Myths bring to mind images Greek gods and primitive cultures. They’re considered vestiges of a pre-modern, pre-scientific era. But they do narrate our world, and colour our science.
People are aware of this. Thus you’re likely to read plenty of myth blogs this Mental Health Week. And surely plenty are good. They often attempt to tackle stigma (although I prefer the word discrimination). They will caution you against blaming people with mental health issues. They will challenge the assumption that people with mental health issues pose a physical threat. And they will implore you to discard beliefs that it is a moral failure. It is a physical illness, after all.
It’s this latter that point – that mental illnesses are just like physical illnesses – that needs further scrutinization. I believe it’s part of an emerging modern myth: that mental and emotional distress are just chemical imbalances.
This week will likely hear this term bandied around. Depression is the result of lowered serotonin levels in the brain. This is fixed by elevating those levels. Schizophrenia is a result of abnormal changes in dopamine function. We have various antipsychotics that serve as a cure. But we know these claims are not wholly true; they are their own modern myths.
We often see myths by looking in the rear vision mirror. But if you stop and look, you’ll see we’re creating our own in the present.
There are many grounds to worry about the physical-mental illness analogy. On a general level, the science does not support it. The DSM is not an objective or scientific account of mental disorder. Rather, it’s based on convention and cultural tides. In psychological terms, the real aim for the DSM – and perhaps this is all that we can reasonably expect at this stage – is to provide reliability, not validity, of diagnosis. However this poses questions about how we ground our diagnoses. The emergence and removal of particular diagnoses testifies to this. Our hysterical treatment of women, confused approach to non-cisgender people, clinical phobia of same-sex relationships, and deplorable approaches to race are evident.
Diagnosis in the DSM does not suggest cause. Thus issues may arise from trauma, behavioural learning as well as biogenetic causes. Of course there are physical substrates for distress. This doesn’t suggest that looking at someone’s amygdala is more useful than addressing that they were sexually assaulted. Explaining trauma responses exclusively in physical terms misses the point. It risks losing the chance to redress the cause, or in some instances could re-traumatize individuals.
This latter point speaks to a tension between biological and social models of disability. The former characterizes the dysfunction and disability within the individual. In this instance, as a result of a chemical imbalance in the brain. The latter shines the light on society. A person’s distress may also be the result of labelling, discrimination and social barriers to participation. By exclusive characterization of distress in physical terms, it hides socially disabling factors. Abuse, violence housing and marginalization are not visible in synaptic misfiring. But we continue with these explanations, with the knowledge that it won’t necessarily help.
So there are real reasons – scientific and social – to question this myth. So I want to ask what the questions: what are the origins of this myth? What is its function?
The origins of this myth cannot be neatly woven or conveniently collapsed into a single thread. There are many causes. There are many histories based on clinical, carer and service user experiences. Therefore different components will prove salient to you. Even so, there are some things we can say.
Much of contemporary imbalance discourse appears a reaction to the past. Psychiatry has a dark intellectual and social history. Its systematic involvement in slavery, eugenics and the Third Reich is often overlooked. Psychiatry has sought to break from this history. It does so by removing the Freudian and speculative explanations that showed no reliability. It also seeks to overturn the long-held idea that mental illness is a social and moral failing. Pulling yourself up by your socks is not necessarily possible. (Disagreement might emerge on the causes and responses)
While this approach seems well-intended, it doesn’t give us a break with the past. History is repeating itself, or as Cole would say, “Time is a Flat Circle“! For while we see a renewed focus on biological explanations, we fail to see psychiatric oppression of women, slaves, homosexual and non-cisgender people are based on these biological explanations!
So what function does this myth play? One is the cultural break with the past. It allows us to feel we have progressed beyond our pre-modern explanations of distress, to something truly scientific. We should be wary though of seductive neuroscience.
Another is the unfortunate role that pharmaceutical companies play in medicine and mental health. It’s important to remember that diagnostic categories and their explanations often came from the drugs. Moncrieff has consistently shown that while medications may provide life-saving treatment for people, this doesn’t confirm the chemical imbalance theory.
Moreover, keeping diseases within an individual also reinforces our liberal and capitalist ideologies. It separates emotional distress or dysfunction from our failures as a society to prevent gender based violence, find secure housing and reduce inequality. It’s a sedative on our collective moral consciousness.
Each of these responses to the origins and functions of the myth are dramatically under-explored. They would and should be open to debate. They are not designed for consumption and uncritical acceptance. It’s an invitation to critically evaluate the discursive construction of distress, during this important week.