Through a Distant Lens

Becoming aware of how other societies define mental illness gives us insight on how our own cultural perceptions shape our own views.

For example, our culture defines psychosis as a distinct illness caused by a biological abnormality which antipsychotic medication is believed to correct. This notion, however, is not shared by psychiatrists in all countries with first-rate medical systems.

A Psycho-Social View of Mental Illness

The British Psychological society, for example, has recently issued a remarkable document, taking a psychosocial view of experiences that psychiatrists in our own country define as biological illnesses--even such severe illnesses as schizophrenia. The British report says that there is “no strict dividing line between psychosis and normal experience." On the contrary, hearing voices and feeling paranoid are common experiences, and are most often a reaction to trauma, abuse, or deprivation. Talk therapy, therefore, not psychiatric medication is the best way to help severely troubled people.

Freud versus Kraepelin

Americans, on the other hand, think of schizophrenia as a brain disorder that can be treated only with medication. Like other categories of “disorders,” schizophrenia is thought to be an entity that is fundamentally different from other diagnostic entities like “bipolar disorder” or “paranoia.” This way of thinking has its roots in the classification system of the nineteenth century German psychiatrist Emil Kraepelin. In the first half of the twentieth century Kraepelin's views about classification of psychiatric "illnesses" were overshadowed by the ideas of his more famous contemporary Sigmund Freud. Unlike Kraepelin, who thought mental illnesses were distinct entities, Freud believed that there was a continuum between mental health and mental illnesses. Anyone could become emotionally troubled under circumstances of abuse or other trauma.

The Neo-Kraepelinian DSM's

Kraepelin's ideas were to resurface in the neo-Kraepelinian manual known as the the DSM--III (the third edition of the Diagnostic and Statistical Manual of Mental Disorders), published in 1980. Ever since then, with the successive iterations of the manual up to the recent DSM-5, American psychiatry has viewed the world though Kraepelin-colored lenses.

In recent years, however, the National Institute of Mental Health has become disillusioned with neo-Kraepelian psychiatric categories of discrete mental diseases because no biological causes have been identified for any of them. And so the NIMH has turned its research in another direction. The new narrative is one not of diagnostic categories but of “neuroscientific structures” (such as genes, cells and neural circuits).

This new approach moves research in mental health even further from the patient and the experiences that disturbed him. Instead of studying people with anxiety, which involves asking about the life experiences that contributed to the person's fears and coming up with behavioral solutions to help them, researchers will now study “fear circuits.” What treatments they will come up with has yet to be determined.

Can traumatic experience change the brain?

Whether the new American form of psychiatry will eventually discover that abuse and trauma changes neural circuits--indicating that talk therapy and corrective emotional experiences may be of use in making people’s neural networks healthier--or whether the emphasis will remain on pharmaceutical therapy for symptomatic relief is still to be determined. In any case, the Bristish Psychological Society seems to be moving in a more fruitful direction in terms of the well being of disturbed people who need actual help from psychiatrists.