How to rethink mental health to avoid stigma? How to have a systemic approach to mental health?
Paving the way for a compassionate scientific approach.
In the contemporary world, mental health issues are attracting more and more interest. Prominent figures in politics and the entertainment industry are speaking openly about their struggles with depression and anxiety, and statistics indicate an increase in reported cases of these conditions among adults.
However, in this context, it is essential to ask whether we are truly facing a mental health epidemic or whether a more nuanced perspective is worth considering. Society's approach to mental health is at the heart of this issue. Life is full of challenges, and it is completely normal to experience feelings of unhappiness, stress, or insecurity when faced with adversity. The last two years, characterized by forced isolation, economic uncertainty and job losses, have affected us all. But do these natural emotional reactions automatically justify the label of mental “disorder”, such as depression? Understanding mental health is a complex endeavor, dealing with subjective experiences and behaviors, unlike the tangible physical abnormalities seen in other branches of medicine.
Science or rhetoric
Psychiatry has presented itself as a scientific discipline, relying on evidence-based research to understand mental health problems and provide treatments. However, there are concerns about the growing dominance of “scientism” in mainstream psychiatric literature. Scientism refers to the promotion of beliefs that appear scientifically credible, but tend more toward rhetoric than true scientific accuracy. While evidence-based medicine aims to improve decision-making, the pervasiveness of scientism has resulted in biased research and the perpetuation of certain concepts and treatments without solid scientific support. Some critics say pharmaceutical companies and market forces may have played a role in this process, potentially undermining the credibility of evidence-based practices.
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Organic and subjective
One of the main challenges of psychiatric research lies in its basic assumptions. Unlike physical medicine, which identifies the organic cause of a problem for specific treatments, mental health often relies on descriptive terms such as "anxiety" and "depression" without highlighting an underlying cause. or a clear etiology. Therefore, psychiatric diagnoses may describe symptoms without offering a complete explanation of their root causes. The notion of psychiatric scientism perpetuates the belief that psychiatric diagnoses are as true or equal to medical diagnoses, although they lack the clear causal connections found in other medical fields. In simpler terms, descriptive classifications such as depression or ADHD may describe certain behaviors, but they do not provide clear explanations of why those behaviors occur. This can lead to circular reasoning and arguments that cannot be verified. As we mentioned in a previous article on Ian Hacking's looping theory, human beings tend to adapt vague descriptions to their experiences, which can sometimes lead to self-diagnosis. In other words, these labels can be applied to behaviors, but they do not necessarily provide a deep understanding of the underlying causes of those behaviors.
The impact of labeling
Labeling people with mental disorders can be harmful, as described in performative language theory. These may include stereotypes and stigmatizing terms, which can lead to biased psychological labeling. Negative or restrictive language perpetuates stereotypes and creates harmful labels that influence how individuals are perceived and treated by others. Labeling theory in sociology suggests that individuals may internalize the labels assigned to them and conform to them, potentially reinforcing certain traits due to the performative aspects of communication. Labeling can overshadow understanding and lead individuals to adopt the identity of a mentally ill person, even if their experiences are completely normal given their life situation. When clinicians follow these rigid performative linguistic categories about mental health, it can create traps and people can begin to behave according to the labels they are given. This can lead to a cycle where labels become true because of how people treat them, thus generating a self-fulfilling prophecy.
A prophecy foretold
The way we talk about mental health can influence the way we view, experience and examine it. Using certain labels to describe a person's mental state can have real-world consequences. For example, if we label a person "depressed," they may begin to believe it and act as such, influenced by how others treat them based on that label. This cycle can cause the label to persist, even if it does not accurately reflect the person's experiences.
Given these challenges, it is important to approach mental health differently. Dominant ideologies surrounding mental health pose serious challenges to traditional services, beyond questions of funding or access. These ideologies perpetuate the idea that mental disorders are widespread and require diagnosis to be effectively treated, thus fueling an industry centered on psychiatric labels. As a result, these ideologies have seeped into our daily lives, making us feel like potential patients, distancing us from normal emotions, and making us believe that our experiences are signs of deep-seated issues in our minds. Many people can end up seeing themselves as broken and in need of repair, instead of understanding that their emotions are part of normal, natural human experiences that require empathy, connection, and compassion.
The objective of a new approach
The current model of diagnosing mental disorders and providing specific treatment may be outdated and flawed because it risks neglecting the natural resilience people demonstrate in the face of adversity. It is essential to abandon the idea that mental disorders are solely linked to genetics or biological factors, as there is not enough evidence to support this view. The ultimate goal should be to prioritize observing the relationships that human beings have or develop with their own reality and social context. By focusing on human connections and meeting basic needs like safety, housing, and meaningful employment, we can better understand what is being called the “mental health epidemic.” While it is necessary to challenge scientism, abrupt and hasty changes could have unintended consequences. Collaboration, open dialogue, and unwavering attention to authentic scientific evidence, gleaned from real-world clinical settings, are paving the way for mental health professionals to evolve into a more compassionate and effective field, truly helping those who need it.
THE ESSENTIAL
What is psychiatry? The operative diagnosis
Instead of starting from a fixed idea of the nature of the problem, a scientific operational diagnosis encourages a flexible approach. Clinicians must closely observe and evaluate how different methods and treatments affect the problem and the person's behaviors. The central idea is to “know by changing”. Instead of relying solely on theories or preconceived notions, clinicians take an active interest in the problem and observe how it responds to different treatments, just as we do in science. One of the main advantages of operative diagnostics is that it emphasizes effective problem solving. Instead of being locked into a rigid diagnosis, the main goal is to achieve positive results and meet the patient's needs. This approach prioritizes the individual's unique needs and situation. By actively interacting with the person and continually assessing their response to treatments, clinicians can think more creatively and avoid being limited by strict labels.
Operative diagnosis recognizes that each problem is different and requires personalized attention, because it is expressed in the context of the person concerned. It’s about being patient-centered and ensuring positive outcomes and overall well-being of the person. This approach provides a flexible framework for treating psychological and behavioral problems. Clinicians are encouraged to think outside the box and remain open to new and innovative solutions.
Reference
- Cohen, C. and Timimi, S. (eds.) (2008) Libratory Psychiatry: Philosophy, Politics and Mental Health. Cambridge: Cambridge University Press.
- Gibson, P. (2023) When the Bubble Burst: A New Approach to Understanding and Treating Depression. Strategic Science Books. (In press)
- Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. ISBN: 9780671622442.
- Gunnell, J. G. (1983) Scientism and the Study of Society. ISBN: 9780691630847.
- American Psychiatric Association (2013) DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. ISBN: 9780890425558.
- Hari, J. (2018) Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions. ISBN: 9781632868312.
- Timimi, S. (2007) Mis-Understanding ADHD: A Parent's Guide to Alternatives to Drugs. Milton Keynes: Author House.
- Timimi, S. and Begum, R. (eds.) (2006) Critical Voices in Child and Adolescent Mental Health. London: Free Association Books.
- Watzlawick, P. (1984) The Invented Reality. Norton Books.
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