“A chronic absence of meaning is the spiritual crisis of western society. The so-called mentally ill are perhaps just those who feel it most strongly.”
Russell Razzaque, Consultant Psychiatrist and author ‘Breaking Down is Waking Up’
This film comes at a time when a tipping point is arguably being reached in our cultural understanding of mental health treatment.
Debates over the nature of mental illness, and the best way to treat it, reflect deeper conflicting views of what it means to be human. In short, it’s where sometimes esoteric philosophical discussions about the nature of consciousness or assumptions about the relationship between the physical world (brain) and the non-physical world (mind) have a real world impact that affect millions.
As such it is a battleground between those who hold fast to the traditional perspective, that of scientific materialism, and those who argue for a more holistic, even spiritual perspective.
The limits of materialism
The principal assumption within science is materialism – so deeply held as to be taken for granted – the belief that the physical reality is all there is, and that everything must be explainable in terms of the physical world. In psychiatric terms, that all psychological states should be explained in terms of the chemistry of the brain, and therefore principally treated with drugs that change that chemistry.
By contrast, another perspective exists that the material world is not all there is, and that the physical world is just an aspect of a much deeper and larger reality. This philosophical debate has less impact on other areas of science and medicine, but is arguably central to psychiatry.
The story of psychiatry
To explain the current situation, it helps to look at the recent history of psychiatry, and why it has arrived at the state it is in now.
Until as recently as the middle of last century, psychiatry was in a different state of crisis, regarded as nowhere near scientific enough compared to its cousins in medicine or surgery. Its critics saw it as an unscientific backwater peddling quack remedies.
It was saved by the arrival of ‘big pharma’ – the major pharmaceutical companies with their miracle drugs and vast budgets for research and development. The early psychiatric drugs had powerfully positive effects on many mentally debilitating conditions.
The effectiveness of these drugs fed into a theory that imbalances in brain chemistry were at the root of many mental disorders. The supremacy of this ‘biological model’ was confirmed with the publication of the hugely influential Diagnostic and Statistical Manual of Mental Disorders (DSM). This lists and categorises all known mental disorders and is the ‘bible’ of the psychiatric profession.
Long term, expensive drug regimes were prescribed for tens of millions of people, and a vast industry was established with financial incentives for doctors and lucrative bonuses for senior consultants to recommend drugs. Psychologist and writer James Davies explains in detail how this happened in his book ‘Cracked, Why Psychiatry is Doing More Harm Than Good’ (1).
But as time went on, this chemical hypothesis was not in fact proved. To this day there are no good laboratory or brain-scan tests for any of the major psychiatric disorders, no ‘biological markers’ as the phrase goes. Moreover, the psychiatrists who put together the DSM (and the follow up DSM 2, 3, 4 and 5) admitted that their categories were largely arbitrary.
While most mental health professionals agree that drugs can be useful in stabilising acute conditions, many are coming to the conclusion that reliance on them is counter-productive. In 2010, American investigative journalist Robert Whitaker published his highly influential expose of psychiatric drugs; ‘Anatomy of an Epidemic’. He looked closely at the evidence related to long term psychiatric drug use, and showed conclusively that their long-term use is doing immense harm.
Together with many other credible and powerful voices (2), they explained that while it is certainly true that powerful psychiatric drugs CHANGE the brains of the patients who take them, in the same way as any other legal or illegal psychoactive drug, and can give a temporary relief from symptoms, there is no evidence that they correct any underlying brain imbalance. In fact the long term research shows that the effects in the long term are generally to change brain functioning for the worse and that the recovery rates for patients who do not take drugs are much better (4).
There is a growing public battle between the hard core ‘materialist’ psychiatrists who see mental illness as being essentially about ‘faulty brains’ and many psychologists, who largely reject brain-based explanations in favour of explanations based on patients’ histories and experiences in their upbringing.
The hard core currently have the upper hand in terms of their public profile and media support. This was seen strikingly recently when the BBC ran a series of programmes on mental health, which all took the materialist perspective – prompting an impassioned response from the main representative body for psychologists, the British Psychological Society.
“Instead of laying out the controversy in the unbiased fashion for which the BBC is known, they took for granted the view that mental health problems are necessarily a manifestation of biological illness. As a matter of urgency, then, we ask you to commission a similarly high-profile programme featuring professionals and service users who adopt the approach outlined here.”
Open Letter to the BBC signed by hundreds of top mental health professionals.
Many of those on the front line are dismayed and angry at the damage they see being done to patients’ lives, as consultant psychologist Simon Matthews explains:
“People come to see me, usually after they’ve seen a psychiatrist first, where they were told they have a genetic disease, that it’s a lifelong condition and only mind altering drugs can treat it. Many are told not even to bother with therapy as it’s a biological condition.
They come with that narrative and none of it is true. There is no disease, there is no evidence of a biological basis for any condition or any genetic component. And I’ve had plenty of people get better.
Medication is not the only way of treating it – arguably it’s consigning people to a lifetime of pill pushing and their natural ability to self-regulate will be lost.”
The shift towards the ‘medical model’ in the 60s and 70s came at the expense of other interpretations of mental distress. The most celebrated was that offered by the influential psychiatrist RD Laing. He argued that ‘mental illness’ was best understood as a crisis of meaning that needed to be understood and supported.
We are on the verge of a resurgence of interest in these theories, with several plays and books about Laing, and a major film about him set for release next year starring David Tennant.
Alternative perspectives on mental illness have continued to flourish at the margins – with organisations like the Hearing Voices Network, and the Spiritual Crisis Network offering support to people to share experiences and support each other.
Some of the psychiatrists who have done the most deep work in exploring consciousness, such as Stanislav Grof, the father of both holotropic breathwork and transpersonal psychology, have come to very different understandings of mental health and consciousness. In his lecture series ‘Psychology of the Future‘ he argues that altered, transcendent states of mind (he calls holotropic) are extremely valuable and, if carefully managed, can be transformed from a crisis to a powerful healing journey.
“Consciousness does not just passively reflect the objective material world, it plays an active role in creating reality itself”, Stan Grof
Research that points to the failure of the ‘drugs and medicalisation’ model is starting to be heard – including studies that show how recovery rates for most of the major psychiatric conditions is higher in developing countries (3), and how long term prospects for recovery are far better for patients who come off the drugs.
A recent Danish study found that many psychiatric interventions dramatically raised the risk of suicide, and that being committed into a psychiatric hospital raised the likelihood of suicide by a factor of forty-four. The authors hypothesised that the reason could be that – when patients were committed and told by doctors that they had an incurable brain disease, this pushed many of them into taking their own lives (5).
And these perspectives have begun to infiltrate the mainstream. Russell Razzaque is the medical director of an London NHS trust, and also the author of the book ‘Breaking Down is Waking Up’ about the links between mental illness and insights he had in meditation practice. He is pioneering a new form of therapy inside the NHS, ‘Open Dialogue’ which allows patients to take ownership of their care in a new way.
He says that around 80% of his patients describe their experiences in ‘spiritual’ terms.
The way out
Scientists and doctors have begun to speak out against the materialist worldview itself, arguing that it rests on a set of unexplored assumptions that need to be challenged for science to move forward.
A group of high profile scientists published the Manifesto for a Post-Materialist Science in 2014, saying that science was being constricted by a dogmatic insistence on materialism. They called for a more open attitude to scientific practice.
The materialist worldview is looking increasingly out of date, under the multiple attacks on the effectiveness of the drugs and the failures of the medical model to improve the long term health prospects of its patients.
A major shift, from a materialist perspective to one that recognises the primacy of consciousness and finds a place for spirituality, is possible, but there are serious obstacles.
The main one is financial – there are powerful vested interests with large financial stakes in the current system – the worldwide market for psychiatric drugs in 2015 was $88bn.
There is little money to be made in shifting to an understanding around the psychological and spiritual aspects of health care.
But there is hope from another angle – the media perspective on mental health is out of date and ready to be challenged. This film is aimed squarely at challenging the media narrative, using our extensive experience of journalism and the media.
Notes from text:
(1): A series of scientific studies have been done that show how use of psychiatric drugs is correlated with marketing and financial incentives, as James Davies outlines in his forthcoming book: “The primary drivers of this epidemic have had little to do with the their clinical success in rectifying the problems they purport to treat, than with powerful processes of pharmaceutical sponsorship and marketing (Greenslit, 2005; Smith, 2005; Lacasse & Leo, 2005; Donohue & Berndt, 2004), the manipulation and burying of clinical trials data (Kondro & Sibbald, 2004; Turner et al., 2008; Spielmans & Parry, 2010; Angell, 2008), strong financial allegiances between industry and psychiatry (Campbell et al. 2007; Cosgrove, 2006; Timimi, 2008)”
(2): Professor Peter Gotzsche was one of the original founders of the Cochrane Collaboration, recognised as the gold standard in research analysis. He has become more and more outspoken about the damage that long term drug use is causing, saying: “the evidence is clear: not only are psychiatric drugs dramatically overprescribed and overvalued but the harms they unleash completely overwhelm any benefits accrued”.
(3): A World Health Organsation (WHO) study of patients diagnosed with schizophrenia, covering 10 countries, revealed that after the 5 years follow up period the best symptomatic and functional outcomes were not found in the developed countries where 90% of patients were taking antipsychotics, but in countries such Nigeria, Columbia and India where, on average, only about 15% of the patients were taking antipsychotics (Jablensky, et al., 1992).
(4): Prof Martin Harrow has done the most exhaustive follow up studies with patients on long term psychiatric drugs, as reported in ‘Anatomy of an Epidemic’ by Robert Whitaker: http://www.madinamerica.com/2012/02/interpreting-harrows-20-year-results-are-the-drugs-to-blame/
(5): Danish study reported here: http://www.alternet.org/personal-health/research-suggests-psychiatric-interventions-admission-mental-facility-could-increase