Joy is a 19 year old woman who is brought by her parents for psychiatric evaluation. She is the only child of her parents, who are both extremely religious and austere. She was born at term by normal vaginal delivery and met all her developmental milestones. She never caused a problem for her parents. A shy child, she often kept herself to herself and preferred to play alone. She had few friends at school, and was a B-average student. Her parents were very strict and have a cold, loveless marriage. Her father drinks heavily, and though never violent, he would often say hurtful things to Joy and her mother. When she was 17, Joy met a boy of 16 at church whom she liked and he liked her. They started secretly seeing each other, and after 6 months, their relationship became sexual.
Joy was not allowed out of the house except for church and school, and though she had wanted to go to college, when she graduated high school she worked instead as a secretary in her father’s business. When she was 18, Joy fell pregnant, and although unplanned, the prospect of having a child who she could love unconditionally and who in turn would love her back delighted her. When her mother discovered her daughter was pregnant she forced her to have an abortion, and would not let her out of parental sight. Joy was crushed, became almost flat, withdrew to her room, insisting she was still pregnant. She stopped going to work, stopped helping around the house, and eventually stopped washing. She would pat her stomach as if she were pregnant and when she did speak, which was less often, it was only about her unborn child.
Let’s imagine this fictitious patient existing at two different eras and seeing two different psychiatrists – first in 1964 and then in 1994. In 1964, the psychiatrist admits her to hospital for a period of observation, psychoanalytic therapy, and treatment with the new neuroleptics. He tells the parents that her diagnosis is schizophrenia. Despite treatment with chlorpromazine, and daily sessions of psychoanalytic psychotherapy, Joy fails to improve. The psychiatrist believes that Joy lives in an impossible situation in which she is expected to be independent, but any attempt at doing so is thwarted. As such, her psychosis is a special strategy she has developed in order to avoid this double-bind. He posits that the forced abortion was so traumatic to Joy that she clings on with delusional conviction to the idea that she is still pregnant, and her failure to improve is a resistance on her part to the therapy.
If Joy sees a psychiatrist in 1994, she is diagnosed with major depressive disorder with psychotic features. The psychiatrist treats her as an outpatient with Prozac and haloperidol, and sees her again in a month. She fails to respond to this treatment, and is tried on a variety of different antidepressant and neuroleptic agents with little success. The psychiatrist postulates the patient has a genetic, biologically-based brain disease that is treatment-resistant. Her failure to respond is because the neurochemical abnormality has not been addressed by drug treatment.
In the first psychiatric evaluation, the failure of the patient to improve is blamed on the patient’s resistance which is psychological, and her condition caused by the familial environment in which she resides. In the second, her condition is caused by a genetic disease, and her failure to improve is because drug therapy has not adequately targeted the chemical problems in her brain. In 1964, the patient is tacitly blamed for not recovering, and the parents blamed for Joy’s illness. In 1994, Joy is the unfortunate victim of defective genes and twisted molecules that seem impervious to pharmacological remedy.
The idea of schizophrenogenic or refrigerators mothers was an embarrassing era for psychiatry, and so psychiatrists were only too happy to explore the brain and the genome to unlock the secrets of mental illness. In this caricature of 1960s treatment, it appears as though patients and their families were blamed for their mental illness or failure to improve. In reality, these psychiatrists believed that both the patient and family’s behavior was determined by unconscious forces beyond their control and for which they could not be held responsible. Today, the rhetoric has shifted away from intrapsychical conflicts and traumatic ruptures, and instead aberrant neurochemistry or delinquent genes are held as the source of mental illness. Regardless, 1964, 1994, or 2014, the message is clear: mental illness is beyond our control and requires psychiatric intervention. The moral authority the mental health industry claims over our mental life rests on this claim.
What is striking about this claim that often goes unchallenged is that it isn’t new and isn’t necessarily true. If the creeping imperialism over our minds is to be thwarted, we need to reassess this claim.