The following was directed towards an undergraduate class of the Harvard Divinity School, entitled “Rethinking Mental Health: Spirituality, Healing, and Culture.”
In this class we have run the gamut from meditation to yoga to exotic healing rituals from around the world. What we haven’t examined, though, is the Western side of the story. Realizing this class was all about rethinking mental health, we need to know what the standard in conventional medicine is to appreciate the alternatives. Alternatives will be taken to mean anything not done when seeking treatment from a medical facility, such as meditation, yoga, and natural food choices. Conventional medicine will be taken to include medication, imaging studies, talk therapy, and any other treatment one might receive in a hospital. This paper will explore how the standard in mental health came about, why it’s worked for so long, its pitfalls, and why people consider alternatives. I’ll also discuss how alternatives can strike a balance with conventional measures and why abandoning one for the other isn’t necessarily the best thing.
Overview of the History of Mental Health
The field of metal health began when people started to wonder why their friends and neighbors would sometimes act strangely. Before we knew about organic brain diseases and mental illness, these people were either considered criminals or possessed by demons or spirits. They were locked up, shunned, or exorcised. However, sometimes people with illnesses were worshiped. We saw in Anne Fadiman’s “The Spirit Catches You and You Fall Down” that people considered epilepsy, an organic brain disorder, to be a sacred disease. People with epilepsy were thought to possess special abilities to have visions or to speak in tongues. Of course before scientific study classified epilepsy as an organic brain disorder, all people saw were the symptoms. They saw violent convulsions, and then babbling afterwards. They didn’t know the cause, so they attributed it to the divine.
Others whom we now suspect to have suffered from mental illness were very accomplished in their time. People such as Beethoven and Virginia Woolf were said to have suffered from bipolar disorder; Vincent van Gogh suffered from epilepsy; John Nash suffered from schizophrenia; and countless others including Abraham Lincoln suffered from clinical depression. However, so many more were locked up for life in asylums or prisons. In the 1800’s talk therapy emerged with some success, but having a mental illness carried a stigma, so many people swept it under the rug. In addition, only those who lived in modern times, like John Nash, were able to benefit from medication.
Freud’s theories brought the issue of mental health into the mainstream. Getting help for your mental illness was not as taboo as it had been previously. His ideas were based off of the supposed existence of a 3-part mind: the id, the ego, and the superego. These parts of the psyche, as Freud called one’s mental life, were responsible for the way in which one thinks, how one makes decisions, and how one experiences the consequences of those decisions. The id is focused on getting what one wants as soon as possible, and only wants immediate pleasure. The ego is one’s extreme practicality focus, and tries to combat the desires of the id. The superego is the mediator. In addition to this theory, Freud was focused on the psycho-sexual component of the psyche. A person goes through various stages as they grow, and if a person gets stalled in a stage then that person will exhibit behaviors pertaining to that stage. For example, a person stalled in the oral stage may become an alcoholic, they may smoke cigarettes, or they may get in trouble for the things that they say. The sexual bent in his theories, especially the Oedipus complex theory, has turned off modern psychology practitioners, though. Freud has now been placed in the pages of a history book instead of the practitioner’s handbook. Still, before the advent of medication and talk therapy, people could only rely on what we would now classify as alternative measures, such as prayer or art. They had to rely on explanations that included spirits raging through the body, or the pattern of lumps on one’s head.
Many other theories have given modern psychology the pedigree it has today. There is still a stigma that goes along with having a mental illness, but it’s much more prevalent and accepted. The most common type of therapy is a combination talk and medication. Many people suffering depression, for instance, are treated with talk therapy as well as medications such as Prozac to regulate brain chemistry. We know this works because modern technology has proven that people with depression have an abnormality in the regulation of a neurotransmitter called Serotonin. Prozac helps to regulate Serotonin while talk therapy helps people to deal with their emotions. A particular type of talk therapy has been shown to be the most helpful to psychiatric patients. Cognitive Behavioral Therapy teaches people to recognize harmful thought patterns and then reframe these thoughts into a positive light. It’s also a combination of group therapy and individual therapy. It is a goal oriented therapy that is beneficial to people with depression, anxiety, obsessive compulsive disorder, various phobias, and many other types of mental illnesses. Certain types of mental disorders, though, cannot benefit from talk therapy. Disorders such as schizophrenia must be treated with harsh medication that many find unbearable. Thus the likelihood of going off medication against medical advice is extremely high in this population. People end up self-medicating with alcohol, drugs, or tobacco. Either that or they are forcibly committed because they refuse to take medicine.
Taking psychiatric medication in general is extremely uncomfortable, no matter if you have mild depression or severe schizophrenia. Side effects of Prozac, the medication many use to treat depression, include: anxiety, dizziness, loss of appetite, weakness, lethargy, flu-like symptoms, insomnia, and sexual dysfunction. Antipsychotics, the class of drugs used to treat schizophrenia and other disorders with psychotic components, have side effects that include: drowsiness, blurred vision, and Tardive dyskinesia which causes a person to have involuntary movements in their face or in other parts of the body. A side effect of psychiatric medication in general is weight gain. Unbelievably, a side effect of antidepressants in people under 18 is suicidal ideation.
Why So Many Pills?
Today it seems that there is an overabundance of diagnoses that carry a psychiatric component. This begs the question, are we experiencing a mental illness epidemic, or are we over-diagnosing? We have created a great many new “disorders” that seem to be rather strange. For instance, a diagnosis of Road Rage is being petitioned to be included in the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). It seems to me that we’re simply trying to find a biological explanation for everyday idiosyncrasies. However, it’s no secret that Westerners in general experience massive amount of anxiety on a daily basis, simply because of our lifestyle. Anxiety leads to poor health choices, which could lead to depression, or other health problems. I’m not certain that we can distinguish whether we are in an epidemic or we’re over-diagnosing.
Another explanation could be that we have gotten so used to the instant gratification afforded to us by modern technology that we expect healthcare to behave in the same manner. Feeling depressed? Here are some pills to take and you’ll be happy. The thing is that those pills don’t always work, so that person is prescribed more pills, or different pills. Everyone’s brain chemistry is different, so the same dose won’t work for everyone. It can take months, if not years to find a dosage that works. People with unbearable psychiatric disorders are left to deal with a mountain of pills, a dizzying array of side effects, and the frustration of never having the right answer; not to mention dealing with the symptoms of their mental disorder.
So who’s at fault here? It’s safe to say that we’re all to blame. Doctors want to help people who ask for help. Those people who want help want a cure. To get a cure we need a diagnosis. For a diagnosis we need a disorder. People with disorders approved by the American Psychiatric Association and ones that are in the DSM-IV-TR, get coverage from their insurance for medication, but not always for talk therapy. Most alternatives are definitely not covered by insurance. Therefore, people must rely on medication when they can’t afford therapy as much as they might need it. We create disorders to help people who need it in order to provide them a way in which they can get treatment that will be covered by their insurance. More diagnoses equals more pills equals more side effects. Supply meets demand. It’s simple economics.
Healthcare, particularly with mental illness, should not be about simple economics, though. People have turned to alternative curative measures because healthcare, unfortunately, has become a business, and we’re all to blame. But once again, supply meets demand in the scientific study of these alternatives. Gaelle Desbordes mentioned in her lecture that neuroscientists have been able to perform clinical trials on the benefits of meditation because people have been pressuring insurance companies to support the alternatives. Studies are able to be done because of funding, and the results of these studies are used to determine why an insurance company should cover certain treatments. If we look back to a few decades ago at the introduction of psychiatric medication, the same trials had to be done. After their utility was scientifically proven, their use became much more prevalent. And this happened despite how little we know about how the brain works. Ask any neurologist, he’ll tell you that these medications balance brain chemistry. But if you keep asking why or how, he’ll tell you that we don’t know, it just works. That’s why conventional medicine is still the preferred method of treatment for illnesses ranging from the common cold, to depression, to cancer. As much as I believe that we overprescribe pills, the fact of the matter is that it works.
The whole idea of modern medicine is to seek cures for illnesses man could not otherwise cure naturally. We’ve forgotten that for the most part, which is why we now have a pill for everything. It’s not all bad though. Medicine has evolved to a point where we have done away with illnesses such as polio, and illnesses like AIDS is no longer a death sentence. Medicine definitely has its place, and so do the alternatives.
Why the Alternative?
If conventional medicine works so well, why would people even need an alternative? Many people have sought alternatives in the past simply because they have nothing else left to try. Cancer patients who have been subjected to numerous surgeries and chemotherapy have resorted to prayer or holistic medicine to shrink their tumors. Doctors usually approve of these measures saying that they’re going to die anyway, why not make them feel better? The weird thing is that sometimes it works. Many in the scientific community will say that it’s just a coincidence; the radiation worked and the cancer is in remission. The patient will tell you that it was the prayer or the holistic medicine that saved their life. These seemingly miraculous events have caused a great many people to turn away from conventional medication and rely solely on holistic medication.
There are a couple of things we’re forgetting though. Any history lesson will teach you that the human race got along just fine without imaging studies, without radiation, and without pills. Holistic medicine is a hark back to a time when man didn’t have any of this. Natural medicine is better for your body because your body is natural. It’s able to recognize what you put into it better than synthetics, which is why things like fast food and preservatives are so bad for you. Treatments such as chemotherapy and radiation cause such devastation on the body because they’re designed to literally kill all cells that can replicate. But they’re designed like that because cancer is caused by cells that abnormally replicate. Any sort of natural medicine can’t do that. Albeit there are plenty of natural foods and medicines that can help prevent cancer, but once you get cancer conventional medicine needs to step in.
Striking a balance between conventional medicine and the alternatives requires a certain amount of education about both. Alternatives are becoming the norm. They’re no longer just a last resort on one’s deathbed. Meditation in particular is being studied because it’s been prevalent for centuries with people who seem like they have all the answers, or at least inner peace. Desbordes talked about working with the Dalai Lama to ascertain the physiological benefits to meditation, particularly with the anatomy of the brain. They’ve found that the longer people have practiced meditation, the thicker the regions of the cortex associated with attention and sensory processing are. This is great because it means that meditation practitioners have increased abilities for memory, stress reduction, and even empathy and compassion. Before these studies, we knew that meditation activated the relaxation response, but now with actual physiologic proof can these claims be taken seriously in the scientific community. Yoga has been shown to provide some of the same benefits while providing a pretty good workout. People who practice yoga are not only more physically fit, but because meditation is an important component, practitioners experience less stress and anxiety on a daily basis.
Meditating and practicing yoga by yourself is free of cost, but if you require coaching things start to get pricey, especially if you’re trying to use them as alternatives to or in conjunction with talk therapy. Asking an insurance company to cover your yoga classes will get you laughed out the door. With these studies though, perhaps that will change. If the alternatives are providing the stress relief and health benefits we seek from pills, it’s no wonder people are converting to alternatives. As I said, the key between conventional medicine and the alternatives is balance. We need to learn when to use one over the other, and when it would be prudent to use both. Even people who practice healthy living are susceptible to illness, even mental illness.
Kay Jamison, a well-known author and psychologist, has written numerous books about her struggle with bipolar disorder. This is a disorder characterized by periods of mania and periods of extreme depression. One of the only medications that have had great success in controlling the symptoms of bipolar disorder is Lithium. In “An Unquiet Mind,” she describes her experience of being diagnosed, and being on and off medication. Jamison went off her Lithium numerous times because of the side effects. As a psychologist she knew the dangers of doing so, but she did it anyway. After some time, she realized that being on Lithium was the only way she could live a life relatively free of symptoms and not hurt herself or others. Sometimes medicine, even if it makes you uncomfortable, is the only way some disorders or symptoms can be relieved.
Cancer, HIV, broken bones, schizophrenia, antisocial personality disorder, and traumatic injuries all require intervention by modern medicine. Natural methods and alternative measures can’t work on these things. What they can do is aid us in having an overall healthy life. They keep the rest of our body healthy when disorders, injuries, and illnesses occur. For other things that are normally treated with medicine like depression and anxiety disorders, alternatives could be better to try first rather than a last resort. As I said before, these do have a chemical basis in the brain. But meditation and yoga promote a healthy lifestyle, as well as activate the relaxation response, all of which aid in regulating brain chemistry – and they do it chemical-free. If alternatives provide significant relief, then medicine will not be needed. If they provide some relief but not all, then medication can be considered.
Most importantly, holistic medicine, eating natural foods, and practicing yoga and meditation all aid in preventing every day annoyances, such as the common cold, headaches, anxiety, pain, and stress. These every day annoyances lead to bigger problems such as prolonged illness, heart disease, and resorting to stress relievers such as drugs, alcohol, violence, or smoking. In addition, they make you feel better about yourself in general. Higher self-esteem leads to a decreased likelihood for depression, eating disorders, and self-harm. If you can prevent the smaller problems, you can prevent the bigger ones for the most part. Then you can rely on medicine when it is truly needed, as opposed to going right for the medicine cabinet or the emergency room when you have a headache.
The current studies on meditation and the growing trend of the “green” lifestyle are both leading to wider acceptance of alternative ways to stay healthy. With scientific backing, people are more likely to choose to practice them. Education about balancing a healthy lifestyle with the potential need for medication will also be required of people wishing to use alternatives. With this understanding, people can take advantage of the best of both worlds. There are so many reasons why conventional medicine is necessary in our lives, but that’s not to say that it doesn’t have its share of mistakes. Alternatives offer a way in which people can find peace and regain control over their lives that sometimes get lost in a sea of pills and insurance paperwork.
DesBordes PhD, Gaelle. Lecture: Neuroscience and Meditation, Boston University – Rethinking Mental Health: Spirituality, Healing, and Culture. Harvard Extension School, Feb 12, 2011.
Fadiman, Anne. The Spirit Catches You and You Fall Down. New York: Farrar, Straus, and Giroux, 1997.
Jamison, Kay Redfield. An Unquiet Mind: A Memoir of Moods and Madness. New York: Vintage Books, 1995.