Models of Madness

Mental health services around the world are largely based on the assumption that being upset or disoriented is a sort of condition like medical illnesses. Here in Australasia, we imported this perspective from overseas, actively suppressing more holistic Maori and Aboriginal understandings about human distress. We did so despite numerous studies that show that recovery rates from “mental illness” in “underdeveloped” countries are far superior to those in “advanced” societies.

Nowadays, more and more problems are being redefined as “disorders” or “illnesses,” supposedly caused by genetic predispositions and biochemical imbalances. Life events are relegated to mere triggers of an underlying biological time bomb.

Thus, feeling very sad has become “depressive disorder.” Worrying too much is “anxiety disorder.” Being painfully shy has become “avoidant personality disorder.” Beating up people is “intermittent explosive disorder.” Excessive gambling, drinking, drug use, or eating are also illnesses. The same applies to having too little food, sleep, or sex. Our Diagnostic and Statistical Manual of Mental Disorders has 886 pages of such illnesses. Unusual or undesirable behaviors are called “symptoms” and the labels are “diagnoses.”

Our children are labeled, too. Being bad at math has become “mathematics disorder.” Ignoring other people’s feelings (once called being naughty) means that the child is suffering from “conduct disorder.” If this includes getting angry at grownups, he or she (usually he) has “oppositional defiant disorder.”

A “diagnosis” frequently in the news is “attention-deficit/hyperactivity disorder.” The “symptoms” include fidgeting, losing things, talking excessively, and difficulty playing quietly or taking turns. Of course some children sometimes have problems. But does anyone help them? Perhaps it sometimes conceals the causes, while locating the problem entirely within the child, who is often stigmatized as a result.

Indeed, making lists of behaviors, applying medical-sounding labels to people who manifest them, and then using the presence of those behaviors to prove that a person has the illness in question is scientifically meaningless. It tells us nothing about causes or solutions.

How did this simplistic, certainly unscientific, and frequently damaging approach gain such dominance?

First, it is tempting to avoid facing the painful events in our lives that might be the cause of our difficulties. If we just accept the diagnosis on offer, nobody is to blame. Nobody needs do anything differently – except take the tablets. We were just unlucky enough to get the “illness.”

Second, a model of individual pathology is invaluable to politicians. They don’t need to spend money on prevention programs to address the psycho-social problems –overwhelming stress, poverty, discrimination, child neglect and abuse, and loneliness, to name but a few – that research has repeatedly demonstrated play a large role in undermining mental health.

Third, exciting developments in technologies for studying our brains and genes have created the hope that we are about to discover the biological causes of, and solutions to, human misery and confusion.

Finally, a new player has entered the nature-nurture debate. The pharmaceutical industry, fueled by our desire for quick fixes, has effectively deployed its considerable power to promulgate the notion of “disorders” and “illnesses” in all domains of our lives. The fundamental purpose of drug companies is to produce profits for shareholders. Naturally, they encourage us to diagnose eating, sleeping, or feeling too much (or too little) as illnesses requiring a chemical cure.

Having listened for 20 years to people unfortunate enough to be labeled “schizophrenic,” considered to be the most extreme form of “mental illness,” and having subsequently researched the causes of hallucinations and delusions for ten years, I believe that the public understands madness better than we experts.

Surveys of public opinion all over the world find that most people believe that emotional problems, including those deemed severe, such as hearing voices, are primarily caused by bad things happening to us rather than by faulty brains or genes. The public also favors psycho-social approaches, such as talking to someone and getting advice, or help finding friends or a job, rather than drugs, electro-shocks, or admission to psychiatric hospital.

Some experts, however, dismiss these views as “mental health illiteracy.” They continue to insist that mental illness is an illness like any other, despite many studies showing that the more we adopt this medical model, the more prejudiced and frightened we become.

Mental health services should offer something more than having our feelings chemically suppressed, or having our children’s difficulties sitting still controlled by amphetamines (which, apart from teaching children that problems are best solved with drugs, stunt growth by an average of one centimeter per year).

A wide range of effective treatments are available that don’t cause weight gain, sexual dysfunction, diabetes, memory loss, or addiction. Funders and policymakers who keep up with the relevant research are slowly beginning to introduce more talking therapies (such as cognitive therapy and trauma-focused counseling), more alternatives to hospitalization, more culturally appropriate services, more family-focused therapy and, most importantly, more genuine consultation with service users about what actually works.

If these new treatments aren’t used more frequently, this isn’t because they don’t work. The main obstacle is that they won’t increase the profits of drug companies, on which, in the absence of adequate government funding, our professional organizations, conferences, journals, research, and teaching institutions have become so dependent.