Psychiatric-Less

Rethinking mental health

Lindsay Clancy, the woman who tragically killed her three children and attempted to take her life, has generated controversy from two opposing sides of the spectrum. A mental health industry that failed her (and, more importantly, the children that were dangerously under her custody), and those outraged that her case is gaining any sympathy to begin with.

An obvious point evades this debate. Lindsay was taking psychiatric medication, and what the effects those medications were having on her mind should be the object of scrutiny, not to exculpate her of responsibility, but to understand how dangerous these medications can be to those consuming them. She was prescribed numerous drugs in the months before her actions, including antidepressants and anti-anxiety pills like sertraline (Zoloft) and lorazepam (Benzodiazepines). Her defence team claims this led to psychosis, as she was actively seeking more comprehensive support. Prosecutors argue that she wasn’t taking enough of the medication prescribed to her and that’s what led her to premeditate the murder of her children.

According to a report, there is a net increase in mental illness. Another report argues that the primary reason for this rise is a lack of mental health services for those in need, and that more investments need to be made in providing these services as a preventative measure rather than punishing crime. The same argument is being used by the defence team of Lindsay, claiming the system failed to provide enough support to a mother suffering from post-partum depression. However, spending on mental health services increased by 52% since 2009, reaching $225 billion in 2019, according to a report. It includes spending on treatments like therapy, prescription medications, and stays in psychiatric or substance abuse rehabilitation facilities.

If available treatments were successful, we would expect to observe a decrease in mental health disorders. Instead, what is evident is a vicious cycle: The more patients need mental health services, the more these services will grow. However, when the industry fails to provide long-term solutions, or when the supposed treatments exacerbate existing issues, those patients need more help. To explain the ever-increasing number of patients seeking mental health support, the industry deflects responsibility to a lack of sufficient services as opposed to a failure of the quality of those already provided. The result is that a highly lucrative industry continues to grow unquestioned.

A distinction should be made between psychiatry and psychology. Though psychiatry is presented as another form of care that can work in tandem with psychotherapy, opposition from psychotherapists towards psychiatry is growing. The two schools of thought stand increasingly at odds because they operate on irreconcilable epistemological frameworks. One advocates developing the inner ability to overcome life’s challenges, which relies on the concept of personal agency. The other seeks to replace that ability with medication, which relies on the concept of biological determinism.

The risk with long-term use of daily psychiatric medications cannot be understated. Many patients consume these drugs for years, some for a lifetime, but the FDA and the EMA require only 6-8 weeks of clinical trials as adequate for regulatory approval. A minority of conditions are studied for longer, for 6 to 15 months, which, despite representing an improvement, remains a much shorter time frame than the duration of prescriptions provided to many patients. Furthermore, the study argues that the testing for these drugs fails to reflect real-world patients, and pharmaceutical companies with conflicts of interest have overarching say in determining outcomes: “The EMA and FDA clinical research guidelines for psychiatric pivotal trials recommend designs that tend to have limited generalisability. Independent and non-conflicted stakeholders are underrepresented in the guideline development.”

Permanent rewiring of our neurological pathways, including brain damage, and dependency from long-term use of psychiatric medications are already accepted in clinical literature. Yet governments do not factor these findings into their testing for regulatory approval. Government approval should be viewed with a high dose of skepticism. One needs to look no further than the fact that the surgical lobotomy was never made illegal in the Western world. Rather, it was gradually replaced with non-surgical, more palatable neurological alteration: A chemical one.

How did such an industry become so influential in the first place? The power of political language is often unnoticed (because of its subtlety) in affecting our critical faculties.

The word psychiatry derives from the ancient word psyche (ψυχή), meaning soul, and -iatry (-ἰατρεία), meaning healing. It was coined in 1808 by German physician Johann Christian Reil. It translates into the “medical healing of the soul”.

In 1984, George Orwell spoke about how institutionalized political language weaponizes words through contradiction. He wrote that, "War is peace, freedom is slavery, and ignorance is strength." The intent behind the inversion of language is to make rebellion close to impossible. With the term psychiatry, one believes they are “medically healing their soul”, a definition that even in scientific terms is mistaken, as psychiatry offers treatments, not cures (which is what healing, by definition, means). The more profound implication is that a patient is brought into a state of confusion. One will enter treatment believing they are helping themselves, so if that treatment fails, the problem must clearly be with them, not, of course, with a profession whose intended purpose is to heal them. Suppose your treatment didn’t work; it’s time to increase your dosage or try stronger medication. In other words, we need more of that care, not a different kind. The underlying premise isn’t open to dispute. Ironically, such an approach is fundamentally unscientific, as scientific development relies on the concept of fallibility.

It’s important to look at the history of psychiatry to explain how these hidden, more insidious forms of control compromise our sense of agency. Michel Foucault, a philosopher mistakenly looked down upon by many modern conservatives, made the point of discovering the genealogy of ideas to prove that what is accepted as truth in modernity is merely a construction. This doesn’t imply moral relativism as critics suggest. To the contrary, it’s a historical method used to shed light on the truth behind modern tools of propaganda.

In Ancient Greece and Rome, mental illness was viewed as a supernatural phenomenon cured with medical-philosophical naturalism and, at times, superstition. Physicians used warm baths, massages, even music to calm an agitated mind. Doctors prescribed improved diets, physical exercise, and a change in scenery. Talk therapy was used, though differently: Philosophers replaced negative thoughts with positive ones (an approach more akin to modern psychotherapy such as CBT or DBT). Pagan priests and priestesses would make sacrifices to the gods to win their favor.

In the Middle Ages, the rigidity of monotheistic thought combined with the belief in demonology narrowed down the meaning of mental illness to spiritual possession and offered exorcisms by priests as a cure. With the Enlightenment, a refutation of Christian dogma in favor of the wisdom of the classics was attempted, though it was a largely misguided attempt. The advent of mass industry and scientific experimentation created psychiatry as an internal, biological diagnosis, separated from one’s conditions and reduced to a correctable chemical imbalance through synthetic drugs. Organic and natural forms of care, whether through healthy habits and fitness, redirection of negative thoughts into positive ones, changing one’s circumstances, support from loved ones and community, as well as transcendental purpose through spiritual connection, were cost-free cures that didn’t serve the interests of an increasingly profitable pharmaceutical industry.

The psychiatric industry was born with the advent of industrialization in the 18^th century, when agricultural life, constituted by large, extended family networks, was uprooted. Individuals moved to work in factories alone for wages. Through the technological revolution, by the end of the 20th century, the lives of ordinary people were transformed more extremely and at a faster pace, from performing labor in industrial towns to working in service-based economies in large cities. While offering dynamism and opportunity, this lifestyle produced a profound sense of solitude. A support structure was missing to overcome life’s inevitable challenges. Psychiatric services sought to provide a practical, immediately gratifying solution to this sense of alienation.

The new deterministic approach to medicine undermined the inevitable upheaval and dissent that society created during this time. It’s no coincidence that this period produced “The Age of Revolution”. There was a deep sense of anger and unrest that made individuals organize collectively to change their circumstances. However, with the invention of psychiatry, institutional consent was more easily achieved. It popularized the notion that individuals who are allergic to their surroundings, surroundings that may in fact be unhealthy, must be medicated to make those conditions tolerable and become obedient to the prevailing orthodoxy. In other words, the society you live in cannot possibly be the problem: You are the problem. Healthy rebellion to a sick society is turned into a sick reaction to a perfect society. Extrinsic causes become a form of intrinsic culpability.

The effectiveness of this form of power in achieving conformity lies in changing our relation to and understanding of human suffering. Unhappiness has been stigmatized; it is now considered an unacceptable feeling that, rather than being embraced and overcome by listening to what it can teach us and deserving of support, must be externalized through a medical institution. The psychoanalyst Carl Jung argued, “There is no coming to consciousness without pain.” By accepting the idea of a chemical imbalance, we are, by definition, led to pathologize every form of suffering as an illness to be synthetically fixed. However, authentic suffering is preferable to artificial happiness because it allows us to learn and grow from the inevitable obstacles life presents us, instilling a sense of becoming and progress. The chemical alteration delivers an uncanny remedy. One needs to look no further than celebrities like Britney Spears and Amanda Bynes to see how decades of psychiatric medication, under forced conservatorships, led them to become a shadow of their former selves. One can barely recognize them.

The question is not merely whether struggle is preferable to complacency, but what is worth struggling for? The industry formulated a premise that was unusual in history: Discontent is a mistake that must be corrected, rather than a necessary part of human existence. Not because humans seek to be masochistic, but because struggle is inherent to finding meaning. Christianity rests on the notion that Jesus suffered and died for our sins. We were born as sinners and can achieve redemption through remorse. Before Christianity, the ancient Gods expected sacrifices from us to show our devotion to them and gain fortune. Pain is a beautiful part of our humanity when tied to meaning. It allows us to strive for something greater than ourselves.

Foucault critiques the rise of psychiatric treatment in the modern age in Madness and Civilization:

Confined on the ship, from which there is no escape, the madman is delivered to the river with its thousand arms, the sea with its thousand roads, to that great uncertainty external to everything. He is a prisoner in the midst of what is the freest, the openest of routes: bound fast at the infinite crossroads. He is the Passenger par excellence: that is, the prisoner of the passage. And the land he will come to is unknown—as is, once he disembarks, the land from which he comes. He has his truth and his homeland only in that fruitless expanse between two countries that cannot belong to him.

The madman was once seen as a “nuisance” to the village, but still cared for and provided with a purpose in the community. He now assumes the role of “the leper,” shunned away from society entirely and made to alter himself through isolation. The more concerning implication is how the introduction of this system of exclusion doesn’t merely target madmen in the more conventional sense. Rather, it conveniently seeks to create madmen from those it perceives as a threat. Foucault spoke about how the mental health industry homogenizes society to guarantee obedience to the dominant ideology. He argued we live under an imperceptible, and for this reason, more effective form of power today than in the past: “Traditionally, power was what was seen, what was shown, and what was manifested. Disciplinary power, on the other hand, is exercised through its invisibility.”

In Zero to One, Peter Thiel argues that “courage is in shorter supply than genius”. Our society appears increasingly unable to produce the great minds that characterized our civilization in the past. The causes are multi-faceted, but the psychiatric industry is one of the primary methods used to erode the capacity for one to think originally, as such a thought process inherently requires rebellion from the status quo. Individuals who would be considered mentally ill in today’s age were often considered exceptional throughout history. A study by Science Direct found that people with a hyperactive brain, or high IQ, are prone to what are now defined as “personality disorders”. By labeling these individuals with sophisticated clinical terms used to denote mental illness, they undergo social and political pressure. As a result, these minds find it more difficult for their unique capabilities to flourish. Researchers speculate that Leonardo Da Vinci suffered from ADHD (Attention Deficit Hyperactivity Disorder). Isaac Newton was thought to have suffered from a form of schizophrenia and occasional psychotic breaks. Would they be medicated today? If so, who would they have become?

For the Western mind to find lasting, meaningful remedies to the increasingly diffused growth in depression, it must first develop an acute awareness of how modern forms of propaganda behind the supposedly neutral and positive institution of psychiatry operate.

Alessandra Bocchi is editor of Alata Magazine and artist at Painting Life.