Follow-Up to The Campaign Narrative of Mental Illness

As I tackled in a previous post, there are many reasons, often society at-large, rather than identified mentally ill persons that contribute to the deaths, and mistreatment, of those with mental illness.

This article from the American Psycholoigical Association titled, The roots of mental illness details other important factors to consider:

When it comes to mental illness, a one-size-fits-all approach does not apply. Some diseases may be more purely physiological in nature. “Certain disorders such as schizophrenia, bipolar disorder and autism fit the biological model in a very clear-cut sense,” says Richard McNally, PhD, a clinical psychologist at Harvard University and author of the 2011 book “What is Mental Illness?” In these diseases, he says, structural and functional abnormalities are evident in imaging scans or during postmortem dissection.

Yet for other conditions, such as depression or anxiety, the biological foundation is more nebulous. Often, McNally notes, mental illnesses are likely to have multiple causes, including genetic, biological and environmental factors. Of course, that’s true for many chronic diseases, heart disease and diabetes included. But for mental illnesses, we’re a particularly long way from understanding the interplay among those factors.

That complexity is one reason that experts such as Jerome Wakefield, PhD, DSW, a professor of social work and psychiatry at New York University, believe that too much emphasis is being placed on the biology of mental illness at this point in our understanding of the brain. Decades of effort to understand the biology of mental disorders have uncovered clues, but those clues haven’t translated to improvements in diagnosis or treatment, he believes. “We’ve thrown tens of billions of dollars into trying to identify biomarkers and biological substrates for mental disorders,” Wakefield says. “The fact is we’ve gotten very little out of all of that.”

To be sure, Wakefield says, some psychological disorders are likely due to brain dysfunction. Others, however, may stem from a chance combination of normal personality traits. “In the unusual case where normal traits come together in a certain configuration, you may be maladapted to society,” he says. “Call it a mental disorder if you want, but there’s no smoking-gun malfunction in your brain.”

You can think of the brain as a computer, he adds. The brain circuitry is equivalent to the hardware. But we also have the human equivalent of software. “Namely, we have mental processing of mental representations, meanings, conditioning, a whole level of processing that has to do with these psychological capacities,” he says. Just as software bugs are often the cause of our computer problems, our mental motherboards can be done in by our psychological processing, even when the underlying circuitry is working as designed. “If we focus only at the brain level, we are likely to miss a lot of what’s going on in mental disorders,” he says.

The danger in placing too much attention on the biological is that important environmental, behavioral and social factors that contribute to mental illness may be overlooked. “By over-focusing on the biological, we are doing patients a disservice,” Wakefield says. He sees a red flag in a study by Steven Marcus, PhD, and Mark Olfson, MD, that found the percentage of patients who receive psychotherapy for depression declined from 53.6 percent in 1998 to 43.1 percent in 2007, while rates of antidepressant use stayed roughly the same (Archives of General Psychiatry, 2010).

The key to solving mental illness issues in the United States may not be Protestant ethic, religion, drugs or victim blaming approaches, but rather listening to the person who has the mental illness and not hindering their efforts at recovery in society, and at-large. Can we really sit there and agree that denying valued resources, denying supportive social circles and important relationships, and victimizing others will lead to benefits to our society overall? I would think not.

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One thought on “Follow-Up to The Campaign Narrative of Mental Illness

  1. Pingback: It Happened Again Last Night | The Progressive Democrat

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