How To Think About The Mental Health Industry
I was recently invited to review an advanced reading copy of a book called We Can Do Better by David Goldbloom. He’s a professor over at the University of Toronto. There were a number of ideas he brought up in this work that I’d really like to respond to in the next several blogs. In this one particularly, I wanted to share a point he made in addressing the evolving landscape of the mental health industry, overall.
A developing science
Being that it has undergone so much transformation over the years, it is easy to dismiss it as an imperfect, perhaps even pseudoscientific discipline. Psychology, after all, still can’t seem to shake its reputation as a soft science. And Goldbloom makes a brilliant analogy about this.
The analogy Professor Goldbloom opens his book with is a useful way of thinking about mental science – and the psychiatric profession that’s built upon it. He speaks about a trip he made to Barcelona, Spain and his encounter with the Roman Catholic Basilica, The Sagrada Familia.
He captures his awe of the structure in the first page with an almost literary flare. As he approaches the edifice, he’s obviously taken aback just by its sheer scope and scale. When he looks closer, though, he notices scaffolding that dots the exterior and inquires of a nearby aid what the reason for construction is.
The local explains that it’s been under construction since the year 1882, and will likely not be completed for another decade yet.
Now, you have to stop and think about that for a minute. Yes, sure, we’ve all heard of behemoth projects like this before. The wall of China, for instance, took over 200 years to build. As I write this, my fiancé is reminding me that I still haven’t mounted our television in the living room yet. What can I say, Rome wasn’t built in a day. Anyway, Goldbloom draws attention to how things have changed around this building, poised as a fixture within a bustling metropolis.
He discusses how the main method of transportation when construction started was horse and buggy. By contrast, in our modern day, a high-speed train runs underneath the monstrosity. You also have to think, not only about the evolution of the church’s surroundings, but how the very materials and building methods themselves have changed…utterly!
Even though the building is unfinished, you see a mix of the old and the new. And he likens this to how things are in the mental health industry. It’s a developing science. He says that we have an incomplete understanding of how to care for mental illness sufferers. He also alludes to how the theories and treatments are controversial and in a fluid state of transformation. They have always been.
Sometimes mental health care gets it wrong!
One very prominent example of this is captured in the following excerpt from his book. It reads,
“I came of age as a psychiatrist in 1985, when the field was in a state of major change. A seismic shift had occurred when psychiatry turned its back on its heritage of psychoanalysis (still today the popular public perception of the discipline). As psychiatry made its somewhat delayed entry into the mainstream of scientific medicine, it was finally abandoning the long-held view of the origins of mental illnesses – namely, that they could be primarily attributed to early childhood experience and faulty parenting. It was becoming increasingly clear that those traditionally endorsed views could no longer be propped up – we needed a new paradigm…A new direction meant new medical standards; psychiatry had to create an entirely new common language to talk about mental illness.”
All of this can leave one with a lack of confidence in the industry. Mental science – even these 82 years following the death of her founding father, S. Freud – struggles to find acceptance among her more rigid cousins physics, chemistry, biology & math.
I believe it was Earnest Rutherford who once arrogated that “all science is either physics or stamp collecting.”
As a casualty of any mental disorder it can be extremely disquieting to surrender one’s well-being to such uncertainty. Let’s face it, some reversals that have been made to treatments and theories – which at one time enjoyed mass endorsement – have been far from trivial! Indeed, other diagnoses considered to be minor (such as ADHD or OCD) are being given greater attention. These conditions can be truly debilitating.
Then add the human element. Freud and Jung – the legends of psychiatry – could not have been more different from one another in their approach and conception of the discipline.
It reminds me of a similar problem: how disorienting it can be for victims of poor parenting to, in turn, become competent guardians themselves. Such a background can be a profound asset for some (in terms of lessons learned) and a complete liability for others.
Another poignant comparison
We have really seen this in some of the revelations that came out of Canada’s Truth and Reconciliation Commission. Many indigenous peoples of Canada who survived the heinous residential school system managed to patch somewhat of a life together and became excellent parents. Others became heartless tyrannical copies of their oppressors. Still more, while gentle and kind, perpetuated the vicious cycle by carrying unattended baggage, scars and trauma. They were just not able to adequately measure up to the responsibility of being a parent, despite the best of efforts and intentions.
This is how unsettling it can be to place trust and authority in people and institutions. The mental health industry is deeply flawed. And even experts can have unresolved issues of their own. You might have heard the old saw, ‘therapists need therapists’.
Having said all that, is it better for children to be thrown to the wolves with no parents or figures of trust in their lives? Certainly not! Likewise, with all its frailties, is psychiatry to be discarded? I believe that would be a mistake.
We can toss aside the residential school system as an objectively abominable stain on Canadian history. That’s fair! But should we dispense with schools, as such?
Goldbloom’s Sagrada Familia analogy should give people a way of thinking about mental health care. It’s imperfect, but how amazing it is that we have the kind of insight we do now. And throughout these dialogues I will be conducting on this book in the future, you will read about some really wonderful advancements that have been made in our understanding of the human mental condition, psychopharmacology, diagnosis, treatment, legislation, access, AI, and so many other improvements.
What experiences have you had with psychiatry? Does this analogy hold water for you? Did you get better? Would you recommend it to others? Tell me below in the remarks.