Finding Jesus in the Storm. John Swinton

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СКАЧАТЬ some problem, though they are really addressing different problems or different aspects, interpretations, or readings of the problem. For when a theory talks about a phenomenon, it inevitably does so in terms of its own representation of it. The phenomenon gets incorporated into the theory in a particular way, structured by a definite set of assumptions and presuppositions about its nature. This makes it very important that we recognize those presuppositions and discover how the theory has represented a particular object of explanation.38

      For current purposes, it is important that we recognize the kinds of presuppositions that lie behind reductive biological explanations of mental health challenges and the dangers of uncritically accepting such explanations.

       “Mental Illness” Is Not like Measles

Take, for example, the common strategy of equating mental illness with physical illness. One reason people are keen on this way of thinking is that it destigmatizes mental disorder. It draws it out of the messiness of society, politics, and stigmatizing views and places it on par with forms of physical illness that tend not to attract stigma. In his book Surviving Schizophrenia, the psychiatrist E. Fuller Torey explains what he thinks mental illness is (in this case, schizophrenia): “Schizophrenia is a brain disease, now definitely known to be such. It is a real scientific and biological entity as clearly as diabetes, multiple sclerosis, and cancer are scientific and biological entities. It exhibits symptoms of a brain disease, symptoms which include impairment in thinking, delusions, hallucinations, changes in emotions, and changes in behavior. And, like cancer, [it] probably has more than one cause.”39

Putting to one side the fact that the evidence for the biological roots of schizophrenia is not clear-cut,40 let’s think through how this explanation works. It claims to give us a plausible explanation of the various experiences that bring people under the description of schizophrenia. People experience symptoms because of an underlying biological condition. The primary task for mental health care is to adjust the person’s biology in ways that will bring about relief from suffering. There may be other aspects to the patient and her care, but the central focus is on biology, because that is where the problems are fundamentally located. Schizophrenia is a malignant biological process similar to cancer, over which no one has total control. Within such an explanatory framework, people’s mental health experiences are explained as the result of such things as chemical imbalances, genetic predispositions, neurological pathology, viruses, and so forth. The assertion “Mental illness is like any other medical illness” implies, as Insel suggested, that mental illness can be fully explained according to its biological basis.

Positively, as mentioned, one of the intentions of this kind of approach in general and Fuller Torrey’s approach in particular is to destigmatize mental ill health. When Fuller Torrey wrote his book in 1982, there had been a strong tradition of blaming parents (often mothers) for the formation of schizophrenia. This blaming of family and mother had caused a lot of unnecessary grief for parents.41 Recognizing this, Fuller Torrey had become a strong advocate for families. Surviving Schizophrenia was the first handbook designed specifically to help not patients but families “survive” schizophrenia. His strong emphasis on the importance of the biological had significant social and political as well as medical origins and intent.42

      The ascription of biological explanations has also been used in an attempt to destigmatize the experiences of people living with mental health challenges. The suggestion that the causes of such challenges are similar to the causes of physical illnesses such as cancer, diabetes, and influenza is intended to reduce the stigma that surrounds mental disorders. The compassion behind this approach is clear, and the sentiment is laudable. The problem is, it doesn’t seem to work.

Malla, Joober, and Garcia note that “Several well-conducted studies have concluded, almost uniformly, that this strategy—destigmatization by emphasizing the biological aspects of mental health challenges—has not only not worked, but also may have worsened public attitudes and behavior toward those with mental illnesses. Investigations of stigma have shown that those who consider mental disorders as primarily attributable to biological forces, just like other medical disorders, while absolving the mentally ill person of responsibility for their behavior and actions, tend to feel less optimistic about their ability to get better and function well, are less accepting of them and feel less positively toward them.”43 The problem seems to be that in using biology as an explanation for mental disorders, within the minds of the public and for the individual who lives with the experiences, the disorder becomes ontologized and totally defining of the person. People no longer have an illness; now they are an illness. The DSM offers descriptions that function epistemologically rather than ontologically. Biological explanation does the exact opposite. A biological explanation is much deeper, much more personal, much more tied in with the “is-ness” of who and what a person is. Biological explanations are thus seen to have unfortunate side effects.

      In his book How to Become a Schizophrenic, John Modrow, a psychiatrist who lives with schizophrenia, offers a powerful insider’s critique of biological explanations and points out a hidden danger:

I cannot think of anything more destructive of one’s sense of worth as a human being than to believe that the inner core of one’s being is sick—that one’s thoughts, values, feelings, and beliefs are merely the meaningless symptoms of a sick mind. Undoubtedly the single most important causal factor behind my mental breakdown was a sense of worth so badly shaken that not even the most florid delusions of grandeur could save it. What the concept of “mental illness” offered me was “scientific proof” that I was utterly worthless, and would always be worthless. It was just the nature of my genes, chemistry and brain processes—something I could do nothing about.44

Schizophrenia is not like measles. One can have measles, but one becomes schizophrenia. Sally Clay addressed the First National Forum on Recovery from Mental Illness as follows: “Those of us who have had the experience called ‘mental illness’ know in our hearts that something profound is missing in these diagnoses. They do not take into account what we have actually endured. Even if the ‘bad’ chemical or the ‘defective’ gene is someday found, madness has its own reality that demands attention.”45 Stigma is a way of stealing someone’s story and forcing the person to accept a false, negative identity. It needs to be fought against. Biological explanations may provide a helpful and nonstigmatizing version of disturbing experiences. However, such explanations can have a shadow side that we miss at our peril.

      The point is not that biology may not be formative of mental challenges. We do not yet have the evidence to make such a case across the board, but in time it may emerge. The problem is that biological explanations on their own can be highly reductive, closing down aspects of our experiences and forcing us to interpret them in a very narrow and confined way. In the end, such attempts at destigmatizing “the mental” actually end up reinforcing the idea that there is a problem with that aspect of our humanness, rather than addressing the key issue—that there is no need to stigmatize issues of the mind dualistically. A psychological description is no different from a biological one; it simply addresses different aspects of our humanness—shifting the problem from the mind to the body is nothing more than another manifestation of Cartesian dualism. The unhealthy and inauthentic anthropology that underpins this way of thinking remains fully intact. Biological descriptions are simply too thin to do the work of realigning and clarifying that is necessary for the tasks of destigmatizing and healing.

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