Our Approach to Mental Health Isn’t Working

Eleanor Longden was a university student when she first started hearing voices. After she was given a diagnosis of schizophrenia, a doctor told her she’d be better off with cancer instead, because it was easier to cure. 

Longden’s experience of being “diagnosed, drugged, and discarded” by the health care system is not unusual. But her subsequent recovery—she is now a research psychologist completing her PhD and an international speaker on mental health—isn’t unusual, either. She still hears voices, but she doesn’t need medication to handle them. 

Longden’s story challenges mainstream perceptions—that schizophrenia is a debilitating illness—and it underscores why we need to rethink the biomedical approach to mental health.

What is the biomedical approach? Put simply, it’s the tendency to see mental health problems as biological diseases of the brain: inevitable, incurable, and genetically determined. But the evidence for this model, which has come to dominate both medical practice and public opinion, is shaky at best. 

For example, while genes may play a role in influencing vulnerability to trauma, there is much stronger evidence that experiences and environment have a significant impact on mental health. Children who experience poverty, abuse, and discrimination are much more likely to develop mental health problems later in life. According to clinical psychologist Richard Bentell, “the evidence of a link between childhood misfortune and future psychiatric disorder is about as strong statistically as the link between smoking and lung cancer.” 

The biomedical approach can also lead us to pathologize normal human responses to suffering. It’s not surprising that people who go through divorce or unemployment may experience depression and anxiety, but needing support and services isn’t the same thing as having a disease.

Because the biomedical model tends to isolate mental health from the broader social context, it emphasizes treatment rather than prevention, and the treatment models it promotes tend to rely heavily on drugs. While psychiatric medications work for some people, they certainly don’t work for everyone, and their side effects can be debilitating. A pill won’t erase the effects of being homeless or bullied in school.

Moreover, there’s evidence that the perception of mental health problems as a disease might actually increase its social stigma—which causes further harm to people who need support and community to recover. And recovery is possible; people can and do get better. They can go on to live full and rich lives, supported by family and friends, and succeed in education and work. But recovery is harder if the only treatment available to them is pharmaceutical, and fails to address the root causes of their distress and provide the resources they need to heal.

We need a better way of thinking about mental health. We need to develop health systems that integrate mental and physical health care, especially at the primary care level. Mental and physical well-being are inextricably linked—physical illness and pain can cause depression and anxiety, and conversely can mask underlying medical conditions, especially when doctors interpret these experiences solely through the lens of a psychiatric diagnosis. 

Any treatment has to start with a focus on the whole person. We need appropriate community-based care and holistic solutions that take social, economic, and cultural factors into account. We also need to broaden our understanding of recovery to mean a person’s ability to live a good life on their own terms, rather than defining it as the absence of certain symptoms.

Finally, we have to start treating mental health as a social justice and human rights issue. That’s why Mental Health Europe advocates for a psychosocial model that acknowledges the profound impact of lived experience and social environment in shaping mental health. We know that poverty, racism, and violence put people at higher risk of developing mental health problems—so that means we need population-level interventions which can focus on fighting the root causes of this public health crisis.

Our current systems for mental health care are failing at both treatment and prevention—and the biomedical model is one of the chief reasons. Future research may provide more insight into the complex relationship between genes, the brain, and mental health. But no discovery will prevent people from experiencing painful things, or erase their need for support. 

By focusing on disease, the biomedical model leaves little space for the voices of people with lived experience of mental health problems—who are the real agents of recovery, because they’re the best experts on their own lives.

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a fantastic thoughtful article with the courage to break away from the thoughtless re-iteration of mental illness as a 'disease'. Sometimes it is, but so very often it is the sequelae of childhood trauma and that is something that happened to us not something that is wrong with us.

I couldn't agree more however, as well mental and physical approach, a spiritual element needs to explored. I'

Open Societies approach to “mental health” is not far enough removed from mainstream biological medical model to be able to call itself an alternative.

The fatal flaw in this thinking is that poverty and other "experiences" lead to "mental health" problems.

It is far more accurate to say that accumulated experiences of trauma are worsened by poverty (lack of access to vital nutrients, poor housing conditions in poor neighborhoods and working conditions that lead to toxic exposure, overwork, underpay, and other hardships that take a toll on the human body leading to real biological disease (medical mimics such as thyroid disorder, brain injury and countless other disease (poor hygiene, bad teeth, lack of sleep, extended stress, use of drugs, dangerous or unhealthy lifestyle.)

The above are NOT “mental illness's” but are used as pseudo-evidence of a “mental health” condition. The failure of this approach continues to be the medicalization of social problems, conveniently positioned as impending “mental health” problems. Bunk.

The insidious creep the this fraudulent medical model, benevolently mascaraing about as "mental health" help, is the problem. This approach, like the rest of them takes advantage of all situations and uses them as “evidence” of “mental illness” in order to force stream (by default-, owing to lack of appropriate services) everyone into the system where they are treated like cattle, labeled, drugged and possibly much worse, for profit without consideration for the lack of science, facts and positive outcomes from being in contact with the system.

One is guilty by virtue of birth, by the mere act of being alive, of being vulnerable to adverse life experiences that corrupt ones “mental health” into a disease. Where does it end?

Had bad experiences? Think long and hard before you answer, because what you are really vulnerable of here, is being accused, tried and convicted of the crime of "mentally illness" by association of having “mentally ill” alcoholic parents, by genetics, or epi-genetics, or whatever meme works to push you into the “mental health” system.

This myth is dangerous "any trouble in your life" Yes- BOOM – this IS your "mental health" problems, that were lying in wait to become the “disease” in living, in later life”.

So although this approach has the good sense to criticize the dangers of the medical model, it falls prey to and supports the medical model throughout and most specifically with the statement:
"Mental and physical well-being are inextricably linked—physical illness and pain can cause depression and anxiety, and conversely can mask underlying medical conditions, especially when doctors interpret these experiences solely through the lens of a psychiatric diagnosis. "

Wrong. The problem is that the medical model invented "mental health" as a separate and unique health for the head/mind/brain that is NOT remotely accurate. The is only one health, human health. There is no separation so no link can be claimed. Claiming one affects the other, IS saying that the medical model is accurate, while pointing out that it is problematic. It's a confusing contradiction and a totally twisted misunderstanding that mistakenly solidifies the problem while claiming to try to mitigate the damages of the same. Its just as wrong headed and dangerous as the medical model it claims to be an improvement upon. It isn't.

This approach also claims to support "prevention", and yet any "prevention of mental health" by designs will include the invasive judgment of and into people's private lives, their individual thoughts, feelings and believes and as such, had nothing to do with supporting their rights, and everything to do with judging and labeling them. Although it may come under a different disguise, it will be some other toxic version of "mental health first aid"; and state-trained watch-dogs groomed to peer over our shoulders looking for signs to point their finger at and cry out "poor mental health" alerting the mind police to arrest the accused for per-disposition to psychosis or over-texting, or excessive fidgeting (AKA - ADHD).

This is not remotely a "rights" based model as it claims to be. It is just another slightly twisted version of a bigger brothers every impending reach into our minds so it can continue to attempt to control what happens to us in our lives on this planet. This approach, claims to be different and more humane (like all of them) but anyone who chooses to continue to use the fraudulent medical model concept of “mental health” is the same old thing hoping no one will notice and call them on it.

© JMG 10/11/17 MH, AB, CA

OMG the most brilliant explanation of mental health status that I have ever heard!
why are there not more people like you of intelligence and insight in the world today? I salute you and your thought process

it is unfortunate that some models for prevention have come across as being "invasive judgement" and "labeling." but there are other ways to work on prevention. i have been thinking that we need better psycho-social classes in schools. from the beginning. on how to deal with each other, ourselves, family, and the larger society. there is no reason why we can't be talking about this openly. and yes i would feel free to suggest healthier means of communication and boundaries for example. there is room for positive prevention.

I agree 100% with the first comment to your description of mental health! You hit the nail on the head. Thank you for your thoughtful insight on this issue. I was a target of workplace bullying by verizon communications for many years. They could turn on the harassment and then off again while they smiled at your face and then claimed, "they can do that!" Workplace bullying is legal in the United States!!!! The accumulated trauma associated with workplace bullying is mind boggling in every description of the words "mental health." There are about 23 states with forms of a Healthy Workplace Bill pending at different stages of the making of the law creating process. I'm going to share this article with 3 of them that I post to from time to time! Thank you very much! Merry Christmas, Happy Holidays and a Happy New Year.

OMG! Judy, thank you so much for your wonderful analysis of this article. As someone who has seen the overcriminalization of mentally ill and seriously mentally ill people due to the atrophying of long-term treatment and care in New Orleans after Hurricane Katrina, I couldn't agree with you more. Funds have been siphoned off for anything and everything that can be shoved under the rubric of "mental health" for people who are not actually sick but suffer due to other social determinants of health. For example, I have noticed a distinct correlation between my situational depression and how much money I have in my bank account. Consequently, I have an unopened bottle of celexa in my cupboard that was prescribed for me during a bad moment recently that triggered a lot of anxiety.
The mental health industrial complex has abandoned folks who are really sick in favor of lining the pockets of CEO's of "for profit" companies and they, unlike the criminal justice system, have the luxury to do so. In the CJS, Sheriffs must take anyone the police bring to their door.
That said, is there any society or region that has succeeded in creating a full continuum of psychiatric care?
I do not believe that there is a panacea to our troubles or either/or solution. I cannot superimpose what works for my loved-ones on others any more than they can on us. What is needed is to meet people where they are with a full array of programs and services that exist within a continuum of care - and WHERE THEY ARE involves many scenarios. Through early diagnoses to Stage 4 psychosis.
Some may chose to live with voices, others may lack the capacity to make good choices for themselves and need more intensive care. But none should fall victim to overmedication to increase profits for shareholders. That is absolutely a mental health injustice!

I have been in the mental health scene in USA for years
and between stigma fromworkers and family and lack of
useful treatment, I feel totally cheated !!

In the US there is very little hope for people with Mental Health issues the medical community is still looking at the "eugenics" and many "advocacy NGOs" are as well. One prime example is Autism Speaks they are more focused on finding the "cure" instead of combating stigma and changing public discourse or public policy to help those with Mental Health issues. There is also a large correlation between mental health diagnosis and life-long poverty or homelessness.

I was diagnosed with,bipolar,depression,anxiety when I complained of being sick. I began to believe it and live it. Although some is true but I functioned well until I became very sick , doctors just kept telling me I had four kids I must be depressed. After two years working full time twin babies and two teen girls I began feeling a little nuts, I was finally diagnosed properly with Cancer ,Hodgkins lymphoma stage 3b. Well damage was already done. I went through my chemo among added illnesses, when completed I had no job no money and A home in foreclosure. I am still just barely hanging on to my home and probably have to declare bankruptcy because My income not enough . I am more scared of being homeless as I was age 16 when my parents divorced and just left me alone. I worked hard went to college had a great career. Unfortunately today mentally I am a mess with such anxiety ,it's hard to even go out. I am more afraid for my children,the twins ,now age 13 having a home. It all began with being told I was depressed,and nothing was wrong with me just my own craziness basically a doctor told me ,I had four kids that's what's wrong with being a women the emotions are messed up. I believe it starts with the doctors diagnosing properly. That was the start of my downfall,severe anxiety and social anxiety. When you are told enough you begin to act it out. The worst part is when I was finally diagnosed with cancer ,family seemed to just disappear. Today I am more concerned about my girls completing college ,and the twin boys having a roof over their head. It all started with a doctor that misdiagnosed me .

Valóban az egészségügy betegségügy csak diagnosztizálunk,megbélyegzünk,nem tudjuk mi az ember ki az ember bio-pszicho-szociális és spirituális Egység,ha ezt tesszük lesz EGÉSZ-ség!

Mental illness is a broad term for many things: some are temporary, some become permanent, some begin for no obvious reason and some are due to the effect of trauma (from crime or natural disasters), disability, economic stress, changes in family dynamics, physical illness or diagnosis of disease and even changes in the seasons. As we have cultures that like to fix or solve problems and some forms of mental illness do not fit the model, they get ignored. Also mental illness is often not dealt with until a criminal element or behavior shows up, so often the person who acted out now is seen as a wrong-doer who must be punished - think off all the inmates in prisons around the world, whose un-diagnosed or untreated mental illness spurred the behavior that led to time in jail that increases their stress and trauma. Mental illnesses can become cyclical due to poverty or disability, and social isolation. And for those who cannot communicate due to cognitive, intellectual, or physical limitations, mental illness is probably something they suffer with in silence. Even those who feel they have "something wrong with themselves" cannot get the help they request, as wait times to see therapists are long and to get into see a psychiatrist for a proper assessment is near impossible, so these people too suffer and may resort to self medication, which is dangerous. Too many problems and no solutions on the horizon; but we need to begin to deal with these issues in all of their forms.

I don't think so. The brain, as the more complex organ on our body, can be sick and this fact can't be ignored. I don't think this is the problem. People still see mental illness in a wrong way, but the knowledge is the main factor to overcome it. Studying mental illness is very important, just as much as knowing the factors that influence the development of mental illness. Social factors are considered, as the person, once the treatment consider the person and his/her history. Moreover, knowing that the genetic factor exists can lead us to be alert, and prevent the person – since the childhood, to go through various bad experiences untill discovering what it's happening (only after too many years and too many damage). So, knowledge is the solution. Besides, it's not every mental illnes that can be caused by - and only by bad experiences, there are various factors inside of it. The bigest problems are the bad health professionals and the trivialization of the drugs usage, as the expensive costs of it all. I thinks it's just as important as the individual to know about mental illness and so it helps the professional to get the right diagnostic.

It is disingenuous to give a one-in-a-million wunderkind's success story of self-healed PhD, with a book just out, with a catchy title to boot, as a model of "proper mental healthcare." The author's expertise is clearly not in Medicine nor Statistics. Several days spent with a person, from a very uptown neighborhood and loving family, and yet suffering from an acute mental illness episode, would change her mind about denigrating the medical approach. Her thinly veiled allusions to socio-economic conditions as the root cause of "mental health problems" and some unsubstantiated and frankly dangerous statements of "biomedical model" being the problem is charlatanry pure and simple. Other than that, great job elucidating the complex matter.

I think what Jan said makes sense!

how can one person's personal experience be called disingenuous? the whole point of this article is that when you get lost in statistics that the actual people are overlooked. just because someone had a good childhood and then ended up with severe mental illness as an adult does not mean that we should definitely jump towards medication everytime for everyone. she is offering another way of approaching the same problems from a more person centered place. and are you arguing that we shouldn't worry about childhood abuse? that it doesn't have a negative affect on any particular person and thusly the community at large? your insistance on focusing on one rich person's experience to judge the whole issue is unbelievably short sighted. you're coming across as having no sympathies for those of us who have had to suffer rough childhoods. maybe you'd have something more insightful to say if you were the one who had experienced mental illness yourself. at this moment it seems you are just talking out of turn.

State of mind is a product of nature/nurture and free will interacting with causal circumstance. Spirituality (but not all religiosity) can guide humans toward peaceful, joyous, engaged living.

Chicken or egg: I am born into a very large family, a good number of whom are unstable mentally. The nurture model in our family is broken or fragmented to the degree that so many of us have suffered violence, neglect and abuse in our childhoods, that we do not have the proper resources to maintain ourselves or our children in a “healthy way.” The cycle of abuse/neglect is so strong within our family that many of us have become noticeably ill in our behavioral thought pattern. When medical experts describe these negative thought patterns as a chemical imbalance of the brain, I feel they really don’t understand that chemical imbalance comes from the incredible unhappiness resulting from negative trauma. The chemical footprint our brains produce tells the story of how we are feeling. It shows that we are UNHAPPY as a consequence of not learning from our parental/societal upbringing how to deal with life in a position of positivity. Now, of course, there are many who would say that the cycle of abuse within our family actually is caused by a negative thought pattern developed genetically within all of our brains. Guess who my family is? The human race.

I was a university student too when psychotic episodes started. In those days (80's) schizophrenia was considered the result of bad education or upbringing. Thus, my whole family was included in my treatment. I said it was nonsence, but I was the one with the disease so my voice didn't count. But my upbringing had been great, without any doubt. It was painfull to see my parents being consired the 'bad guys' in my 'childhood misfortune'. It was a miracle that I nevertheless managed to finish my study successfully. A holistic approach is good,of course. But being careful about reasons of a disorder is important: prevent guilt-feelings of others. The link between mental health, 'lived experience' and 'social environment' may be strong, but cannot considered the 100% reason in all cases!

it is a wonderful thing to have your whole family included in your treatment. if you have schizophrenia with psychotic episodes then you must include all of the people surrounding you to help out. holistic approaches and traditional healing modalities always include the surrounding families as part of figuring out what is going on with a person (especially in cases of psychosis) and making plans on how to keep everyone safe in the future. if your upbringing was great then i would assume bringing your family into this process wouldn't have to be too painful. who was making your parents feel badly? themselves? that is where the stigma comes in.

In my own 25 years of research I have come to see how it is possible we are born with inherent properties that allow us to find resolve, and return to a generalized sense of calm. It is what I have seen as an innate sense, paradigm, (model of behavior), that is in fact something that we have all forgotten about for one reason or another, and it goes by the name of moral sense, or, moral law. Reasoning that "use it or lose it" is real in terms of as many say in grey matter, a certain view or perception model that is no longer considered by an individual, would in reference to neural transmission, cause certain pathways to lie dormant and give way to other dominant perception models even such as what is dictated by Society in a large community. If true indeed , then many people that appear to be of mental unrest, would be perplexed as to finding resolve for seemingly complex human issues, and seeing this we could say that is enough to cause exacerbated symptoms reflecting confusion, while being the precursor too many bad decisions that would only promote unstable thoughts, behavior, responses and reactions to watch someone deemed healthy would consider frivolous or nonsensical and have no real concern. The one being healthy would be the one that has passed through his or her life gracefully with proper guidance, nurturing and discipline. At present the majority would appear to be healthy in mind, but that may only be because everyone is putting on a show for others to see and are acting to serve and satisfy unrealistic dictates of an apathetic society of which they are not aware of any other paradigm, or model of thought and behavior such as at one time was the norm and did produce youth that were straight forward, upright, and just, all supplied by a shared and inherent perspective or way of viewing the world and the people in it, including the self. Until we recognize the inherency of moral sense and or common sense, things will most definitely get worse as it is being reported by the National Institute of Mental Health that by 2020 the world will see an epidemic of depression and suicides.

This post sounds like Mad in America blogs. We are psychosomatic beings with a mysterious link between the two. Schizophrenia is a problematic diagnosis and there are many people right now fighting for new perspective of this. There are other ways to approach it besides drugs such as Open Dialogue. It's important to listen to patients who have recovered and who have critical opinions of professional treatments. No one should be forced to take antipsychotics or get ECT.

Need more information also some of your facts are inaccurate.

As Danielle noted ...open society's approach sounds similar to Mad in America's. I ardently try and use the word mental injury instead of illness as I know damn well where I got the injuries that resulted in PTSD and moreover the lack of treatment for it negatively affected my development from childhood into old age (bio predisposition or not and I suspect not) and illness suggest contagiousness and mysterious origins and other connotations.

Dear Officer,

I read the article carefully and I think it represents a fundamental innovative and updated theory of viewing and curing mental health problems. I work in the area of disability and as I find this study very truthful, I would like to talk and discuss about it in a seminar session in my country. I would furthermore like to ask if there is any empirical study behind these findings. I mean which has been the methodology used in conducting the research which supports the results of this study. Thank you for any information.
Kind regards,
Suela Kalia

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