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Mental Illness: A Way Out

Neeta Misra interviews Professor Andrew Scull on the mental health crises in America. You can reach her at neeta@businessworld.org

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For the past forty years or so, mainstream psychiatry has looked solely to biology for the explanation and treatment of mental disorder, relying increasingly on psychopharmacology and seeking answers to the riddle of its origins in neuroscience and genetics.  The payoff for patients has been minimal.  Those with serious mental illness live, on average, 15 to 25 years less than the rest of us, and that gap has been growing, not diminishing.  We remain no closer to understanding the roots of schizophrenia, bipolar disorder, or major depression than we were decades ago, and our drug treatments remain crude and at best partially effective.  

Tell us a little bit about yourself. 
I am a Professor of Sociology at the University of California, San Diego. I hold a B.A. from Oxford University and a Ph.D. from Princeton. I am a historian and a sociologist, not a clinician.  I have been studying mental illness and its treatment for more than a half-century, and my new book, Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness, presents what I’ve learned about American psychiatry and its interventions, from the profession’s earliest days to the present. 

What are the social dimensions of mental illness? 
Mental illness is a source of immense suffering and a profound challenge to our sense of ourselves and to our humanity.  Ironically, we often respond by avoiding and stigmatizing those who suffer from it, heaping social opprobrium on those in the throes of mental turmoil.  So one important social aspect of mental disorder is how our social arrangements either mitigate or worsen the problems sufferers face, and shape their experience as mental patients.  Our ancestors shut up mental patients in mental hospitals that often licensed experimentation and abuse.  More recently, we abruptly closed those places, embraced the myth of community care, and abandoned the mentally ill to their fate. 

Social factors unquestionably play a major role in the genesis of mental illness.  But in saying that, I immediately want to take issue with the false distinction between the biological and the social. We know, for instance, that human brains are incredibly complex organs.  They continue to develop for many, many years post-natally, and their structure and functioning are deeply affected by the environment and culture in which we mature, particularly but not exclusively our families.  Bearing that in mind, the idea that in seeking to understand mental illness we can ignore social factors is absurd. A variety of epidemiological data shows, for example, the significant role childhood traumas and deprivations play in later susceptibility to mental breakdowns. 

Any observations about how the pandemic has moved our thinking on mental illness? 
This returns us to your opening question: one of the most powerful demonstrations of the importance of the social has been the impact of COVID-19.  Lockdowns produced unprecedented levels of social isolation.  The social interaction and maturation of children and adolescents was affected in profoundly negative ways.  Those embarking on careers and independent lives found themselves trapped and immobilized, powerless to move forward with their lives.  The loneliness that too often accompanies old age was amplified, and the fear of dying alone and uncared for was all-too-often realized.  These are massive losses that are likely to have life-long effects. 

We are reaping the consequences, nowhere more so than among the young.  Children returning to the classroom are exhibiting all sorts of developmental problems. Depression, self-harm, and suicide among the young are all sharply on the rise.  The American Centers for Disease Control reports, for example, that from March to October 2020, emergency room visits for mental health crises increased by 24 percent among children from 5 to 11, and 31 percent for those aged 12 to 17 compared with a year earlier.  Moving forward will only be possible once we recognize the complexity of the problem mental illness represents and attack it in a more comprehensive and balanced fashion than we have hitherto. 

Where does the future of treatment lie? 
For the past forty years or so, mainstream psychiatry has looked solely to biology for the explanation and treatment of mental disorder, relying increasingly on psychopharmacology and seeking answers to the riddle of its origins in neuroscience and genetics.  The payoff for patients has been minimal.  Those with serious mental illness live, on average, 15 to 25 years less than the rest of us, and that gap has been growing, not diminishing.  We remain no closer to understanding the roots of schizophrenia, bipolar disorder, or major depression than we were decades ago, and our drug treatments remain crude and at best partially effective.  

If we can’t cure – and mostly we cannot – we need to make a major commitment to housing, supporting, and sheltering people who are incapable, for the most part, of providing for themselves.  That necessitates serious engagement with research about the best ways to provide those things.  And a changed political climate. 

What are the frontiers of public policy for mental illness? 
We need to recognize that abandoning the mentally ill to the flophouse, the gutter, and the jail has been a disastrous failure.  Nor are pills – even far better pills than we presently possess – going to come to our and their rescue.  Indeed, the major pharmaceutical houses have largely ceased research in this area.  Politically, the path forward is very difficult.  Those incapacitated by psychiatric disability all too often find themselves the targets of policymakers and pundits who would abolish social programs because they consider any social dependency immoral.  If we can’t change that attitude, the future for those with grave forms of mental illness looks bleak indeed. 

Neeta Misra is the executive editor for public policy and this interview is one in a series on global recovery from the pandemic. You can reach her at neeta@businessworld.org 


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