The intellectual shortcomings of mental health care have never been a secret. Pick most any year in the last century, and you can find plenty of books, articles, and scholarly or scientific papers explaining why then-current mental health ideas were wrong.
Today’s rich market for exposés of the ills of medication and the outrages of DSM is, in a sense, nothing new. The complaint that mental health professionals just don’t deserve the credulity, respect, and patronage they demand has long been with us.
And yet the mental health industries grow—in patients, practitioners, public influence, and revenue. And grow. And grow. The medical model—the idea that the variety of psychosocial ills that befall us result from, and reveal, mental health problems—just won’t die.
Before we get up in arms about the distance between the mental health industries’ influence and their scientific credentials, though, we should take a deep breath and get a little perspective: Generally, belief has precious little to do with knowledge. Even the most assiduous, conscientious scholars and scientists believe far more than they know.
And social practices are just that: practices. They’re things we do, which we evaluate by the effects they seem to have on our experience. We rarely, if ever, require of social practice a spotless intellectual pedigree.
Believing is itself sometimes—perhaps most times, for most people—social practice rather than intellectual exercise. Religious services, political rallies, gossip sessions, reading your alumni magazine or trade organization newsletter, posting inspirational messages to Facebook or Twitter, joining an internet discussion or debate—countless activities that look like seeking or sharing information would be more aptly characterized as formulating, solidifying, and reaffirming social arrangements.
In asking why the medical model won’t die, then, the question becomes not, “Why do people believe such ill-founded things?” but “What’s being done here? What social needs are served by the services and ideology of the mental health industries? Why do we need to believe and do the things its practitioners tell us?”
The short answer is that “health” has supplanted virtue or righteousness or sanctity as our culture’s prime normative ideal in personal behavior. “Mental health” is just a subsidiary of the lust after healthiness; mental illness seems, on the face of it, simply its corollary.
As a guiding ideal, “health” has several things going for it:
Health seems to be objective, in some sense. Kidneys, livers, bellies, skins, brains, etc., do what they’re supposed to, or not.
Health seems harmonious with—part of—Nature, which is bigger than ourselves and, we think, has its own forces at work beyond anything we may choose or do. Nature, like God, promises us goodness if we get with the program.
Health offers guidance for relieving or avoiding suffering—healthy actions.
Health can be studied and served by science. In principle, we should be able to discover objective truths about nature, hence about health, hence about healthy actions.
Health doesn’t seem to depend on ethereal fictions like God, reincarnation, Nirvana, or karma.
For a secular age, then, “health” seems a good organizing principle. It offers us ways to understand suffering, teaches ideals that transcend our current situation, and enlists the demonstrable power of science on our behalf. As a body of beliefs, then, our notions about health provide us clarity, reassurance, and promise.
As practice, ‘health’ gives us institutions, industries, and positive reinforcement for virtuous—“healthy”—actions.
It’s important to realize that health care professionals never got the job—the social tasks institutionalized in the health care industries—because they showed up with well-developed bodies of knowledge. Quite the opposite: health professionals are those who’ve taken on the job of finding out what needs to be done for our health. Health practitioners have work to do, to which disseminating information is instrumental, not foundational.
The question, “Why won’t the medical model die?” can be more precisely framed, then, as “How did physicians get the job, how do they keep it—and how do they manage to ‘rule the roost’ over the rest of the mental health world?”
The answer involves a great deal of politics and money. But it also involves hope and faith. Physicians promise to bring to bear on our behalf multi-billion dollar research efforts, limning the secrets of Nature, so that we may understand and transcend our suffering, living (in due course) as we’re supposed to live. They promise to fix what’s broken.
That’s a powerful promise. In an age where we trust God less and less to attend to our travails, where we are less and less likely to believe there’s a “home over Jordan” where we’ll “understand it better by and by,” where our lives are less and less within our own control as the economy becomes global and corporate, where social mobility and rising individualism make families and neighbors less and less likely to care for us when we’re in need—but where we’re more apt to romanticize Nature, while the fruits of science and medicine do in fact make many things much better—we’d be hard pressed to refuse it.
As a culture, we’re unlikely to give up our faith in science and technology, or our romantic notions about nature. They serve us very well, and probably need to be strengthened if we’re to save our planet while surviving economically.
As humans, we simply will not give up the demand for ideology that explains suffering, provides ideals, and offers guidance for our thoughts and actions.
We’re likely to insist on better science, and on not being misled. But we’re unlikely, any time soon, to give up the faith that health holds the promise of happiness. And for now, the mental health industries are firmly ensconced as stewards of that promise.
