Is It Time for a Paradigm Shift in Mental Health?

“Insanity is doing the same thing over and over again but expecting different results.” – Albert Einstein

I just returned from visiting one of my best friends currently living in a mental health facility in the Midwest. Mike grew up in a difficult, unstable family situation that would have pushed any precious child into a state of high alert. After seeing his first professional at age 5, he was placed on Ritalin for the next four years – with dosages increasing to a point that he remembers having visual hallucinations for the first time.

This understandably frightened him and those trying to support him – prompting additional treatment at a young age from anti-psychotics, which got titrated up over the years as the lower dosages wore off.  Although helping with the delusions, these caused shakes, muscle spasms, and sedation.

Since his mood was often low, an antidepressant was eventually added.  Since his mood was sometimes manic, a mood stabilizer was also added. Since all this led to some anxiety and agitation, an anti-anxiety drug was added.

I have little doubt in my mind that every professional trying to help my dear friend over the years has done their best – and offered what they understood might best help him find healing.

But as I sat with my pale, thin friend last week, I saw a painful reminder of what many others have been discovering in their own uncomfortable ways. Whatever short-term benefits people may have had from conventional treatment support, the long-term picture is not always so ideal.

Mike stares with glassy eyes, and now shakes permanently. His affect is muted, except when he expresses rage and anguish over his current forced institutionalization: Am I ever getting out of here? 

I can’t give him a straight answer. I speak of how loved he is by so many, including God – and reassure him one day his dreams of marriage and family can come true, even if that’s in the next life.

Is that the future his doctors imagined when they earnestly sought to help him at a young age?

Of course not. And of course parents envision something more hopeful and positive than chronic, life-long illness.

And yet, that’s what more and more precious brothers and sisters seem to be experiencing today. Why?

There are two main explanations – one you’ve probably heard. And one you probably haven’t.

The first:  This is just how serious mental illness is. Over the last several decades, we’ve gradually come to speak of mental illness as a chronic condition centered on semi-permanent imbalances in the brain. Patients and their parents are now regularly encouraged to go through a process of acceptance that they may need to face this the rest of their lives.

That may be true.  If so, why would these conditions be increasing though? The usual response:  It’s not that we’re seeing more of these problems, we’re just being more honest, up front and aware about them. Such widening awareness should be embraced as a positive, albeit painful step forward, this argument goes – and a corresponding expansion of treatment access needs to continue.

Thus, community leaders have been advised over recent years by prominent psychiatrists that the problem behind the teen suicide epidemic is lack of treatment. If only we could get more teens in contact with services, we’d surely see a stabilizing and decrease of numbers.

The problem with this argument is substantial.  Namely this:  we have increased treatment – for years and years. And during this same period, rates of virtually every mental health condition have increased sharply – as has suicide itself.

Nobody wanted that to happen.  Just as no one wanted my dear friend to end up permanently disabled.

But inadvertently, in spite of much better intentions, it’s all happened. That brings us to the second explanation for this expanding burden of mental/emotional distress:  that it’s emerging not from the fundamental nature of the illness itself – but from the way we are approaching and responding to the problem.

While the first explanation calls for an expansion of the existing approach, the second explanation calls for a thoughtful revaluation and reappraisal. Pausing long enough so we can get down on our hands and knees and reexamine everything we’ve been assuming – about the brain, about what’s causing the pain, and about healing itself.

In his famous book, the Structure of Scientific Revolutions, Thomas Kuhn argued that science progresses not just linearly – but in more dramatic transformations he called “paradigm shifts.”

Is it time for that to happen in mental health today?

Yes….past time! The current paradigm has not led to the results that we have earnestly, desperately sought after.  And it’s time to have the courage to face that fact.

The good news is there are many other ways to work through emotional pain and get at the roots of some of what’s contributing to it in the first place.  The entire Council for Sustainable Healing effort aims squarely at educating and connecting people around just that.

In my attempts over recent years to draw attention to these possibilities, I have with remarkable consistency been ignored and written off by those within the medical  community or with authority to make a big difference.

And I get it. Paradigm shifts are not comfortable.  They’re potentially disruptive.

But look around:  is this really what we want to continue?

If not, we’ve got two choices ahead of us:  double-down on the existing approach (decreasing stigma, expanding access, etc.) or considering another approach entirely.

I pray we’ll have the humility and courage to consider an alternative.

It’s time.


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