How to rethink mental illness | Day 162

Once you become aware of the myriad ways in which mental health issues can influence the life of a person, it colours your perception of the world. I’ve seen up close how the sudden manifestation of a psychiatric disorder can destroy relationships and family ties; I’ve experienced crippling and all-consuming anxiety myself; during my cognitive science studies I read many, many papers, textbooks and case studies describing the various ailments of the mind.

The spectre of illness is constantly present in our society, but mental illness is almost in a league of its own. We go through waves of political correctness, from shaming people who use diagnostic terms in a derogatory way to reclaiming them, and all the way back to using them. When was the last time you referred to someone or something as ‘crazy’, without giving it much thought?

The more research is done in order to understand the human mind, the more is uncovered about its quirks and pathologies. Over the past century several classification systems have attempted to measure, weigh, and organise the many ways a human mind can differ from a ‘normal’ one, and yet the list has never reached its definitive state. We’re still overhauling and changing things.

Of these classification attempts the most widely used is the ‘bible’ of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Since the first volume in 1952, which featured 106 descriptions of disorders (including homosexuality), this body of work has ballooned into a veritable mammoth, now into the fifth edition.

Diagnostic criteria in the DSM have continually morphed and shifted, creating new syndromes where none were before, and getting rid of others when more research came to light. The manual is nothing to be sneezed at, and countless top researchers of their fields have contributed to its development… but the whole diagnostic system is pretty much a glorious mess.

Hence no wonder that experts are calling for a rethink of mental illness, to move away from diagnosing a bunch of symptoms as a disease, and search instead for the underlying biology, the surrounding environment, society, and many other factors to find out how to call these things that go wrong with one’s mind.

This topic is discussed in a recent New York Times op-ed by psychological anthropologist T. M. Luhrmann:

…mental illnesses are complex individual responses — less like hypothyroidism, in which you fall ill because your body does not secrete enough thyroid hormone, and more like metabolic syndrome, in which a collection of unrelated risk factors (high blood pressure, body fat around the waist) increases your chance of heart disease.

The implications are that social experience plays a significant role in who becomes mentally ill, when they fall ill and how their illness unfolds. We should view illness as caused not only by brain deficits but also by abuse, deprivation and inequality, which alter the way brains behave. Illness thus requires social interventions, not just pharmacological ones.

It’s an enlightening read.

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