“This shift to biological explanations in our own lifetimes did not just come out of the blue. It is driven by NAMI, and funded by the pharma industry. Questions for you:
Why does NAMI drive this theory, despite studies that show biological explanations increase stigma? … Who, besides NAMI has set up the causation debate between that of bad character or biology?”
In response to some great questions from flawedplan , I’ve been considering why the biological explanations of mental illness have triumphed in the common understanding about causation. Unfortunately, I have no idea of the answers to many of his/her questions but I think the biologic explanations for mental illness have become predominant because of the confluence of a number of trends.
Firstly and most obviously, big pharma has driven this paradigm because it dovetails with their commercial imperatives. If mental illness is primarily biologically caused then pharmacological interventions are quite naturally the best and, indeed, the most rational treatments. The influence of big pharma on determining the debate in this, and in neutralising dissenting opinion, via its enmeshment with drug approval entities and professional bodies that define what is and is not mental illness and via advertising and “astroturfing” community-level understanding of such illnesses, cannot be underestimated.Secondly, psychiatry in its desire to be considered a “real”, hard science has abandoned what it considers outdated psychological aspects of its history and practice to embrace the more physiological explanations for mental illness. At its most crude: Freud et al = bad, neurotransmitters = good. This shift has been driven more by a desire to position the practice of psychiatry to enhance its authority, validity and prestige rather than in response to the science. The evidence of the biologic nature of mental illnesses is actually very weak.Thirdly, the commercial pressures applied to health extend beyond big pharma. There is a strong incentive for people needing treatment for mental illness and their primary carers (both medical and social) to redefine mental illness from behavioural/situational to physiological/biological in an effort to get the care they need in a system that is fundamentally concerned with containing costs. Health insurance companies, whether private or public, are less likely able to refuse paying for care when the cause of an illness is considered biological.Fourthly, the system in which we live has a vested interest in locating the source of mental illness in the individual rather than looking at systemic causes of distress and dysfunction. Although this doesn’t discount the explanations of mental illness as “character flaw” or other “personal failure”, such explanations implicitly question the relationship between the person suffering and the society in which they live. But to ascribe the cause of mental illness to biology/physiology is to remove any responsibility from society and place it entirely on the individual’s “broken brain”.Finally, there’s a strong impulse in our Western cultures to search for technological solutions for problems, regardless of the cause of those problems. We’re encouraged to have such faith in science that we almost instinctively look to that paradigm and methodology for explanations and solutions. The unconscious belief is that any difficulty we encounter can be remedied by science. “Hard” sciences (such as biology and neurology) are privileged over “soft” sciences (such as psychology and sociology). In such an environment, it’s inevitable that biologic explanations of mental illness will be considered more valid.There’s an interesting article by Guy Rundle, “This is the Night, Remembered if Outlived” from Arena magazine. It’s quite old but, like a lot of Rundle’s pieces, it’s well written and says much that makes one think. There’s a particular paragraph that I think is relevant:
Furthermore, a shift in the process of self-understanding had begun to occur, with people’s reading of themselves as ‘systematic’ beings — rather than as selves or souls — starting to become a dominant mode by which behaviour is interpreted. This was not a new phenomenon of course — everyone learns to recognise the effects upon themselves of, say, drunkenness, and to distinguish between their ‘intrinsic’ and chemically induced emotions — and this sort of self-understanding is vital within a limited scope. But to give oneself over to this sort of thinking about one’s whole personality is to make it impossible to interpret any given emotion as a meaningful event? Angry? That’s a rush of adrenalin. Stressed, nervous, hunched, tired — your cortisol is out of whack. Feeling low? No, you’re serotonin deficient.
by auchel
This whole divide between biopsychiatry and psychology is really only relevent to people who take an actively antipsychiatry stance. Psychiatrists refer people to psychologists all the time. Everyone knows that nobody’s entirely sure about the etiology of (most) mental illnesses and it’s generally a case of using the most practical model of diagnosis and treatment. Pretty much everyone agrees that the causes of mental illnesses are complex and probably involve both physical and environmental factors.
Aside from anything else, there is no contradiction between a disease being both biological and environmental. Take diabetes, which is undeniably a physical disorder of the pancreas. It’s caused by a mixture of environmental and genetic factors. Treating it requires both medication to address the biological features and also psychosocial treatments to address things like diet and monitoring.
Furthermore, the brain is biological and, if you don’t want to start inventing souls, the mind and its behaviour is what the brain does. Which means that all behaviour is biological in origin. In that respect it makes sense to go looking for biological explanations of mental illnesses, because they are there. Whether the ones we have at the moment are at all correct is another matter, of course.
Nope, this divide begins at the pharma-funded feet of the family “advocacy” organization known as NAMI. Tell them this and prepare for a shitstorm:
And I daresay, research helps, google is your friend, etc.
flawedplan: Placing the blame for the divide between biopsychiatry and psychology with an American organisation seems a little parochial to me.
The roots of the biological model go back to the 1930’s with Moniz’s development of the lobotomy. They were strengthened by the invention and widespread adoption of the antipsychotics in the 1950’s. And various psychiatrists – Laing and Szasz among others – began to dissent from this in the 60’s. Since NAMI wasn’t set up until the end of the 70’s, your statement is a little confusing.
Yeah, I know all that, and black bile and phlegm too. I was fixating last week because NAMI is the BORG.
>experimental chimp:
“This whole divide between biopsychiatry and psychology is really only relevent to people who take an actively antipsychiatry stance.”"
Untrue. I’m certainly not antipsychiatry, either in its historical of literal sense, although I think that Thomas Szasz and RD Laing make a lot of interesting points. Yet I’m firmly of the belief that the dominance of biologic explanations of mental illness are not only interesting but relevant to how we view and deal with psychological suffering.
As I commented on a related post in another forum, “I’m certainly not against pharmaceutical use …; I’ve used antidepressants and would again if I really felt the need… [But] the shift in the dominant explanations for depression is interesting: it used to be caused by an excess of ‘black bile’ (hence the term melancholia), then it was caused by Freudian concepts of conflict in the unconscious etc., now it’s caused by neurotransmitter imbalance. (I know I’m grossly reducing the history here.) What’s most disturbing is that, at each historical point, the theorists of the dominant explanation were SO certain that their theory was correct and final. I wonder if, when the next theory displaces the current (how about “Depression is caused by not buying enough stuff; it’s a shopping deficiency”), will we be encouraged to consider the serotonin-deficient explanation as outdated and quant?”
As much as you claim that “Pretty much everyone agrees that the causes of mental illnesses are complex and probably involve both physical and environmental factors”, I wonder how secure “pretty much everyone’s” explanations of mental illness are.
“Aside from anything else, there is no contradiction between a disease being both biological and environmental.”
True, but I’d argue that privileging biologic explanation of mental illness is now epidemic and the consequences of such is to distort our understanding of and remedies for the suffering that people experience.
“Furthermore, the brain is biological and, if you don’t want to start inventing souls, the mind and its behaviour is what the brain does. Which means that all behaviour is biological in origin. “
This is the worst kind of biologic reductionism that I object to most strenuously. To reduce people – who they are, the sum total of their lives and experience (mental illness included) – to neurology/neurobiochemistry, is not only misguided but offensive. It’s akin to saying that Beethoven’s Ninth Symphony is merely changes in air pressure. It may be literally true in a physical sense but it dangerously misses the point, it displays an almost embarrassing misunderstanding of what it means to be human.
For the record, I am not my brain. To equate who I am with neurology is not only inadequate and disempowering but laughable in its stupidity.
It’s FEAR.
What’s most disturbing is that, at each historical point, the theorists of the dominant explanation were SO certain that their theory was correct and final. I wonder if, when the next theory displaces the current (how about “Depression is caused by not buying enough stuff; it’s a shopping deficiency”), will we be encouraged to consider the serotonin-deficient explanation as outdated and quant?
I hate to bring up Kuhn, but I’m going to have to. I don’t really find this shift of explanations disturbing – that’s how science tends to work. The dominant paradigm shifts from one certainty to the next, with each generation holding onto their explanations to the point of breakage. Psychological explanations do seem to have been even less useful than the catecholamine theory. I do find it interesting how everyone who attacks the biological explanation attacks the serotonin-imbalance theory of depression – which, at this point, isn’t much more than a marketing gimmick for SSRI’s.
As much as you claim that “Pretty much everyone agrees that the causes of mental illnesses are complex and probably involve both physical and environmental factors”, I wonder how secure “pretty much everyone’s” explanations of mental illness are.
Why should it need to be secure? Neither biopsychiatry nor psychology provide a convincing account of mental illness. That’s not secure, but that’s not a bad thing.
I’d argue that privileging biologic explanation of mental illness is now epidemic and the consequences of such is to distort our understanding of and remedies for the suffering that people experience.
Feel free to do so. I’d argue that while psychological remedies to mental distress are important, the biological understanding of how mental distress occurs should be priveledged because it represents the only realistic way forward towards better treatments and, perhaps, cures.
This is the worst kind of biologic reductionism that I object to most strenuously. To reduce people – who they are, the sum total of their lives and experience (mental illness included) – to neurology/neurobiochemistry, is not only misguided but offensive. It’s akin to saying that Beethoven’s Ninth Symphony is merely changes in air pressure. It may be literally true in a physical sense but it dangerously misses the point, it displays an almost embarrassing misunderstanding of what it means to be human.
I’m bemused at how merely pointing out that we are biological and our behaviour has a biologial basis can be offensive to anyone. I don’t deny that thought, emotion and meaning are real, only that a biological account of each is both possible and important.
I hate to bring up Kuhn, but I’m going to have to.
I’m glad to brought up Kuhn. His paradigmatic-shift model only adds weight to the possibity (not probability) that biopsychiatry is blinded by the assumptions it unconsciously accepts. It may be true that Kuhn’s theories about how developments in science are stratafied are true but it hardly demonstrates that the current ideas about mental health are free from erroneous biases.
Psychological explanations do seem to have been even less useful than the catecholamine theory.
Really? I find it curious that since the biologic explanations (and treatments) became dominant, the prevalence of depression seems to have grown exponentially. Hardly a proof of the value of the “catecholamine theory”.
I do find it interesting how everyone who attacks the biological explanation attacks the serotonin-imbalance theory of depression – which, at this point, isn’t much more than a marketing gimmick for SSRI’s.
There’s an endless number of references I could provide for the ubiquity of the “serotonin-imbalance” therory of depression; without doubt it’s the dominant rhetoric around depression causation. I find it somewhat amusing that you would champion the “catecholamine theory” in one sentence then disparage the “serotonin theory” in the next. I agree that the “serotonin deficiency causes depression” theory is as unproven, as is attributing the cause to deficiencies in noradrenaline, dopamine or any other catecholamine.
…the biological understanding of how mental distress occurs should be priveledged because it represents the only realistic way forward towards better treatments and, perhaps, cures.
Evidence please? That’s such an assumption unsupported by research. What evidence do you have that biological psychiatry is the “only realistic way forward”?
I’m bemused at how merely pointing out that we are biological and our behaviour has a biologial basis can be offensive to anyone.
If you’re bemused as how reducing one’s experience to neurology, dismissing the value and meaning that one gives to one’s experience, is disempowering and offensive, then I can’t help you.
I don’t deny that thought, emotion and meaning are real, only that a biological account of each is both possible and important.
Possible and important maybe, but grossly insufficient.
Just a general comment. It is good to see someone taking an active role in fighting against the stigma that comes with mental illness. I believe the hardest part in my battle is not dealing with my disorders but to have people see me as me and not what is written down on a piece of paper.
It has not helped that psychotherapies came out of disciplinary measures that started in the 18th century when Pinel released his manic patients from their chains. The language used in psychotherapy is rift with “objective” moral judgments of character. It’s not so much about breaking chains as it is laying on guilt and shame until the outer behaviors that so much bother others are stopped. If the guilt and shame are redirected away from the patient it is to throw it on his parents. Not a single criteria of a DSM “personality disorder” takes accurately into account the subjective experience of the sufferer.
Psychotherapists try to get around this with their often very genuine empathy, warmth, compassion and sincere desire to help. But there’s always a moment, when for example, the insurance company insists on it’s expertise, especially if the problem is “Borderline PD”, that both patient and doctor find themselves caught up in the same punitive language.
To make matters worse, society at large applies moral judgments to people who they do NOT see as “biologically ill” – and we are far from accepting that someone’s behaviors and pain merit just as much compassion when they stem from adaptive formations to hostile environments. Society is the first to forget that trauma actually damages the brain, the central nervous system, etc.
If the world can only think about other people in terms of good and evil, no wonder we look to biology to find a way out.
If we want to reduce stigma, using the biological model does not help. Studies show that folks who believe mental illness is a brain disorder desire more social distance from folks labelled mentally ill than folks who do not believe that.
I have to say where is the evidence that psychological theories have not been helpful in treating mental illness? A famous psychiatrist has noted that patients at the now gone Chestnut Lodge used to leave to marry and hold down jobs before the use of drugs became universal. After that very few went on to marry and rejoin mainstream society. There is no medication that helps folks recover from PTSD, so do we say it isn’t really a mental illness or what?
I believe NAMI’s contribution to the biological paradigm arose out of fear of being blamed for their children’s illness. Refrigerator mothers were a ridiculous theory, but the impact of child rearing practices and childhood abuse on the later development of mental illness is not.
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