Cracked (22 page)

To explore this criticism further, we must first unpack what is actually meant by the term myth. To do this, let me share with you an event a friend once told me about concerning his five-year-old daughter.

He
was driving her home along a country road late one clear summer's night. She had been looking out of the car window quietly the whole time, until after about twenty minutes she finally spoke up. “Daddy,” she asked with great seriousness, “why is the moon following us home?”

The poetry of the question took him so off guard that he mumbled something about near objects seeming to pass by quicker than distant objects because of relative distances, and so forth.

His daughter wasn't impressed. “Daddy, I think the moon is following us home because it's lonely.” With this conclusion she appeared satisfied. She picked up her book and started humming contentedly to herself. She now had her myth.

We are not so different from that little girl. We seek myths to settle crucial questions for which we have no clear answers, but about which we feel we need answers so that we may turn our attention to other things. This is why every society throughout time has its multifarious myths about all aspects of life—about where we are from, about where we are going, about why we are here, and so on. Myths help soothe our anxiety about some of our most fundamental human uncertainties.

Take one of the greatest uncertainties of all: what happens to us after death. This issue provokes such universal anxiety that anthropologists haven't found a single community upon this vast globe that does not have a myth about the afterlife. One community speaks of ethereal angels awaiting us at pearly gates; another of a cosmic mother we'll all return to after death; still another of gamboling ancestors welcoming us with barrels of manioc wine. The myths are everywhere, all telling fantastically different stories but all, in effect, serving the purpose of providing answers to questions which if left unanswered could drive many of us to mad distraction.

Because the maddening questions are so plentiful, every society has its manifold myths, addressing every conceivable quandary from what is the meaning of love or happiness to what are the purposes of fear, death, and birth. Myths speak to the realms of life that matter most, including “whence comes and how goes our suffering”—a matter that, in contemporary Western societies, we turn to psychiatrists for help.

Surely the help that bio-psychiatry offers is located in something more substantial than myth. After all, apologists argue that psychiatric notions are scientific, not mythic; that they are a product of scientific investigation, not human imagination. Critics are keen to retort that this is clearly not the whole story. Many psychiatrists' claims are no more substantiated than are the claims of religion. This is because, in so many areas that they survey, psychiatrists do not prove things but
decide
things: they
decide
what is disordered and what is not,
decide
where to draw the threshold between normality and abnormality,
decide
that biological causes and treatments are most critical in understanding and managing emotional distress.

Granted, many of these decisions are informed by research, yet none of these decisions, or the research upon which they are often based, is free from the subjective persuasions and interests of the players involved.
DSM
definitions are not fashioned in scientific laboratories but in committee rooms,
drug research cannot be impartial when it is wedded to drug company interests, and the profession's commitment to the biological vision of mental strife can't be shorn from psychiatry's historical struggle for biomedical status.

That many psychiatrists' claims and pronouncements issued by their lobby groups and professional associations cannot be scientifically substantiated has led critics to state that it is therefore no more objective than many traditional systems of belief. Take systems like Shintoism, Confucianism, Shamanism, or Christianity, for example. Each of these systems offers explanations about the causes and meaning of suffering, about what is normal or abnormal, sick or healthy, mad or bad. And each of these systems says different things about the experiences each is aimed to explain and manage. What is considered wrong, pathological, or odd in one society simply isn't regarded that way in another. In what sense, then, can we conclude that our own psychiatric system has somehow transcended the bounds of culture and thus attained access to universal truth?

Abstract questions like these are always best answered by looking at concrete examples on the ground.
So let us now look at one such example: the experience of hearing voices. As I have written elsewhere, in a society where this experience is chiefly associated with mental illness, any individual harassed by these visitations must also contend with the difficult idea that they are psychologically unwell—an idea which, if believed by the hearer, is likely to generate additional anxiety as well as compound, with each new episode, the hearer's sense of abnormality. This means that in societies where these experiences are perceived negatively, individual sufferers will struggle not only with the experience itself but also with the consequences of how these experiences are socially perceived, defined, and managed.

By contrast, in a community where “hearing voices” does not invite the same cultural suspicion, or where these voices are seen (as in the poleis of ancient Greece) as possible signs of divine inspiration, the hearer is believed to be less mentally afflicted than potentially blessed. The individual subjected to this more favorable cultural diagnosis will invariably possess a far less tortured relationship with his internal voices and will therefore be freer from the burdens of shame and angst attending our first individual.

Thus an experience that can mark you as unhinged in one society can mark you as inspired in another. And because the way we are marked can shape how we feel, when trying to make sense of any human experience we must always relate it to the dominant myth through which people define and pronounce upon their experiences.
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This comparison reveals a major danger with psychiatric diagnosis. As soon as you are assigned a diagnosis of “depression” or “anxiety disorder” or “attention deficit disorder,” you become a protagonist in a larger myth—you now have a mental disorder that marks you as a
patient
. You have entered into a social contract in which you are now socially positioned as dependent on psychiatric authority. From then on it is harder to think of yourself as a healthy participant in normal life, or as a person in control of your own fate. You have a psychiatric condition that has seized control, that has set you apart, and that has made you dependent upon psychiatric authority.

Admittedly, for many people, being diagnosed will bring initial relief (at least someone has named your suffering, and so presumably can treat it—when you're in that kind of pain, the promise of any kind of help brings relief). Many other ways of responding to suffering can also bring initial relief (psychotherapeutic, spiritual, religious, etc.), however, and these may not always entail the unfortunate side effects of being labeled psychiatrically unwell. For instance, patients' complaints about the burden of their diagnosis are widely documented in mental health literature. This is because we know that being diagnosed can bring additional stresses that accompany self-identifying as different, disordered, and in need of medical help. In other words, receiving a diagnosis can have negative secondary effects that are not always anticipated at the start.

In the work of the psychiatrist Marius Romme, there is a particularly striking example of precisely what these effects can be. Romme was working with a 38-year-old woman who had been given a diagnosis of schizophrenia. This woman had been hearing voices for a long time, but her medication was just not helping her. After enduring many years of failed drug treatment and the awful negative effects her medication caused, she was finally on the brink of suicide. But then one day she unexpectedly took a turn for the better—appearing much happier and more optimistic than before.

This sudden change followed her reading of a book by the psychologist Julian Jaynes, who argued that the ancient Greeks were different from many modern Western individuals, as they regularly understood their inner thoughts as coming from the gods. Whether Jaynes's theory stood up to academic scrutiny or not did not matter to this patient. All that mattered was that the book provided her an alternative myth, a new way to understand or think about her internal world. This patient decided that she was probably an ancient Greek rather than a schizophrenic. And this simple change to the myth she embraced altered her mood significantly by changing her whole relationship to her voices, making her feel less frightened of them, less odd, and consequently less alone.
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So if the myth we embrace affects how we read and experience our psychological states, changing the myth through which we understand such states can be just as therapeutic as can be taking a pill or undergoing therapy.
Consider, for example, another significant change many patients report once they reject the psychiatric view: they often no longer experience the stigma that accompanies being identified as psychiatrically unwell. This is an important point because a popular justification for the biological vision of our emotional troubles is that it reduces the stigma of mental disorder. After all, if a patient has a biological disorder, they cannot be blamed for the way they are.

Groups like the National Alliance on Mental Illness in the United States and SANE in Britain take this position: The biological myth helps sufferers because it indicates to others they are not responsible for their predicament. They are like anyone else with a medical condition, and so should not be seen or treated otherwise.
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While in theory this position is sensible enough, in practice things seem to unfold very differently. Many people experience negative secondary effects from their diagnosis, including either concealing their diagnosis from others out of shame (which can compound their isolation) or they become so identified with their label that they regularly declare it to others (which can in turn invite real rejection). For example, researchers have shown that today's most popular public perception of mental disorder is that it is biological in origin.
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This is particularly problematic in the light of recent research revealing that patients whose emotional problems are believed to be caused by brain disorders are treated far more harshly by the average person than patients believed to have problems caused by social or psychological factors.

A research team at Auburn University revealed this troubling fact by asking volunteers to administer mild or strong electric shocks to two groups of patients if they failed at a given test. The results were alarming: the patients believed to have a brain disorder were shocked at a harder and faster rate than the patients believed to have a disorder that was social or psychological in origin, suggesting that we may attract harsher treatment when our problems are considered in brain-based terms.
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Results like these are obviously alarming but not entirely unexpected. After all, we know from other research that people who are believed to suffer from biological abnormalities are seen by the average person as more unpredictable and dangerous than “normal” people. Such perceptions have also been shown to lead “normal” people to avoid interacting too closely with the “mentally distressed”—an avoidance which can, once again, compound the sufferer's isolation.
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Studies like those above show that being diagnosed with a psychiatric condition—with depression, anxiety, or one of the more severe disorders—often comes with powerful cultural baggage, especially when our suffering is perceived as being rooted in our biology. Paradoxically, then, the worldwide psychiatric campaigns whose goals are to reduce the stigma associated with mental illness through use of the assertion that it is just like any other biological disease may well have helped bring about the very opposite of what they intended.
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I feel by now that you may be wondering if I have exaggerated the extent to which the dominant myth in psychiatry is biological. Surely psychiatry takes into account the relevance of factors that are non-biological in nature? Is the dominant myth of psychiatry as biological as I have made out?

Many psychiatrists do in fact recognize, at least in principle, that the causes of mental distress can be various mixtures of social, biological, and/or psychological factors.
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This view has been captured in what is dubbed the bio/psycho/social model of suffering, which is that these diverse factors interact to precipitate and perpetuate emotional distress. The problem with this view is that psychiatric treatment has, in spite of it, increasingly involved biological treatments since the 1980s. As the British psychiatrist Professor Christopher Dowrick put it:

… the biopsychosocial model has little substance beyond the descriptive, and in everyday general practice is viewed mainly as necessary rhetoric. In reality, general practitioners work to what I have characterized as a “bio(psycho)” model of health care. We tend to see acute physical problems as most appropriate for us to deal with, followed by chronic physical and psychological problems. But we generally consider social problems to be inappropriate for medical attention, and can become irritated if we are presented with too many of them.
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While Dowrick states that the “bio(psycho)” model now dominates, others argue, and with justification, that even the “psycho” arm of psychiatry is on the decline. As a recent president of the APA admitted, psychiatry has allowed the “bio-psycho-social model to become the bio-bio-bio model”—meaning that prescribing pills is all that most psychiatrists now only want to do.
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British psychiatrist Duncan Double also confirmed this when he bemoaned to me that even those who most ardently avow a bio-psycho-social view often tend at bottom to put the biological first in their treatment practices.