Welcome to From Insults to Respect. Today, let’s see if we can tie together some of the loose threads of my last post, which chronicled Joni Mitchell’s experience of depression. There we found that she explicitly rejected the idea that her experience indicated that she was mentally ill. Instead, she came to believe that, “Most of my best work came out of it. If you get rid of the demons and the disturbing things, then the angels fly off, too. There is the possibility, in the mire, of an epiphany.”

We also discussed that in contrast to Joni’s position is the medical model, which views people who experience depression as having an illness that requires, as the first line of treatment, taking pills that are called “antidepressants.” Many who hold this view have absolutely no respect for people who hold the view expressed by Joni.

Upon publishing my post about Joni, one person that has impressed me over a period of time as being highly intelligent expressed a concern that attitudes like Joni’s will lead people to view depression as perfectly normal. The consequences of so doing, he feared, will lead to all of the efforts to increase access to mental health services getting flushed down the toilet. If depression is normal, why wouldn’t the majority of people decide to ignore this group of sufferers and their needs?

Well, in my opinion, this is a legitimate concern, and before this post draws to a conclusion I intend to address it. But first, let’s take a look at another example of someone who, like Joni Mitchell, came to believe that the experience of depression can be of enormous value.

Leo Tolstoy’s Experience

In his painfully personal book, My Confession, the great Russian writer Leo Tolstoy tells us about his two-year period of despair. At about the age of 50, his life had become “flat, more than flat: dead.”

“I felt that something had broken within me on which my life had always rested, that I had nothing left to hold on to, and that morally my life had stopped. An invincible force impelled me to get rid of my existence, in one way or another…. Behold me then … hiding the rope in order not to hang myself from the rafters of the room where every night I went to sleep alone; behold me no longer going shooting, lest I should yield to the too easy temptation of putting an end to myself with my gun.”

All of this took place at a time when Tolstoy’s outer circumstances seemed excellent.

“I had a good wife who loved me and whom I loved; good children and a large property which was increasing with no pains taken on my part. I was more respected by my kinsfolk and acquaintances than I had ever been; I was loaded with praise by strangers; and without exaggeration I could believe my name already famous.”

Tolstoy goes on to explain how his melancholy stimulated a gnawing questioning that eventually led to one insight after another. His trouble had not been with life in general, not with the common life of common men, but with the life of the upper, intellectual, artistic classes, the life that he had personally always led, the cerebral life, the life of conventionality, artificiality, and personal ambition. He had lived wrongly and had to change.

Then, one day in early spring, while he was alone in the forest listening to its mysterious noises, he was filled with a sense of deeper meaning. “After that,” he wrote, “things cleared up within me and about me better than ever, and the light has never wholly died away.” According to Tolstoy, his suicidal feelings disappeared, and he went on to live a productive life until he passed away at the age of 82 of natural causes.

Some Thoughts on Tolstoy’s Experience

The great psychologist and philosopher William James was someone who viewed the pathologizing of human experience as simple minded and nothing more than superficial medical talk. Rather than resorting to mentally ill jargon, the good professor explained in his monumental book, Varieties of Religious Experience, his view of Tolstoy’s experience:

It was logically called for by the clash between his inner character and
his outer activities and aims. Although a literary artist, Tolstoy was
one of those primitive oaks of men to whom the superfluities and insincerities, the cupidities, complications, and cruelties of our polite civilization are profoundly unsatisfying, and for whom the eternal veracities lie with more natural and animal things. His crisis was the getting of his soul in order, the discovery of its genuine habitat and vocation, the escape from falsehoods into what for him were ways of truth. It was a case of heterogeneous personality tardily and slowly finding its unity and level.

Tolstoy’s anguishing experience appeared at first to come on him as if out of the blue. Later, Tolstoy came to understand it as having been due to living wrongly. Only by questioning deeply and repeatedly the meaning of his despair did he come to this understanding.

Now, with all of this as background information, let’s return to the concern that came up at the beginning of this post–if we don’t accept the medical model, might it provide a perfect justification for not funding mental health services?

In my view, the medical model actually gets in the way of adequately funding services.

Viewing someone in the midst of an anguishing experience as someone with an illness that is no different than any other illness leads many prescribing doctors to most often send the client home with some pills. That is viewed as sufficient. The patient is left with a host of negative side effects, and maybe in time, the patient will begin to feel better and attribute the improvement to the pills. If not, they go back to the doctor who will try adjusting the dose, trying a different pill, or adding other pills.

It is my view that even when people learn to value, even treasure, depression experiences, they don’t say that’s all there is to life. These experiences lead them to more deeply delve into their personal concerns thereby potentially leading them to seek more effective, efficient, economical, and beautiful ways to address their concerns.

Although Tolstoy did manage to successfully work out his most pressing concerns without professional help, keep in mind that he was an extraordinarily gifted person with a great deal of supportive people around him, and he was financially comfortable. Even with all of that, a well trained mental health service provider who avoided pathologizing his experience may have been of enormous help.

In my previous post, we saw that Joni Mitchell was not only experiencing the physical sensations of depression. Fully part of her experiences was to delve deeply into several concerns– “How am I going to get back in the saddle? And what about the audience? Would you still love me if you knew what I was really like?” She sought help from a psychotherapist.

As someone who provided mental health services for many years, let me present an example of what I am trying to get at.

Phil, not his real name, came to my office troubled about how depressed he had been feeling. After some time listening in a caring way to his concerns, I discussed this notion that depression can be viewed as a valued experience. He was pleased to learn this. At the same time, he didn’t in the slightest bit come to the conclusion that with this interpretation of the nature of depression there was no more need to continue to see me. However, I do think that framing depression as often a very valuable experience that many of our most gifted people put to good use was far more hopeful than framing it as due to defective genes.

Over the course of a year I found that the concerns Phil was most troubled about was his drinking, and that he had trouble developing close relationships. Both of these concerns are genuine health risk factors. My job was to help Phil to transform these risk factors to “health protective factors.” By doing so, this could prevent far more serious health issues down the line.

So we explored what was interfering with his developing close friends. It soon became apparent that he was very critical of people he met, and his style of criticizing was very nasty. For example, he would call people he disagreed with stupid in a very nasty way. And it also became apparent that he would criticize himself in the same disturbing manner.

I explored with Phil options that have been helpful to others. He selected learning to meditate, and to get more exercise in order to work off his anger in a positive, healthy manner. He learned the value of saying more supportive things to people he met, and to himself as well. He came to realize the value of minimizing the negative criticism that he provided, and when he did criticize, to do so in a far more charming manner. In the end, he made a new group of friends, joined AA, and was in a far more healthy state when my services came to an end.

So, as this example illustrates, rather than a mental illness model, in which pills are often viewed as sufficient, we can utilize a mental health concern model to advocate additional support for mental health services. With a mental health concern model, counselors and psychotherapists can be viewed as valued members of the allied health profession because they help to transform health risk factors into health protective factors.

The need for these types of mental health services, therefore, need not be reduced by framing depression as a valued experience. Rather, it allows us to move on from this understanding to advocate that our services fully address real mental health concerns.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

If your behavior, thoughts, or feelings become a concern, for a fee, many psychiatrists, psychologists, and social workers are eager to translate your experiences into a language of symptoms, diagnoses, psychopathology, and mental illness. In an earlier post I provided negative criticism about this type of name-calling (see here). Today, we focus in on an additional problem with the pathologizing approach.

Psychiatric Name-Calling Simplistically Devalues What William James Referred to as “Exceptional Experiences”

Tools can be used for good or evil. A hammer can be used to drive in nails in the construction of a life-preserving shelter or to bludgeon an innocent person to death. A car can be used to rush a child to an emergency room so that life-preserving treatment can be administered, or it can be used to tragically end a prom night. Are experiences that are oftentimes referred to as pathological really tools, and is it up to each one of us to use them either for good or evil?

The first time I came across this question occurred while reading about William James’s 1896 series of lectures on “Exceptional Mental States.” Harvard psychologist, Eugene Taylor, had reconstructed these lectures from James’s original handwritten lecture notes, newspaper reports, letters, and a variety of other sources.

At the very beginning of the lectures, James argues that experiences that are commonly viewed as unhealthy or morbid are really “an essential part of every character,” and give life “a truer sense of values.” To support his contention, James first provides three examples of famous individuals who suffered from melancholy, a term that corresponds closely with what modern pathologizers call “major depressive disorder.” St. Paul, the religious figure of the New Testament, Cesare Lombrosa, a late 19th-century Italian criminologist, and Immanual Kant, the 18th-century German philosopher, became, according to their histories, better as a result of their troubling experiences.

Not only is melancholy far more normal and potentially beneficial than the pathologizers would like us to believe, so too, James argues, are delusions and hallucinations. James tells us that the belief in the possession by demons, which is often viewed as a delusion by pathologizers, is remarkably common. “[It] is the one most articulately expressed doctrine of both Testaments, and . . . reined for seventeen hundred years, hardly challenged in churches.”

James then goes on to tell his audience about Buddhist sects in Japan that have priests who believe they can put themselves into a trance so that a god can speak through them. These people seek to cultivate these experiences, apparently believing that they provide some benefits to their sect.

Although hallucinations can be construed as a symptom of mental illness to some, James presents the case of Socrates who “once stood motionless for many hours in the cold and spoke of having a guiding demon.” Attempting to counter the association between pathologies and hallucinations, James states,

Even if this demon [of Socrates] were really meant hallucinations of hearing, we know now that one in eight or ten of the population has had such an experience and that for insanity we must resort to other tests than these.

Like melancholy, delusions, and hallucinations, the “symptoms” of obsessions and manias are treated in James’s lectures as experiences that are normal and potentially beneficial. Thus, James states that there is no end to the possible types of obsessions that we see all around us. And what about “the anti-slavery mania?” Is this to be viewed as pathological? What benefit can such experiences have? James tells his audience about Henry Borg, founder of the American Society for the Prevention of Cruelty to Animals; Charles Henry Parkhurst, a Presbyterian clergyman and reformer who launched a furious attack on organized crime in state government that led to an official investigation; Dorothea Dix, a mid-19th-century humanitarian who visited the insane asylums and successfully advocated for legislation to improve the care for those now labeled mentally ill; General Booth, founder of the Salvation Army; Frances Willard, a suffragette; and others. “These persons,” said James, “are not insane, not maniacs, not melancholics, not deluded.”

Later, he states, “Individuals are types of themselves and enslavement to conventional names and their associations is only too apt to blind the student to the facts before him.”

As Taylor (1984) closes his reconstruction of the lecture series, he quotes James as follows:

There is a strong tendency among these pathological writers I have cited… to represent the line of mental health as a very narrow crack, which one must tread with bated breath, between foul friends on the one side and gulfs of despair on the other. Now health is a term of subjective appreciation, not of objective description….There is no purely objective standard of sound health. Any peculiarity that is of use to a man is a point of soundness in him, and what makes a man sound for one function may make him unsound for another…. The trouble is that such writers . . . use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with. . . . The only sort of being, in fact, who can remain as the typical normal man, after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity . . . Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all?

The Review of the Evidence

It may seem a fanciful theory that the experiences now referred to as mental illnesses can be potentially helpful. However, in 2010, Robert Whitaker published a book titled Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness. To write the book, he pored through the scientific literature for the past 50 years and found a dramatic increase in the number of people who are pathologized, which led to an astonishing increase in psychiatric drug consumption. And more people then ever before became disabled for longer and longer periods of time.

Here is just one of many such studies that Whitaker describes.

In the 1980s, Martin Harrow, a psychologist at the University of Illinois, began a long-term study of 64 newly diagnosed schizophrenia patients. Every few years, he assessed how they were doing. Were they symptomatic? In recovery? Employed? Were they taking antipsychotic medications? The collective fate of the off-med and medicated patients began to diverge after two years, and by the end of 4.5 years, it was the off-medication group that was doing much better. Nearly 40% of the off-med group were “in recovery” and more than 60% were working, whereas only 6% of the medicated patients were “in recovery” and few were working. This divergence in outcomes remained throughout the next ten years, such that at the 15-year follow-up, 40% of those off drugs were in recovery, versus 5% of the medicated group.

Whitaker also found studies that compared cultures, like our own, that employed the pathologizing model with cultures that framed exceptional experiences as potentially beneficial. Countries infected with the pathologizing approach had outcomes significantly poorer.

These findings lead me to conclude that it is time to have a reasonable discussion about embracing other models of care.

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