I read somewhere recently that when Millenials are feeling upset, agitated, down, confused, hopeless, exhausted, or out-of-sorts they wonder if they are just going through a hard time, just struggling with concerns about themselves and their lives, or if they are suffering from a mental illness. No wonder. Since they have been able to comprehend language they have been bombarded by what I call the Biopsychiatric Belief System (BBS).
They have been told that mental illnesses are caused by chemical imbalances, genetic anomalies and brain disorders, that they are not different from diabetes, cancer or acid reflux. They have been told not to be ashamed of such conditions; after all, they have no control over them and they should not be objects of stigma for having them. They have been told that an appropriate response is to take pills that will make them feel better. During their lifetime, the number of Americans using psychotropic drugs has increased dramatically.
Millenials are the victims of a belief system which is cynical, harmful and erroneous. If you believe that how you feel and behave is controlled by biochemistry, genetic dynamics and brain anomalies, you believe that you have no control over your thoughts, emotions, intentions, reactions and behavior. That’s pretty cynical.
There are at least two ways in which the BBS is harmful. First, if you subscribe to it you are likely to see those scary, painful, troubling feelings as being alien and worthless; all you want to do is get rid of them quickly. In doing so you miss an opportunity to learn some valuable lessons from those uncomfortable feelings: what you want and don’t want, what you are afraid of, what threatens you, what is vitally important to you, why you do what you do and don’t do what you don’t do. Second, you are unlikely to enthusiastically and wholeheartedly pursue some form of psychotherapy. That is harmful because psychotherapy writ large is far and away the best way of responding to the states of being that become diagnosed as mental illness.
The research which supports the BBS runs afoul of the confusion between correlation and causation. Believing in it is a form of scientism, “an exaggerated trust in the efficacy of the methods of natural science to explain social or psychological phenomena” (Webster’s New Collegiate Dictionary). Erroneous indeed.
Here is the answer to the Millenials’ Dilemma. There is no difference between mental illness and reactions to troubling and difficult life circumstances and deep concerns about oneself and one’s life. They are one and the same thing.
The great majority of mental illnesses, including the most serious ones, are reactions to life crises, emotional distress, spiritual emergencies, difficult dilemmas, inner conflicts and various forms of overwhelm, including trauma. Mental illnesses are essentially how people avoid emotional pain, protect themselves, feel more adequate and powerful, gain the illusion of control in a world in which the most dangerous things are outside of our control. Mental illnesses are reactions to significant loss and to concerns about one’s ability to live the way one wants to live. They are wake-up calls, signals that something is wrong and needs to be dealt with. Mental illnesses are the painful, uncomfortable, dangerous and debilitating emotions, thoughts and behavior that people experience in the course of dealing with the problems of life. Mental illnesses are reactions to difficult, scary, terrifying, rage-creating life situations. They are reactions to things that have happened to the person. They are caused by the following kinds of concerns:
• Am I going to be able to live the way I want to?
• Am I going to be able to connect with other people in satisfying ways?
• Will I be able to build a love relationship that will enable me to have a satisfying love life and family life
• Am I going to be able to find a job that is satisfying and which pays enough to support me?
• Am I smart, strong, personable, attractive, creative, resilient, flexible enough to be able to live the way I want to live?
• Am I adequate or inadequate?
• Am I going to be able to do what I want to do or am I going to have to shrink myself to fit into the only roles, jobs, relationships that are available to me?
• Am I OK the way I am?
• Am I worthy of living?
How people conceive of mental illness is important because it will determine the kind of treatment they seek. If they believe that mental illnesses are essentially physiological problems of biochemistry, genetic dynamics and brain functions, they are likely to turn to drugs for help, and less likely to enter wholeheartedly into psychotherapy.
By psychotherapy I mean all forms of psychotherapy: cognitive-behavioral therapy, hypnotherapy, body-centered therapy, trauma-informed therapy, narrative therapy, solution-focused therapy, group psychotherapy, art and music therapy, mindfulness meditation, yoga, nutrition, exercise, support groups, supported housing, 12-step groups, help with love relationships and family relationships, help with finding satisfying and rewarding work, help with finding enjoyable and healthy ways of expressing oneself.
Here are the comparable benefits and risks of treatment with drugs and treatment with psychotherapy:
Treatment with drugs
You may feel somewhat more energetic and alive if you take an upper like Prozac, Paxil, Adderall or Ritalin or somewhat less anxious and agitated if you take a downer like Atavan, Xanax, Zyprexa or Risperdal. In the case of antidepressants the research says that the feeling better is largely due to the placebo effect but, nevertheless you may be feeling better.
You’ll suffer from serious “side effects” including increased incidence and risk of:
• Sexual dysfunction
• Akathisia – extremely uncomfortable and dangerous restlessness
• Emotional blunting – loss of conscience and caring
• Depersonalization – a sense of loss of contact with yourself
• In the case of antipsychotics like Zyprexa, Abilify, Geodon and Risperdal, “side effects” include:
• Tardive diskinesia – a Parkinson-like loss of control over muscles and gait.
• Cognitive impairment
• Brain shrinkage
• Early death – persons who take antipsychotics die on average 25 years younger than people who don’t take them
If and when you stop taking the drug you will suffer serious withdrawal effects. In the case of anti-anxiety drugs such as Atavan and Xanax, that can involve years of debilitating recovery. This is because the drugs have caused your brain to compensate for its changed condition so when you stop taking the drugs, your brain will be in a dysfunctional state. Since the drugs you are taking act on the brain in the same way that cocaine, heroin and meta-amphetamines act on the brain, you will suffer the same kind of withdrawal effects as do persons who use illegal drugs.
If and when you stop taking the drug you are likely to experience a relapse of the symptoms that led you to seek treatment.
You will have bought into a very cynical and unhealthy message. When you are feeling bad, take a drug.
Treatment with psychotherapy:
• You will gain self-management skills and knowledge that you will be able to use for the rest of your life to stay healthy and happy:
• The meaning of your symptoms and how you can use them to become healthier and happier;
• What makes you tick;
• Why you do what you do and don’t do what you don’t do;
• What you want and don’t want;
• Develop compassion for yourself;
• Become aware of the beliefs, assumptions, attitudes and habits which drive your behavior but which lie below the level of your consciousness;
• Learn how to deal with the difficult dilemmas we all face from time to time;
• Become able to connect with others in satisfying ways without giving up too much of yourself,
• Manage your fears so that you can avoid what you need to avoid and walk with the fears you need to walk with;
• Become more accepting and comfortable with parts of yourself that are scary, painful and shameful and which have been taking lots of energy to hide from yourself and others;
• Learn how to become more aware of what you want and how to get it without threatening your relationships and;
• Become more able to use your strengths, talents and faculties in satisfying and contributing ways.
• As you learn how to manage your thoughts, feelings, intentions and perceptions in healthier ways, your brain will change in beneficial ways.
• You might waste some time and money.
• You might receive some advice or messages that will get in the way of you becoming healthier and which might send you down the wrong path for a while.
But what about the scientific evidence? Isn’t there evidence through brain scans that mental illnesses are caused by chemical imbalances and brain disorders? Of course, all human behavior involves biochemistry and brain function. But that doesn’t mean that the chemistry or the brain function causes anything. From what we know about how the mind and body function together it is more likely that the biochemical and brain changes are reactions to what is happening to the person, what the person is perceiving, the difficulty the person is having, the concerns the person has.
That is what happens in the stress response, the most widely studied and best understood of the human mind-body dynamics. The stress response is a profound biochemical dynamic which includes the secretion of neurotransmitters such as norepinephrine and noradrenaline. But it doesn’t come out of the blue. It doesn’t just happen. Rather, it is a response by the person to some threat or to some demand that is placed upon her or him. It is a reaction to something that has happened to the person. This is in keeping with what we know about human beings. Human beings are not random organisms. They are meaning-making, desiring beings who live with a purpose. States of being such as mental illnesses don’t just come on them out of the blue. Rather, they are reactions to something that has happened, to some kind of concern, fear, need, thwarted desire, frustration.
So the good news is that you do have control over your psyche – your thoughts, intentions, reactions and behavior. You do have the ability to heed the wake-up call, to deal with, learn from and recover from emotional distress, life crises, spiritual emergencies, difficult dilemmas, trauma and overwhelm. The bad news is that you now have to deal with this perverse issue of blame. One of the reasons for the popularity of the Biopsychiatric Belief System is that it takes away blame. You are not to blame for your genes, brain or biochemical system going awry.
Apparently, the obverse thought is that, if you have control over your psyche and if your psyche is in bad shape, you are to blame for it. That has never made sense to me. How can I blame people for the states of their psyches? People have no control over their early experience. That experience is essentially under the control of their parent(s). And what happens to them during the first 18 or so years of their lives has a powerful impact on the rest of their lives and on their ability to manage their psyches effectively. If a person does not receive the care, support, affirmation, attunement – love, if you will – that a person needs in order to grow into a healthy adult, s/he is going to have a hard time managing her or his psyche. S/he may learn how to do that but it is going to take a lot of hard work and help from others. How, then, could I blame someone for having a hard time managing his or her psyche?
So I would encourage all of us, including the Millenials, to remove the word “blame” from our vocabularies when we are talking about psychological difficulty. The bottom line is that what you believe about mental illness and mental health can make a big difference in your life. Think about it.
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.