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Is medical science enough to explain mental health problems?

In January, an article titled “Redefining Mental Illness” by anthropologist Tanya Marie Luhrmann was published in the New York Times. In the article, Luhrmann explores how symptoms of mental illness are felt by a diverse range of people and are quite common. By noting that these same experiences – anxiety, depression, and even auditory hallucinations – are interpreted differently in various cultures, Luhrmann suggests that the labels psychiatry uses may not be the best approach for what patients experience, and asks the medical community to reconsider the diagnostic terms assigned by American psychiatry.

Soon after, Jeffrey Lieberman, the former president of the American Psychiatric Association (APA), published a response in Medscape titled “What Does the New York Times Have Against Psychiatry?” Lieberman argues that Luhrmann’s article is unscholarly, and ultimately misinformed. Although Lieberman admits that a wider perspective on mental illness is necessary, he questions the idea that an anthropologist should speak about the medical validity of psychiatric diagnosis. He claims that there is no room for an anthropologist’s opinions in medical specialties like cardiology or gastroenterology, and therefore asks why they should be taken to account in psychiatry.
Is Lieberman right? Has American psychiatry and its Diagnostic and Statistical Manual of Mental Disorders (DSM) succeeded when it comes to characterizing mental illness? Is the biological framework enough to explain mental disorders?

Most medical schools and many psychiatric programs do not include any courses in anthropology, social psychology, or cognitive science. Nor do they try to give students a background on the ancient inquiries of various disciplines that sought an understanding of what the mind is and its relation to the brain and nervous system – the so-called mind-body problem.

Deep down, I think we all know that unlike the functioning of a kidney or a lung, the biology and what we know of the function of the brain are still not enough to explain the mind.

When diagnosing a patient, many psychiatrists rely only on the APA guidelines, which are based only on the presence or absence of certain symptoms, ignoring the fact that that these manifestations do not only depend on biology but on the way patients interpret and understand their own symptoms, as well as on social and interpersonal processes. However, the DSM does not include remarks on the effect patients’ social and cultural contexts (such as their economic status, language, and faith) could have on their mental health.

Deep down, I think we all know that unlike the functioning of a kidney or a lung, the biology and what we know of the function of the brain are still not enough to explain the mind. A mere biological framework is often not enough to explain why cognitive processes deviate and lead to a disturbed mental life, and thus mere biological remedies cannot be enough as treatment.

In the fifties, the development of modern psychopharmacology brought the wonderful hope that people’s psychological suffering would be cured by the swallowing of a pill. Unfortunately, this has not been shown to be the case. It is true that many patients with psychosis acknowledge that their medications make these experiences less frequent, intense or distressing, and help them to go through the day. However, their lives are still often shattered by their alienation from society, and their readaptation to their social environment becomes an additional struggle. Overwhelmed with the enormous amount of work they have in hospitals, psychiatrists do not treat this part of patients’ experiences – social workers, psychologists, and others will often be the ones involved in a patient’s life after the initial prescription of their medications.

It is a huge mistake to disqualify what those in other disciplines may have to say about the mind.

We should also reconsider the arbitrary line society forges between psychiatric patients and so-called normal people. According to the World Health Organization, one in four people will suffer from an episode of mental illness during their lives. As long as these episodes do not disrupt the way a person functions in the world, they will not be classified as “crazy” by their doctors and by society and alienated as psychiatric patients often are. Let’s also consider that, besides suffering when dealing with mental health symptoms, psychiatric patients are told that they are abnormal, permanently ill beings because they may have to take medication for the rest of their lives if they want to be able to take part in society. This is not the case in other contexts, such as in spiritual groups in India in which psychotic experiences can even be considered as “illumination” and bring respect and admiration to people who experience them.

So, while it is true that presenting mental health problems as the product of chemical disturbances has led us a long way in the development of pharmacological compounds and has provided an interesting framework to study these conditions, this view alone has failed to be enough to treat and define mental disease. In fact, the disease rhetoric has contributed to the stigmatization of the population of people who are diagnosed with mental health issues, as it frames these people as being biologically abnormal and inferior.

There is no doubt regarding the importance of psychiatry, and of the fact that we need doctors to treat people whose minds have somehow turned against them. What I would like to question is the narrow vision expressed by Lieberman that argues that mental illness is merely biological and that nobody but medical specialists should authoritatively speak on it.

Humans are living beings immersed in a social and cultural context, and it is a huge mistake to disqualify what those in other disciplines may have to say about the mind. What psychologists, anthropologists, ethologists, philosophers, and even artists have to tell us about the mind and subjective experience represents a richness that will be lost if doctors remain self-righteous and unaware. As French physiologist Claude Bernard observed in the 19th century, a human being is more than just the sum of its parts.