UN Report Criticizes Biomedical Approach to Mental Health

UN official writes that States should focus instead on resolving social inequality and injustice as determinants of health and human rights

Zenobia Morrill
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A new report from the United Nations Special Rapporteur, Dainius Pūras, emphasizes that structural conditions such as poverty, discrimination, and violence are the root causes of mental distress and suffering. The top UN official maintains that States have an obligation to promote policy and practice that addresses social inequality and disconnection to advance the cause for human rights, dignity, and mental health.

The Special Rapporteur notes that effective mental health intervention has been stifled by overreliance on outdated approaches, individual-level interventions, and the biomedical model:

“Mental health services suffer from an excessive focus on outdated approaches through which the majority of resources are allocated to individual treatment for diagnosed mental health conditions, including psychotropic medications and institutional care. This global imbalance continues to reinforce an equity, evidence and implementation gap.”

Pūras argues that “Good mental health and well-being cannot be defined by the absence of a mental health condition, but must be defined instead by the social, psychosocial, political, economic and physical environment that enables individuals and populations to live a life of dignity, with full enjoyment of their rights and in the equitable pursuit of their potential.”

UN flags being prepared for UN General Assembly General Debate
(Photo Credit: UN Photo/Kim Haughton/Flickr Creative Commons)

Pūras is a medical doctor who holds special expertise on mental health and children’s health. Since his appointment as the Special Rapporteur on the right of everyone on the enjoyment of the highest attainable standard of health, he has been an outspoken human rights advocate (see MIA report). On World Mental Health Day of 2017, Pūras criticized the medicalization of depression, stating that the neurobiological paradigm is reductive, harmful, and “must be abandoned” (see MIA report).

In his latest report, Pūras continues to establish a focus on mental health and human rights as developmental priorities. The report outlines that a commitment to promoting the right to mental health must include addressing the underlying social and relational determinants of health such as poverty, discrimination, bullying, and various forms of violence.

For example, the report describes that “the explanation of mental health inequities extends well beyond the biological and individual to the social, economic and political. People’s lives are often constrained by inequitable laws, structures of governance and power, and policies that stratify society, profoundly affecting human relationships and how people act throughout their lives.”

Alternatively, a biomedical, disease-oriented approach narrowly focuses on individual rather than social interventions. In contrast, Pūras advocates for policies and structures that value and facilitate social connection and access to resources which are vital components to health.

The Special Rapporteur makes several points to aid in merging a social determinants approach and a rights-based approach to mental health. First, the right to health is viewed as indivisible to other human rights, since it enables attainment of other rights and vice versa. For example, rights such as equality, labor rights, right to housing, right to education, environmental rights, cultural rights, access to justice, and freedom from discrimination are all entangled with health. Therefore, Pūras writes, state accountability and the meaningful participation of everyone in decision-making and civil action are essential.

The rights-based framework emphasizes States’ obligation to fulfill and promote human rights, participation, non-discrimination, equality, and rights-based international assistance. It also holds States accountable to implement a social determinants approach.

The report delineates examples of risk factors that interfere with human rights. These include forms of social exclusion, xenophobia, welfare cuts, attacks on labor organizing, violence against marginalized community members (e.g., women, children, individuals who identify as LGBT), bullying, and environmental pollution.

According to the report, protective factors that support human rights involve policies and practices that not only prevent risk factors (e.g., violence) but engage in protection through the bolstering of inclusion, welfare, and investment in resources, environment, and education, to name a few examples. The Special Rapporteur specifically attends to the importance of relationships across all life stages that include relating to community and nature.

Finally, the report includes a number of recommendations to the States. To secure the right to mental health, the Special Rapporteur calls for a reduction of coercion, institutionalization, and medicalization. The rights-based approach, therefore, is presented as an alternative to the biomedical approach and practices of paternalism and coercion:

“Trust, the bedrock of therapeutic relationships, has been corroded, particularly where coercive and paternalistic practices are prioritized.”

According to Pūras, “User-led advocacy initiatives, peer support networks and, vitally, new working methods, such as co-production based on genuine equality for people with lived experience of mental health conditions and services, are essential to restoring trust and building new alternatives.”

Survivor and user-led initiatives are highlighted as central to effectively shaping interventions and the overall development of a rights-based approach to mental health. As stated within the report:

“User-led research, with its emancipatory traditions in the production of knowledge and evidence, should be accorded equal standing to other approaches in the formulation of mental health policies that are compliant with human rights obligations.”

The Special Rapporteur acknowledges that the terminology of “mental health” may in and of itself be invoking a medical model discourse.

“Terminology in the sphere of mental health is a contested terrain. There is a need to accept different terms according to how people define their own experiences of mental health. ‘Mental health’ itself can signal a biomedical tradition for explaining and understanding lived experiences, psychic or emotional distress, trauma, voice hearing or disability. The Special Rapporteur acknowledges this contested area and the importance of the health sector and the medical model when used appropriately.”

The report continues to clarify the Special Rapporteur’s view that overmedicalization has obscured social determinants of health and forced the burden of health onto the individual. In the pursuit of the right to health, the individual may have little to no access to health systems or may confront systems that engage in ineffective practices.

The Special Rapporteur “challenges stakeholders to reflect on how biomedical dominance has led to overmedicalization in the health sector, particularly in mental health, diverting resources away from a rights-based approach to the promotion of mental health. The Special Rapporteur welcomes a diversity in terminology, which can promote different approaches to mental health that are equally important.”

Amid the movement to globalize a biomedical paradigm of mental health, the UN’s Special Rapporteur pushes for the prioritization of human rights and a holistic focus on social and contextual determinants of health:

“The global community should prioritize sustainable systems that enable and adopt a human rights-based approach to the promotion of mental health. Human beings, in all their diversity, are rights holders and should not be seen as subjects of diagnosis or a disease burden.”

The UN report calls for urgent action toward this aim:

“Narrow conceptions of determinants, together with an overreliance on biomedical explanations of emotional distress and mental health conditions, deflect political attention away from rights-based policies and actions that promote health. This grossly neglected human rights issue requires urgent action.”

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Pūras, D. (2019). Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. United Nation Human Rights Council, Forty-first session (24 June–12 July 2019). A/HRC/41/34. Retrieved from: https://www.un.org/en/ga/search/view_doc.asp?symbol=A/HRC/41/34

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Zenobia Morrill
MIA Research News Team: Zenobia Morrill is a graduate of the dual master’s counseling psychology program at Columbia University. As a doctoral student and researcher at the University of Massachusetts in Boston, she seeks to understand the context informing psychology research and the underlying social factors that influence individual psychology. She is currently involved in projects examining the impact of structural violence.

15 COMMENTS

  1. It’s good the UN is speaking out against the biomedical approach to “mental health,” which is based upon the DSM billing code “bible.” Will that “invalid” and “unreliable” “bible” ever be flushed?

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    We’ve already scientifically shown the primary iatrogenic etiologies of the two “most serious mental illnesses.” Whitaker pointed out that the ADHD drugs and antidepressants create the “bipolar” symptoms. And the “schizophrenia treatments,” the antipsychotics/neuroleptics, can create the negative symptoms of “schizophrenia” via neuroleptic induced deficit syndrome, and they can create the positive symptoms via antipsychotic and/or antidepressant induced anticholinergic toxidrome. But neither of these medically known psychiatric drug induced ways to poison people is listed in the DSM, so they’re always misdiagnosed.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    I agree, “the medicalization of depression … is reductive, harmful, and ‘must be abandoned.’”

    The primary function of the “mental health” industry, historically and today, is covering up child abuse. Which is illegal, since our so called “mental health” workers are all mandatory reporters.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    But instead of reporting child abuse, they’re misdiagnosing child abuse survivors on a massive societal scale, because the DSM “bible” doesn’t allow them to bill to help ANY child abuse survivor EVER. And that’s what profitable for the “mental health” workers.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    The US needs a return to the rule of law. We need to start arresting the pedophiles and child sex traffickers, and the “mental health” workers need to get out of the business of aiding, abetting, and empowering these criminals.

    The banks stole “$trillions worth of houses, thus the banking thieves should be arrested.

    https://boingboing.net/2013/08/12/unsealed-court-settlement-docu.html

    The religions are covering up child abuse, in part because having the “mental health” workers turn their child abuse survivors into the “mentally ill” is much more profitable for their hospitals.

    https://www.amazon.com/Jesus-Culture-Wars-Reclaiming-Prayer/dp/1598868330
    https://www.theguardian.com/world/2003/aug/17/religion.childprotection

    “We now live in a nation where doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the press destroys information, religion destroys morals, and our banks destroy the economy.”

    All these systems need to be changed, they’re all corrupt. And we all know, “Power tends to corrupt, and absolutely power corrupts absolutely.” Thus the solution to the corruption is decreasing the power these corrupt organizations or systems or industries have.

  2. This could be difficult. Pseudo-medical psychiatric interventions have a background of centuries of failure treating imaginary causes of psychological distress, but now pseudo-medical treatments can successfully turn raving maniacs into zombies, giving its practitioners reasons to expand their activities. Lots of luck trying to put them in their place.

  3. “Survivor and user-led initiatives are highlighted as central to shaping interventions…”

    I totally agree with this statement. I think it’s too bad that the people running the show (big pharma, most of psychiatry, etc) seem to have no interest in hearing from survivors/service users. The people who have been patients – who have been diagnosed and drugged and locked up – have hard-earned, first hand knowledge of what needs to change, of what would have been helpful as opposed to what we were actually subjected to, but our voices aren’t heard in mainstream media. Instead, in the media it’s just a continued push for more screening, more diagnosis, earlier diagnosis, which amounts to more drugs since the system still operates on the biomedical model. It’s not so much that the people in power haven’t gotten the memo. It appears they don’t want the memo. I saw a headline somewhere the other day that said (paraphrasing) “there’s more access to mental health treatment than ever before, the stigma is less than before, but the number of people with mental illness is higher than ever, the disability and suicide rates are higher, this is very mysterious”. I thought, have they not heard of Anatomy of an Epidemic? Is this willful blindness?

    I’m curious…does anyone know of books written by psychiatric survivors that have reached any measure of a wide audience? I’m aware of books criticizing the bio medical model, psych drugs, the DSM, like Mr. Whitaker’s, Dr. Breggin’s books, etc. and I’m grateful for those as they validated what I’d always suspected was the reality. But books by people who went through the system and survived it and told their story about it?
    When I was first diagnosed with borderline, there were a few books out by people who had gotten the diagnosis and recovered, through some kind of treatment. All of those books hewed to a formula that I would now categorize as “recovery porn” – “I was crazy but then I learned I had borderline and got treatment and now I’m much less crazy thanks to DBT”. I’m looking for a book by someone saying, “being diagnosed with a mental illness and the treatment that followed made things so much worse but I survived it and found a way to escape the system” or something along those lines. The New Yorker article about Laura Delano’s experience comes to mind, but as many have expressed I don’t think it went far enough in making clear the extent of the danger and potential damage involved in being a psychiatric patient.

      • Thanks, Jonathan. Yes, this is the sort of thing I was talking about. My oldest brother, now deceased, was diagnosed with schizophrenia in his late teens. This was about 40 years ago. The notion, passed off as fact, that this was destined to be a lifelong illness, that he would need to be medicated his entire life…that’s all he heard from his doctors. After multiple hospitalizations and forced drugging, he fled to Puerto Rico. He was determined never to take another psych med for the rest of his life, and in that he succeeded. In my mind, it’s huge for someone to recover in spite of medical “intervention”, and to get across to people that having one or more psychotic episodes does not mean someone will never recover, never be able to have a life without psych drugs and hospitalizations.

    • If Tina really did help thanks!
      Katel,
      There are tons of books, plays, television shows, and movies.
      Some are into the biochemical approach some are not.
      There seems to be a timeframe with the early sixties past and after taking a nonchemical approach- “ I Never Promised You a Rose Garden”
      Movies such is “ A Child is Waiting” and “ Lisa and David” skim the area but are not true survivors films.
      After Jen Jersey’s “ Ine Flew Over the Cuckoo Nest” which was biographical portrayed as fiction – things started changing and there has been a steady stream of folks who are fine taking the chemicals proscribed. Kay Redfield Jamestown MD is one
      Cheryl Townsend started Intentional Peer Support And has some writing our Don Writz Book is here free.
      There are so many strands from Sci FYI to Horror to “Almost Normal”
      The psych survivor tales get pushed out by the literary big wigs because many many are involved in treatment and using the chemicals.
      I still have not been able to figure out the whole addiction process in all of this.
      12 step folks struggle as well.
      Old timers would say no way to any chemicals and then there were so many folks but my doctor gave me a prescription that it seems many became resigned to their use. But some 12 steppers will swear some are addictive.
      And with the opioid mess it gets to be a real nightmare. And the medical profession seems lost.
      I think they know but see chemicals as a band aid to stop the bleeding but everyone who is aware band sids are not long term solutions and do not cure.
      If anyone wants I could write a blog on the arts and name more names and artistic endeavors and it could be used as an ongoing list for folks. I certainly don’t know everything and even what I do know hits and misses.
      Especially if oneblioks st this white privilege. This is a huge gap. Other subjects touch in this like Roseanne Guy’s “Hunger”
      We need so much more than we have no to pull it all together. Do many times it seems multiple hidden moons circling.

      • Thanks for this, CatNight. I tried to reply to you after I first read your comment but I think I got overwhelmed with it. Sometimes I need to take a step back. I spent 35 years in the system, swallowed all the pills and the lies… worked out great for my family who needed a scapegoat. It’s hard not to feel like I’ve been a fool. On the other hand, the pressure was so strong from everywhere – family, “friends”, acquaintances. “Call your therapist. Sounds like you need a med change. You haven’t found the right cocktail. Do you need to spend some time in the hospital? I’ll help you pack a bag” (never mind that they won’t let you keep anything once you check in).”. Any reaction I had to it was pathologized. my anger was seen not as a response to my human rights being violated over and over again. In everyone else’s mind my anger had its own life, it was born in a vacuum, because I was a borderline. Over time I became the one who couldn’t get well despite all the help she had had.
        Now I’m 53, alone, physically ill and too scared to see a doctor. It feels like a lot.
        When you say, “so many hidden moons circling” it reminds me of something I read (can’t remember the source) about how childhood trauma and the huge lifelong impact it has on a person physically mentally emotionally etc… This gets “discovered” once every 50 years or so and then buried. Then the line goes right back to, “we don’t know what causes mental illness. We’re really working hard to come up with new drugs and new treatments but the whole thing is a big mystery”. As many others here have said, keeping it a mystery serves the abusers and it serves an entire industry that wants to keep making money off diagnosing and drugging.

  4. There’s story after story on Mad In America of people that have Genuinely recovered from Schizophrenia/Bipolar Diagnosis through rejection of the Medical approach:- I notice a lot of this Genuine Recovery “has come about” through similar means.

  5. Of course you’re right, Fiachra, and I’ve gotten a lot out of reading people’s stories on this website. I didn’t mean to dismiss this resource although I can understand if it came across that way. I guess I’ve just been dumbfounded that so few survivor experiences and survivor resources have breached whatever invisible wall there is surrounding mainstream media. I hear bits and pieces in mainstream media about “the drugs don’t work for some people” but nothing that gets across the idea that getting sucked into the mental health system people are actually in danger of having their health and their life ruined. It seems like the media would want to jump on this story…but what I read in the NY Times, etc, it’s not getting across just how dangerous psychiatry can be.
    Just as an example, there was an article in the Times about a week ago about how the pharmaceutical companies have such a bad reputation but now they’re all providing AIDS medications and other medications to less developed countries for very low cost or free. The idea of the article seemed to be, oh look big pharma isn’t so bad after all. I went right to the comments section. There were 12 comments many of them bashing big pharma and basically saying, these people don’t do anything out of altruism. The comment section had been closed after 12 comments. I had wanted to make a comment to the effect that maybe they want to export there DSM diagnosis, chemical imbalance myth, and all their psych drugs to these countries. Maybe that’s their endgame. I don’t know why the Times close the comments section after only 12 comments. I don’t know if I’m paranoid or if they are part of the conspiracy. I just wish some of the stories that I read here would reach a larger audience.

  6. ^^^^^^ Except Fiachra, there is no such thing as Genuine Recovery from ~Schizophrenia/Bipolar~ because these illness do not exist.

    What there hopefully is are people who have decided to start standing up for themselves and are telling their Psychiatrists, Psychotherapists, and Recovery Groups where they should stick it.

  7. Hip, hip, hooray for ” Pacific Dawn ” . Best comment all week !
    In the first sentence of this article:
    A new report from the United Nations Special Rapporteur, Dainius Pūras, emphasizes that structural conditions such as poverty, discrimination, and violence are the root causes of mental distress and suffering.

    I completely disagree with this statement. While poverty, discrimination, and violence are undesirable situations; they rarely make one mentally ill. The so-called ” mental health system ” with its massive dope pushing of highly toxic Psychiatric Drugs on millions of people worldwide, is the real cause of mental illness, period. This should be an easy concept to understand. It has taken a very long time for people to understand it. Of course, Mainstream Media ( Lamestream Media ) , primarily financed by drug companies, keeps putting out disinformation about ” mental health ” and blocking the Truth, every chance it gets. ( Take note KateL ! )
    The Special Rapporteur doctor also talks about ” Survivor-User led initiatives “. He should know that most people who recognize that they are Survivors of the so-called ” mental health system ” would not want to have anything to do with people who consider themselves ” Users ” or ” Consumers ” or even Lovers of the ” mental health system ” . People like that would be completely repulsive to a real Survivor.