I believe the question of whether to medicate or not cannot be kept separate from the question of whether or not to consider individuals responsible for their own state of mind, as well as their behavior. That in turn cannot be kept separate from the related question of what it really means for a human being to be “responsible,” and the question of how something that looks like “free will” emerges out of biological systems.
At this point in our culture, the majority of both the general culture and of the mental health industry have endorsed a paradigm that says that mentally healthy individuals are responsible for their mental activity, but that those who are “mentally ill” or who have a “biochemical imbalance” are not. The latter are advised to try drugs to correct the “imbalance” and to try more drugs if the first ones don’t work.
What is missing in this perspective is any sense that people can take responsibility for their own mental wellbeing and behavior, even after they have been overwhelmed by serious problems of some kind.
I would argue that this abdication of responsibility occurs not so much because we are a weak and lazy society, but because we have misunderstood what it means to be responsible in the first place. Because of this misunderstanding, when we try to be responsible, we are likely to do it in a way that makes us vulnerable to becoming overwhelmed, and then once we become overwhelmed we think this must be due to something wrong with us. This follows from our cultural belief that being responsible for oneself should be easy and simple, and not require contact with anything deep. The resulting sense of “something wrong with us” is then interpreted to be something chemically wrong, fixable by a pill, or perhaps by a dozen pills in an ever changing “cocktail.”
Simple systems operate in a linear, consistent and predictable manner. Many people associate “science” with boiling everything down to that which is simple and predictable. Our culture tends to assume that things operate in this fashion. But it turns out that only linear systems are consistently predictable, and non-linear systems, of which humans are an example, are not. Humans become even more unpredictable when they have been perturbed by major events such as trauma, or if they have genes that facilitate creativity, or when they are going through certain developmental stages.
If we ourselves are a non-linear, unpredictable system, how can we take responsibility for controlling ourselves? Certainly we cannot do this by applying any consistent formula, as any such formula could only work part of the time. If our nature is to be fundamentally mysterious, then how can we know for sure what it is inside ourselves we are encountering at any given time, and if we don’t even know what we are encountering, how can we respond to it in a way that allows us to be in control?
As a practical matter, responsibility is something that emerges in people over time. When we are children, our minds are a mystery to us, and strange things happen within them all the time. But we learn through a process of experimentation to respond to what is happening in our minds in a way that gives us a kind of control, within limits. Later, when we encounter new life events or new changes within us, we find we are going out of control again, but we again experiment with responding to what is happening, and find a new kind of control.
After awhile, we may learn to take this sense of being “in control” for granted, and forget that it is just the outer layer of a mysterious process that we will never fully understand. Then, when something changes radically changes inside us, maybe in response to some life events that we aren’t equipped to handle, or perhaps as part of a developmental process we don’t understand, we might be surprised to find that our existing ways of responding to ourselves don’t achieve a sense of being in control anymore, or even spin us further out of control.
What is critical at this point is how we, and others, interpret this breakdown in control.
There could be an interpretation that we are “bad” which means we deliberately decided to go out of control and cause problems, and we should be punished. At the opposite, and more medical, extreme, there could be an interpretation that we aren’t responsible at all, but since we have no responsibility, we need something external to us to take control over us – whether that be institutionalization or just control through drugs.
There is another option however. That is, we could make an interpretation that this lapse in self control is temporary, and that what is needed is experimentation to find out the best way to respond to this new and unexpected development within ourselves and our world. In other words, we could repeat the process that allowed us to develop self control in the first place.
When we accept that both our minds and the world outside of our minds are mysterious, then we accept that we don’t know for sure what it is we are encountering at any time. For example, we don’t know how much of what we see is because of our way of looking at things versus what things are “in themselves.” But what we can do is take responsibility for investigating, for having an I/thou encounter with what we find, which means experimenting, and that includes being vulnerable and being open to doubting ourselves. This means we consider the possibility that anything going wrong may be in our approach to what we encounter and not just in the “other,” or the fault may be in the way our conscious mind is handling things, we don’t just jump to the conclusion that there is an “illness” in us (or in the other) that needs to be medicated away.
What does it mean when a person can’t sleep, or has disturbing feelings, thoughts, voices, impulses or expressions? Where did they come from? What is to be done about them? Must they be eliminated, or are they in some way a helpful contribution, an indicator of something that needs to be attended to? When we can be curious about this, rather than have fixed answers, we can find solutions that match the particular person and situation.
Our culture needs greater awareness of the limits of our ability to make linear sense of things. The presumption of linearity is a key factor that has contributed to making it so difficult for people to see that psychiatric drugs are harming people. If something seems to make things better in a few weeks, then linear expectations would have us believe that the long term effect will also be good. But within a highly non-linear complex system, there is no reason to trust this will be true – in fact, the very linearity of the interaction, always the same drug effect, is actually damaging to humans who are nonlinear systems that need instead sensitive interactions with mystery, interactions with other non-linear systems such as other people, creatures, ecosystems etc. Drugs dull such interactions.
While “madness” may emerge out of the spontaneous experimentation of our minds, it turns out we need that same spontaneous experimentation in order to figure out a way of responding to what is happening in our minds. The mental health system instead pushes drugs reduce such experimentation – this causes the madness to appear diminished, but it also impairs the person’s ability to really regain a sense of responsibility and self control.
It is interesting to observe that none of us are as “in control” of ourselves as we think we are. Recent research shows that “by monitoring the micro patterns of activity in the frontopolar cortex, the researchers could predict which hand the participant would choose 7 SECONDS before the participant was aware of the decision.”
When we are aware of the limits of our own conscious awareness, we are more willing to be curious about what is happening within our minds, to learn about what is disturbing to us by interacting with it, forming a relationship with it, seeing what happens as we try various ways of responding to it. So what we take responsibility for is not somehow knowing in advance what to do (which can only be done with linear systems, which are predictable and “straightforward”), but rather for being curious, open to feedback, open to learning what works and what doesn’t, and also aware that what seems to work at first may actually be making things worse – the trickster spirit is alive and well in complex systems, despite our culture’s desire that he/she be banned!
Traditional explanations of inner experience in terms of spirituality often cultivated awareness of mystery. While it is not necessary to use traditional spiritual language or metaphors in order to develop understandings of ourselves, it is necessary, I believe, to acknowledge the reality of mystery if we are to effectively encourage a sense of responsibility within individuals and social groups.
Mystery and nonlinearity applies to our responsibility for interactions with others as well as interactions with aspects of ourselves. Parents for example should be prepared for unpredictable kinds of interactions. There is this expectation in our culture that if one follows some defined set of instructions, a “good” child should be guaranteed, unless of course the child has a biological illness like ADHD or bipolar! This belief system creates incompetent parents, parents who feel they have to make a choice between believing that they themselves are “bad” as in they failed to follow the linear instructions that every “good” parent should know, or believing that their child is “ill” and that care should be turned over to the psychiatrist for diagnosis and chemical repair.
In contrast, a parent who is aware that his or her child is a mystery, and is a complex and inherently unpredictable non-linear system, will instead approach signs of trouble with curiosity and an open mind. Such a parent will be open to feedback about what works with this particular child, and will always consider the possibility that if the parent and others communicated differently to the child, any problems might be resolved. This does not guarantee a positive outcome, because in non-linear interactions nothing can be guaranteed, but the chances of success are much greater. The child now lives in a world of human beings who respond to him or her in a way that models both self respect and humility, and out of such interactions, the child can learn to also have both self respect and humility, firmness and flexibility, etc. Problems do not entirely disappear, but become manageable.
Competent therapists are able to help people restore this sense of mystery, this willingness to engage. But therapists are often instead like parents who believe there should be some set of defined instructions that should always work, and if the problem doesn’t resolve by using such tactics, then the problem must be a biological illness, and the therapist isn’t responsible at all. Instead, what the person really needs is a medication check.
A responsible society would never be sure that particular “problems” exist within individuals; rather, it would always be open to the idea that it might be responding inappropriately to those individuals, and would be open to experimenting with doing things differently. Such a society would take more responsibility for preventing trauma in childhood, preventing other traumas like homelessness, and preventing coercive mental health interventions that create more trauma. And it would be aware that “quick fix” solutions could make things worse in the long run, and would take responsibility for noticing when that might be happening.
In the bigger picture, I believe we will never achieve this sort of responsibility until we accept our own mysterious nature. We are all unfathomable beings, that is, when we look deeper inside we always find something that contradicts what we just said or how we have been representing ourselves. But this condition we are in, where any time we “make sense” we are always leaving something important out, does not mean there is something wrong with us. It just means that we are human, we are complex non-linear beings who cannot be reduced to a formula. The more we believe we should be a certain way inside, the more likely we are to find something wrong with ourselves, and then to try to “straighten it out,” often with chemicals, and usually to our own detriment. The alternative? Accepting that we are mysterious, and taking responsibility for learning to live with it, and with the other mysterious beings with whom we co-inhabit this planet.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.