I was shocked to discover that approximately 100,000 lobotomies were performed throughout the world, starting in the early 20th century and continuing right up until the 70’s. The heyday was the 1940’s. The procedure might seem both bizarre and gruesome. And it was both. But it was consistent with a burgeoning belief, still prevalent today, that mental illness is a physical disease located in the brain. It made medical sense to cut out a section of grey matter, given the prevailing view of materialist science. Today, we use magnets and electric shock and drugs, but the basic idea is still the same. Mental illness is believed to be a physical disease located in the brain. In the materialist worldview mind=brain. So “mental” illness is actually brain illness.
The quest to reduce what is called mental illness to physics has been going on for centuries. In an effort to be scientifically legitimate, Freud followed his teacher, neurologist, Josef Breuer, in attributing a physical cause to hysteria, a “disease” wherein the patient (usually women in the day) displayed physical symptoms which had no apparent physical cause. But it had to have a physical cause because, well, science deals with physics. The cause was typically associated with wombs (the Greek is hystera, thus the diagnosis of hysteria), and then using a hydraulic metaphor (physics) the prevailing theory was that impulses inhibited from flowing freely are damned up and then converted into physical symptoms.
But even before Freud, Shakespeare was on to it. Remember that scene in which Lady Macbeth, having murdered King Duncan, has gone mad? Macbeth demands that her attending physician cure his wife. The wise doctor, however, understands that this is not a physical disease she is contending with.
The doctor tells Macbeth “She is not sick my lord. She is troubled with thick-coming fancies that keep her from rest”. Macbeth responds. “Canst thou not minister to a mind diseased? Pluck the memory of a rooted sorrow, raze out the written troubles of the mind, and with some sweet oblivious antidote cleanse the stuffed bosom of that perilous stuff which weighs upon her heart”. The doctor responds: “Therein the patient must minister to himself”.
Notice four things about this dialogue:
1) The wise doctor tells Macbeth “she is not sick”. In other words, this isn’t a physical disease and therefore it’s beyond his scope of practice. In Shakespeare’s day you would send for the priest.
2) But Macbeth wants to physicalize it. The problem is a “mind diseased”, just like syphilis, say, in the body. There is “perilous stuff” weighing upon her heart. The solution for him must also physical: “Pluck the memory…out” (sounds a bit like a lobotomy)
3) Failing that, Macbeth wants the physician to tranquilize her with a “sweet, oblivious antidote” (Oxycontin comes to mind).
4) The doctor is having none of it. He shifts responsibility to Lady Macbeth herself.
Today, this physician might be jeopardizing his license, along with his reputation, for the last assertion. Medical policy bends over backward to ensure that those who suffer “mental illness”, along with the prevailing conditions in their family of origin and society, bear little or no responsibility. Today Macbeth’s physician might be accused of “blaming the victim”. Many of today’s psychiatrists, steeped in a materialist medical model that reduces reality to the physical, and enmeshed in a relationship with the pharmaceutical industry, would not be particularly interested in the circumstances of Lady Macbeth’s life, or in exploring how her own choices might be, ahem, contributing factors. Indeed, in a court of law her murderous inclinations might be presented by her lawyer as caused by a chemical imbalance in the brain, inducing depression. Charges could well be reduced based on this defence. She might end up incarcerated, but blameless.
Hungarian psychiatrist, Thomas Szasz, goes so far as to claim there is no such thing as “mental illness”. It’s not like having a canderous kidney which, if indicated, is removed. Hopefully the physical problem is solved. Now it’s possible that there are emotional issues underlying the kidney problem, but for this piece I’m leaving that conversation aside.
Bad kidneys can be understood legitimately to “happen” to human beings. But psychological abnormalities, says Szasz, not being physical, are strategies of the mind. They are their own kind of language. The presenting symptoms need to be de-coded as a language that is trying to communicate some “problem in life” that is unspeakable. He finds this model of “mental illness” more helpful because it signals to the person suffering that just as s/he strategically, if unconsciously, created an indirect language (for good reason) so s/he can find a more direct way of communicating. Rather than act it out, s/he can use words that de-mystify and empower her. After all, s/he is with a person who will not punish her for being direct with her language, which might have been the case when she was a child.
That’s the theory and Szasz is clear, psychiatry and psychiatrists need to give up their status-based attachment to being a branch of science. He points out that the theory and practice of psychiatry is itself schizoid. In theory, because it must be scientific and therefore grounded in scientific materialism, it looks for the cause of mental illness in the brain. In practice, many psychiatrists, including Freud himself, behave more like artists and healers who know that the quality of the relationship between Dr.s and patients is what heals.
Nevertheless, national health institutes, pharmaceutical companies, health insurance conglomerates, hospitals, most psychiatrists, physicians, and even some psychotherapists, continue to function from the paradigm that mental illness is a physical disease. It has the advantage of de-stigmatizing those who are suffering emotionally and psychologically. If it’s a disease after all, one need look no further for treatment than prescribing a fix in the form of a pill or doing something to the brain from whence the disease springs.
Of course, if a person has emotional difficulties that are caused by a malfunctioning gland in the brain, or a tumour, then a physical intervention is called for. But, by definition, then, it is a physical illness, not a mental illness, i.e. a physical illness displaying emotional and psychological symptoms, both of which, if correctly diagnosed and treated, will disappear.
The downside of identifying mental illness and physical disease is that it robs the “patient” of freedom to understand the wide ranging circumstances of their suffering, the broken relationships, the fear of self-expression and the impact of being treated badly?and through this insight the ability to assume greater power over their lives. There is very strong, ideological commitment to ensure that, in the words of Howard Jone’s classic 1985 song, “No one ever is to blame”, duh, duh, duh… But if a woman who has been raped by her father is depressed, surely to gawd, no human being with a beating heart will ignore her history, and treat her as though her depression or anxiety originated in her brain? Well, actually…
Leading trauma expert, and psychiatrist, Bessel Van der Kolk, has tried in vain for over a decade to get early childhood trauma included in the Diagnostic Statistical Manual of Mental Disorders (the DSM). If childhood trauma was included in the DSM, it would call into question the exclusive focus on treating the brain and the theory that chemical imbalances are the source of all suffering. Instead, a monstrous parent, uncle, or other social conditions might appropriately be held accountable. Thereby, it could threaten the viability of medical/pharmaceutical cartel. (See below).
Some psychiatrists worry that including early trauma is tantamount to playing the blame-game and locking people into a life sentence of victimhood. But, there are actual victims of actual atrocities who heroically take their lives back despite their history. It could fairly be argued, on the other hand, that reducing all mental illness to a physical disease results in a lifelong dependence on pills and the humans who pay for second homes by manufacturing and prescribing the pills. (Yes, you do detect a cynical tone. But this is based in the actual sordid history of pharmaceuticals, shady research methods, exorbitant marketing budgets which control the media, and the complicity of the FDA and the medical system itself.)
AA is a good example of the ideological commitment to turn what Szasz refreshingly calls problems of living into a physical disease. Yes, AA helps many people and I will refer clients from time to time. Still, I disagree with its philosophy and worldview which, like psychiatry, tries to get people to believe that they are victims of a disease. (Fetal alcohol syndrome, obviously, is a disease, with actual physical causes).
Alcoholism as “disease” in AA first confers a core and enduring identity (“My name is Bruce and I’m an alcoholic” – even though I gave up drinking twenty years ago), and this “disease”, along with alcohol itself, is deemed to be more powerful than its victim (“I am powerless”). Therefore I must turn my sovereignty over to God, who alone is powerful enough to overcome the disease. This all represents a belief system and a religious one at that. This is not dissimilar from the role of the psychiatrist who assigns labels to patients (I am a borderline personality disorder); and then plays the role of God, rendering the patient powerless over the disease, potentially fostering a lifelong dependence on the doctor, the pills, the government agencies, and the insurance companies. When AA is effective, and I repeat, it can be, it is due (I suspect) to the support of a community, in particular, the model of sponsorship, in tandem with sufficient personal resolve to stop hurting self and others.
Macbeth’s physician is clear though: “The patient must minister unto herself” with this particular torment. The doctor has nothing in his bag of tricks that will “pluck out the memory of a rooted sorrow”. Psychotherapy helps a person actually feel their sorrow, and integrate it, rather than plucking it out. Then Macbeth asks for some “sweet, oblivious antidote” to take away her pain. Today, she would be prescribed opiates. But this doesn’t remove the pain. It removes the patient. I have nothing against opiates, used judiciously and responsibly, and even recreationally. Whatever floats your boat. Your mind is your mind. We should all be free to do whatever we wish with our minds.
It’s when our minds are controlled through false advertising and aggressive marketing that a world of hurt begins. The Sackler family, and Purdue Pharmaceutical, as one example among many sadly, were fined six billion dollars for over-prescribing and over-selling oxycontin, which led to over 500,000 deaths between 1999 and 2019. This represents the worst of the capitalist profit motive to increase shareholder value. The promises made by pharmaceuticals are particularly compelling because they use the authority of science to manipulate the public. This is “science” in the service of capitalism. And sadly, this is the norm today, not the exception.
The (previously mentioned) DSM has an ever-broadening list of mental “diseases”, which have included homosexuality, hoarding, caffeine withdrawal, internet gaming disorder, disruptive mood dysregulation disorder (formerly known as a tantrum). It goes on and on, and for each new disorder, there needs to be a prescription, which the pharmaceutical industry is only too willing to provide. In fact, some suggest that they first create the drug and then the disorder to match it. An industry insider, psychiatrist, Dr. David Healy, wrote a damning expose of the creation of SSRI’s for the treatment of depression (Let Them Eat Prozac). He cites compelling evidence, in the form of firsthand patient reports that the cure for many was far worse than the “disease”. In fact, when Dr. Peter Breggin (Talking Back to Prozac) exhaustively reviewed the research that led to the approval of Prozac by the FDA he was shocked to uncover the statistical gymnastics that were required to make Prozac perform better than a sugar pill. SSRI’s seem to alleviate symptoms in approximately 20% of individuals.
What About Psychedelics?
I’m concerned that psychedelics are on course to be squeezed into this medical/physicalistic model. Much of the research, in order to be approved by various health authorities, focuses on brain chemistry to legitimize their effectiveness. I get it. Science necessarily looks for quantifiable, repeatable, and falsifiable evidence of effectiveness. But the brain lighting up on mushrooms doesn’t mean that the unlit brain is the cause of depression and anxiety. Correlation is not causation.
Let’s not confuse what is quantifiable (physical) with the totality of Reality. It’s a slice, an elegant, complex slice for sure. But it’s just the outer form of a more subtle, interior reality, called mind or consciousness. Szasz distinguishes the physical and the mind as the difference between the members of a football team and team spirit. You can measure the former by scientific methods, but not the latter. When you actually try psychedelics, the brain gets lit up, sure. But you quickly realize that the cause of your suffering lies elsewhere. Typically in experiences of trauma, lovelessness and all manner of neglect, which is to say, failures in relationships. So, let’s treat the life problem, not the symptoms. If a medication is supportive while the deeper work is being done, (and that is a big “if”) fine. The critical thing is to recognize that it’s never only a physical problem, and rarely it is ever a physical problem in the first place. If it is, it is a disease, and should be treated as such.
The real potential of these psychedelic medicines is not what they do to the brain. Beside uncovering trauma as the source of our life problems, they open up the mind. The tripping mind is faced with fundamental existential issues, such as: Who am I? Who are you? Can I know you? Why do I care about you? What am I doing with my life? What is life? How does the life force want to expand in, through, and as me? What does an ethical life look like? What is the meaning of life, given the reality of death? How do I defend my freedom and human sovereignty? How did my heart get so shut down? What is the relationship between my unexpressed grief, feeling thwarted in my desires, and my depression/anxiety? I just experienced that I am the localized expression of a mighty and incomprehensible intelligence and love, that our ancestors named G_D. What does that mean for my life? What is keeping me from love? St. Augustine wrote that the unexamined life is not worth living. These medicines give us back the capacity to extract ourselves from information overload and deposit us in the land of Sophia, the archetype of wisdom.
Our brains are incredible. There are more cells in the brain than stars in the sky (Ok, I made that up, but prove me wrong). It is a marvel of electrical circuitry and bio-chemical intelligence. But I say respect it as an instrument through which the larger intelligence of a universe (Mind) manifests and evolves. If we want to stop the blame game, we could stop pointing the finger at our brains. That’s not likely to happen because the scientific community already has too much invested in “fixing” it, gawd help us. I’m waiting for the day when a brain researcher reads the the work of Nobel-prize winning geneticist, Dr. Barbara McClintock, in her study of the lowly corn kernel. She decided to start listening instead of dissecting, paying attention rather than probing, coming into relationship rather than objectifying and dominating. Wouldn’t you know it, the corn happily revealed its inner workings.