By Bart Magee, Ph.D.
In my last post, I questioned why we haven’t yet witnessed a declared goal from any government agency, professional organization, or major institution to end mental illness. I reviewed the fractured history of how we theorize disorders of the mind and formulate their treatment, a history that goes part of the way to explaining why we’ve been held back from such an ambitious objective. But there’s more to the story. It’s not enough to say that mental illness is such a complex problem that a total solution can’t be conceived. For other difficult problems, like poverty, or cancer, or human trafficking, ending or eliminating the problem absolutely is the stated goal. Go to Google and write “ending” in front of any of those issues and you’ll see books, articles, and organizational goals clearly aiming to solve the problem — for good. If you do the same for mental illness you won’t find the same determination. (The closest you’ll get will be demands to end mental health stigma or discrimination against the mentally ill.) Solving those other big social problems won’t be any easier than truly tackling mental illness. However, stating the aspirational aim to end poverty or any other deeply-rooted affliction is imperative even if you recognize that the road to reaching that goal isn’t yet mapped out. Not only is it a way to inspire, to marshal resources, and get the needed attention on the problem, it also says something important about the problem; it creates a narrative of the issue. It says that the problem’s causes can be discovered and addressed, and more importantly, that the problem itself is fundamentally unacceptable, and therefore, that we bear a moral responsibility to work toward its eradication.
By not declaring a goal to end mental illness, we sidestep that obligation and get away with only paying lip service to really confronting the issue, instead, consciously or not, we accept the status quo: that mentally illness will always be a part of the human condition. We perpetuate the myth that it’s out of our control. We perpetuate stigma. We can try to reduce that stigma, help people access care, improve the care they receive, give them pills, tweak our therapies, and help them manage, but that’s about it. That’s the story we’ve been telling and it’s the wrong one.
Calling for the end of mental illness says we are taking it seriously. And that’s long overdue. Every day that we don’t, the situation gets more dismal as rates of anxiety, depression, and suicide rise to appalling levels and all the related social problems — school failure, drug addiction, disability, homelessness, and incarceration become more intractable.
Calling for the end of mental illness moves the issue squarely into the social realm, taking it out of the moral universe (that it’s a problem of a weak character) and out of the strictly medical one (that’s it’s a solely biological or genetic issue). This is important because it helps us take clearer aim at the causes which are primarily social and environmental, and not biological or endemic to the individual person. One of the most profound changes that can happen in therapy occurs when the patient realizes that their suffering isn’t caused by something in them, some inner badness or brokenness, but it has to do with something that happened to them and relates to how they’ve responded to their environment and how they’ve worked to survive. The former mindset is fixed, imbued with shame and hopelessness. It reinforces the symptoms. It also reinforces stigma. The latter perspective locates the problem in a relational matrix between the individual and the social world which creates space where change can happen. It relieves the individual of bearing all the responsibility for their suffering and also gives them psychological freedom, a new sense of agency, and permission to really make use of help from others. We need to make the same shift as a society. What if we saw mental health problems as ones that originate in relationships, between people and between people and the social world? What if we saw them as not solely individual problems, but a collective one? If we did, then new and creative possibilities for forming responses to the mental health crisis would come into view.
Taking such a fresh perspective gives us a way to unify the four main theories of mental illness — the supernatural or spiritual, the biological, the psychogenic, and the social — and out of that create a more potent understanding of its prevention and treatment. But that would just be the start.
In my third and final article, I’ll sketch out a picture of this new paradigm and how it can lead us to the end of mental illness.