mental illness, physicians, the brain and the mind in pain

I’m having serious questions about the role of physicians in mental health. It seems to me that the mental health field should be returned to non-physicians, and physicians should limit themselves to neurology and the study of the brain. Which is in fact what they do anyway, except psychiatrists’ power to dictate the terms of the discourse is so strong that brain chemistry is becoming more and more the theoretical framework we use to talk about mental health and mental illness, and psychiatrists the people we naturally turn to to get an opinion about the way minds work.

We don’t need a dramatic philosophical revolution to re-establish, and collectively agree on, what we have always known: that the mind (the heart, the soul) and the brain are two separate, qualitatively different albeit related entities, and that we have only the faintest idea of how they are connected.

The specific forms of pain that attach to the mind should be the province, exclusively, of mind-specialists, or psychologists. Psychologists should be people who study the way people relate to themselves, the world, and others incessantly, and garner ever new knowledge about what makes all these relations happy and peaceful rather than unhappy and tortured. There is a tremendous amount of wisdom accumulated on this subject and psychologists should not engage with patients unless they 1. have put some serious efforts into delving into this wisdom, 2. keep delving into it,  and 3. realize that there is much they won’t ever know.

Point 3. leads directly to recent movements in psychoanalysis according to which the person who knows best about the torture of the mind is the sufferer, and this knowledge, much of it unconscious, is the treasure the therapist and the patient need to unearth together.

Any other approach to mental pain is foolish. Unfortunately, the vast majority of people operating in mental health today use foolish approaches, and people stumble through life carrying untold burdens of suffering they could turn to each other to relieve.


if you blame

If you blame yesterday’s act of terrorism against several US citizens going about the business of democracy on the aberrant delusions of someone with mental illness, you wrong all the victims of terrorism gunned down, blown away, gassed, or hacked to pieces by people who are certifiably sane.

You also wrong men and women in armies everywhere, who commit atrocities in the name of patriotism or just the imperative to follow orders and, as a consequence, become mentally ill.

Mental illness is not simple. Sane people kill every day, for good or bad reasons. Most of the people who will be murdered tomorrow (and there will be many), will be murdered by certifiably sane people. Many certifiably sane people become profoundly disturbed as a consequence of having killed.

The relation between killing and insanity is not simple.

If you blame the violence perpetrated yesterday on an elected official of the United States on the aberrant behavior of a deranged young man you wrong all elected officials everywhere whose right to govern freely has been and is being tampered with by the United States government. This is violence too. It may not always be bullets in the head, but it’s violence against international law, cooperation, and respect for the sovereignty of other country-states. It hurts freedom and democracy and the respect we owe one another.

The relation between killing and other forms of violence is not simple.

If you blame yesterday’s killings on the deranged behavior of “the mentally ill,” you make us all very nervous about the strange, introverted, unhinged, pained, and often fabulous people who populate our communal lives. In particular, you cast a black shadow of panicked danger on the students in our high schools and universities, and make teachers everywhere nervous and suspicious around students who think and act differently.

Blame yesterday’s act of terrorism on a culture of intolerance and violence and you won’t wrong, hurt, or marginalize anyone. Blame it also on the easy availability of guns, and, again, no one will be hurt – many will be spared instead. Blame it, too, on the paucity of true support for those who are tortured by mental pain — not the availability of drugs and mental jails but that of safe and anonymous places to turn to in order to be heard and made to feel less alone — and you will be helping more people than you think.