, or similar, from health care professionals every day. Perhaps you are among them? I don’t subscribe to this biomedical model of mental illness, for several reasons.
Firstly, the shocking truth is that there is no reason to think that those suffering from mental health issues have a biological abnormality. Depression is not associated with a lack of serotonin or adrenalin. Anxiety does not indicate a malfunction in the adrenal or cortical systems. Schizophrenia and ADHD are not shown to be caused by dysregulation of dopamine. These are myths with no scientific evidence to support them. For many people, this is a difficult assertion to accept. The “chemical imbalance” story is so prevalent that it has come to be understood as unquestionable fact. How can the entire paradigm upon which mental health is understood be wrong? And yet, the shameful secret is that all attempts to uncover biological markers that distinguish between mental wellness and illness have failed, and nobody even knows where to look for them. This is why there is no blood test or brain scan that can diagnose depression, or any other mental illness.
Secondly, contrary to popular belief, recent research shows that instead of reducing stigma and promoting better mental health outcomes, belief in the chemical imbalance story is actually associated with increased stigma and poorer outcomes. This is probably because it disempowers those experiencing psychological struggles by encouraging a view that they are disordered and therefore helpless to overcome them.
Thirdly, the biomedical approach to diagnosing mental illness ignores the circumstances contributing to a person’s mental state. Every “disorder” listed in the DSM is defined by a stringent checklist of quantifiable symptoms, with a black and white boundary between health and disorder. It’s a neat and convenient way of categorising mental illness, but unfortunately provides no flexibility to account for whether a person’s so-called “symptoms” might be a normal, understandable reaction to the life events they are facing. Feeling sad and lethargic? Lost your appetite? Difficulty sleeping? Trouble concentrating? Has this been going on for two or more weeks? You have a brain disorder! Never mind the fact that you were made redundant from your dream job last month. What a person is going through in their lives is, quite deliberately, excluded from consideration, as this would blur the clear cut diagnostic boundaries.
Despite these glaring flaws, the DSM-based biomedical model of mental illness has become so prevalent that it frames the way in which almost all mental health professionals understand and approach psychological difficulties. It guides a philosophy that views happiness and contentment as humans’ natural, default state, and by extension (incorrectly) assumes that psychological distress is abnormal and a sign of pathology. Much like a fever or sore throat, clients’ negative experiences and difficulties in functioning are therefore viewed as “symptoms” and linked to diagnoses that are considered to be valid illnesses arising from a biological cause. These are grossly misleading and potentially harmful falsehoods.
But hang on a second! We are all organic beings, so there must be a biological component to our psychology, right? This is true! However, we are so far from even beginning to comprehend the extraordinary complexity of how our psychological experiences manifest biologically, that it is not at all clear that we will ever be able to understand it in these terms. In fact, it’s entirely possible that this complexity is so great that it’s beyond the scope of human intellect to grasp it.
And even if we could, it still does not follow that negative emotion is a sign of brain malfunction. In fact, in some circumstances, it would be more accurate to say that an absence of negative emotion is unhealthy. Consider the anxiety that our hunter gatherer ancestors may have felt about the upcoming winter scarcity as the seasons changed. Without this emotion driving them, they may have lacked motivation to work hard in stockpiling food stores. If the winter bit hard, they may even have starved. All emotional states, positive and negative, exist because they served an adaptive purpose.
But many people do face very real and genuine psychological struggles. If we can’t understand them as some sort of biomedical disorder, how do we make sense of them?
An alternative approach is to view psychological issues not as symptoms of abnormal brain function, but as normal, understandable responses to adversity. It advocates for a different type of mental health literacy that involves broadening our understanding of the circumstances that constitute adversity and how we react to them, rather than seeking to define and categorise disorder in isolation. This approach differs from the biomedical model by seeking to understand the contexts in which psychological issues arise and paying attention to the meaning we ascribe to our experiences. In short, instead of asking “what’s wrong with you?” it asks “what’s happened to you that has caused you to feel that way?” More detailed information can be found here.
I think this approach more accurately honours what it means to be human, and better empowers those who are struggling with psychological issues to take control of the circumstances that are creating them. If this resonates with you, I invite you to adopt this alternative perspective, and join a growing number of people who are starting to think differently about how our psychological functioning relates to our well-being.
