Thomas Unger is an associate professor of psychiatry at the University of Toronto and a research consultant with the Mental Health Commission of Canada.
It is not uncommon in medicine to fall in and out of favor with various methods. In psychiatry these days, the pendulum has moved too far towards viewing mental illness as a disease resulting from social determinants.
I am seeing philanthropic physician care providers who are making professional identifications as Social Justice Warriors – when their first and foremost responsibility is to practice medicine. It’s an oath they took, and, often, an effort backed by taxpayer dollars.
let me elaborate.
We have moved from a narrow biomedical model of understanding mental illness to a more comprehensive approach that touches on three factors: biological, psychological, and social. Addressing all three is the secret sauce for best results. But as we increasingly look at the social determinants of health, we should not lose sight of the biological and biological (in the body) aspects of mental illness. They are essential for understanding, healing and care.
Still, many of my peers want to throw the baby out with the bathwater. Being “awake” today means acknowledging the factors that influence mental illness, but ignoring the illness. It is almost taboo to suggest that social inequalities are not the only reason for the development of mental illness. It annoys me because it is not a matter of opinion.
It is suppressing a bitter truth.
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A particular focus on social is a limiting, exclusionary, all-or-nothing mindset that is both reductionist and discriminatory. In fact, I would argue that serious mental illness should be a health disparity in its own right, as it is misunderstood and stigmatized both in society and in healthcare.
If you think I’m exaggerating, consider two scenarios – both involving serious mental/brain disease. Have you ever had an emergency alert wake you up in the middle of the night after wandering away from the home of a grandparent living with Alzheimer’s dementia? It has definitely happened to me. And I have watched the media with admiration, with first responders and community members joining together to mount the discovery.
Now, ask yourself this. Have you ever seen the same reaction when a person with schizophrenia wanders away from home? My answer is no. nothing. Zip. Zero. Nada. The only response it can elicit is perhaps an unbalanced crossing of the road at the sight of someone wandering unnaturally in your direction.
The inconvenient truth is that we readily take for granted the brief news stories of individuals who, without a whisper, starve to death. It is ironic, then, that we raise our voices against homelessness and poverty, ignoring the serious brain/mental illness that leaves many people socially marginalized in the first place.
Mental illness has been slammed as less real, less tangible – and by extension, less valid – while “real” medicine involves physical goods. I guess I can place some of the blame at the feet of René Descartes, whose mind-versus-body separatist ideas have had dire consequences that resonate for generations.
We are content to provide separate care for mental illness by building separate hospitals. Let’s not worsen the situation by discounting legitimate biological aspects and attributing mental illness only to social consequences.
look no further than the book hidden valley road, a poignant story of an all-American family ravaged by schizophrenia – where at least six out of 12 children were diagnosed with the disease. Simply put, genetics can be brutal.
Understanding mental illness as biological is too optimistic. It lets it be something that we can observe, study, treat and correct. Arguably, this reduces stigma and discrimination.
In my efforts to recruit and appoint psychiatrists over the years, I have been impressed by the kindness, compassion and strong sense of social responsibility displayed by doctors focused exclusively on the social determinants of health.
But the irony of his inclination to do the work of social and community activists and run on the streets to save the world in trendy Chelsea boots doesn’t strike me. The next time you see your doctor for bronchitis do you really want them to focus specifically on building codes and HVAC systems?
To root out true equality, compassion and better health outcomes, it is necessary to delve into the biological and biological aspects of mental illness. The fight for health justice is not a glamorous one. It is often a behind-the-scenes slogan to bring approaches, resources and treatments for severe mental illness in line with similar illnesses.
The pendulum will not heal on its own unless we give it a push.
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