Well this post will cement my return to tackling the far more controversial and “difficult” topics on my blog. I want to acknowledge that this post does not provide all the answers you may be seeking, but after doing 2 low-level psychology units at university I feel it is imperative to share with you some of the contradictory information that set off alarm bells in my head, by highlighting some of the large unanswered questions the discipline leaves us. But firstly consider this: I’m asking the question “is mental illness a sham”. A sham does not mean that it doesn’t exist, what it does mean is that at some level there is a misalignment of priorities, a miscommunication of fact versus theory, and at least some level of deception.

I want you to consider a peer-reviewed journal article titled Spirituality, religion and health: Evidence and research directions, by Williams & Sternthal (2007), you can read the text online here. It talks about the evidence that exists for the connection between religion and health. Overall the effect is positive, but there are some negative effects also. This is not controversial, this is something very well known. For all the bashing I did to Christianity in recent posts, note that I’ve never denied the evidence that does show conclusively that religion generally brings participants better health. Doesn’t matter if it’s ‘right’ or ‘wrong’.

There are two main responses that critically thinking people have to the above. The first (the point of view I subscribe to) is that community involvement in solving health problems and promoting positive health should be valued and nurtured. The World Health Organisation also shares this view, as does the National Aboriginal Community Controlled Health Organisation. Some benefits include that it is cheap and can break through barriers that prevent people from accessing other health services. I would further argue that strictly from an evolutionary point of view as it applies to human culture (game theory etc.) it predicts that behaviours and structures that benefit the whole should ultimately rise and prevail above those that don’t. To put it in a nutshell, religion and culture exists because the people who practised them outperformed the people who didn’t. Religion does create barriers as well, and that’s one of the negatives.

The other main point of view is that although religious beliefs have a positive correlation with health they do not benefit society overall. This point of view could suggest that religion has been a powerful force for good in the past, but that now its benefits do not have the merit that they once had. And it’s certainly true that people slip through the cracks when religion gets involved. At one time Christians believed that all illnesses were caused by daemons as per Acts 5:15-16. Later this belief was changed to daemons causing some illnesses but miasmas causing others. In Romans 1:26-27 Paul writes pretty clearly that homosexual desires are caused when people turn away from God and his truth. This type of primitive mythology for explaining so-called ‘deviant’ human behaviour is the seed from which discrimination and oppression are grown and has caused a great deal of suffering for different people. It creates barriers between people. But I would argue that although that is true, in every society there are marginalised and disadvantaged people. You can’t judge a society just because it has disadvantaged people, but you can judge it on their attitudes and whether they minimised the number of people who would be disadvantaged.

So how do we apply this information to modern medical thinking then? Well an effective medical treatment will either alleviate symptoms or cure an ailment. It should improve the quality of life, and reduce the burden of disease. But it does come with a similar expense to that of religious participation – medical treatments also have negative health effects. And as you will see, Psychology cannot always offer any improvement to existing techniques for treating certain mental illnesses.

If a person has been diagnosed with a mental illness, there are an array of theories behind how or why that illness has developed. Behavioural, Cognitive, Biological, Evolutionary, Genetic, Physiological, Psychodynamic, Naturalist. The only two theories that have absolute conclusive proof for causing a mental illness is physiology and genetics. We know for instances that brain damage can cause an irreversible impaired mental state. We know that roundworms in the small intestine can cause clinically significant depression. Impaired foetal development can also cause lasting mental illness. Autism and Alzheimer’s have strong genetic predispositions, but both are thought to be due to an autoimmune disease (i.e. triggered by an environmental factor such as an infection).

Now that’s all fine and well, but we also know that life events can contribute to or cause mental illnesses. There’s really not a debate that this happens – even the social gradient effect on the cognitive ability of children has been established – the question however is why it happens. So let’s take something like Gambling Disorder. How should it be treated do we think? With medication perhaps. What about interventional therapy? Okay, well the most researched forms of therapy are cognitive therapy (CT) and cognitive-behavioural therapy (CBT). But there’s also behavioural therapy (BT), motivational therapy (MT), and “minimal intervention” (MI), a striped down intervention that simply has a therapist deliver targeted advice to the patient just once for as little as 10-15 minutes or as long as an hour. There’s also the 12-step program that’s refused to change or update the 75 year-old method – Gambler’s Anonymous (GA). Surely CBT and CT based treatments did best, right? WRONG! CBT, CT, BT, MT and MI all performed essentially equally well according to Toneatto and Gunaratne (2009). Well there’d at least have to do much better than Gambler’s Anonymous anyway. WRONG AGAIN! Marceaux and Melville (2010) found that GA was just as effective as CBT after 6-months (their results are from a controlled study). Petry et al. (2009) conducted a study with one cohort receiving CBT in addition to MI, one receiving just the MI session, and a control group, and found that both of their groups that received the intervention showed improvement with no significant difference between the group that received the CBT and the one that didn’t!

How can this be? If you don’t know what a mental illness is to begin with, then how could you possibly know how to treat it? The disciple of Natural Psychology argues that mental illnesses are non-existent:

The question is not, “What is the best definition of a mental disorder?” The question is not, “Is the DSM-5 definition of a mental disorder better than the DSM-IV definition of a mental disorder?” Those are absolutely not the right questions! The first and only question is, “Do mental disorders exist?” The phenomena certainly exist. The birds and bees exist; pain and suffering exist. But birds do not prove the existence of gods and pain does not prove the existence of mental disorders. Let us not play the game of debating the definitions of non-existent things. Let us move right on. (Eric R. Maisel Ph.D. on Psychology Today).

So if we don’t understand how mental illnesses occur, and we can’t clearly define it, and all of our wildly different treatment options performed equally well as each other, wouldn’t that tell you that something is seriously amiss? Now I want to acknowledge that I’m not saying I know either – but I do know that the risk can be reduced environmentally. That is through policies that provide better safeguards for people who are at risk of developing an addition, and ensuring early proactive intervention rather than reactive intervention.

Pharmaceutical companies are some of the most immoral in the world.

Certainly more immoral than tobacco companies – at least tobacco companies can’t advertise their products on TV, radio, newspapers, and magazines. And yes, the risks are stated on the label, supposedly, the label that you see AFTER you buy the medication. Many of the patients who are currently dependant on pharmaceuticals were never told that in the first place, because the development of dependency wasn’t known at the time. Over-medication, dependence, and people accessing the wrong medications for their health issues, as it is, creates a huge amount of pharma-waste. Pharmaceutical advertising encourages people to self-diagnose, and self-select the medications they think they need. This is a massive problem with non-mental medical disorders; so you can just imagine how big a problem it is with mental-health related diagnosed “disorders”.

If you see a psychiatrist here, in Australia, they will diagnose you according to the DSM-V. If you go to China, and see a psychologist they will diagnose you according to the CCMD-3. That’s right – there are two completely different diagnostic manuals, that define mental illness differently to each other, and designate a number of different illnesses. Each has illnesses that are unique to their manual as well – in other words there are illnesses that exist in CCMD and not in DSM (and vice versa)! Mental health illnesses are also defined in the ICD-10 (maintained by WHO) with some difference to DSM.

So then, is mental illness a sham?

Yes I believe so. Hypothesises are presented to clients as medical fact and that means it’s falsely presenting mental health issues as sure and certain factual illnesses. Now I just said before that there are some mental health issues that we know are illnesses like Autism and Dementia. But those are believed to be autoimmune diseases; they’re a physiological disorder that causes mental health problems. But the mental health problems that are purely mental health related with no known link to physiology or bacteria or viruses are not proven to be illnesses per se. They may masquerade themselves into a diagnosable condition; but that’s not an illness. Think about this: we still call gender dysphoria an illness because all conditions in the DSM are mental illnesses by definition (DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5); yet this is offensive to many people who suffer from the condition, and the French government actually declared that it is not to be considered a mental health condition whilst guaranteeing that people who suffered from the condition would still be able to receive subsidised healthcare.

So I personally welcome a clear delineation between illnesses and other states of mental health, and I look forward to the day that we stop using the word “disorder” to refer to people’s health problems that we don’t understand.

References

Check back they will be edited in. :)