Wednesday, March 4, 2015

Facing the Facts about Mental Illness

T. M. Luhrmann is an anthropologist at Stanford University.  One of her interests has been mental illness with a focus on schizophrenia.  She has been writing about the need to consider what we label as mental illness as a psychological condition as well as a biological condition.  She has been interested in reminding the world that there are means of treating—if treatment is necessary—behaviors that do not fit within society’s definition of what is normal without resorting to dangerous medications.

Just as people are born with a range of intelligence, they are born with a range of responses to sorrow-inducing or threatening circumstances.  If the magnitude of the response is deemed excessive, we have decided to describe those people as suffering from depression or anxiety.  The range of such responses is continuous across individuals so the point at which one becomes “mentally ill” is absolutely arbitrary.  In addition, people have a considerable degree of control over their responses.  They can learn to deal better with sorrow and threats more effectively over time.  That is why Luhrmann and many others suggest drug therapy as more of a last resort than the treatment of choice.

As an example of learning to cope, consider a fascinating article Luhrmann produced for The American Scholar: Living with Voices.  She describes the discovery that people who are troubled by hearing voices, a certain path to a schizophrenia diagnosis, often find relief from confronting the voices and negotiating with them rather than fearing them or trying to make them go away.  Forming a relationship with the voice seems to change the character of the voice, transforming it from a threat to something that can occasionally even provide encouragement.  A movement has been formed promoting this approach.  Many participants had previously been subjected to intolerable brain-altering medications aimed at making the voices disappear.  They like to refer to themselves as “survivors of psychiatric care.”  More on the topic can be found here.

Luhrmann produced an article for the New York Times titled Redefining Mental Illness.  She was encouraged by recent developments that seemed to indicate a greater acceptance for more flexible treatment of mental issues—and not treating all issues as illnesses.

“TWO months ago, the British Psychological Society released a remarkable document entitled ‘Understanding Psychosis and Schizophrenia.’ Its authors say that hearing voices and feeling paranoid are common experiences, and are often a reaction to trauma, abuse or deprivation: ‘Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages’.”

“The report says that there is no strict dividing line between psychosis and normal experience: ‘Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without’.”

It was particularly encouraging to find the report recommending that psychological approaches be made available as well as medicinal.

“The report adds that antipsychotic medications are sometimes helpful, but that “there is no evidence that it corrects an underlying biological abnormality.” It then warns about the risk of taking these drugs for years.”

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