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Almost every day, we see in the media a plea to take "mental illness" more seriously. While this is a noble and worthwhile endeavor, it has had little or no effect on increasing services for those in need. There are many reasons for this state of affairs, some psychological, some economic and some epistemological, that is, how do we know this is even an illness.
The one I want to discuss today is the very designation of “mental illness,” which is nothing more than an archaic attempt to imitate physical medicine. Let’s follow this metaphor, for mental illness is only a metaphor and not a scientific term, and see where it takes us. Suppose you are walking along the street and come upon someone bleeding. What you do next depends on an important aspect of assessment.
Is this a result of an illness or an injury? Was the person just stabbed or is he suffering from hemophilia? A mistaken diagnosis can be deadly, as it would lead to exactly the wrong treatment. Do we administer infusions or close up a wound?
Yet we casually throw around the term “mental illness” in psychology and in the popular media, as if we know something that we do not. In fact, we do know from scientific research and the burgeoning field of epigenetics that most of what we call “mental illnesses” are really injuries and not just post-traumatic ones, but chronic and repeated complex trauma. Even our very biological genetic material is affected not only by our own experiences, but those of our ancestors. The field of epigenetics has revived the evolutionary theory of Lamarck[1] from the dustpan of history.
Lamarckian theory states that acquired characteristics can be inherited. Wounds experienced by our ancestors, such as surviving terror or violence, are written on our genes. Many feminists have also countered Darwin’s argument that only the fittest survive through fierce competition and have pointed out that cooperation, such as evidenced in an ecological system, allows the survival of the entire system.[2] In other words, Darwin’s approach was and is strongly influenced by masculinity, not by what he saw so much as what he did not see.
Most of what we see psychologically are injuries and not illnesses at all. Until we become clear on what we are treating, our treatments will be, at best, inefficient and misdirected. History, geography and the current context of the individual being treated must be included in any assessment and treatment plan.
Neuroscience, also in its infancy may be the best route for bringing to the fore what may actually be a brain illness, but even in these cases, we must learn to take a broader and more complex look at the entire physical and psychological system and not make the same mistake of isolating the brain from the rest of the body. What appears to be depression, for example, may be a result of the biology of the gut and not the brain at all.
Reductive science can answer some questions but not others. We must look to better methods and interpretations and that requires that we ask better and more complex questions. This comes only from diversity, from multiple perspectives and different ways of seeing.
Perspective matters. Words matter. Whose eyes we see through matters.
[1] Singer, Emily, A comeback for Lamarckian evolution, MIT Technology Review, February 4, 2009.
[2] Campbell, Ann, A mind of her own, the evolutionary psychology of women. Oxford University Press, 2014.
