In a beautiful article for Nature, David Adams recently wrote, “Psychiatric research has yet to provide a single reliable biomarker to aid diagnosis and treatment. Self-reported symptoms and their subjective interpretations remain the basis for clinical diagnosis. Drug companies have walked away.”
For years I have taught and will continue to teach that the symptoms don’t care about the diagnosis. And working from the other side, people have wrestled with what diagnosis creates what symptoms. It’s a paradox that we are still working to unravel – does the “nature” of biomarkers we haven’t found yet create mental illness, or do experiences create symptoms that in turn lead to a diagnosis? Nature or nurture?
For example, biochemical markers exist for syphilitic lesions (a neurological problem whose symptoms are relegated to “mental illness”), and also for inflammation of the basal ganglia (another neurological problem whose symptoms are relegated to “mental illness”), and for the newly emergent science of the biome (the “second brain” as it is called, that wonderful universe of gut bacteria that can create symptoms related to, you guessed it, “mental illness”). Oh, and we now know that there is a connection between some parasites and suicidality but, again, guess what–that gets relegated to mental illness as well, not parasitology.
So what the heck is mental illness anyway? Maybe some mishmash of these conditions that affect the brain with experiences that we carry with us and likewise adjust our thoughts and emotions?
More people get treated (often poorly) for “mental illness” than are assessed for these bug-based causes of brain challenges. In part, that’s because the germ-based theories underlying the medical model of mental illness don’t hold up, which is part of what has led to the abandonment by drug-makers.
There’s a challenge here: we want relief, the sooner the better, and the challenge is that if at least part of what we call mental illness is due to some form of overwhelming experience and not to a bad bug, the secret to relief isn’t in a pill but in managing emotions, creating and fostering connections, and feeling worthy of life.
And there’s another challenge in this dichotomy between what happens to us and what’s wrong with us – the symptoms and the diagnosis: the cause of mental illness influences the degree to which society “blames” those with a diagnosis. The parent of a mentally ill child leans hard on the biological explanation that gets him/her off the hook for parenting that could cause symptoms of mental illness, whereas the person with the diagnosis who fears being victimized because of their behaviors/symptoms leans on the diagnosis to engender understanding and compassion.
Cure is unlikely – it takes an act of sorcery to utterly rewire the brain to a totally neurotypical pattern. And frankly, we probably don’t want it. We don’t want to eradicate the Albert Einsteins, Temple Grandins. John Nashes, Mary Lincolns, Ellyn Saks and many others of us who are bright (if not brilliant) and different to the point of diagnosis.
Care is a better term than cure. It means feeling as well as we can by the best means possible. It means committing to health as much as we commit to treating illness. It means we need to offer one another kind support.
To me, the process of being diagnosed and figuring out how to live well in spite of symptoms that were maddening to others has been such an education. I came to the realization that – no matter nature or nurture, parasites or experiences – the most important task in front of me was to disregard diagnosis and figure out how to act more like the people whom I thought were “mentally healthy.” It required a lot of learning. And believe you me, I’m still learning every day.
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