As I was reading this article, it resonated with my familiar objections to the diagnostic labels contained in the DSM-IV, as well as to the theory holding that mental illness is the result of a chemical imbalance in the brain. The use and abuse of psychological diagnosis, to begin with, makes people believe they have a recognizable disorder, akin to a medical syndrome, and that it’s beyond their control to do anything about it. If you are told and believe you suffer from borderline personality disorder, that it’s a lifelong malady you can do little to modify, then you have no reason to struggle with it and try to gain insight. If you are told and believe you suffer from Asperger’s Syndrome, you won’t try to understand the particular nature of your defense mechanisms and to confront what lies beyond them. In my experience, providing a psychological diagnosis to people essentially deprives their suffering of its meaning, discourages them from self-exploration and encourages a sort of passivity. “I have Asperger’s Syndrome — what can I do?” I don’t mean this as a criticism. When the medical establishment, the media and just about everything in our culture supports this view, why should anyone believe otherwise?
The chemical imbalance theory is even worse. Because people are told and believe that their symptoms of depression, their panic attacks or their bipolar disorder symptoms all result from chemical irregularities in their brain chemistry, they have no reason to dig in and do the hard work of self-exploration. It’s a chemical imbalance; I was born that way and I need to take a pill to rectify it, like my doctor said. One of the beneficial side-effects of the medicalization of mental health is removing much of the stigma from mental illness, especially as celebrities such as Catherine Zeta-Jones have publicly acknowledged their struggles with bipolar disorder and other issues. But in the face of the relentless public relations push for psychiatric medication as the answer to all forms of mental illness, few people have the will power and self-control to struggle with their inner conflicts. They have been told that will power and self-control are irrelevant — it’s all about your biology — and so they believe they can do nothing to help themselves get better.
There are some bright spots in the mental health profession. Cognitive Behavioral Therapy provides depressed clients with some useful techniques for coping with their negative self-talk and self-defeating behaviors — in other words, it assumes that you can make a difference in your state of mind by exerting effort. Will power and self discipline are necessary parts of the work. Dialectical Behavioral Therapy appears to be effective in reducing suicidality, substance abuse and hospitalizations with borderline personality disorder, using a highly structured program to help clients develop a degree of self-control where impulsive behavior is concerned. Neither treatment modality explores the meaning of the client’s symptoms, however, or helps them access their unconscious dynamics. Both reduce people to a recognizable syndrome that can be treated with a uniform approach, in the process accepting severe limitations on what is possible to achieve through psychotherapy.
Assumptions by the therapist as to what is possible for any given client will naturally have a profound impact on the treatment. If therapists believe they can do little to help a borderline client, they will communicate such a conviction to that client, who will then come to believe it as well. If a therapist believes that his or her client’s depression is the result of a chemical imbalance, both therapist and client will come to share limited expectations for what their work together can accomplish. Everywhere I look within my profession, I see evidence of this acceptance of limitations, a kind of widespread learned helplessness in the face of mental illness, a rejection of the long hard work involved in psychodynamic psychotherapy. I’m not advocating a return to the era when we blamed people for their difficulties, when our culture viewed mental illness as a weakness, a lack of will power, the failure of self-discipline; but the pendulum has swung too far in the opposite direction, so that we no longer expect anyone to take responsibility for their struggles.
It’s a medically-recognized syndrome, a chemical imbalance — you can’t help it. When you accept such a belief, you’re like the subject in that study from the NYT article, who did significantly worse on assigned tasks when they believed their own will power and self control were limited.