The labyrinth of the mind: what’s the solution to the mental health crisis?

Joshua Gilbert examines the lack of consensus among psychiatrists as to how mental health issues should be dealt with.

Mental health issues seem to be on the rise. According to recent global statistics from The Economist, roughly one person in eight is living with a diagnosable mental health problem – approximately double the number of people suffering from diabetes.

Alarmingly, other statistics project that the number of diagnosed mental health conditions is set to rise still further, thus causing a further strain on medical services. This has led to renewed interest in public policy on mental health. But it also begs the question: just what do we mean by ‘mental health’?

The intersection between medicine and mental health is a very controversial topic. Contemporary understanding largely adheres to the biomedical model that assumes a biological cause of mental health issues, such as hormone imbalances or neurophysiological damage.

The influence the biomedical model has in psychiatry can be found in current psychiatric diagnostic provisions, with a main element of that being the DSM V – the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Current interpretations of the biomedical model could be called ‘mild’ in that they only observe – and attempt to treat – the patient based upon their behavioural symptoms without attempting to identify a pathological cause.

A fundamental issue with this interpretation is that the diagnostic process is laden with subjective judgements and biases by the psychiatrist.

For instance, one famous study found that, when assessing the same patients, American psychiatrists were much more likely to diagnose schizophrenia, while British psychiatrists tended to diagnose bipolar disorder. Subjective judgement-making seems inappropriate for a medical context.

A stronger interpretation of the biomedical model demands that the underlying medical bases of psychiatric illnesses be identified. Indeed, proponents of this view argue that this would stay true to the very essence of medicine where the suspected causal links between biological factors and observable symptoms are identified. Thus, mental health problems would be conceived pathologically instead of by the current ‘mild’ behaviour-based approach.

Advocates for the mild and stronger interpretations of the biomedical model agree that mental disorders are caused by neurobiological dysfunctions, but the difference between them lies in how they believe these should be treated.

Alternatively, a more radical understanding of mental health is that of the Hungarian American psychiatrist and philosopher Thomas Szasz (see his paper here), who argued medical consensuses must shift to recognise that mental health and medical problems are fundamentally distinct and separate. He went so far as to talk of the ‘myth of mental health’.

He claims that mental disorders do not have a dysfunctional medical basis, but instead are caused by the patient’s emotionally unhealthy living environment, thus merely amounting to ‘problems in living’.

Szasz does not deny the existence of human suffering, but his wider argument is that mental health problems and medical diseases – cancer, for instance – are not analogous because of the differences in how they manifest themselves and should therefore be treated as different problems.

Despite their appeal, both the stronger interpretation of the biomedical model and Szasz’s argument neglect fundamental considerations in psychiatric diagnoses.

Perhaps it is inaccurate of the strong biomedical model to try to identify psychiatric diagnoses in such a reductive manner.

Causes of psychiatric illnesses are deeply multifactorial, encompassing genetic, environmental, and biological factors that will surely be ignored in a simple biological reductionist investigation.

In a similar vein, Szasz arguably disregards the influence which biological factors have on mental health, such as endocrinological and genetic considerations. A paper by the Stanford Medical school suggests that certain genes inherited from parents can genetically dispose people to developing depression. Though exact figures are elusive, the study states that someone with a sibling or parent with severe depression is two or three times more likely to get it than a normal person.

It therefore seems more appropriate for the mild biomedical model to be intentionally shallow in its application to psychiatry by not attempting to recognise the underlying cause since thereby it is better able to encompass the various causes of mental health problems. However, to do this, any hope of an objective diagnosis process must be sacrificed.

But this raises the question as to whether Szasz is at least partially correct that psychiatry should not be a branch of medicine since it deviates from the commitment of objectivity that medicine attempts to achieve by focusing primarily on symptom management.

Indeed, treatments currently being administered are deeply controversial, with academics like Joanna Moncrieff and Ben Goldacre arguing that anti-depressants are based upon faulty studies and therefore do not work, whilst Peter Breggin criticises the use of electroconvulsive therapy to treat depression because, he argues, of the potential for severe side effects like short-term memory loss, with little observed improvement in patients.

Reaching common agreement on how best to understand mental health issues is extremely difficult in today’s medical and academic climate. Deep divisions remain between experts, and it seems inconceivable that a comprehensive conclusion can be agreed upon by most.

Yet few if any psychiatrists dare to ask if the growth in mental health problems might not be linked to the societal problems we are facing, even though common sense might suggest that the connection between these should at least be considered. 

These problems include the breakdown of the family, the pressures of working and urban life, the decline in religious faith, the lack of security in working patterns, an enormous increase in our time spent on screen, and the influence of social media, particularly on the young. 

There is, furthermore, a growing trend among doctors, and even at a governmental level, that current medical practice is to over-prescribe pharmacons and that more life-style remedies should be sought instead.

Though medicine attempts to be an objective, empirically based field of study, contemporary psychiatry appears to be far from this due to its arguably subjective nature. To fully figure out public policy for the ongoing mental health crisis, people must be able to answer the thorny question of how to understand the concept of mental health, but this looks unlikely due to the number of (and lack of) interpretations of the biomedical model.

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