This blog post is part 2 in my 3 part series on Mental Health. You can find part 1 here: Medicating Ourselves Into Lives Not Worth Living, and part 3 here: Towards A New Paradigm of Mental Health And An Enlightened Society.

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The blog post that I wrote 6 days ago, Medicating Ourselves Into Lives Not Worth Living has sparked quite a debate. It stirred up a lot of new thoughts for me, so here is my follow up post.

Recap

I’m glad I wrote this post and got the conversation started, although the dialogue wasn’t as productive as I hoped. Most of the comments were from people taking medication themselves, who were riled up and ready to defend their life choices. The critique I received basically boiled down into to two arguments.

1) Medication does improve many people’s lives
2) I didn’t experience depression, I only experienced teenage angst. Therefore my analysis is invalid.

In my opinion, the biggest problem with my previous post, was that I failed to properly scope which part of the mental health spectrum I was talking about. I do so in this post, and address both points of criticism in more depth and proper context.

I would have liked the discussion to evolve towards a more holistic debate about mental health and personal transcendence. Granted, this didn’t happen because my post was perceived by many as incendiary, but I believe my tone was necessary to get the conversation started. And fortunately, this discussion helped me understand more clearly where the discussion needs to be taken.

There was some talk of “science”, but it was mostly a mudslinging of one-off studies that sought to confirm the commenters current worldview. This is certainly a complicated issue, but my strong feeling and observation is that our society is often in pursuit of the quick fix, the magic pill. And the solution will almost always lie in hard, diligent, regular practice and work. Most people don’t know how to do this, or aren’t willing to put in the effort. While it is bad for people to put “blame” on themselves, there’s danger in people believing they don’t have what they need inside themselves. Most people don’t realize how much our mental states are affected by actions within our control. We make probably hundreds, if not thousands of decisions every day that positively or negatively influence our mental health. How much sleep we get, what we eat, how much water we drink, whether we exercise, who we decide to talk to, the tonality of our voice, what we decide to put our attention on etc. etc. These daily decisions cumulatively add up day after day, and determine the majority of our mental health and our life. It’s rare to see someone doing all the right things and still be depressed.

I also received plenty of personal anecdotes across the spectrum about how medication was helpful or harmful in people’s lives. But what almost all of these comments failed to do was point the discussion towards how we need a more complete theoretical model of mental health. The fact is, the mind is a very complex system, and without a strong theoretical model that can integrate theories and findings about different parts of the psyche, most of our scientific studies will only be isolated insights that are unable to capture reality, and for the most part make inaccurate prescriptions. The inadequacy of our current paradigm is what enables the main problem I was pointing out in my post: that too many people aren’t realizing their full potential because they don’t know how to shape their internal reality to enable outward excellence. And our failure to acknowledge that reliance on medication is one of the biggest inhibitors to this.

Until we change the paradigm of mental health, and give people both the tools and a new belief system to replace their internal narrative of mental health, which has strong undertones of victimization and helplessness, then their lives will continue to exist far away from their potential.

Psychiatric Discontents & A Movement Towards A Better Model Of Mental Health

One of the only comments I received that pushed the discussion in this direction, was from my friend Ian Spector, who said that,

“Mental state/illness falls on a spectrum — and there isn’t just one. It’s all quite multidimensional. I completely understand your frustration with how most people are generally inefficient. That being said, unless you know your DSM, PDR, and a few other things inside and out (which professionals spend years studying), you can’t jump to the conclusion that anyone who is “functional” isn’t mentally ill or “close to 0.”

This comment refreshed my memory on what the current paradigm of mental health is, and is the implicit worldview in most people’s comments. What this helped me realize is that one of the main sources of confusion and controversy in my post, was my failure to properly scope my argument. I needed to provide more clarity and structure around what part of the mental health spectrum my post was directed at.

This is not easy, because mutual understanding is dependent on the resolution of a worldview conflict. My attack of the status quo did not come out of “thin air”. It came from making inferences on a mental model I’ve intuitively constructed through the synthesis of many different fields of knowledge. Understanding where I’m coming from may be difficult because I haven’t explicated this model, (I unfortunately only have the time to explicate a model on entrepreneurship and innovation right now), and if even I were to do this, most people probably aren’t ready to accept many of the underlying assumptions I have made. To make things more difficult, I can’t communicate as effectively as I would like because 1) I’m not well versed enough in the language currently used to describe mental illness 2) Most of the people I’m talking with aren’t either, and 3) The DSM is itself a legacy framework, with perverse incentives from the drug companies, lacks a solid system of classification, particularly in its understanding of personality types, is categorical rather than dimensional, and most importantly is focused almost exclusively on pathology, ignoring human flourishing all together.

A few quotes on the inadequacies of today’s “bible” on mental illness, The Diagnostic and Statistical Manual of Mental Disorders (The DSM), and how we need a much better model of mental health:

“The most fundamental scientific criticism of the DSM concerns the validity and reliability of its diagnoses. This refers, roughly, to whether the disorders it defines are actually real conditions in people in the real world, that can be consistently identified by its criteria. These are long-standing criticisms of the DSM, originally highlighted by the Rosenhan experiment in the 1970s, and continuing despite some improved reliability since the introduction of more specific rule-based criteria for each condition.”

“Critics, such as psychiatrist Niall McLaren, argue that the DSM lacks validity because it has no relation to an agreed scientific model of mental disorder and therefore the decisions taken about its categories were not scientific ones; and that it lacks reliability partly because different diagnoses share many criteria, and what appear to be different criteria are often just rewordings of the same idea, meaning that the decision to allocate one diagnosis or another to a patient is to some extent a matter of personal prejudice.“

From Personality Types: Using the Enneagram for Self-Discovery:

“As you would expect the terminology of the DSM-IV is pathologically oriented and as you might not expect it sometimes seems rather arbitrary.”

“Perhaps the Enneagram can throw light on the psychiatric personality disorders by sorting out the basic personality types, which, after all are what become disordered when people become neurotic.”

“One of the main problems of the DSM-IV is that its compilers erroneously, albeit understandably, combined traits from one personality type with another, with the result that the brief schematic descriptions they offer are sometimes confusing.”

And one quote that points to a failure to be able to use the DSM effectively due to cognitive fallacies and the incentives from the drug companies:

“Psychiatrist Joel Paris argues that psychiatry is sometimes susceptible to diagnostic fads. Some have been based on theory (overdiagnosis of schizophrenia), some based on etiological (causation) concepts (overdiagnosis of post-traumatic stress disorder), and some based on the development of treatments. Paris points out thatpsychiatrists like to diagnose conditions they can treat, and gives examples of what he sees as prescribing patterns paralleling diagnostic trends, for example an increase in bipolar diagnosis once lithium came into use, and similar scenarios with the use of electroconvulsive therapy, neuroleptics, tricyclic antidepressants, and SSRIs. He notes that there was a time when every patient seemed to have “latent schizophrenia” and another time when everything in psychiatry seemed to be “masked depression”, and he fears that the boundaries of the bipolar spectrum concept, including in application to children, are similarly expanding.”

The Spectrum of Mental Health

Having finished this preamble about some of the problems with our current paradigm of mental health, I will say that I agree mental health falls along a spectrum. It’s also important to note that I call the spectrum mental health, whereas the status quo is to call the spectrum “mental disorders” or “mental illness”, indicative of today’s corrosive pathological worldview.

Given there’s a spectrum, what should we label the points along the spectrum? Rather than try to define my own spectrum, I’ll take the Enneagram’s for now, since it’s pretty good:

This gives us some language for classifying mental illness along a spectrum that puts mental health into 9 levels with three triads (healthy, average, unhealthy) and goes from psychosis and neurosis to ego transcendence, enlightenment and beyond. But we also need language to talk about illness from different perspectives, including genetics and neurochemical deficiencies but also more interior perspectives, such as mental models of the world, internal belief systems, the stories we tell ourselves and inner dialogue, as well as the strong influence of our environmental factors such as our relationships with friends and family.

I’ve done some reading and the most accurate model I’ve found to describe mental health in the holistic way I am advocating seems to be the biopsychosocial model. This model says that mental health comes from three interdependent spheres of being: biological, psychological (thoughts, emotions, and behaviors) and social. Notably this implies that psychological and social spheres are under our control and play a major role in determining our mental health. In complex systems top down causalityoften exerts a greater or equal force to bottom-up causality, implying somewhat crudely that more than 66% of mental illness is within our control.

Why do some people so strongly reject a worldview that places mental health within our control? At least part of the reason why people who have suffered from some form of mental illness reject this kind of model of mental health, can probably be explained by Martin Seligman’s concept of “learned helplessness”.

“Seligman’s foundational experiments and theory of “learned helplessness” began at University of Pennsylvania in 1967, as an extension of his interest in depression. Quite by accident, Seligman and colleagues discovered that the conditioning of dogs led to outcomes that were opposite to the predictions of B.F. Skinner’sbehaviorism, then a leading psychological theory.

Seligman developed the theory further, finding learned helplessness to be a psychological condition in which a human being or an animal has learned to act or behave helplessly in a particular situation – usually after experiencing some inability to avoid an adverse situation – even when it actually has the power to change its unpleasant or even harmful circumstance.Seligman saw a similarity with severely depressed patients, and argued that clinical depression and related mental illnesses result in part from a perceived absence of control over the outcome of a situation.” (The counter to learned helplessness is learned optimism.)

Furthermore, our current paradigm, and one that many commenters are preaching, is characterized by an unfortunate dose of biological reductionism. (Not unlike the reductionism that pervades many branches of knowledge in today’s society). This view reinforces the narrative that billion dollar drug companies seek to profit from the most, and also reinforces the victim mentality of many mentally unhealthy people, by giving them permission to attribute their illness solely to biological factors, i.e. something completely out of their control. Interestingly, in the mind of mentally ill people the reasons actually are often attributed to reasons outside of their control. But this is an unlearnable mal-adaptive psychological process calledExplanatory Style.

“People who generally tend to blame themselves for negative events, believe that such events will continue indefinitely, and let such events affect many aspects of their lives display what is called a pessimistic explanatory style. Conversely, people who generally tend to blame others for negative events, believe that such events will end soon, and do not let such events affect too many aspects of their lives display what is called an optimistic explanatory style. Some research has linked a pessimistic explanatory style to depression and physical illness.”

Unfortunately, though not surprising to me, the biopsychosocial model has been given lip-service and severely perverted, stunting its development and dissemination. Check out a few of these quotes:

“The president of the organization that designs and publishes the DSM, the American Psychiatric Association, recently acknowledged that in general American psychiatry has “allowed the biopsychosocial model to become the bio-bio-bio model” and routinely accepted “kickbacks and bribes” from pharmaceutical companies.”

“He states that the biopsychosocial model should be seen in a historical context as bucking against the trend of biological reductionism, which was (and still is) overtaking psychiatry.”

“It has also been alleged that the way the categories of the DSM are structured, as well as the substantial expansion of the number of categories, are representative of an increasing medicalization of human nature, which may be attributed to disease mongering by pharmaceutical companies and psychiatrists, whose influence has dramatically grown in recent decades. Of the authors who selected and defined the DSM-IV psychiatric disorders, roughly half had had financial relationships with the pharmaceutical industry at one time, raising the prospect of a direct conflict of interest.”

Now that the theoretical underpinnings of my perspective have been more clearly defined, let’s dive deeper into each triad of mental health.

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This blog post is part 2 in my 3 part series on Mental Health. You can find part 3 here: Towards A New Paradigm of Mental Health And An Enlightened Society.

Related posts:

1. My 3 Part Series On Mental Health
2. Mental Health In An Enlightened Society