The End of Mental Illness

From my earliest days as a Clinical Psychologist I never believed that individuals became mentally ill; indeed, the concept of mental illness or insanity never made sense to me. Nevertheless, I worked in British and Irish psychiatric hospitals and psychiatric community services that were run on the premise that people’s troubled and troublesome behaviours had a biological/biochemical basis and clinical psychology was seen as offering support (not therapy) to individuals to accept the hopeless and incurable reality of their mental illness. In the face of considerable pressure to conform, I refused to cooperate and gradually set up psycho-social clinics separate from those of psychiatry. Eventually, I left the psychiatric services and set up in private practice and continue to work with people who had been diagnosed with schizophrenia or bi-polar depression or personality disorder or endogenous depression or attention-deficit disorder (ADD) or attention disorder with hyperactivity (ADHD) and other such hypothetical conditions.

My experience is that I can always trace the origins of the person’s ‘problems in living’ back to childhood traumas which had continued unresolved into adulthood. Much of what underpinned such distressing behaviours as paranoia, hallucinations, delusions, bi-polar depression, obsessive-compulsive behaviours was buried in the unconscious mind of these distressed individuals, a necessary and creative hiding away of aspects of themselves that had been hugely violated and that would have been devastatingly threatening to bring to consciousness.

After thirty years of practice my conviction has deepened and I so often in awe of how individuals who have suffered harsh abandonments and overwhelming disempowerment managed to survive and find ways of not only reducing the threats to their wellbeing, but also, symbolically, through their presenting symptoms, communicated precisely their terror of exhibiting some or any aspects of their real self.

In the fifties and sixties there had been a movement within psychiatry away from the notion of mental illness and towards seeing individuals as having ‘problems in living.’ The latter phrase was coined by Thomas Szasz, a psychiatrist, who along with other psychiatrists, believed that a medical model for people’s deep emotional distress had ‘outlived its usefulness’ and it was no longer accurate to talk about people having a mental illness. However, a parallel phenomenon was also happening during this time and this was the development of drugs to treat the so-called mental illnesses and also the emergence of a new theory that people’s mental illnesses were caused by chemical imbalances. For example, it was thought that depression was due to a depletion of the neurotransmitter norepinephrine or serotonin and schizophrenia due to a depletion of dopamine.

As a result of these chemical imbalance theories, there developed a very unhealthy relationship between psychiatry and the drug companies and the manufacture of drugs to deal with nearly every human emotional problem became a multi-billion dollar and euro industry. The thoughts of Thomas Szasz were forgotten and it appeared that psychiatry was now even more strongly established as a medical profession. All of this would have been wonderful if the theory was substantiated and that the chemical properties in the multiple drugs developed worked to relieve the undoubted human misery that individuals endured. However, after nearly fifty years of research into the chemical imbalance theory of mental illness there exists a ‘ton of data indicating that the chemical imbalance theory is simply wrong’ (Kirsch, 2009). What is equally devastating for the profession of psychiatry is that there’s another ton of research later showing that the drugs don’t work, but what works are the promises about the drugs’ therapeutic effects and the clients’ own expectations – known as the placebo effect.

People who are truly interested in the wellbeing of people who experience seriously debilitating ‘problems in living’ would do well, along with Kirsch’s book to read other relevant recent publications that convincingly indicate that the chemical imbalance theory is dead in the water and the effectiveness of all the drugs used in psychiatry are illusions – book list at the end of this article.

As the field of psychiatry is thrown into a state of crisis, what is even more alarming is the unsubstantiated basis for what psychiatrists do, particularly, in terms of their legal status to commit and coerce into drug-taking people who come under their care. Psychiatrists, themselves, need support to deal with this crisis but Governments have an urgent responsibility to review the situation and look for a new paradigm that is strongly supported by research evidence and works in practice. Such a paradigm already exists – psychotherapy – I will write more on this next week.

Bentall, Richard (2009): Doctoring the Mind, Why Psychiatric Treatments Fail, London, Penguin.

Carlat, Daniel (2010): Unhinged, The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis, New York, Free Press.

Kirsch, Irving (2009): The Emperor’s New Drugs – Exploding the Antidepressant Myth, London, The Bodley Head.

Whitaker, Robert (2010): Anatomy of an Epidemic, New York, Crown Publishers.

Dr. Tony Humphreys is a Clinical Psychologist/Author, National and International Speaker.  His recent book with co-author Helen Ruddle, Relationship, Relationship, Relationship: The Heart of a Mature Society is relevant to today’s topic,