My profession
has been coopted. Seduced by the siren of medicalization whose sweet medical-model
notes lure my colleges into a diagnostic slumber. While we mental health therapists, psychologists
and psychiatrists amble along in a prescriptive haze, it is easy to dismiss
from mind the curious and magical roots of the healing arts. In our current counseling climate, most
people seeking therapy expect to receive and are given a clinical diagnosis. A diagnostic
code based on the medical model of illness and disease is necessary in order to
bill insurance companies who have situated themselves in the lucrative position
of reimbursing clinicians for approved therapeutic services. While diagnostic codes have become a
pragmatic reality for the business of therapy, I fear my field is loosing sight
of the exquisitely human, relational and mysterious art of psychotherapy.
Symptoms have
been rearranged into diagnostic checklists categorized to codify evidence-based
practices developed to treat mental disorders, the list of which has expanded
decade by decade. This mental health
manifest destiny, we are assured, empowers patients and enables practitioners to
use the most scientifically advanced treatments possible. We are barreling headfirst down the
mental-illness-as-a-brain-chemical-imbalance-disease path and I want us to slow
down and take a break by a waterfall or in a sunny spot to give us time to contemplate
if this road will truly take us where we want to go.
I am concerned
the mainstreaming of medical modalities to treat mental illness may be making
us crazy. Or, more alarmingly, is pathologizing
reasonable responses to human experiences.
The quest to mold mental illness into a brain disease model has been motivated
by multiple social and political forces.
Treatment and profit, once engaged, have married in an opaque market driven
ceremony and my profession is doing a celebratory prescriptive waltz.
Mental illness
does exist. Medication is one of many viable treatment options. My worry is that this one viable treatment
is expanding in every direction to the exclusion of other possibilities and to the
detriment of all of us.
As a therapist,
I am regularly asked to give a diagnosis or make an educated guess about
whether or not someone needs medication.
When a client asks me if they should take psychiatric medication because
they are depressed or anxious or worried they are bi-polar because they
experience ups and downs in mood, a tiny mental health seraph urges me to
scream, Hell no! This brain chemical
imbalance theory supports fictional disorders designed by a cadre of big pharma
sponsored psychiatrists and has absolutely no currently credible medical
evidence to back it up and the medications themselves are toxic and deadly! Another therapist seraph sits on my shoulder
and whispers the stories of all the people whose lives have been saved by
psychiatric medication.
I am not
anti-medication, nor am I an advocate of the Just say no! approach. I
like drugs. I have taken drugs to treat
illness, heal from injuries and trauma, alter consciousness, connect with people,
disconnect from the chaos of life, and sometimes just to have a good time. I am by no means anti-drug. I am, however, a steadfast advocate of empowered
and informed choice. I am concerned that
informed choice is being coopted under the banner of consumer choice. The psychiatric medication-marketing machine is
just too big, too strong, too wealthy and too invested in the medical model for
other theories and treatments to be accessible in any mainstream manner.
Mental health
treatment is now almost synonymous with a mental health diagnosis and more alarmingly,
with a psychiatric medication treatment protocol. Increasingly, a mental health diagnosis is a
required component for services such as having your insurance cover therapy,
accessing counseling through a mental health agency and participating in some
state funded programs. School children,
for example, receiving supplemental support services often face compulsory
conditions: they must obtain a diagnosis and take any prescribed psychiatric
medication in order to receive services.
Typically there are no other treatment modalities available. The brain chemical imbalance disease model
has become the only treatment available for many people. That this is happening when the scientific
evidence for a brain chemical imbalance theory is slim to none is disturbing. There are no blood tests, or any other actual
tests, that can prove definitively that someone has a brain chemical imbalance
or a mental illness. The philosophic
roots of psychology are being ripped out from underneath our profession. The relational importance of healing work is
becoming a radical outlier. This
concerns me.
People should be
involved and engaged in their healing.
In order to do this, we need to be informed, not coerced by science and
it’s mental health proxies. Informed and
engaged consent is not unlimited access to direct-to-consumer psychiatric
medication advertising. As a mental
health therapist, I continuously struggle with how to support my clients in
making informed decisions about medication.
Informed consent is critical. The
massive amounts of pharmaceutical industry messaging that floods professional
offices, personal homes, consumer advocacy groups, university research programs
and media outlets is staggering. No
other mental health treatment modality has as much professional and cultural
influence as the pharmaceutical industry.
How then, is informed and engaged consent possible?
I used to think that
offering a space for clients to reflect on their values and beliefs about
medication was enough. Not any
more. Not in the face of
medical-model-brain-chemical-imbalance marketing madness. I can no longer in good conscious simply say,
there are many options and medication is one.
The influence of big pharma sits between me and my client luring them with
the sirens song of clinical trials, brain imaging photos, late night heat to
heart infomercials and bouncing yelling mascots.
I don’t have a
mascot or MRI machine. I do however, have the power to speak up and share my concerns
about where I see my profession heading and the damage I believe is occurring
in the name of scientific, psychiatric progress. If I remain silent I am, in effect, colluding
with an out of control, profit driven industry that has obtained seemingly
unregulated access to and control over psychiatry, psychiatric research,
psychology and mental health counseling.
I worry that we are pathologizing reasonable responses to complex human
experiences and that countless normal behaviors are being diagnosed and treated
with medication. I fear this is creating
a mono-social-psychological cultural landscape in which a vast range of human
behaviors are equated with disease. We
need radical provocateurs, daring visionaries, audacious artists, outspoken healers,
courageous warriors, brilliant loners, mischievous
misfits, obsessive mechanics, insomniac bakers, anomic urban gardeners,
wildlife saving savants and every other wild child, quiet adult, party animal
and solitary scientist. Nature abhors monoculture. We are learning this lesson in devastating,
bee colony collapsing ways. Humans are incredible
diverse and it is our differences that make humanity possible. Just as different crops nurture, feed and
sustain one another, we pollinate humanity through difference.
Psychiatry and
psychology need to widen, rather than narrow, the enormous range of acceptable
normality in behavior, personality, and psychological constitution and embrace both
the science and the art of healing. It will take serious effort to counter the
cultural influence of pharmaceutical driven care so that multiple treatment modalities
are widely accessible for the general public and that the craft of healing work
is recognized as being viable even as it eludes scientific verifiability. Consumers, clients and clinicians will need
to continue to collaborate, speak truth to power, support seemingly “radical”
alternatives, mainstream multiple healing modalities, challenge science to
research towards collective good, and organize in solidarity across different therapeutic
approaches, fields and professions.
