I was recently talking with a young man about his anxiety, which he experiences as extreme. When I asked him what the anxiety was about, he didn’t know. When I suggested that we become curious about it and explore what it might be about, he told me that it was so extreme, it must be “biochemical.” This meant to him that the anxiety could not be understood in a psychological way, but had to be dealt with as part of his “illness.”
I acknowledged to him that anxiety certainly involves biochemistry, but suggested that there are also experiences and interpretations of experience that trigger the biochemistry into action. For example, if he experienced someone pointing a firearm in his direction, he would likely experience an intense biochemical process within his body, but the experience would not be “just biochemical.”
If people are going to understand themselves and work through emotional problems, it is essential that they get curious about their experiences and reflect on what might be triggering them. Sometimes such curiosity or reflection results in getting valuable messages from those experiences, or at other times, it involves identifying a mistake that triggered the emotional experience, which then allows for resolution. To use the simple example of the threat perceived from the firearm, one might either take quick action to avoid being shot, or in another situation perhaps observe more carefully and notice a movie is being filmed and that the firearm being pointed is just a prop.
Of course, experiences like anxiety and depression often have their sources in much more complex experiences, and so more complex reflection is necessary to sort out what actions to take or what interpretations to revise. We live though in a society that does not like complexities or deep reflection, so we already have a bias toward thinking that disturbing emotions that don’t quickly make sense must just be something wrong with us. This bias makes us think we “shouldn’t have” disturbing emotional states, so we tend to push them away or dissociate from them, which just makes it more difficult for us ever to understand their sources and decide what to do about them.
Those who market psychiatric drugs take advantage of this cultural bias to offer a seductive pseudo explanation, which is that unwanted emotional states that aren’t easily resolved must be the result of a “biochemical imbalance” or some other biological problem. Our culture has become heavily influenced by this viewpoint, to the point where it seems the majority believe that seriously disturbing emotional states lacking easy explanations must be caused by a fault in biochemistry, rather than being something that can be potentially understood and resolved.
The sad result of this marketing effort has been to dramatically aggravate a cultural tendency to avoid deeply listening to each other, or even to ourselves. Any mental or emotional problem which does not rapidly resolve must be “biochemical” and not worth even trying to understand; instead we should be trying to drug it away.
While many others have pointed out how this dishonest marketing pushes drugs that often cause damage or make mental health problems worse in the long term, I think it is worth reflecting on how the beliefs promoted by the marketers are themselves damaging to mental health. In particular, I want to emphasize the way these beliefs aggravate splits within a person, typically splits between more conscious aspects of the person and the less conscious parts that are experienced as disturbing emotions and/or voices.
A certain amount of “division of labor” within a person is actually functional: we are complex beings with multiple needs that must be attended to. But when people are traumatized, or when they experience conflicts that exceed their ability to manage them, such divisions often become entrenched and deep and troublesome. One word that has been used to describe such splits is “dissociation.” Such splits can be seen as the basic dynamic behind all the common mental and emotional problems, as described in my (free) recorded webinar on Dissociation as a Common Factor in Many “Mental Disorders” Including Psychosis. (You may also be interested in the paper “Dissociation, trauma, and the role of lived experience: Toward a new conceptualization of voice hearing” for which voice hearer Eleanor Longden was the lead author, and you may be interested in a new “transdiagnostic” approach to therapy which sees conflicting purposes within a person, and not pathological “symptoms” as the basic mental health problem: for a great introductory video, see Introduction Vignette – Method of Levels.)
When dissociation is the problem, there is a need to work toward more understanding and integration. Dialogue (such as in the Open Dialogue method) is needed, both within the person, and between people, to give voice to the various purposes that may need to be integrated. But the effect of beliefs about a “biochemical imbalance” is to instead aggravate the dissociation. Rather than wonder what the anxiety or depression is about, for example, the person convinced it is a biochemical imbalance seeks only to get rid of it, to wall it off even more, without attempting to understand its source within.
When people are convinced their problems are biochemical, they are also less likely to explore the problem with others or with a therapist. And when a therapist is convinced that his or her client’s problem is “biochemical” then that therapist is likely to focus on sending the client in for a “medication check” rather than looking deeper into what may be going on. (“Biochemcal imbalance” theories are also great for explaining away any failures of understanding on the part of therapists!)
The end result is that marketing misinformation may itself be hugely iatrogenic, and be one of the primary causes, along with negative long term effects of drugs, of the worsening of mental health outcomes.
This issue is one I hope to address in a seminar Pam Birrell and I will be teaching called “When Treatment Might Cause Harm: Exploring Ethical Dilemmas related to Diagnosis, Drugs, and other Possibly Iatrogenic Aspects of Mental Health Care.” We will be presenting in Eugene OR and Portland OR in early September, but we hope to present it later in other locations, and also as a webinar, so that mental health professionals can earn their CEUs in ethics while also learning how to minimize iatrogenic harm, including harm that results from the unfortunate effects of believing drug marketing propaganda.
I encourage all of you who might be interested in taking this course at some point, perhaps as a webinar, to get on my email list. Also, I hope some of you consider yourselves teaching a course like this in your own locality: we need to spread the word widely about the importance of these considerations if we are ever going to create that necessary revolution in mental health care! I will be happy to help you do that if I can.
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.
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