The March 2013 Walrus magazine featured “The New Normal: The Mainstreaming of Mental Health” an article describing current psychiatric care and research as embodied in the new buildings and grounds at the Centre for Addiction and Mental Health (CAMH) on Queen Street West in Toronto. I wrote a letter critiquing this article which is published in the current (May 2013) Walrus. Sadly, what was published was cut by half. So, for the record and even though it’s not about art, I’m posting my entire response below. The original article can be found in the March 2013 Walrus copies at many Toronto Public Library branches or in a back issue available for purchase on the Walrus website.
The May 2013 issue of the Walrus also includes an article on “Psychiatry’s Bible: What’s Wrong with the New DSM-V.”
Dear Walrus, In “The New Normal,” Rachel Giese writes of our hope that neuroscience will provide “. . . a neat fix for what feels most irrational and inexplicable: our emotions and temperament.” After nearly 40 years as a clinical psychologist, I am not so hopeful. Compare mental illness to HIV/AIDS. HIV/AIDS was virtually unknown in 1980, yet in a little over 30 years, the symptoms and course of the illness, underlying biological mechanisms, infectious agent, modes of transmission, means of prevention, and effective treatments have all been delineated. The outlook for a person living with HIV infection is now much better now than in 1980, and much has been done to limit spread of infection.
Psychiatric conditions have been investigated for more than 100 years, and present diagnostic categories used, with some refinements, for over 40 years. Breakthroughs remain, however, “just around the corner” with little more known about causes, course, treatment or prevention than what was known when I began my professional career in the 1970s. Diagnoses such as schizophrenia or major depression are simply names for symptom clusters. Years of research have shown that things are complex and that individuals likely come to the same diagnosis by a variety of different paths. Psychoactive medications sometimes help in the way that aspirin help to reduce fever, i.e., alleviating symptoms without addressing underlying causes. Could it be that “illness” is a construct with limited usefulness in naming and responding to what we call mental health difficulties?
I’m far more hopeful about healing and recovery-focussed approaches that emphasize helping each person to achieve as much wellness and wellbeing as possible through caring relationships and activities such as psychotherapy, exercise, healthy eating, creative arts, and meaningful work. The 2006 Senate report, Out of the Shadows at Last, recommends the recovery model as the basis for mental health reform in Canada. The new CAMH grounds appear to provide much improved support for recovery and Ms. Giese’s closing paragraphs beautifully illustrate the power of recovery-oriented values and attitudes. Wish the article had explained more about this powerful alternative to an illness model.
Rosemary Barnes Psychologist, Toronto, Ontario