A FEW OBSERVATIONS ON CONTEMPORARY PSYCHOLOGY January 25, 2004. Preface
Mental health professionals fall into basically three categories. Psychiatrists are trained in both psychology and medicine, and are true medical doctors with the authority to prescribe drugs and perform invasive surgery. Psychologists are educated only in the mental areas, although most practitioners have some formal psychiatric training; drugs are prescribed via referral. “Psycho-therapists” are people who may or may not have had competent instruction in the mental health field; often individuals are accredited by suspect “schools”, and although some may have a true talent for psychology, others are comparable to social workers at best. For the purposes of this discussion, ‘therapist’ will refer to those formally accredited as psychologists, which includes psychiatrists.
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Mental health professionals have been a part of human society for much, if not all, of our existence. Long before psychology developed as a science, tribal cultures relied on the witch doctor or medicine man to deal with mental dysfunction. Although their methodology was based on superstition and religion, they were obviously successful enough at banishing “evil spirits” to ensure that the practice endured over the ages.
There are those who feel that psychologists today are little different from the shaman of old, and this argument contains an element of truth. Some of the success therapists achieve is the same as that of their mystical predecessors. In the case of mild mental problems, it is often enough that the patient is receiving the attention of another human being, and feels that someone actually cares about their predicament.
A number of older studies have shown that from forty to sixty percent of patients are cured through therapy. Similar studies have also concluded that from forty to sixty percent of people will recover without treatment. On the surface it would appear that therapy is just as successful as nothing at all, but there is an intrinsic flaw in the way the control group (those who receive no treatment) must be set up.
In order to collect subjects for this type of study, individuals who are seeking help are separated into two groups. Half receive therapy immediately, the other half are told they will have to wait. The control group is consequently affected by this strategy, for by promising eventual counselling, you have not only shown that someone cares, but also given them hope for the future. Such positive reinforcement can be construed as a form of therapy that would be lacking in a true control situation. As well, if a person is seeking psychological help, they have already taken the most important step toward a cure, which is admitting that there is something wrong.
More-recent studies have indicated a seventy to eighty percent cure rate. Does this suggest that psychology has made progress in the interim? Not exactly. First, we must recognise that ‘cure’ can have a different connotation in mental health. Many disorders are chronic, and it is impossible to eliminate them, often because a genetic anomaly is to blame. Frequently, a marked improvement in behaviour or quality of life is all that can be hoped for.
What we are seeing in recent times is a shift from attempting to treat the cause of mental dysfunction, to a system of treating the symptoms via drug therapy. This has been basically the only option when dealing with serious irreversible disorders, such as schizophrenia, but this approach has been widely expanded to include a great many previously curable problems.
The appeal of treating symptoms over causes is fairly obvious. For one, a detailed diagnosis is no longer necessary, since a drug for that general class of disorder can be prescribed, which will control the patient’s behaviour. Over time, the dosage or type of drug can be adjusted to better suit the individual; an aspect of therapy that could be somewhat difficult in the past now becomes much easier.
Secondly, this form of treatment can be quite lucrative. It is now possible to have a much larger client base, with patients who may never go away, and make brief visits simply to renew prescriptions. Drug companies pay professionals handsomely for enthusiastic endorsements of their products in trade journals.
It can be argued that using mind-altering drugs allows a person to get through a particularly difficult period, and with time they will get over their disorder. This is often true in the case of a traumatic experience, but it does not address the underlying inability to cope with events. Subsequent trying situations will lead to further periods of medication.
Without doubt, long-term use of drug therapy entails a risk of psychological or physiological dependence. A patient must want to get better in order to make significant progress; with addiction, there will be an aversion to the very idea of growing beyond the need for medication. The vast majority of people who seek psychological help are afflicted with a minor neurosis, rather than a serious disorder. These patients usually require little more than a sympathetic ear to allow them to talk through their difficulties.
In recent times, any child exhibiting behaviour that does not conform to very narrow parameters is assigned a syndrome or disorder that did not even exist in the past. Youths that are overly restless or boisterous, naturally lacking an average level of intellectual ability, or simply poorly disciplined may find themselves receiving mood-altering drugs for the duration of childhood, and perhaps beyond.
The brain is capable of being, as we discovered with the opiate class of chemicals, uncompromisingly efficient: if the body is receiving opiates from an external source, then the brain will severely curtail the output of the opioid peptides it naturally produces to combat pain and stimulate pleasure. There is insufficient data available to enable us to conclude that long-term drug therapy for Attention-Deficit/Hyperactivity Disorder will not have an adverse affect on brain chemistry. If, as a few suggest, the problem is the result of a chemical imbalance, then this form of treatment may actually create a true dependence upon a drug by inhibiting the production of naturally-occurring chemicals in the body. Of course, there are also those who suggest that ADHD is not actually a disorder at all, and its prevalence in America, and non-existence in most of the world, is due to a cultural influence, with the current focus on the subject primarily due to pharmaceutical industry profit margins.
Serious mistakes have been made in the past, and one of them remains with us today. Electro-convulsive Therapy (ECT), commonly known as shock treatment, was introduced in 1938. It was not long before the therapeutic value and safety of the procedure was questioned. Regardless, ECT gained in popularity. By the Seventies, studies were showing that ECT was of little benefit. There is unsubstantiated evidence that the routine sedation of patients prior to electrocution may be the source of any positive results.
In certain extreme cases, ECT is able to make uncontrollable and dangerous individuals into docile members of society, whereas other alternative treatments would fail. However, these people are not cured in a conventional sense. ECT causes irreversible brain damage, and systematically destroying portions of the mind can leave a person incapable of feeling or acting upon impulses.
Many, if not most, mental health professionals are now opposed to the use of ECT. Sadly, a number of jurisdictions in otherwise “civilised” countries allow the courts to inflict the procedure on individuals. This accentuates the trend present in the use of ECT in general, in that it is primarily applied to members of lower classes and racial minorities. Being that a judge is fundamentally ordering the physical destruction of a portion of someone’s mind, there is little difference between this and requiring the amputation of a transgressor’s hands or feet. Being that a person’s memories and experiences form their individuality, the methodical destruction of a significant amount of someone’s memory is the equivalent of killing that particular manifestation of individuality, for the original is gone forever, replaced by a new “individual”.
Herein lies a fundamental ethical problem. When we intentionally damage the internal structure of the brain via surgery or electrocution, we are in truth eliminating an essential component of that which makes a person a unique entity. I would venture to say that, since people attracted to the mental health field generally care about the well-being of others, most of them oppose capital punishment. Yet, some are faced with the decision to commit a comparable act for what they must judge as being in the best interests of society.
Mental health is assessed by determining a person’s ability to function within society, and the patient’s potential threat to themselves or others. In choosing to destroy the psychological self, a therapist is deciding to sacrifice the individual in favour of either the greater good (society), or the biological organism (the physical body). It is fairly easy to imagine situations where it might seem necessary to forfeit the individual in order to protect the lives of others, but it is not so clear-cut when it comes to saving people from themselves.
In traditional therapy, you are introducing new experiences to the patient; that is, you are leading them to new thoughts and perspectives meant to modify the way they see themselves and the world around them. It is a matter of constructively adding to the sum of their experiences. Eliminating a phobia, for example, involves adding the empirical knowledge necessary to understand why the fear exists and how to cope with it. You have not removed the past experiences that led to the fear, only introduced further knowledge to augment their perspective on it. In other words, the patient has undergone mental growth. With physically destructive methodology, or drug therapy that inhibits andrenal output or blocks emotions resulting from the release of other natural hormones, you have “taken away” from the patient. The result is someone who is less of a “person” than before.
A significant problem we encounter is determining what is or is not a mental disorder. A great deal of our behaviour is shaped by the culture we belong to. For instance, that which we legally define as pedophilia in Western society is considered normal in most others. In America, a person is legally deemed to suffer from pedophilia if there is five years or greater difference in ages, the offender is at least sixteen, and the child is less than fourteen years of age. However, in the older cultures of the world marriage to adolescent girls is commonplace.
In a society that is predominantly religious, an atheist hearing voices in his head will be diagnosed with a psychotic disorder, while a devout Christian who claims that the voice is that of God will be permitted to claim sanity. Visions of Napoleon indicate mental problems, while those of mythical religious figures are allowable.
Changing social values also alter our interpretation of illness. Until relatively recently, homosexuality was classified as a mental disorder, but lobbying by special-interest groups succeeded in having it removed from the DSM (‘Diagnostic and Statistical Manual of Mental Disorders’ - the guidebook of the mental health field). At one time in American history, many actions that did not conform to strict Christian guidelines were considered acts of madness, or with worse consequences, those of demons. The difficulty is that legal, religious, or political definitions of mental dysfunction are not clinical definitions. Unfortunately, the public-in-general is not aware of the latter, and hence has a distorted perception of mental illness.
We must keep in mind that opinions in the psychological community are far from united as one. The DSM IV-TR may be the newest standard used for determining what constitutes a mental disorder, but many decisions on the content of each version are made via ballot. The removal of homosexuality was supported by a modest majority, but still opposed by thousands of psychiatrists, as was the inclusion of numerous disorders. Psychology, like most sciences, is an evolving discipline, and society is still a long way from creating incontrovertible diagnostic standards.
Pedophilia is a serious and often incurable disorder, but a clinical diagnosis should require that other criteria be met (including more than presently in the DSM). The courts fail to account for this, and consequently sentences are either too harsh for those who do not suffer from a mental illness, or far too lenient for those who will be mentally compelled to re-offend. Even our own culture contains males in their late teens and early twenties who, due to mental problems related to self-image, social pressures, and even physical appearance, form consensual sexual relationships with twelve or thirteen year old girls. These particular individuals usually mature out of their aberrant behaviour, and rarely repeat their crimes later in life.
A person who suffers from auditory hallucinations involving disembodied voices likely has a psychotic disorder, regardless of their religious beliefs. Granted, faith can sometimes control the mentally ill, but then again many horrendous atrocities have been committed by people acting upon “God’s instructions”.
Homosexuality as such may no longer qualify as a mental disorder in that now it does not significantly affect one’s ability to function within society, nor threatens one’s personal safety; but homosexual behaviour can be indicative of a variety of disorders, and if homosexuality is the result of a causal mental dysfunction, then for these particular cases it should remain in the DSM as a category qualified by specific diagnostic criteria.
Similarly, I personally do not treat ADHD and related categories as being disorders, but rather consider them to be symptoms of more traditional mental difficulties. Hence, to use drugs such as amphetamines and methamphetamines to treat a symptom is an unproductive approach, since we should be focused on finding the underlying cause.
We live in a culture where our very way of life causes mental stress. There is a profound difference between the rate of psychological problems in the Western world, and that of other cultures; and the more materialistic the economic system, the greater the rate of dysfunction. The United States is the “sickest” of nations because it utilises an expansionist form of economy far “colder” than traditional societies. Gone are the extended family and community support systems that are a natural part of human instinct. People move away from family and friends in the pursuit of financial success. Elderly parents and dependent relatives are considered a hindrance to one’s own ability to survive in a cut-throat culture. Corporations introduce programs allegedly intended to make the workplace more “family-friendly”, when in fact psychologists have designed these programs to intentionally blur the distinction between work and life.
Stress is a constant companion to most Americans, and it is reflected in the high rate of mental disorders. Beneath the lofty levels of serious psychotic behaviour, there are widespread problems indicative of an inability to cope with our social environment. Individuals manifest psychosomatic illnesses that are imitations of real childhood maladies, in an attempt to regress to a time when other people cared about their well-being, or to create an excuse for failing to triumph in an intrinsically inequitable financial competition. Pets become surrogate children to those who cannot form intimate bonds with other human beings. Children are no longer allowed to fully experience a childhood, as we impose earlier and earlier structured learning environments upon them in order to prepare them for the workplace.
Each succeeding generation is born into an increasingly stressful world. Each generation is endowed with less intelligence than the preceding one, and consequently is less able to deal with the challenges of a technologically intimidating and financially competitive culture.
Because of the direction Western society is headed, psychology will play a significantly greater role in the future. Life can only become more mentally demanding as the baby-boom generation approaches retirement knowing that logistically their basic financial requirements cannot be met under our current system. The younger generations comprising the middle-class face inevitable and substantial tax increases in order to pay for a portion of the costs associated with an ageing populace. Struggling to adapt to deteriorating economic circumstances puts pressure on both individuals and families, and subsequently there is an increase in mental dysfunction.
Western governments have a tendency to use military conquest to solve their domestic economic difficulties, which creates ethical conflicts in the minds of many of their citizens, where they must compromise their religious and moral beliefs in order to justify killing others for material gain. This is not exactly conducive to good mental health, for religion or personal moral framework are often the cornerstone upon which a person builds their entire self-image. In America, public support for these wars roughly corresponds to the percentage of the population that conforms to the Christian faith, but such support is rooted in animal instinct rather than reason. Followers blindly endorse the Alpha Male (political leader) when he claims to be representing their god’s wishes, but faith in this surrogate of their “ultimate” Alpha (God) is understandably fragile.
We need to re-evaluate our approach to mental health. The patients kept in a fixed state because we medicate their symptoms, while failing to treat the underlying cause, will ipso facto remain uncured. A priority must be placed on curing the common disorders afflicting the majority of patients. Dysfunctional parents usually raise dysfunctional children, hence we have a continuing and growing problem. An already overburdened medical system is further strained by those suffering from psychosomatic illnesses and individuals who are afflicted with some level of hypochondria; the latter accounting for the majority of all visits made to doctors.
More mental health professionals are needed in the field of forensic psychology. Being that our system of simply exacting revenge for criminal activity has proven to have no effect on crime rates, we should be making more of an effort to understand the psychological factors that shape those who commit crimes for reasons other than subsistence.
Mental health is important not just to the well-being of the individual, but society as well. Those who see psychology as hardly more than quackery fail to realise that there is little the legal system alone can do to protect the public from the potential actions of psychotic individuals. Without the ability to detain those who may possibly harm others, a possibility can become reality.
There is an overall need for the working class to have quicker access to therapy. Cost is a factor, so whereas the nature of the work done in forensic psychology justifies additional staff trained in psychiatry, a more economical approach is required to deal with the comparably minor problems experienced by the general population. With standardised curriculum and mandatory accreditation by the APA, the institutes that now produce psycho-therapists could help bridge the gap between expensive professionals and the often under-qualified social workers, current psycho-therapists, and clergy.
Psychology must advance our knowledge of brain chemistry and genetic aberration in order to find more effective and tolerable drugs for those chronic disorders requiring chemotherapy. Restricting a person’s ability to function as a truly sentient being, for the purpose of safeguarding society, is often necessary, but far from an ideal solution to the problem. Preferably, drugs can be developed that are discriminating, and target specific abnormalities while allowing the patient to experience a wider range of emotions.
We have come a long way from the days when the mentally ill were isolated and shunned, with no effort made to understand or treat their problems. Society no longer entertains mystical delusions about demons possessing those with mental disorders, nor burns them at the stake. Yet there is still much progress to be made. As the rate of mental dysfunction continues to increase in the Western world, new ways to deal with the problem need to be found.
