The Myth of Mental Illness

by Gayle Williamson

Introduction

I believe that nothing short of a revolution is needed in how we deal with mental and emotional distress, instead of the stigmatising and increasingly discredited medical model of distress and trauma. This article argues that the counselling and psychotherapy profession needs to encourage a more non-pathologising understanding of mental and emotional distress and by doing so, stop perpetuating the diagnosis culture and ceding expertise to psychiatry (Watson, 2019a). Instead, the counselling and psychotherapy profession needs to value what we have to offer. In my view, an

appreciation of our true multiple nature as human beings (Schwartz, 2021) and the fact that there is a wide range of what can be considered normal about our thoughts, feelings, and behaviour (Davies, 2013; Watson, 2019a; Schwartz & Sweezy, 2020) would go a long way to facilitating much needed change. The aim of this article is to outline the following: the unscientific nature of psychiatric diagnoses (Moncrieff, 2009; Sanders, 2019; Davies, 2019); challenge the prevailing culture of pathologising mental and emotional distress; highlight how counselling and psychotherapy can offer an alternative non-pathologising approach; and to profile the non-pathologising paradigm of Internal Family Systems (IFS) therapy (Schwartz, 2021).

Time for change

I feel the need to write this article in response to the prevailing media narrative that perpetuates what I, and I suspect many others, believe to be the myth of mental illness.

“I have PTSD and borderline personality disorder”

“My disorders are lifelong illnesses and I will never be free of my illnesses”.

I was listening recently to an interview with another mental health expert-by-experience who was pathologising herself, as she had perhaps learned to do from those she had turned to for help.

Despite attempted revolutions in our approach to emotional distress over the past 70 years (Schwartz & Falconer, 2017) our prevailing explanation for things like mood swings, extreme sadness or anxiety, rage, hearing voices or being suicidal remains that there is a fault, a chemical imbalance or disease in our brain that needs psychiatric drugs in order to be fixed (Davies, 2013 & 2021; Moncrieff, 2009).

The psychiatric profession and pharmaceutical industry have done an incredible job, to their own benefit, of constructing a biomedical model of distress, marketing biased and deceptive research (Lynch, 2001; Davies, 2021), and ensuring it has become entrenched not only in the professional sphere but in wider society. Diagnostic terms are widely accepted and well known - ‘bipolar disorder’, ‘ADHD’ or ‘OCD’ - and some cause a lot of fear, such as schizophrenia and borderline personality disorder. We have been taught to think of addictions to alcohol, drugs, or food as diseases instead of as attempts to cope with overwhelming emotions (Schwartz & Sweezy, 2020) or unsupportive environments (Hari, 2019). I sometimes wonder, too, about the amount of children labelled as having ‘ADHD’ (Davies, 2013) and interestingly, the woman who pioneered ‘autism’ as a diagnosis, Prof Uta Frith, expressed her concern recently over how elastic the diagnosis has become (Jourdan, 2021). Of course, many parents are forced down the diagnosis route if they are to qualify for extra support.

CAMHS scandal

The scandal uncovered last year in the Irish Child and Adolescent Mental Health Service (CAMHS) highlights just how flawed the approach to mental health is. Hundreds of children in south Kerry were exposed to significant harm after being given random diagnoses and then prescribed psychiatric drugs, including anti-psychotics. For example, when interviewed, ‘Paul’, a young service user, described having found talk therapy very helpful. When reviewed by one doctor in particular from south Kerry CAMHS however, he was prescribed psychiatric medication before any diagnosis was confirmed (Lenihan, 2022). Paul then described how his medication was adjusted and changed, sometimes without the doctor seeing him in person. Eventually he collapsed and was admitted to hospital. Among the alarming findings of a subsequent interim report by the Mental Health Commission in January this year (MHC, 2023) investigating the CAMHS service across the Irish state were that children were left on anti-psychotic medication for years without review.

While we don’t fully know how anti-depressants or anti-psychotic medications really work (Moncrieff, 2009; Davies, 2013), the fact is that sometimes they may be the only option. If psychotherapy or counselling waiting lists are too long, if personal resources to avail of private therapy are not adequate, or if a person simply needs to be able to function and look after their family or continue to work, then medication may be needed. But personally, I do not believe we should give psychiatric drugs to children or young people whose brains are still developing - something that feels particularly shocking when you read about the effects of anti-psychotics (Moncrieff, 2013). One of the myths we’ve been sold is that smaller brains are a symptom of ‘schizophrenia’. However, as prominent critic of the disease- centered model of psychiatric drugs, Joanna Moncrieff, a UK psychiatrist and academic, writes in her book The Bitterest Pills (2013), rather than smaller brains being intrinsic to ‘schizophrenia’, it is actually the anti-psychotics themselves that cause brain shrinkage, among other serious side-effects (Dorph- Peterson et al., 2005; Moncrieff, 2013; Read & Magliano, 2019).

Non-scientific

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the bible of diagnoses. But it’s actually a nonsense (Moncrieff, 2013; Davies, 2013; Johnstone, 2019; Horwitz, 2021). The current edition, DSM 5, lists about 370 kinds of disorders - there is no end to the number of ways we can pathologise what are actually forms of thinking, feeling and behaving (Sanders, 2019; Johnstone, 2019) as though there is only a narrow range that is ‘normal’ in human beings, as though we aren’t the complex and amazing creatures that we are.

What isn’t perhaps widely known is that the DSM, which encourages us to view our clients as inherently damaged, is probably the most deceptive and unscientific of publications (Davies, 2013). It has been widely criticised since it first appeared in 1952 and is essentially put together by highly secretive committees of psychiatrists and other health ‘experts’ whose main way of coming up with disorders and their symptoms is subjective opinion (Davies, 2013; Horwitz, 2021). Somewhat incredibly, they take a vote on the criteria; there isn’t any supporting neurobiological evidence despite decades of trying to find it and many members have financial ties to the pharmaceutical industry (Davies, 2013; Horwitz, 2021).

Social scientist Allan Horwitz’s 2021 book, DSM: A History of Psychiatry’s Bible, gives a comprehensive, eye-opening, and admirably objective account of the rise of the DSM and finds that the manual is a highly flawed social document that has essentially created mental illness. The fact is there are no biological hallmarks for psychological disorders, and there is no medical test you can take to confirm the existence of a mental ‘illness’, unlike with physical illnesses (Moncrieff, 2013; Davies, 2013). The theory that depression was caused by a chemical imbalance has also been comprehensively debunked in a recent umbrella review of decades of research (Moncrieff et al., 2022). Much of what the DSM, published by the American Psychiatric Association, calls symptoms of illness can also be interpreted as survival strategies. Any behaviour, thought, or feeling, makes sense as a normal health-seeking or survival response when you consider a person’s wider context (Lynch, 2019; Watson, 2019b; Schwartz & Sweezy, 2020).

Non-pathologising approach

Internal Family Systems therapy, developed by Richard Schwartz, the popular and non-pathologising approach I use in my practice, takes this view. Essentially, the IFS model of our minds is that we are all ‘multiple personalities’. The ‘multiple personality disorder’ diagnosis has much to answer for - it’s the one that seems to have kicked off the diagnosis culture (Schwartz & Falconer, 2017). But it turns out we are all born with lots of personalities inside of us, or what IFS calls ‘parts’, and that this is normal, not a sign that you are ill or crazy. Some of our parts carry our pain and distress, and the others try to protect us from that pain in all kinds of ingenious and sometimes distressing or extreme ways (Schwartz & Sweezy, 2020). And just under all our parts is a core, compassionate Self that is capable of healing or transforming all our parts. We are all inherently good, not basically bad (Schwartz, 2021).

Dehumanising

What is really concerning is that studies have found that if a mental health professional learns that someone has a diagnosis of a ‘biogenetic condition’, this is enough for them to view the person as somehow less human, potentially dangerous, and not the same as them (Lebowitz & Ahn, 2014; Larkings & Brown 2018). The research found that humane and compassionate responses were then inhibited, and dehumanising interventions used.

If you understand that a person who is experiencing hallucinations, episodes of rage, obsessive behaviours or thoughts, or extreme mood swings, has a part who is causing this behaviour and that this part is doing this to try and get their attention or protect them in some way, then that’s very different. It is a part I can help the person to talk to, address its concerns and offer it options. It means that I’m never thinking of a person as ‘sick’ or ‘mad’, rather I’m seeing a part of a person that is doing its best to help them, as well as other more vulnerable parts inside them that can be healed.

Discussing a topic like this with a client can be fraught as many people are often attached to their diagnosis. As Allan Horwitz (2021) writes, one of the main reasons why the DSM endures is because of the many interest groups who depend on its diagnoses to access care. Also, those with mental health difficulties often pick up messages from society that they are somehow weak or at fault. If, for example, you are told you have ‘bipolar disorder’ due to a chemical imbalance, then you can perhaps feel reassured that you’re not weak or somehow to blame for your symptoms. Then if someone like me questions the label, it can raise a lot of defensiveness.

No blame

I am in no way seeking to make individuals feel bad or to invalidate anyone’s distress, rather the opposite. I am trying to highlight the actual causes of their very real distress, get rid of the stigma and scientifically invalid labels and facilitate more compassionate and effective treatment. I believe the cause of much mental and emotional distress is usually trauma - the kind that happens in relationships. We know that healthy brain development needs lots of eye contact, attunement, consistency, and responsiveness from primary caregivers. If this is lacking, then children will develop signs of this trauma (Siegel, 2002). But today’s parents were once children themselves who suffered their own relational traumas. Now that we understand more about the intergenerational transmission of trauma (Frankl, 1984; Siegel, 2002; Wang et al., 2022; Mate & Mate, 2022), or what we call legacy burdens in IFS (Schwartz & Falconer, 2017; Schwartz, 2020) it seems more compassionate for all of us to be aware of our own emotional scars and how we may pass them on, instead of just focusing on the child or the individual as the problem to be fixed.

Alternatives

So, what is the alternative to what some claim are scientifically invalid diagnoses? Well, various options have been emerging in recent years, including the Power, Threat, Meaning Framework, developed by UK-based psychologists, which places the focus on listening to what has happened to someone, rather than on what is ‘wrong’ with them. It identifies ‘general patterns of distress’ based on people’s difficulties, life experiences, social factors and power dynamics, not biology; and it can still offer the validation and pathway to supports that some people seek through a diagnostic label (Johnstone & Boyle, 2018).

A move to psychotherapy concepts of co-created healing and cure is another alternative framework to the psychiatric model. Unlike the psychiatric approach involving symptom numbing and the [mis] management of understandable human suffering, the psychotherapy approach recognises that, in fact “suffering is often the precondition for positive change” (Davies, 2019, pp. 285-6) and it works with underlying root causes.

Psychedelic-assisted psychotherapy, which is getting closer to being a legal option in the UK (Jackson, 2023), is another potentially positive new avenue for healing. As UK psychiatrist Ben Sessa, a leading researcher into psychedelics, said in a recent British Medical Journal article:

Current prescribing [in psychiatry] is what we call maintenance prescribing - you take this antidepressant day in, day out for weeks, months, decades, which has the effect of masking symptoms but not treating the core illness. … Whereas cure - if we use the ‘cure’ word, which strangely we don’t in psychiatry - only comes from psychotherapy. It only comes from tackling the trauma that is the root cause of most chronic unrelenting mental disorders. (Jackson, 2023, pp. 19-22)

Personally, I would love to see a world where instead of a parent describing their child as having ADHD, they could simply say “my child struggles with social cues and paying attention” and then still get any assistance they may need. Or instead of someone saying they have a personality disorder, that they just said something like “a few things went wrong in my childhood and so I sometimes get anxious and sad”. Let’s just start saying it like it is and Drop the Disorder, (Watson, 2019a).

Conclusion

Unfortunately, I didn’t always know everything I’ve written about here. Counselling and psychotherapy training courses, despite their focus on the therapeutic relationship and humanistic values, often continue to perpetuate the diagnosis culture (Watson, 2019b). It’s only through my own work and research that I came to fully understand the scandal that is the medicalisation of emotional distress and normal feelings. Even though the DSM has now been widely discredited, psychiatrists continue to cling to it to protect their profession, to protect the illusion of their greater expertise and justify their high fees (Davies, 2013). But I think we in the counselling and psychotherapy profession need to play our part in raising awareness of this increasingly untenable medical model of distress and trauma by really valuing our own expertise and insight and stop deferring to psychiatry.

Gayle Williamson (MIACP) has written widely on mental health. She presented a workshop on IFS for the IACP last year; and runs online IFS trainings and group supervision. www.ferneytherapy.ie.
Further information: disorder4everyone.com - a UK-based movement challenging the culture of psychiatric diagnosis since 2016. www.ifs-institute.com

References: 

Davies, J. (2013). Cracked: Why psychiatry is doing more harm than good. Icon Books.

Davies, J. (2019). Deceived: how Big Pharma persuades us to keep taking its medicines. In Watson, J. (Ed.), Drop the disorder! Challenging the culture of psychiatric diagnosis. PCCS Books Ltd.

Davies, J. (2021). Sedated: How modern capitalism created our mental health crisis. Atlantic Books.

Dorph-Peterson, K. A. et al., (2005). The influence of chronic exposure to antipsychotic medications on brain size before and after tissue fixation: a comparison of haloperidol and olanzapine in macaque monkeys. Neuropsychopharmacology, 30 (9): 1649-61.

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