In the late 1700’s Benjamin Rush (a signer of the Declaration of Independence) wanted to bring a scientific focus to the study of those suffering with mental illness. Prior to Rush, those suffering from madness were generally treated like animals, and were held in asylums that had one major purpose – to keep mentally ill people away from normal people. Rush’s endeavour had kindness at its heart; upon seeing the positive impact of the application of the medical model to medical illness, he wanted to improve the lives of mentally ill people.
However, there was a problem with this well-intentioned move; in contrast to medical illnesses, no frailty with the biological systems of mentally unwell individuals had been discovered. Consequently, Rush developed medical treatments on the basis of questionable hypotheses (guesses) about what caused psychopathology. Unfortunately, this often resulted in horrid interventions, and the pattern of ‘scientifically-questionable-hypotheses-leading-to-gruesome-intervention’ has repeated itself on numerous occasions in the past 250 years.
For example, Rush felt that mental illness occurred due to irregular actions in the blood vessels. Consequently, he developed treatments that could target this supposed deficit; bleeding, blisters, water therapies, purges, emetics, spinning therapy and the famous tranquilizer chair. Later on, physicians felt that psychopathology was caused by worn out nerves, subsequent treatments included cathartics, bloodletting and physical restraints (strait jackets, cribs). By the late 1800’s lesions in the brain and defective germ plasm were thought to cause psychopathology and the treatments developed to correct these abnormalities were just as awful as those already mentioned. Then in the early 1900’s hydrotherapy units became widely popular, which ‘worked’ by improving the functioning of the kidneys and liver. Next, glands were thought to be the problem, so patients were injected with the hormones of animals, which had dire side effects. After this a bunch of other medical explanations of mental illness led to the development of more and more extravagant interventions. Physicians removed various parts of the human body (ranging from teeth to ovaries), patients were given malaria treatment, frozen treatment, insulin coma therapy and metrazol convulsive therapy. All of this and we haven’t even mentioned lobotomies or electroconvulsive therapy, where people’s brains are operated on or electrocuted.
All of this was the context that preceded the development of psychiatric drugs. So you can imagine in the 1950’s, when the latest medical hypothesis of mental illness was presented (chemical imbalances) and the treatment simply involved taking some pills with very few side effects, that physicians jumped all over it. In the last 50 years, in following this path, we now have a number of drugs designed to change inadequate biological systems. The problem is that the chemical imbalance hypothesis, consistent with the medical-based hypotheses of the past 250 years, hasn’t panned out. Those drugs, as with the interventions from the past, target biological systems that seem to have nothing wrong with them, and the data is now emerging which suggests that the long-term use of those drugs leads to real harm.
I guess, as I read this history, that my overwhelming question concerned why this trend of chasing medical explanations of psychological illness continues despite the horror story I’ve just described. I think the conclusion I came to was that people often interact with the development of psychiatric treatments as if they occur in an objective vacuum. The bottom line is that the societal context surrounding the aforementioned treatments probably account for a lot of the disasters that occurred. For example, around the time that Darwin proposed evolutionary theory, his cousin (Francis Galton) popularized the notion of eugenics – that people were born either genetically superior or inferior and that society should help the superior to reproduce and to stop the inferior from reproducing. This had a huge impact on society in general (it is quite scary to see the list of people in favour of eugenics – Carnegie, Rockefeller, Maudsley to name but a few). However, it had serious implications for the treatment of mentally ill, who were stopped from re-producing in the US, and in Germany they were killed in the exact gas chambers that were later used to exterminate Jews. You’d be shocked to know how much Hitler was influenced by this mode of thought, and various eugenic supporters from the best Universities in the world saw him as progressive when he started taking radical action to rid the earth of certain types of genetically inferior people.
Of course, the major societal factor that makes people cling to the medical model is money. Throughout history, ranging from individual physicians who wanted to become wealthy to the vast sums of money involved in the pharmaceutical business, many people are invested in the medical model continuing to dominate mental health treatment. But the medical model continues for reasons located at the individual level too. Patients themselves tend to feel relief when they are told that a biological system caused them to feel such things, and it takes away blame: ‘this isn’t my fault, I have a biological problem’. However, although it offers short-term reinforcement, adhering to the medical model has a few down sides that people too often ignore:
- Firstly, the treatments don’t work. Plenty of evidence seems to suggest, as with treatments from the past, that pharmaceutical drugs not only don’t cure people of psychological illness but they can make things worse.
- Secondly, clients who are told that they have a broken biological system become imprisoned by that information. It becomes the go-to excuse in life.
- Thirdly, physicians themselves, when they believe that biological systems cause psychopathology, underestimate the importance of questions about the patient’s context. The bottom line is that if a person’s marriage has just broken down and they are living in poverty, then it is those contextual factors, and not an underlying biological problem, that are causing the development of psychological issues.
And it is that that I want to leave you with. In the history of medical treatments, not only did the societal context provoke the dominance of the medical explanation of mental illness, but the societal context has been all but ignored when trying to figure out the source of suffering. In trying to make sense of these things I am becoming convinced that in addition to giving clients a space to talk about their woes, we also need to improve the societal contexts and systems that are likely at the heart of suffering.