When the concept of mental illness became relevant in the early 1900’s, it was relatively undefined and generally misunderstood. But, in 1952, the DSM (Diagnostic Statistical Manual of Mental Disorders) came along and the first edition had defined certain psychotic, neurotic, and character disorders in about 132 pages, and so there was now a basis for diagnosis of ‘diseases of the mind’. Today, we are on issue 5 of this book and it has grown to be 947 pages long with over 541 diagnostic categories.
While this may at first seem like a positive, that more mental illness diagnostics means we are discovering and understanding more about the mind, it in fact means quite the opposite. Nearly all human behaviors, ranging from clumsiness to coffee drinking, can fit into a disorder in the DSM. Mental health has now become more about diagnosis and fixing our ‘problems’ than it is about our experiences and histories. The human experience has become pathologized.
In the 1930’s, psychiatry began to take the form of a medical practice and started moving treatment into general hospital settings. Did this improve treatment of mental health issues? The answer is complicated. We started off with Freud and his theories of psychoanalysis and then we graduated to brain dysfunction and chemical imbalances—and today these two approaches have merged, advocating medication and therapy in tandem as the best treatment. However, both biomedical and psychodynamic approaches to mental illness have their flaws and many aspects of their methods have been disproven. Despite new methods and new research, in 2019, we still have an incredibly high number of people who struggle with mental illness and we continue to employ treatments that are often ineffective.
One of the reasons behind ineffective treatments for mental illness is a lack of acknowledgement of the causes of certain mental states, and not just their manifestation. In the field of psychiatry, there is less and less recognition of trauma and more and more diagnosis and medication. But these are band-aid solutions. What about our adverse experiences? What about the food we eat and the amount we exercise? What about the neighborhood we live in? It becomes very easy to skim over these factors and jump to what seems like a quick fix.
I am no exception. Last year, I went to many doctors and did hours of research trying to find a diagnosis for what I was feeling—but nothing fit. In the end, three different doctors suggested three different diagnoses and I was put on a medication that did nothing but change my music taste. Psychotropic medications treat the symptoms of an illness, not the illness itself. Why is this? Quite frankly, it is because we don’t know what the illness is. We can’t reasonably run tests on an individual and scan their brain to understand why they feel the way they do. All a doctor can see is a manifestation of a person’s illness. Science may never get us to the point where we can understand exactly what another human being is feeling or perceiving.
This is why mental illness and the treatment of it in many cases can seem so convoluted and confusing. No matter how hard we try, each person’s complicated and unique life experiences cannot fit neatly into the categories the DSM has created for us. Meeting 5 out of 9 diagnostic criteria for a mental illness still fails to describe why a person is thinking, feeling, or behaving the way they are. And medications for these ‘illnesses’ can often have extreme adverse side effects, or be generally ineffective, or create lifelong dependencies . On the other hand, some individuals may not want to know the ‘why’ behind their feelings or may be unreceptive to psychotherapy; it may also be too time consuming or expensive. Either way, the treatment of mental illness is far from simple.
Rather than create a new model of care for psychiatric patients when the asylum went out of style, psychiatric treatment was incorporated into the existing framework for treating physical illness, adopting aspects of treatment ranging from hospital settings to symptom-based medications. With this, there is an expectation that the treatment and resolution of mental illness is as straight-forward as the treatment of physical illness. But we need to accept that although mental and physical illness undoubtedly influence each other, the way in which they must be treated could not be more different. Therapy is effective for some and not for others. Medication is effective for some and not for others. Hospitalization is effective for some and not for others. And there’s no formula for who finds success. Treating mental illness is filled with uncertainty and we have to be okay with that.
Mental illness is incredibly complicated and is unique to each person it affects. While the grouping of individuals into categories of mental illness often makes sense for treatment, research, or medication purposes, it is an oversimplification of human experience. We simply cannot fully understand the mind of another individual, nor can we expect a psychiatrist or psychologist to be able to. New contributions to the fields of psychology and psychiatry are incredibly important, but it is just as important to recognize that there is always an element of uncertainty in the treatment of mental illness as we may never know nor fully understand exactly how another person experiences the world.
By Georgia Spurrier.
