An Anti Anti-Stigma Philippic

John McManamy Health Guide
  • If a tree fell in the forest and no one saw the lumberjack, would everyone blame the tree?


    Let’s apply this to stigma: Our brains fail on us. No one can spot a clear cause. Ergo: Let’s blame the malfunction on the brain’s owner.


    Donna lays out the issue. In response to an earlier piece, When Anti-Stigma Backfires, she comments:


    If you say a person's "insanity" is caused by a brain tumor, then people act like it is perfectly understandable and they bring chicken soup and sit with you while you receive chemotherapy. They are supportive and send get-well cards. If you say a person's "insane" because they got it from their crazy grandfather who was mowing the lawn naked one day, people shy away. It means the end of friendships, the end of compassion, and the beginning of furtive glances and avoidance.

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    Donna, in effect, is inviting us to compare neurology with psychiatry. Many would argue that the distinction is artificial, but as a general rule neurology is all about biological smoking guns while psychiatry is dealing with circumstantial evidence.


    With neurology, we are taking about tumors and lesions and neural degeneration and the like. We can pretty much link cause to effect. With psychiatry, we are talking of a zillion-and-one things that can can possibly go wrong in the brain at any given moment. Brain science is yielding stunning insights, but, alas, no clear cause-and-effect.


    We’re not through. A neurological condition implies an abnormal event in an otherwise normal brain, with perhaps a definitive fix. By contrast, a psychiatric condition is notoriously difficult to separate out from one’s personality. How can you fix what you can’t find? 


    Thus, you can see the challenge faced by an earlier generation of mental health advocates (such as the people who founded NAMI back in the 1970s). Their task was to convince skeptics that mental illness was biological - read neurological - and therefore no-fault.


    The biological psychiatrists of the fifties and sixties naively believed that psychiatric meds could do for mental illness what antibiotics had done for bacterial infections. (A good account is provided in Robert Whitaker’s 2002 Mad in America.) Mental health advocates (in particular NAMI) eagerly embraced this model, and the pharmaceutical industry found a license to print money. Thus, this message:  


    Mental illness is caused by a chemical imbalance of the brain. Mental illness is a treatable medical condition equivalent to diabetes.


    But what, precisely is a “chemical imbalance of the brain”? And how “treatable” is it? And how is mental illness even remotely comparable to diabetes? 


    Meanwhile, those opposed to the medical model displayed a similar (though opposite) affection for neurology. Show me the lesion or tumor they said, using those exact words. No lesion, no mental illness. Thomas Szasz, author of the 1960 book, The Myth of Mental Illness, made a career of this. 


    The tune has since changed. We have found the lesion or tumor, opponents of psychiatry are now saying in effect. It is meds. Indeed, Robert Whitaker’s 2011 book, Anatomy of an Epidemic, is framed in terms of biological psychiatry. Still very neurological, but at least we are finally reaching consensus that the brain is not tofu.


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    Likewise, we are also beginning to see these same people cite stress and trauma as the source of their woes, with biological underpinnings but somehow divorced from personality. In other words, abnormal in a normal brain. “Labels” that imply that not all is well are frowned upon. Labels such as “mental illness,” “depression” or “bipolar.”


    Is it denial? Or do these people have a point?


    The short answer is that everyone is right and everyone is wrong. That first generation of NAMI advocates won a huge battle in gaining support for biological psychiatry. But recognition that a mental condition happens to be biologically based hardly implies a compassionate response. “Run like crazy from these people,” is the message those who speak for us unintentionally send to society. 


    Likewise that first generation of those opposed to psychiatry struck a blow for human rights. Unfortunately, in their enthusiasm they also declared war on science. Compared to other illnesses, research and treatment for depression and bipolar is woefully underfunded. Who knows what scientific breakthroughs we missed?


    So - can we start reframing the discussion? Can we get away from this neurological fixation on simplicity and move to psychiatric/psychological complexity, and then move beyond? From easy answers to no easy answers?


    Easy answers haven’t done us any good. A major rethinking is in order.




    This is the fourth in our series on stigma. Previous pieces:


    The Search for Identity

    When Anti-Stigma Backfires

    Don't Call Me Bipolar


Published On: August 09, 2013