Update, 5/2/13: A week after I wrote this, the Times published these statistics on suicide in America.
My walks are now a kind of farewell tour of Brooklyn and New York1, and today I passed by the office of a man who is arguably the most aptly-named psychiatrist in the nation.
Mental health is frequently a “salvage” operation, all right. I think it was the British psychiatrist Anthony Storr who compared the psychotherapist’s job to one who is pulling people out of the water downstream with no time to think about who is dumping them in upstream.
These days, in America at least, the stream overflows with the lost and the floundering, from every imaginable segment of society. The military with its insane suicide rate and PTSD population; corporate America and its shrinking, overburdened middle class work force; the working poor; the unemployed and long-term unemployed; women, minorities, immigrants; and of course the elderly as the baby boomers go well into their 60′s. Perhaps the most ominous social group affected by mental illness is children, who suffer at a roughly equal rate to the adult population.
No matter how you slice or spin the statistics, the story is deeply disturbing. Insurance companies effortlessly climb through loopholes in the law to avoid delivering coverage for mental illness, and that is not likely to change under Obamacare. Meanwhile, our culture’s general attitude merges that traditional shame-repression complex with pharmaceutical dependence. If it cannot be resolved with a prescription, then it is not illness. So just tough it out. The problem there, of course, is that with mental illness, more than with any other kind of human ailment, this mindset breeds suffering far beyond the single person with the disease. But if our culture has trained us in self-denial, we will extend that training to our own pathology, usually at the expense of those closest to us.
As the politicians say, we have to do better. But new and improved institutions or social services won’t do it by themselves. To the extent that they reflect a real commitment, then more funding (exponentially more) and reformed institutions will no doubt help; first, however, we need a fundamental change of attitude to ensure that public money and services are being used genuinely to create a more stable, healthy, and self-healing citizenry.
Money and pills alone can’t make inner healing happen; if that could be so, then Prozac could be added to the water supply (research on whether this is accidentally happening anyway is so far ambiguous as to both extent and effect). When it comes to mental health, our science is at an infantile or at best adolescent level of development. Next month, it brings us a new bible of pathology — the DSM-V, which will tell us again how many ways we can be sick, yet with no guide as to what mental health actually is or how it might be strengthened. That, it appears, must become a common effort — crowdsourced, if you will. One of the founding documents of our nation insists that government allow us the “unalienable right” to seek happiness; but no state or institution can actually deliver it.
In fact, we could use a fresh document — a Decalaration of Inter-dependence, perhaps — that sets forth a common understanding and an acceptance of the critical challenge to our mental health as a people. In short, we need a plan; a plan that contains the outline of a common-sense view of the realities and the potential before us. What follows are a few suggestions for the major components of such an outline.
- Mental illness is real, and its danger to the individual, family, and society at large can scarcely be overstated. We can no longer turn our backs on this vast and socially deadly problem. We can’t confine it to a coffin of myopic vision, which has but two sides: if it responds to a pill from a major pharma company, it counts as illness; if not, it’s “all in your head.” The more we insist on somaticizing, mechanizing, and reifying mental illness; the further will we be lost, and the more that stream of Anthony Storr’s will clot with drowning bodies. The mechanical model of mental illness, which is precisely what the pharmaceutical industry is selling us, is a fairy tale, a nebulous fantasy sold to the credulous — as infantile a pile of delusion as any 14th century yarn about the sale of indulgences for eternal salvation. The sooner we reject this pabulum, the sooner we make our first strident move toward health.
- Treatment of mental illness is, and must be, multi-dimensional. This obviously follows from the first point, but needs to be reinforced in the public mind. I am not against pharmaceuticals: they are a part (though not even a major part) of a solution. When I was afflicted with depressive illness over a decade ago, I sought and obtained a prescription for an SSRI (“selective serotonin reuptake inhibitor” — Prozac-class drugs). The pills were really useful — they took the neurochemical edge off my suffering and gave me enough energy to keep pursuing my own course of self-treatment (the insurance I had at the time wouldn’t pay for the kind of counseling I needed, so I did that part of it myself). Before I had emptied the second bottle, though, I was ready to taper and then discontinue the medication; and I have not had need of it since. This points, by the way, to a more general problem in our society: we have become culturally dependent on medicine. It is too globally assumed that once you’re on a drug, you’re on it for life. Exceptions aside, the rule for medicine should remain: it exists to release the sufferer from illness, so that he may release himself from the need for the medicine. This should be especially true for the vast majority of mental illness. If someone needs to take pills for depression, an anxiety or personality disorder, and even for certain cases of psychosis for years or decades or for life, then there is something inherently and fatally flawed about the entire system in which that person is diagnosed, treated, and managed medically. We may open a free and no doubt vigorous debate about what specific kinds of treatment are medically viable for different forms of mental illness; but there should be no debate about the need for a multi-dimensional approach to treatment. There is more — much more — to becoming healthy than taking pills.
- Teach mental health with a focus on self-healing. I could make a very strong argument that teaching mental health is more important than teaching math or science. If your emotional life is not balanced and vibrant, then your intellectual life will also suffer. The neurotic mind rarely makes sound judgments or calculations.2 So we need to make some commitments as a society, such as: children should spend at least double their time at school studying and exploring mental health as they do preparing for standardized tests. This fresh emphasis on teaching mental health needs to be comprehensive, crossing every socio-economic and professional stratum and being tailored to every demographic it touches. For when it comes to mental health, we have a unique window of opportunity wide open before us: when you increase understanding of this stuff, you increase the very kind of self-awareness that supports self-healing and self-maintenance. Imagine soldiers, students, church parishioners, prisoners, corporate professionals who are taught to recognize signs and symptoms of illness in themselves and their colleagues and peers: how many tragedies of suicide, domestic abuse, perversion, violence, and even homicide might be prevented? But there’s more to it than that: it is not merely a matter of forestalling decadence but of promoting and nurturing health through simple awareness. Thus, we’re not talking here about a complex regime of technical or medical knowledge. The DSM is not the textbook here; life is. There are already a number of good models to follow in this context; I like Jon Kabat-Zinn’s approach, which teaches not mental health or physical health, but just health. This perspective is given a fresh approach in the work of Carol Anthony and Hanna Moog — note how they weave nature and nurture into a “carpet of consciousness.” This leads directly to the next point…
- Destroy the division of body and mind. This is a rare point on which science and genuine spirituality can agree. I am neither a scientist nor a doctor, yet I can see that body and mind are not two3. When necessary as a matter of clarity, yes, we have to speak of them separately; yet if we experience them as divided, we soon become lost. We have to make this a matter of both teaching and treatment. The science here is virtually unassailable: meta-analyses and other broad-based studies clearly show a relationship between factors such as stress and immune dysfunction; anxiety disorders and heart disease; depression and an array of physical ailments. Those of us who teach and practice a non-ideological, non-sectarian form of self-development and psycho-spiritual self-healing are right in line with the direction of that research. If we can agree as a society on the importance of breaking down the wall of prejudice that separates body and mind, to the same extent and with the same consensus as we’ve reached (or are approaching) on topics like smoking and heart/lung disease or global warming and environmental awareness — I think this will be nothing short of a quantum leap in human and societal evolution.
Promoting and teaching mental health in a society has more than the obvious and manifest benefits (a more productive work force; better students with higher graduation rates; decreased incidence of workplace and domestic violence; exponentially lower rates of both mental and physical illness accompanied by better recovery rates and lower medical expenses; etc., etc.). What we are talking about here is similar to the promise of repairing and renewing our nation’s physical infrastructure of roads, bridges, public transport, etc. But when it comes to making mental health a focus of society’s total energy, we are talking about the repair and renewal of our human infrastructure. A society that is healthy within will be far more likely to make sound political and electoral decisions; to develop a healthier and more balanced economy; and to treat its international neighbors and the planet at large with intelligence, vision, and wisdom. When we are healthy and aware within, all those things that we typically fight and argue about lose their poisonous edges. Judgment improves; common ground and consensus are more easily achieved; relationships form and even break within a web of respect and understanding; conflict finds resolution; and the air above Storr’s stream is no longer thickened with the black bile of hatred and prejudice.
Mental health is one of those rare phenomena, one of those few issues, that permit and invite everyone’s involvement. There is no possible perspective from which you can be disinterested. Whether you’re the CEO or the janitor; the President or the village dog-catcher; the accountant or the poet; the geek or the guru — you have a stake in this ground; mental health matters to you. So now we have to work at regenerating our society so that mental health is no longer a salvage operation but a comprehensive, interactive, and enduring creation.
1They say that when you leave New York (for me, that would be next week), you can never come back. It’s been my home for the better part of 30 years, and I suppose that truism applies here: I do not expect to be able to return. Not in this lifetime. But I have been far luckier than many others who have been dislocated or disenfranchised amid our Brave New Economy.
2Please don’t remind me that Newton had bipolar disorder. If we’re going to talk about what makes a better society, we can’t reach any agreement by arguing from exceptions. My only point on this, however, would be that troubled geniuses invent and create in spite of their illness, not because of it.
3In this context, my philosophical difference with the mechanical view that I criticize in the first bullet point would amount to this: body and mind are not two, but neither are they one. They are simply undivided in the field of lived experience. I prefer to take the mathematics out of the question entirely, because the unity I refer to is beyond number or anatomy. My mind is not the gelatinous substance inside my skull that is wired to my spinal column; that is a necessary but not sufficient definition of mind. There is mind throughout and beyond the physical, material space of my body. But this is a topic I’ve covered in more detail in previous essays here.