Restoring Sanity, Part 2: Mental Illness as a Social Construct

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Susan Hyatt and Michael Carter, DGR Southwest Coalition

In 2004 the World Health Organization ranked Major Depressive Disorder as the leading cause of disability in the US among people aged fifteen to forty-four.  MDD afflicts about 14.8 million adults, 6.7 percent of the U.S. population aged eighteen and older in a given year.[1]  The US National Institute for Mental Health estimates that one in four US adults “suffer from a diagnosable mental disorder.”[2]  Many see only one way out: nine in ten suicides—33,000 total in one year in the US alone—had one of these disorders.[3]  How can we explain this?  If the life of privilege and material wealth in the US and other consumer nations is so desirable that every living thing must pay the price for it, why kill yourself to escape it?  What if statistics like these were taken seriously, as a sign of preventable social malaise, not human frailty?  Suppose someone cared enough about all this misery to uncover a cause, and take steps to alleviate some of this pain.  Might that look like the same effort to end poverty, global warming, and the extinction crisis?

Sorting through these questions takes a lot of effort.  It’s hard to excise cultural training from our minds, banish it from our hearts, and fight it in the material world.  In our last essay,[4] we proposed naming the problem: civilization.  Civilization is thought to be synonymous with humanity, but we insist that it is not.  Instead, it is simply one of many possible cultural strategies, one that enables settlements too populous to sustain locally.  It requires agriculture, which itself can never be sustainable because it destroys topsoil.  To continue, civilization must constantly expand with economic and military domination, and will eventually consume the whole of the earth.  Virtually all injustice and environmental destruction is caused by this system.  Because of its total dominance over our lives, regardless of economic or social class, civilization is also the basis for our mental and emotional conditions.

To confront something so abstract and immense is very difficult, mostly because the required will is destroyed by the isolation, loneliness, and hopelessness this power structure creates in the first place.  The most destructive demand is perhaps work—the need to spend the majority of our waking time acquiring food, shelter, and any other necessities.  This is far more exertion than, say, when bird builds a nest and searches for seeds; it requires economic coercion, a way to police the workforce and the unemployed, and constant investments of effort unprecedented in the history of our species.  We didn’t invent this system and most of us wouldn’t willingly participate in it, given an authentic, noncoercive choice.  Yet we are still beings who make mistakes, can be emotionally volatile, and are prone to crippling addictions.  Just as civilization dictates our food, shelter, and productivity, it also explains our personal troubles and prescribes solutions.  These solutions generally serve the needs of civilization—of productivity—not people.

Disease Modeling and the DSM-5

It is widely believed that depression is a disease, a chemical imbalance in the brain.  Though this is only a theory with no physical evidence, it provides the basis for much of the available treatment.  The American Psychiatric Association’s (APA) classification handbook, Diagnostic and Statistical Manual of Mental Disorders, Volume 5, or DSM-5, lists eighteen disorder categories, such as depressive disorders, schizophrenia spectrum and other psychotic disorders, anxiety disorders, trauma- and stressor-related disorders, gender dysphoria, substance use and addictive disorders, and obsessive-compulsive and related disorders.

Under these headings are more specific diagnoses, like “oppositional defiant disorder,” which is a “frequent, persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness exhibited over the course of at least six months, and with at least one non-sibling, and should exceed normal behavior for the individual’s age, gender and culture.”[5]  Since the APA is not interested in reforming culture, the categories outlined in the DSM-5 are by design things that are wrong with people.  Disorders, diseases, pathologies—however they’re labeled, they are considered problems of the individual, not society.  When someone is diagnosed with a mental illness, they are burdened with an authoritative, biased decision about what it is and how to treat it.

Commenting on the institutional view of depression as an illness best treated with medications, psychologists Allan Leventhal and Christopher Martell note that “psychiatry has a strong incentive to believe in the disease model and in the efficacy of drugs.  The pharmaceutical industry, like all corporations, has capital as its bottom line with the need for executives to report profits to investors.  Not only do we maintain that the disease model has created confusion by accounting for human distress as ‘medical illness,’ the increasingly corporate structure of the health care system, including pharmaceutical and managed care companies, has often favored profit over people.”[6]  The baseline isolation of the dominant culture makes us vulnerable to medical modeling, since it’s easier to explain away emotional pain as having a physical cause than to discuss it openly.  Leventhal and Martell point out that additionally, behavioral change is hard and psychotherapy “rarely progresses in a straight line.”[7]  The shortcut of a pill is an appealing alternative.  Rather than truly helping people to heal from the effects of negative experiences, disease modeling can create lifelong “mental patients” with a firmly embedded concept that they have something permanently wrong with them.

This is not, however, meant to invalidate or minimize the pain of those afflicted with depression, or any of the various conditions outlined by the DSM-5.  Though neither of the authors have ever experienced severe depression, we have both felt the dismal, seductive edges of it.  We have never taken psychiatric medications, though we’ve both spent a lot of time in various methods of therapy.  Fortunately we both found relief, in Carter’s case from moderate depression and chemical dependency, and in Hyatt’s, from post-traumatic stress disorder.  Carter’s daily thoughts of suicide—though never any attempts—were related to routine decisions and habitual, repetitive thinking, not a disease.  He needed no medications, but rather a new approach to managing his thoughts and actively engaging with situations and relationships.  Hyatt was offered supplemental anti-depressants as a matter of course for a completely unrelated autoimmune disorder, on the assumption that depression is an expected result of a distressing medical diagnosis.  Refusing the drugs, she lived with her feelings instead of chemically suppressing them.  They taught her their lesson and eventually passed.

There is no doubt that psychiatric drugs can be helpful in some situations.  But the often-lifelong prescription of a substance chemically related to rocket fuel[8] is something to be scrutinized.  That antidepressants are commonly found in drinking water[9] should also be reason to reconsider them.  Medicine is a lucrative business, and treatments are prescribed by doctors who may be strongly influenced by the primacy of pharmaceuticals in the medical industry (including education); these factors are often lost on those who can barely gather the energy to leave their darkened rooms.

Identifying the cause of the misery is hard, perhaps impossible—there may never be a way to disprove the disease hypothesis—but that doesn’t mean that other hypotheses can’t be made, and successful, non-drug treatments can’t be found.  As the Coalition for DSM-5 Reform, critics of the manual and its approaches, point out: “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”[10]

The Coalition also alleges that the DSM-5 misses “the relational context of problems and the undeniable social causation of many such problems,” and that the “[diagnostic] criteria are not value-free, but rather reflect current normative social expectations.”  In other words, if a psychiatrist says you have a problem, that’s a subjective judgment based on cultural conditions—for example, that most people are obedient to power.  To treat our feelings—of depression, of defiance, of hopelessness—as strictly physical or biological conditions to be chemically erased if uncomfortable is to dishonor our instincts.  There are other, durable solutions that don’t involve the unknown risks and unpleasant side effects[11] of psychiatric drugs.

Redefining Healthy Behavior in a Toxic System

Depression indicates a serious lack of confidence in a worthwhile life, a powerlessness over one’s prospects.  It is not so much the opposite of happiness but of vitality.  Leventhal and Martell propose that depression “is the result of life events, negative responses to life events, avoidance of negative emotion, and the limitations on life that avoidance creates.”[12]  There are even some mainstream notions that depression may actually be beneficial.  One 2012 health magazine article reports that symptoms of depression may be evolutionary adaptations that force people to focus on problems and solve them.  J. Anderson Thomson, MD, assistant director of the Center for the Study of Mind and Human Interaction at the University of Virginia in Charlottesville, compares depression to pain, a signal that part of you needs help.  If the pain is bad enough, you will cry out, a call for help from others.  Depression may also be a way of calling for help.  “Depression tells you there’s a problem, tells you where the problem is, stops business as usual, and signals others that you are in distress,” explains Thomson.[13]

It is helpful to remember that our lives are arranged by institutions that are based on power, not care, and psychiatry is one of them.  The aim of power is to control—by force or coercion, or even better for us to control ourselves.  For example, labels affect our behavior; if we think our brain is imbalanced or defective, we will tend to behave that way.  If we consider ourselves diseased, we’ll act diseased, and may instinctively isolate ourselves from others.  Buying into the disease label for depression can exacerbate the problem by driving our isolation deeper and fostering a desperate faith in drugs.

Behavior that is considered normal by civilization—predatory self-interest, say—is considered insane outside of the context of civilization.  This behavior is created by the denial of basic human nature, such as a desire to feel a part of a mutual-interest culture.  If we consider the idea that many symptoms of so-called mental disorders are natural responses of our minds and bodies to an unhealthy, isolating social system, we can then redefine healthy behavior outside of civilization.  We can start to make a conscious effort to reconstruct healthy behavior, remembering that the definitions of healthy, normal, and abnormal behavior have been made by those who have power over us.  We can begin to work according to our interests and not theirs.  We can reclaim control over our lives and restore confidence and trust in our human nature.

Susan Hyatt has worked as a project manager at a hazardous waste incinerator, owned a landscaping company focused on native Sonoran Desert plants, and is now a volunteer activist.  Michael Carter is a freelance carpenter, writer, and activist.  His anti-civilization memoir Kingfisher’s Song was published in 2012.  They both volunteer for Deep Green Resistance Southwest Coalition.

Bibliography and Further Reading

Allan M. Leventhal and Christopher R. Martell, The Myth of Depression as Disease: Limitations and Alternatives to Drug Treatment, Westport, CT: Praeger Publishers, 2006.

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing, 2013.

Awais Aftab, MD, MBBS, “Mental Illness vs Brain Disorders: From Szasz to DSM-5,” Psychiatric Times, February 28, 2014, http://www.psychiatrictimes.com/dsm-5-0/mental-illness-vs-brain-disorders-szasz-dsm-5#sthash.hA4QwWSp.wptbyJ4M.dpuf

Bruce E Levine, “Psychiatry Now Admits It’s Been Wrong in Big Ways – But Can It Change?” Truthout, March 5, 2014, http://www.truth-out.org/news/item/22266-psychiatry-now-admits-its-been-wrong-in-big-ways-but-can-it-change

Ethan Watters, “We Aren’t the World,” Pacific Standard, February 25, 2013, http://www.psmag.com/magazines/magazine-feature-story-magazines/joe-henrich-weird-ultimatum-game-shaking-up-psychology-economics-53135/

John Read, Claire Cartwright, and Kerry Gibson, “Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants,” Psychiatry Research, February 18, 2014, http://www.psy-journal.com/article/S0165-1781%2814%2900083-3/abstract

Madeline Vann, MPH, medically reviewed by Lindsey Marcellin, MD, MPH, “Is Depression Good for You?” Everyday Health, April 4, 2012, http://www.everydayhealth.com/depression/is-depression-good-for-you.aspx

Michael G Conner, “Privileged Children at Greater Risk,” InCrisis, December 13, 2008, http://www.crisiscounseling.com/Articles/PrivilegedKidsAtGreaterRisk.htm

Endnotes


[1] “The Numbers Count: Mental Disorders in America,” National Institute for Mental Health, accessed February 8, 2014, http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#Intro

“The global burden of disease: 2004 update, Table A2: Burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004,” The World Health Organization, accessed February 6, 2014, www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf

[2] Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

[3] “More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.  The highest suicide rates in the U.S. are found in white men over age 85.  Four times as many men as women die by suicide9; however, women attempt suicide two to three times as often as men.”  “The Numbers Count: Mental Disorders in America,” National Institute for Mental Health, accessed February 8, 2014, http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#Intro

[4] Susan Hyatt and Michael Carter, “Restoring Sanity, Part 1: An Inhuman System,” Deep Green Resistance Southwest Coalition, February 6, 2014, http://dgrsouthwestcoalition.org/2014/02/06/restoring-sanity-part-1-an-inhuman-system/

[5] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing, 2013, pp. 461–480.

[6] “Americans [spend] 200 billion dollars a year on prescription drugs.  In 2001, while the median net return for all other industries was a little more than 3 percent of sales, it was more than 18 percent for the drug companies.  Dr. Angell points out that the combined profits of the 10 drug companies listed in the Fortune 500 was more than the cumulative profits of the other 490 companies listed…these companies spend more on marketing and administration than on research and development.”  Allan M. Leventhal and Christopher R. Martell, The Myth of Depression as Disease: Limitations and Alternatives to Drug Treatment, Westport, CT: Praeger Publishers, 2006, p. 27-28.

[7] Ibid, p. 28.

[8] Ibid, p 34.

[9] Harvard Medical School, “Drugs in the water,” Harvard Health Publications, June 2011, http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2011/June/drugs-in-the-water

[10] “Summary of Concerns Regarding the DSM-5 as Currently Proposed,” Coalition for DSM-5 Reform, accessed February 17, 2014, http://dsm5-reform.com/summary-of-concerns-regarding-the-dsm-5-as-currently-proposed/

[11] “[Researchers] concluded that neither [tri-cyclic antidepressants and SSRIs (selective serotonin reuptake inhibitors)] demonstrated greater efficacy than placebo in the treatment of depression for children and adolescents.  Yet until recent alarming reports on the induction of suicidal behaviors by SSRIs, prompted by the urging of the drug industry, primary care doctors and pediatricians increasingly prescribed antidepressants to children and adolescents.  Between 1988 and 1994, there was a three- to fivefold increase in antidepressant medication treatments for children ages 2 to 19.”  Allan M. Leventhal and Christopher R. Martell, The Myth of Depression as Disease: Limitations and Alternatives to Drug Treatment, Westport, CT: Praeger Publishers, 2006, p. 44.  Other side effects of the medications include sexual dysfunction, increased agitation and homicidal urges, diarrhea, nausea, insomnia, and headaches (pp. 51-52).

[12] Ibid, p. 131.

[13]  Madeline Vann, MPH, medically reviewed by Lindsey Marcellin, MD, MPH, “Is Depression Good for You?” Everyday Health, April 4, 2012, http://www.everydayhealth.com/depression/is-depression-good-for-you.aspx

The article suggests “7 Ways Depression Makes You Stronger”: You’re a better problem-solver; you learn how to cope; you have better relationships; you’re more compassionate; you buck stress; you’re a realist; you can detect deception. “‘Depression is part of the design of human nature, and just because it’s painful doesn’t mean it’s bad or without its uses,’ Thomson says.”

5 thoughts on “Restoring Sanity, Part 2: Mental Illness as a Social Construct

  1. deepgreenniz

    Fuck Psychiatry. I’ve known many people who have struggled with it and the dangerous psychiatric drugs.
    “Psychiatry: it’s the latest religion. We decide what’s right and wrong. We decide who’s crazy or not. I’m in trouble here. I’m losing my faith.” -Madeleine Stowe in Twelve Monkeys

    Reply
  2. Pietas

    this blog is like medicine because everyone around me seems to enjoy society I should come here more often to realize that other people understand. I was president of an environmental club telling my vp in 2009 “see that tree, he doesn’t have to work to live. thing is, if we were trees, we wouldn’t be able to stop the humans from chopping us down.” And he was like “What?” I don’t know if it was the exact words said but it was sort of along those lines.

    Reply
  3. Pingback: Restoring Sanity, Part 3: Medicating - Susan Hyatt & Michael Carter

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