Posted by android99 on October 13, 2004, at 12:06:18
Right. I found that urban legend on the FAQ of this site, ( http://www.dr-bob.org/babble/faq.html#trust ) where I was following a link that was supposed to tell us why we need to adopt an idiosyncratic punctuation style when quoting some other published works. Since my reply is not about style, nor about urban legends posted as answers to a FAQ, but about cures for mental "illness", this is the appropriate place to post.
There are a few problems with the fallacy that there is no cure for mental illness:
"Mental illness" is a gross, hasty generalization. There is no accepted medical taxonomy for "mental illness." The professionally accepted description for conditions implied in the phrase is "mental disorders." Mental disorders sometimes arise from fatigue, infection, toxic exposures, confinement or isolation, emotional duress, traumatic stress and other proximate causes, in addition to those in which more deeply seated genetic, biological and socially-oriented causes are implicated.
Though the cases that popularly define "mental illness" tend to be intractable major psychoses, persistent neuroses, or more recently, emotional disorders advertised on television, even some severe mental disorders could also be as temporal as the common cold. Mental disorders often develop in prison settings, where individuals are exposed to dangerous large groups or are isolated in confined spaces for prolonged periods. In many cases, placing the individual in a more supportive environment perhaps with meds to ease the transition can cure these illnesses. Mental disorders can be caused by drug toxicity. Not everyone who takes a few tokes on a crack pipe or sniffs a line of methamphetamine is incurably addicted for life. But the drugs can cause temporary mental illnesses - manias, specifically - that can be cured simply by removing the toxic agent and perhaps with some counseling to help unseat any delusions that arose during the episode and to plan strategies for better outcomes if the individual is again offered potentially dangerous drugs. Mental disorders can also arise in reaction to prescribed drugs, including prescribed psychotropics, as is the case with serontonin syndrome.
Popular lore, and an appreciable body of academic literature, holds alcoholism to be a disease, and one that is as intractable as herpes or HIV once an individual is affected. But other clinicians and scholars recognize social contexts that foster destructive alcohol consumption, and recognize permanent lifestyle changes that can "cure" behavioral disorders described as "alcoholism." An example is the 43rd president of the United States, who claims to have ceased heavy drinking when he had a religious experience. I doubt he advocates a view that he is a lifelong, incurable alcoholic, though I am more than certain he has been recently exposed to peer environments and life stresses that could have prompted a "relapse".
The only way I can figure a physician could conclude there is no cure for mental illness is to exclude from the definition of illness any malady that may possibly be reversible by known treatment strategies. (Before any physician claims they feel put down by my reasoning, he needs to recall that the statement is about the limitations of my reasoning. It would be better, if a physician chooses to respond to this post, to better inform my reasoning than to complain to a virtual large group about his feelings in reaction to my confessed limitations. Please exercise some tolerance if I don't add IMHO to each of the following sentences and paragraphs...) If it is the case that the only thing that is a mental illness is a mental disorder that can't be cured by known treatments, science will never find a cure; it will simply pare down the list of illnesses, eliminating each one from the list of illnesses as successful treatment approaches are perfected.
But that would require some implausible mental gymnastics. It would be similar to saying sun stroke is not an illness, because all one needs to do is get out of the sun and treat the symptoms that arose during exposure. But heat stroke or heat exhaustion also can cause symptoms of a mental disorder - aggression, delusions, depression, etc. Any of these symptoms might be recognized as a mental disorder when assessed merely by the presenting symptom. Are delusions no longer a mental disorder when the source of confusion is discovered and can be corrected? I think not.
Consider the common cold, for which there is allegedly no cure. Bed rest, increased body temperature, and attention to disposal of sources of reinfection (dirty tissues, dank bed linens, etc.) can shorten the lifespan of a "Cold" and prevent it from developing into potentially fatal complications such as pneumonia. Antibiotics, however, are said to cure infections. They sometimes "cure" infection no more quickly than bed rest "cures" a cold, and each can stop a progression toward more serious symptoms. But one is not considered a cure and the other is.
The question cooks down to one of how rhetoric is used to sell professional services. Expectations of "cure" are presented as a way of informing clients of likely outcomes, and of clinical limitations. But the goal of selling professional services implies a different rhetorical strategy than the goal of informing clients and their families about etiology and pathogenesis of a disorder. The second goal -- that of providing accurate information -- is not served by classifying all complaints related to disorders of the brain or mind as mental illness. Psychiatrists are not educated in treatment of "mental illness". They are educated in specific, distinct approaches to a variety of complaints that are classified, collectively, as mental "disorders". There might be debate among clinicians about which of these "disorders" is a disease, but again, only if "mental illness" is defined as "those mental disorders that cannot be cured" does the claim that mental illness cannot be cured appear to have merit. But the merit is shallow, because the argument is circular.
I could speculate about the motivation of clinicians who claim disorders they are paid to treat are incurable, but it would be nothing but my opinion. Analytically, I can offer that the claim reflects a poor appreciation of the sophistication of clients' potential for understanding their condition. It reflects an age-old tendency to establish authority relationships that place a client's capacity for authoritative understanding of a subject at a much lower level than the authority of the clinician. That approach might have worked in the past, when public knowledge was limited and dispersed hierarchically to those who could afford academic training. But in the Information Age, knowledge can no longer be sequestered, and individuals can develop expertise approaching or surpassing that of clinicians. The spread of public knowledge will likely continue to grow, and, the practice among some clinicians of offering dumbed down answers that primarily serve to reinforce clinical authority will not fare as well when confronted by an informed clientele.
And, to return to the core premise, that mental illness (more properly mental disorders) can sometimes be cured, what is the problem with telling people mental disorders can't be cured? Well, as I demonstrated, they can sometimes be cured. Many of us frequently restore a functional order in our minds. Recurrence of disorder no more implies incurability than does the possibility of a soldier being shot again implies that bullet wounds can't heal. Claiming disorders can't be "cured" suggests it is futile to seek simple, proximate causes for a mental disorder. The claim might be comforting to those who genuinely are suffering intractable symptoms of a persistent disorder, but it creates a rhetorical barrier for those suffering symptoms that could be treated by addressing proximal causes, thereby discouraging a quest for the simplest answers before settling for the more discouraging potential outcome. In the final analysis, the legend promotes dependence on clinicians, it discourages clients from seeking clinicians who will explore proximate causes (especially those who offer social and psychological counseling), and it discourages clients from attempting to understand the factors in their environment that might cause or complicate symptoms of a disorder. Stated simply, it is just wrong.
(This original, pseudo-anonymous article is a donation to the public domain. It may be reprinted at will, though it would be improper for anyone else to claim to be the original author, and no one may claim a copyright under any circumstance.)
poster:android99
thread:402662
URL: http://www.dr-bob.org/babble/social/20041010/msgs/402662.html