Opinion | Identifying the obstacles to genuine mental health reform

What constitutes ‘normal’ and ‘abnormal’ varies significantly in different eras in different cultures. And judgements concerning what constitutes mental illness are made by a coterie of US psychiatrists (many with interesting links to insurance and pharmaceutical companies), whose Diagnostic and Statistical Manual of Mental Disorders (DSM) is the basis of diagnosis (and treatment) for most Australian practitioners.

Assuming mental illness to be a medical issue is a major obstacle to genuine revision of the system. Peta says “with less than half of all people improving after first line medication”, and “Australian mental health is one of the only non-measurable areas of health”; but what if mental illness isn’t an illness in any medical sense at all, and this approach has nowhere to go?

Peta gave us a clue when she compared depression with multiple sclerosis and hepatitis. MS and hepatitis are both physical illnesses with accompanying symptoms. Depression is defined by its symptoms alone; it links to no discernible pathology, nor do any of the conditions described in the DSM.   

Mental illnesses are often referred to as “an imbalance of chemicals in the brain”. Yet decades of investigation have failed to reveal reliable, consistent biological or genetic markers in the brain invariably linked to even the most debilitating mental illness. I suggest that ‘mental illnesses’ are not disorders or illnesses at all, but natural variations in the human condition. Psychiatric medications can’t target something that isn’t there; rather they behave in a ‘shotgun’ way by affecting the whole brain, with the long term threat of collateral damage. If the disturbing behaviour is subdued, so are many unrelated brain functions; and when the effect wears off, the behaviour returns.

Everyone exhibits behaviour and personality that are fundamental parts of their identities. I suggest that, for example, schizophrenia describes not an illness, but a mix of behaviours that are part of some people’s identity. Rather than say such people ‘have’ or ‘suffer from’ schizophrenia, perhaps more accurate would be ‘they are behaving schizophrenically’. Their problem is not that they’re sick; it’s that they’re different. And the more different they are, the less they are tolerated by the ‘normal’ majority. They disrupt the workings of mainstream society. The temptation has historically been to either ‘normalise’ or isolate them.

Mental health has become a business – one that sustains many psychiatrists, psychologists, GPs and pharmaceutical companies. But you can’t ‘cure’ people’s core behaviours; rather, you might modify them to better conform to societal expectations – provided such modification is considered desirable by the people themselves. If not, the only acceptable alternative may be to try harder to identify roles in society where those with challenging behaviours can not only be comfortable, but excel. 

‘Mentally ill’ people do indeed suffer; but the root cause of their suffering may be more due to our inability to accommodate them socially rather than any particular illness. Early intervention is desirable; but perhaps by ‘life coaches’ rather than medical personnel.