Sean O’Conaill © Doctrine and Life, Nov 2001
When we read the gospel accounts of what are clearly encounters between Jesus and what we now term ‘mental illness’, we experience again the full force of the Enlightenment’s rejection of the supernatural. Demonic possession is now the domain of Stephen King and the X Files – and ‘scientific’ psychiatry, relying heavily on physiological explanations for mental disturbance, has commandeered the care of the damaged soul. This is just one area of intellectual expertise and social care that the churches have lost to secularization – apparently beyond recall.
Yet if we are to take seriously a recent Irish book on the subject, the current pharmaceutical bias of much psychiatry is itself a confidence trick, in danger of compounding the growing problem of mental illness, especially of what is called clinical depression. Dr Terry Lynch in Beyond Prozac* alleges not only that currently fashionable drugs are likely to create a new dependency, but that their use is justified by bad science, that it merely suppresses symptoms, and that it commonly delays recovery by failing to elucidate the experiential factors which often lie at the root of the problem, and to provide the caring and sympathetic relationship that is needed to address them.
Pointing out that insulin deficiency can be demonstrated to be the cause of diabetes by a blood test which proves the deficiency, followed by the replacement of the missing substance, Dr Lynch points out that although psychiatrists commonly claim a biological imbalance or a genetic deficiency to lie at the root of depression, they make no blood or any other kind of biochemical test, for example for the level of serotonin. Yet so powerful has the mystique of the profession become that journalists will happily tout serotonin as the ‘happiness’ substance in the brain – and marvel at drugs such as Prozac as the magic solution to its absence.
In fact, although some prominent Irish psychiatrists will debunk what they choose to call the ‘endless talk’ approach to mental illness, they are also forced to admit that they do not know exactly what physiological processes underlie it, or how exactly their pharmaceutical solutions actually ‘work’.
The diagnosis of ‘clinical depression’ is especially interesting. It appears that one can trigger this diagnosis by being especially sad. A sense of hopelessness; of being unable to cope; of continual lassitude; of loss of ambition or interest in a hobby; of meaninglessness; of social fear or inadequacy; of low self esteem: a given number of these symptoms will transfer us from the realm of the mentally fit into that of the mentally ill – and this given number can vary geographically.
The truth about western culture seems to be this. If we become so emotionally distraught as to be unable to ‘function normally’, we are mentally ill, and need, in many cases, pharmaceutical support.
It follows from this that normality, and mental health, is now apparently defined by many psychiatrists in anaesthetic terms: we do not feel negative emotions to a degree that will impair our ‘function’. We are, in other words, unassailable by emotional pain. In the context of a world subject to all sorts of pressure, stress, decay and danger, and in which individuals more and more commonly experience severe trauma, this, when we think about it, is altogether ludicrous.
The presumption that psychic buoyancy and autonomy is the norm, that normal people do not ‘break down’ and become persistently distraught, is of course, of great benefit to at least one current economic ideology. In the Thatcher era a popular one-liner ran as follows: “A Bore is someone who, when you ask him how he is, he tells you!”
This goes close to the heart of one of our deepest social problems: beyond a certain low threshold we do not wish to be burdened with one another’s problems. When we ask “How are you?” there is usually an iron rule that the answer will not disturb our own momentum – that any declaration of unwellness will stop short of a claim upon our time, will end with an insistence that our friend, or even sibling, is ‘really ok’. There is, in other words, a rigid ethic of self-sufficiency – especially among males. The purpose of our education is to make us personally autonomous, and we are now educated to believe that we are less than whole if we lose this autonomy thereafter.
This is in itself a complete explanation for the fact that ‘breakdown’ brings us to psychiatry, for it is a radical loss of autonomy. The psychiatrist is the professional expert on those who have ‘cracked up’ – for no-one else is either competent enough, or confident enough, to cope.
Yet an hour’s reflection will show us that emotional autonomy is a myth. Even the ‘successful’ person is dependent upon others to deliver a verdict of success, and one cannot lift a newspaper without tumbling over the rampant attention-seeking that the wannabe-successful wallow in. We are relational, not autonomous beings, which means that our emotional health must be closely related to the quality of our relationships, past and present.
Furthermore, we are role-playing beings, often desperately trying to fulfil the expectations of an employer or a colleague or a relative. We are often, in other words ‘trying to be’ the person we suppose we ought to be – and often we have not in fact chosen this role. It has been chosen for us by a parent or other person influential at a formative stage in our development, or forced upon us by economic necessity. What if it is incompatible with our deepest needs, with who we actually are?
And loss, or lack, of self-esteem, is as potent a factor in mental illness as in addiction – and self-esteem also cannot be autonomously created. We depend heavily for our self esteem upon the esteem of others – and this is precisely why we feel compelled to give the ‘OK’ answer when things are far from ‘OK’. We are afraid we will lose that esteem if we are ‘broken’.
Terry Lynch’s book gives many examples of patients who, following an investigation of the background to ‘breakdown’, reveal a personal history that more than amply explains why they could not possibly be ‘OK’ – why they need to be distraught, to throw themselves upon the resources of another human being, to be reassured, to be – in a word – loved – for themselves.
But love is not a pharmaceutical substance. It is a spiritual thing, because it is a going beyond what can be expected. The person who loves is no longer self-absorbed but lost in sincerely honouring another. If love becomes a scarce resource in any culture, we are headed for large scale breakdown – and a psychiatry which substitutes drugs for love cannot make good the shortfall.
Let us apply this analysis to the stories of mental illness in the gospels – beginning by reminding ourselves that in those times people were more certain of the existence of God, and that they commonly deduced the level of God’s approval from their worldly circumstances. It followed that the more extreme the circumstances, the less self-regard people would commonly have – the more ‘poor in spirit’ they would become. The poorest in spirit would suffer a total loss of self-esteem, followed in extreme cases by breakdown. It followed also that breakdown was likely to be interpreted as a matter of passing out of the care of God, into the realm of the demonic.
Dr Lynch points out that a person who has always felt himself insignificant, and suffers pain from this, is naturally likely to suffer delusions of grandeur – yet if these in turn lead to social rejection and isolation, self-regard will naturally reach an even lower level. At the lowest level of the moral cosmos of the gospel world was Sheol, the place of the dead, where demons reigned. Delusions of demonic possession could therefore naturally follow the complete ostracisation of an individual.
But for all its horrors, the ‘demonic possession’ paradigm has one beneficial characteristic that the biological/genetic theory signally lacks: it does not identify the malady with the sufferer; the whole person is reclaimable by ‘casting out’ the demon. On the other hand, we are stuck with our biochemical or genetic problem – if that is what we’ve ‘got’.
At this point we need only remember that the essential characteristic of Jesus’ ministry – the one that got him into terminal trouble – was its radical inclusiveness. Prostitutes, lepers – the ‘unclean’ generally – were to be restored, not just to health, but to their relatives and friends. No-one was more ‘unclean’ than the demonically possessed : so Jesus’ extraordinary power to communicate the esteem of God for those who thought themselves totally outside it must have hit the self-hating with extraordinary force. When we remember that great social fear lay behind the avoidance of such people, even Jesus’ close approach would arrest their attention – and so the text confirms.
Great love is clearly present in the accounts that Dr Lynch provides of successful ‘friendship’ approaches to the treatment of people who have presented with various symptoms of mental and emotional distress. It requires great faith in the essential goodness of every individual, and in the power of sympathetic investigation of past experience, to get to the root of the problem. This in turn often requires great patience – and here we find the essential reasons for the failure of the psychiatric paradigm. Psychiatrists too are scarce ‘human resources’, highly expensive to train and maintain. Everything must recommend a rapid throughput of patients. The last thing they can possibly have is the time to befriend their clients individually, to become familiar with the detailed contexts of their lives.
When we confront the continuing stigma that attaches to mental illness we must even more seriously question a biochemical/genetic theory which provides no hope of separating the sufferer from the source of their illness, which, must, in fact, reinforce their sense of being ‘different’, and thus of isolation, stigma and despair. An hour’s serious reflection should be sufficient to condemn any search for a ‘happiness’ gene or biochemical substance: human emotional well-being is both fragile and essentially relational – and a society which increasingly deprives us of time for one another must also be one in which psychological breakdown will also increase. Emotional pain, like any other kind of pain, is a compelling warning to rest, and to address the cause
And when we remember that the pharmaceutical industry is part of the globalisation process, and that ‘happiness’ pills are vastly profitable, we need look no further for an explanation of the dominance of the physiological paradigm of mental well-being. The research which appears to support pharmaceutical solutions is largely funded by that industry and therefore seriously biased in favour of the conclusions it wishes to find. To escape this conclusion it need only fund experimentally in equal measure the methods which favour compassionate friendship, psychotherapy and counseling. If this funding should be found wanting the churches should try to supply the deficiency, in faith and love. It is surely time to begin reversing the downward trend towards ‘happiness’ pills for all.
“Beyond Prozac: Healing Mental Suffering Without Drugs” by Dr Terry Lynch