For most of my life, the idea that people could suffer diseases of the mind seemed obvious. As a young boy I’d watched my mother cycle through many psychiatric hospitalizations and rounds of shock treatment. Although she never seemed any less miserable upon returning from these confinements, I accepted that she needed them.
After she eventually killed herself, I concluded that the treatments hadn’t worked, not that she’d been misdiagnosed.
During my first year at junior high school, my sister lost touch with ordinary reality after months of heavy LSD use. Weeks after her last dose of the drug, she continued to speak of forces and beings I couldn’t see. She also seemed unable to resist staring at the sun. It became my job to protect her from this and other dangers in the days leading up to her psychiatric hospitalization at UCLA medical center. That something had gone wrong with her mind seemed obvious, and I never doubted that she needed the powerful antipsychotic drugs she hated.
When I suffered my first major depression at age twenty-one, following disillusionment with my graduate school program and the death of my beloved grandfather, I assumed my family’s genetic tendency toward mental illness was now manifesting itself in my own brain. I was sure of my “brain disease,” and I obediently accepted the judgments of the experts who treated me.
A few years later, medical school taught me about the various illnesses of the mind, and I dutifully memorized the DSM criteria for major depression, generalized anxiety disorder, and so on. I never questioned the concept of mental disease, or the biomedical hypothesis that it resulted from brain dysfunction.
By age forty-two I’d been depressed to varying degrees for two decades. But now I faced a new, massive stress as my surgical career collapsed due to neck disease. My mood plummeted in short order, and I became acutely suicidal. I presented to the mental health department and requested hospitalization. As ever before, I ascribed my misery to a damaged brain, and accepted the judgments of the psychiatric clinicians, even after they ordered legal confinement (since I had voluntarily requested admission, this violated state law). I had a mental illness, after all, and they were the professionals.
The following half-dozen years were the worst of my adult life. Not only did I feel depressed and horribly anxious, but the powerful new medications that were supposed to be helping with these problems wreaked havoc on my body. I grew obese, slow-witted, and clumsy. My cholesterol and blood sugar levels skyrocketed. I suffered embarrassing hormonal aberrations that only worsened my self-image and confidence. Suicide ceased being a temptation, and instead appeared nearly inevitable. I couldn’t work, I looked and felt awful, and there seemed no way to escape the downward spiral.
That’s when I finally woke up to how the traditional mental health system had failed me. For years I’d avoided looking at my mother’s outcome as a warning. I’d watched my sister’s life unfold tragically without recognizing that the psychiatrists never did much to help her. And I’d repeatedly submitted to that same systems’ ministrations since young adulthood, despite the fact that I never seemed to improve. Now my body teetered on the edge of collapse, my mind felt clouded and useless, and I grew more depressed than ever.
I was fortunate to live near a mental health department staffed with young, forward thinking clinicians. Seeing its possibilities, I dumped my elderly psychiatrist and finally started getting effective help. The new providers encouraged me to cut my medication load and take up meditation. They provided industry-standard cognitive behavioral training, but they also connected me with a practitioner of Acceptance and Commitment Therapy (ACT) who taught me how to sit with my emotions rather than run from them. Around this time I also met Tom Wootton of Bipolar Advantage, who taught me how mood fluctuations can be harnessed for creativity and engagement rather than treated as ‘symptoms’ and suppressed with drugs.
Encouraged to embrace my emotions rather than view them as diseased, and under the guidance of a psychiatrist who promoted my spiritual development, I quickly improved. Depression and anxiety melted away. Naturally, I still felt sorrow and fear, sometimes to powerful degrees. But I learned that while moods may feel overwhelming, they don’t necessarily disrupt my ability to remain clearheaded and stable. I also saw that they constantly change, and that even the darkest feelings eventually lighten. I began to understand and trust my mind. I ceased feeling hopelessly mentally ill. Over the next several years, I tapered off all the psychiatric medications and continued to thrive. I shed seventy pounds and felt healthier and more stable than ever before.
I started reading textbooks of psychiatry, thinking I could help others now that my own problems had receded. I applied to psychiatry residencies and psychology graduate programs, but was rejected by them all despite my rather stellar academic background. It became obvious that the programs felt uneasy with my psychiatric history, which I’d disclosed in the naive (or stubborn) belief that it should qualify rather than disqualify me for work in the field. Now I had a new reason to suspect systemic problems in the mental health industry. If it distrusts those who have most used its services, how compassionate can it really be?
So I started exploring critiques of the field. I learned how the pharmaceutical industry manipulates doctors through slick marketing and expensive perks. I discovered that the ‘science’ behind mental illness is far from conclusive, and that drug studies have been hopelessly tainted by profit motives. I awoke to how the field of psychology has been long on theory and short on evidence right from its beginnings. Consider Freud, who refused to believe his patients’ reports of incest, and instead built an entire psychological theory to blame the minds of victims rather than the cruelty of powerful males. That Freud’s theories were so influential despite this dismal start should make us question the current dominance of the unproven “brain disease” hypothesis.
What’s a naive physician to do when he wakes up to how he’s been trapped in a failed paradigm for his entire life? How does he respond when he discovers that his mind works perfectly well without medication and suffers no dreadful, genetic disease? Does he meekly and quietly disappear? Or does he start to speak up?
Understand that there are well-meaning and ethical professionals out there. Many mature, wise individuals work in the field, including increasing numbers who challenge the failed mainstream paradigm. Many theories of mental life have merit, and some very beneficial philosophies have arisen over the years, including the recently emerged “Positive Psychology” movement.
On the other hand, the reason people make so many jokes about “shrinks” is that they so often sound both pompous and clueless. Given such attitudes and a compromised research base, can such individuals be trusted when they proclaim that those who struggle with mental distress have “brain diseases” and need medication for life?
It’s time for those of us who most understand mental distress to speak up. We who’ve suffered with depression, anxiety, confusion, delusional states, and so on are in the best position to understand them, especially if we’ve managed to work through our difficulties to achieve a balanced, peaceful state of mind. We are also most aware that mental health problems as currently defined are not always negative. The ‘system’ has so focused on the shadow side of moodiness and perceptual alterations that the enhancing aspects have been forgotten. But most of us who’ve struggled with powerful mental states recognize that, properly harnessed, they confer a kind of grace. They allow us to feel and embrace the depths of reality in ways that those with more ‘stable’ minds cannot. They awaken fonts of creativity and insight. Kay Redfield Jamison describes these benefits in her book, Touched By Fire, but they are no secret to those of us who’ve seen the situation in a balanced fashion, and know both its shadow and its light.
Mental health care is poised to change. If those it treats demand better, it will move in the direction of empowerment and spiritual growth. But if we remain silent, it is more likely continue to cater to the profits of pharmaceutical companies and the constraints of long tradition. The new paradigm could blossom into an entirely new system of care, or it could be given mere lip service. As someone who lived through four decades of darkness under the old system, and then awoke to an entirely new life after five years of new ideas, I plan to do my part to knock the traditional paradigm of “brain disease” off its undeserved pedestal. I look forward to celebrating as a new era of mental health care dawns.