A new Diagnostic and Statistical Manual of Mental Disorders is due out next year, and there is renewed discussion about what constitutes “mental illness.” One of the world’s leading psychiatrists, Dr. Z, questioned the very concept: “In nonpsychiatric circles, mental illness all too often is considered to be whatever psychiatrists say it is. The need to reexamine the problem of mental illness is both timely and pressing. There is confusion, dissatisfaction, and tension in our society concerning psychiatric, psychological, and social issues. Mental illness is said to be the nation’s No. 1 health problem, and more than 17 million people were diagnosed as suffering from some form of mental illness last year.”
These quotes could be from today, but they are not. They were voiced by one of my teachers when I was getting my master’s degree in social work in 1965. At the time I knew him, Dr. Z (Thomas S. Szasz) was a fellow of the American Psychiatric Association. He caused quite a stir when his book, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, was published in 1961.
Dr. Z acknowledged that people were suffering and they needed our help. He just questioned whether calling their experience a “mental illness” was helpful. “Although I consider the concept of mental illness to be unserviceable, I believe that psychiatry could be a science,” he said. “I also believe that psychotherapy is an effective method of helping people—not to recover from an ‘illness,’ it is true, but rather to learn about themselves, others, and life.”
Although many believe that psychotherapy is helpful to individuals, it doesn’t help solve the major problems we face in the world today. Psychologist James Hillman and author Michael Ventura, who together published the book, We’ve Had a Hundred Years of Psychotherapy and the World’s Getting Worse, in 1992, sat on a bench overlooking the ocean in 1990 and pondered this.
“We’ve had a hundred years of analysis, and people are getting more and more sensitive,” Hillman said. “And the world is getting worse and worse. Maybe it’s time to look at that. We still locate the psyche inside the skin. You go inside to locate the psyche, you examine your feelings and your dreams. They belong to you.” He went on to say: “We’re working on our relationships constantly, and our feelings and reflections, but look what’s left out of that.”
Hillman made a wide gesture that encompassed the oil tanker on the horizon, the gang graffiti on a park sign, and the homeless woman with swollen ankles and cracked skin asleep on the grass about 15 yards away.
“What’s left out is a deteriorating world,” Hillman said. “So why hasn’t therapy noticed that? Because psychotherapy is only working on that ‘inside’ soul. By removing the soul from the world and not recognizing that the soul is also in the world, psychotherapy can’t do its job anymore. The buildings are sick, the institutions are sick, the banking system’s sick, the schools, the streets—the sickness is out there.”
Confessions of a recovering mental health professional
When I was in graduate school, Dr. Z was seen as a radical psychiatrist, outside the mainstream, and we were taught that “mental illness” was real and we needed to learn to diagnose it properly. I went along because I wanted to help people and figured this was the way to do it. But I had a few problems from the beginning:
- Giving the right diagnosis never seemed to translate into offering a different kind of treatment.
- The more I learned to be a good therapist, the less I was convinced that people were “sick.”
- It was clear that big money was being made in “treating the sick” and it seemed that diagnosing more people as having a mental illness was a way to get more customers rather than to help more people who were suffering.
- Real mental health had to go beyond our personal psyches and include the wider world.
Like many professionals, I followed the rules and gave people an official diagnosis, but I never took it seriously as a way to help me or my clients to better understand issues. I did it mostly so I could get insurance reimbursement or so my client could get paid. But times are changing, and more people are suggesting a better way ahead.
Natural psychology and ecological medicine: the wave of the future?
When Dr. Szasz was sounding the alarm of our increasing labeling of so many life problems as “mental illness,” he noted that 17 million people were thought to have it. Now the National Institute of Mental Health estimates that 60 million people need “mental health” services, and the number increases every year.
Dr. Eric Maisel is a licensed family therapist and author of 40 books on topics ranging from creativity to new understandings of “mental illness.” In his recent book, Rethinking Depression: How to Shed Mental Health Labels and Create Personal Meaning, he wrote: “With the rise of four powerful constituencies—the pharmaceutical industry, the psychotherapy industry, the social work industry, and the pastoral counseling industry—and their handmaidens—advertising, the media, and the political establishment—it has become increasingly difficult for people to consider that unhappiness might be a normal reaction to unpleasant facts and circumstances. Cultural forces have transformed almost all sadness into the mental disorder of depression.”
Maisel believes that the health field needs a new psychology for understanding and helping people. He called it “natural psychology” and said it is “a new addition to the ranks of the many existing psychologies. It looks at the human experience with a fresh eye, takes as its starting point a naturalistic world view, focuses on the nature of meaning, and offers a vision of how a person with meaning needs might want to live.”
Ecological medicine is a new field of inquiry and action to reconcile the care and health of ecosystems, populations, communities, and individuals. In the foreword to the book Ecological Medicine: Healing the Earth, Healing Ourselves by Kenny Ausubel, Bioneers founder Dr. Andrew Weil said: “Ecological medicine shifts the emphasis from the individual to public health; from nutrition to the food web and farming system; from human-centered viewpoint to one of biodiversity and all the other ecosystem services that are the foundations of health and healthy economics.”
Clearly, health care as we have known it is changing. A system that sees humans as separate from nature and the mental as separate from the physical just doesn’t work. As a health care provider for more than 40 years, I’m happy that we can finally let go of the “myth of mental illness” and work together to help ourselves, our clients, and the fragile planet we all share to find a better way.
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