The idea of mental illness predates any discovery of mental illnesses. It’s a hypothesis—a proposed way of understanding mental suffering.
‘Nothing wrong with posing that hypothesis.
But how does a hypothesis become a belief? Ideally, by being confirmed. In reality, much more often, by serving our interests, fitting nicely with our wishes, jibing with our hopes, relieving uncertainty, or otherwise making us feel better.
The success and cultural authority of the mental health industries reflects both hope and need: we hope to escape suffering, and we need professions dedicated to understanding suffering and its relief.
Neither of those is a bad thing.
The idea that suffering—some sorts of suffering, at least—consists of mental illness fits both the hope and the need.
If suffering is not our natural state—if healthy people aren’t prey to certain sorts of suffering—but results from something having gone awry, we can hope to set things right. We can relieve pain by restoring health, or even avoid it altogether by good health practices. Health is, by definition, natural, so health should come easy, if we just understand what gets in the way. Ipso facto, happiness should be easy—natural—if we can just understand the impediments to good mental health.
The idea of mental illness, then, made for a nice hypothesis.
As readers of Mad in America know, it has been less-than-robustly confirmed.
But the idea just won’t die. One reason is that so many people hope it’s true. We really, really want to believe that suffering isn’t our natural lot, that just doing the right things for good mental hygiene will make for a happy life.
Another reason the idea won’t go away is the very reason it became widely accepted in the first place: When the idea arose, professions devoted to studying health and illness already existed—namely, the medical professions.
The importance of an institutional home cannot be overstated. With institutional support, a profession gains legitimacy, resources, and access to markets. And institutions, unlike scientific hypotheses, do not die from being wrong. The values and worldviews, livelihoods, and life’s meaning for countless tens of thousands of its adherents depend upon any established institution, and those people will do whatever it takes to keep their way of life alive.
When the mental health industries were aborning in the late nineteenth and early twentieth centuries, exactly two social institutions dedicated themselves to the relief of psychic pain: medicine and religion.
Whatever else was involved in medicine’s usurping the role of religion in care for the mentally anguished—and a great deal else was involved, much of it ugly and dishonest—medicine offered the possibility of new insights. Religion had pretty much said what it has to say, and anguish hadn’t vanished. While the loving kindness some religious institutions offered to the mentally tortured and despairing may have helped—and may still help as well as anything—the cold fact was that religion had nothing new to offer. Religion simply wasn’t a good source for new professions of care.
Medicine, though, could pursue a new idea: mental illness. Maybe that would shed new light.
Medicine had the advantage, as well, of quite possibly making use of the benefits of science. The idea of mental illness arose around the same time—the latter half of the nineteenth century—as medicine began to turn toward science as a foundation for practice.
Medicine, then, could provide an institutional home for professions studying suffering from a scientific perspective, in pursuit of the hope that a normal life is a happy life.
Psychology and social work, and literally hundreds of other movements—from the “New Thought” of the late nineteenth century to many different schools of psychotherapy in the mid-twentieth century to the “New Age” of the late twentieth century—tried to offer alternate ways of understanding mental suffering. None had medicine’s big advantage: an existing profession, with the attendant institutional support, cultural status, and financial resources.
Psychology had the best opportunity to provide an alternate, with its growing institutional basis in schools, and with government imprimatur and protection—by 1977, psychologists had gained licensure in all states. But as I’ve explained before, the lure of money was too great, and psychology made itself subservient to the medical model.
(Social work never had a chance, realistically, of establishing itself as a rival profession. Identified as “women’s work” from its inception, it always suffered the lack of power and prestige that women’s work suffers in our culture. Such advances as feminism made for women came too late, in the course of the competition between mental health professions, for clinical social work to become anything other than what it now is—a devoted handmaiden to psychiatry.)
The hypothesis that mental suffering is due to illness was never a bad hypothesis—and I believe, unlike a fair number of Mad in America writers and readers, that in some instances, it is true. But the idea that suffering consists in the effects of mental illness remains an idea more believed than evidenced. The scope of its application, the devotion and even vehemence with which it is held, and the billions of dollars its economy circulates far outdistance its scientific support.
We believe it because it suits us, and it has found an institutional home.
The medical model has become the faith of a secular age.
More on that next time.