I read an article from the New York Times Magazine written by Ethan Watters titled “The Americanization of Mental Illness,” exploring the impact of the American diagnostic and treatment frame taking over other, culturally specific ways to understand and metabolize the experience of psychological suffering in other parts of the world. Although the article was fascinating and challenging overall, what intrigued me most was the brief exploration of the underlying assumptions making up our domestic, home-grown framework of understanding psychological suffering and mental illness.
Today in the U.S. it seems the predominant narrative available to make sense of much internal suffering is a scientific narrative, the belief that, much like diabetes or cancer, mental illness can be “found,” accurately identified through formal diagnostic procedures, and addressed through scientifically vetted treatments. Much as we colloquially understand diabetes to be an imbalance in, or a compromised capacity of the body to interact with, insulin, one recent narrative of depression is that there is a similarly challenged relationship between the brain and serotonin. More generally the common colloquial explanation for much of what we categorize as mental illness has become that it is, or is often caused by, “a chemical imbalance,” a graciously vague statement which most of us could accurately use to describe as a major influence of our mood before having our morning coffee.iew of internal suffering is that it makes such experiences appear handleable, something which we can tackle with the right approach, optimism, and a lot of elbow grease.
For those of us serving in partnership with those seeking relief from suffering, does this framework help us in our work or does it constrain us? Possibly this narrative is so compelling because it speaks to dearly held cultural assumptions and values of personal responsibility and self-reliance; if our mental and emotional suffering is the same as a medical disease then it resides somehow both inside and outside the self (inside the self as a “physical” entity which we can therefore take control of, and outside the self as something impersonal, not of our making, and therefore not our fault), then theoretically it would not result in self-blame and would also allow us to view it as a concrete issue which can be solved through task-oriented problem-solving. This potent narrative not only makes a great deal of sense, but it is also quite soothing, not only to the sufferer, but equally (or maybe sometimes more so) to the treator. And maybe sometimes that is the more important point of why we are so drawn to it. Too often though, the journey through mental, emotional, or spiritual suffering is not quite so direct.
The dark side of this positivistic view of internal suffering is the potential of our clinging to the belief that control is possible, and that if we are unable to initiate such control through scientific understanding and prescribed evidence-based treatments that we are somehow lacking in the necessary gumption to live a good life; we’re just not working hard enough or just haven’t found the right prescription. This fits in perfectly with an American view of self-reliance and of being captains of our own individual destinies, but what about those times when internal torments and external circumstances swamp such dearly held beliefs? It is far more threatening to consider and embrace the reality that sometimes the sufferings of the mind and heart can be far more mysterious than even the most complicated mysteries of the physical brain, even in its extraordinarily complex and indecipherable functioning. Considering this possibility, much as considering the reality of our own impending deaths (a problem, which regardless of whatever mental and acrobatics we attempt, our minds know is a problem which cannot be solved), can be the cause of intolerable anxiety. The broadening of our scientific and medical framework of mental illness allows us to cling to the belief that the absence or presence of internal sufferings are within our control, a belief which can be shored up especially during the times when such strategies prove effective and identified symptoms diminish or vanish.
Tragically this narrative, in the end, always breaks down. There are things within our influence, but there is very little in our minds, our hearts, or in our brains that are within our control. The successful use of our capacity to influence our minds and the functioning of our brains can be used wisely, with the appropriate gratitude, humility, and humor, lightly holding the relationship between a wise effort and the accomplishment of a desired outcome, or it can be used in the desperate service to temporarily strengthen the soothing delusion that we are in control, an effort which, in the end, is bound to fail, and if that failure happens sooner rather than later, leaving us unmoored and uncertain how to approach a life which continues on its own path, regardless of our wishes and commands. Things change; life is guaranteed to present further experiences full of surprise, joy, and pain, regularly demanding that we either desperately continue to construct edifices to show we can command internal and external tides, or that we find ways to sail those tides, knowing that we cannot see every wind, every reef, every wave of beautiful, terrifying, chaotic or soothing experience which will greet, toss, and cradle our little boat until, like all boats and all lives, it finally springs a leak which cannot be patched.