When I was growing up, people had nervous breakdowns - you know, through some trauma or emotional overload, they temporarily "went crazy" and had to be institutionalized. As a child, we ooed and aahed about such mysterious cases in our neighborhood. Then the person would reappear, somewhat ashen (or was that my imagination), as they reintegrated themselves in their family and work lives.
Then remember Scottish psychiatrist R.D. Laing, who in the 1960s and 1970s led young rebels against the psychiatric establishment? Laing held that psychosis was a natural reaction to family travail and inconsistency. He then created residences where psychiatric patients were allowed to live through their psychotic episodes and re-emerge as whole individuals.
We were so kookie back then, believing such claptrap! (I chalk it up to drugs.) Now we know that mental disorders are specific long-term maladies, as identified in DSM-IV (the American Pyschiatric Association manual of mental disorders). Lately, one PT blogger has been asserting that DSM is hopelessly eclectic and superficial, and that we can drill down to biological, neurological sources in terms of which we can define mental illnesses.
I have been having a horrible thought. Would I someday look back on DSM-IV as the "good old days?" I served on the substance use disorders advisory group for DSM-IV. The section makes no claim as to the genesis of drug or alcohol dependence - i.e., that it is genetic or that it comprises a lifelong disease. Instead, DSM-IV (including-TR) defines disorders in terms of life dysfunctions - psychological, health, social, legal - and defines remission as a year when an individual overcomes such dysfunctions - even if they continue to use!
And the same remission, often permanent, occurs - or at least it used to - with the host of mental illnesses. How do I know? I was just watching the Ken Burns PBS series on America's National Parks, where I learned about Stephen T. Mather
The Stephen T. Mather Story
Stephen Mather was born shortly after the Civil War, and lived until the Great Depression. He became first a successful businessman, founding the Borax Company, then a great advocate for America's places of natural beauty. In 1916, he was appointed the first director of the National Park Service.
Mather was an intense, restless man, who worked best on his feet and interacting with other people. Throughout his life, he had a series of "breakdowns," marked by withdrawal and depression, which he recovered from. Mather found that the best remedy for his emotional malaise was spending time, often alone, in the wilderness.
During his tenure as head of the parks, Mather had a highly visible emotional collapse - the worst yet - in front of a group of park boosters. His wife placed Mather in a quiet private sanitarium. The only person who saw him during this period aside from his his wife was his loyal assistant. The only decorations his wife permitted in Mather's room were pictures of Yosemite. And in those days, they were able to cover up his absence! Mather thus remained director as the NPS, led by his assistant, created and maintained National Parks around the country.
Except one goal remained elusive. Teddy Roosevelt had declared the Grand Canyon a National Monument. But this still permitted all sorts of commercial intrusions and development at our greatest natural wonder. Congress would not vote to designate it as a National Park since so many powerful Arizona political and economic interests opposed it.
After a year-and-a-half, with no particular treatment, Mather re-emerged and fervently set into lobbying Congress, the press, businesspeople, and just about everyone in America. Mather was a very persuasive, very committed, very energetic person. Congress couldn't resist this whirlwind and created The Grand Canyon National Park in 1919. This was the cap on Mather's career and on the entire National Park system - indeed on America's identity according to Burns.
What would happen to Mather today? Of course, in the first place, he couldn't have held onto his job for 18 months. More importantly, he would have been diagnosed for whatever ailed him. He would have been designated as xxxxxxxxxx, treated with drugs and psychiatry, and. . . . . . . would he have come out of his illness, as he did in real time? We may especially ask this because what was most curative for Mather was his communion with nature and the overarching purpose in his life, rather than anything psychiatry could offer him, even today.
It may be that American psychiatry and pharmacotherapy overrate - as dominant paradigms of mental health have always done - their ability to cure people. People have remitted from psychoses and other emotional problems since time immemorial. Our modern society, with its highly mechanized views of and treatments for mental illness may subvert the natural curative processes that were at play in the Mather case. The current prevalence of emotional disorders in our society does not affirm the confident belief that modern science has elevated our mental health beyond that our ancestors enjoyed.