I would say it boils down to this: I believe that mental illness is fundamentally different than infectious disease and defects and injuries to organs, and it is not productive to treat them as fundamentally alike.
If that makes me part of the problem, I guess it's not clear to me what the problem is.
I will try to answer you authentically. Your belief is not necessarily a problem. Every illness is different; that's not really debatable. The problem is how you treat people who suffer from an illness.
Imagine a friend is lying in bed and refuses to get up and go to work.
Let's go through some scenarios:
1) His pelvis is broken from a recent car accident.
2) He has a fever and fatigue from the flu.
3) He has testicular cancer and is recovering from yesterday's chemo.
4) He is depressed.
These scenarios are all fundamentally different. It's common for people to have sympathy in scenarios 1, 2, & 3: "Of course you can't get out of bed, poor fella'. Anything I can do to help?" It's common for people to be skeptical and annoyed by scenario 4: "Why won't you just get out of bed? What is wrong with you? Jesus, go for a walk or something. You need to get your act together."
These responses are caricatures, but they represent "the problem" that often results from people saying they believe "mental illness is fundamentally different." Mental illness is not identical to other illnesses, but to the sufferer, it is just as real and just as debilitating. The problem is that people treat it as less real – not a disease but more of a personal failing that needs to be overcome. You wouldn't tell a cancer patient to just get over it, but for many types of mental illness that is society's attitude.
You wouldn't tell a cancer patient to just get over it, but for many types of mental illness that is society's attitude.
Of course, because we understand how cancer works, enough to know that wishing it away, or meditating, is unlikely to address the problem, and has not been scientifically demonstrated to fight cancer.
There's a spectrum of severity and causes of mental illness. In some cases a patient needs to be medicated just to be able to get through a therapy session; in slightly less severe cases therapy can be tried first, but perhaps without medication the patient will never be normal. In a lot of cases, I think probably the majority, patients on psychotropic drugs could improve well into the normal range through therapy alone without meds. And there are cases where a particular social environment—like a middle class urban lifestyle, trying to make ends meet—may cause certain psychological disorders even when the same people in a different environment would be perfectly happy. Especially in that latter case, can that be called a "disease"?
If psychological intervention or environmental change is enough to turn someone normal, what does it mean to label them "diseased" before the intervention... particularly if the "disease" was due to bad prior psychosocial development (bad parenting and/or bad school/peer environments, generally), rather than genetics or something in the air or water? In other words, if the same person had grown up in a different social environment, or in a different culture, and failed to develop the psychological illness, can it be called a disease or illness at all?
(Of course, availability of professional therapy, or peers or parents who know how to intervene productively, may not exist in many cases. That's a separate issue.)
Psychiatry does not really distinguish the forms of psychological disease based on their likely cause, nor on whether they can be treated to acceptable norms without medication. I think that's what frustrates a lot of people who either object to, or are uncomfortable labeling DSM diagnoses as illnesses or diseases.
Very Well Said, but I would add...When it comes to Bipolar, not getting treatment and not getting medicated is extremely dangerous for everyone around you.
This mentality that its not a physical ailment literally has caused numerous suicides, spousal abuse, violent episodes, etc...
All completely avoidable if they were medicated and treated.
Thinking of mental disorders as fundamentally different leads people to fear seeking out treatment, which is the real problem.
I see what you're getting at, but a number of mental disorders are actually purely biochemical in nature, and not the result of psychological trauma. Treatment and diagnosis of these diseases would be nearly identical to the treatment of infectious disease or other internal medical issues if our diagnostic tools were better...
The problem is that there is clear treatment available for many of these disorders, especially when its a result of a chemical inbalance.
However, people with your belief structure make it stigmatic to seek treatment, because they, like you believe that "its just in their head" that its just a "subjective experience".
The very idea that "its something wrong with you" as opposed to "being ill" is what makes people fear treatment. Very helpful and real scientific treatment for their ailments.
I think you're applying an extremely narrow and inconsistent criteria for deciding what is and is not a disease. Humanity as a whole, in the modern era, does not know how to treat mental health issues very well. We don't know what causes them, and we don't know how to fix them. Yes, for the most part, it's guessing. That's why there is no strictly scientific diagnosis system. But that doesn't mean there isn't a physical cause, It also doesn't matter a hill of beans to anyone that needs treatment for or treats mental illness. And neither is this distinction true for all mental illnesses, nor is it limited to mental illness, nor is it criteria for excluding an illness as a disease.
You're also misunderstanding the role that treatments for mental illness play. Psychoanalysis, meditation, medication, many of our current treatments for many mental illnesses do not cure you. Neither do most of the drugs we use for other, infectious diseases. It's akin to taking cough syrup when you have a cold; it just masks the symptoms until the disease goes away. Valtrax doesn't cure herpes, it just pushes it down and out of the way so the sufferer can live a more normal life. Cutting out cancer doesn't necessarily cure you of it.
The entire notion of "cure" is specious to begin with. There aren't any magic potions you can drink that restore your HP and get you back into battle. The only thing that makes sense to talk about is treatment. Treatment varies between all diseases, all patients, and over time for that patient.
For me, getting enough sleep, eating well, and staying hydrated properly are all parts of my treatment for depression and anxiety. They don't cure. I can have a bummed out day where I don't want to get out of bed even if I've been taking care of myself perfectly, just the same as I can still get a cold if I'm washing my hands religiously. But if I don't keep up with taking care of myself, it happens significantly more often.
The problem is that there are people who are suffering who could be treated and they are not seeking treatment because of social stigmas around treatment.
The brain is an organ, and medical terminolgy is very clear that something like major depressive disorder is a disease that adversely affects that organ.
This is medical science. Its really not up for debate. If you are really questioning the entire field of medical science and the vast corpus of research on mental illness, the only people who will take you seriously are lay-persons.
And thats precisely the problem. While I trust you mean well, attitudes like yours are extremely dangerous because they increase stigma and disuade people from seeking medical help for treatable illnesses.
The question of mental illness is much more complicated than that. This is an issue with a rich and long history and shoe-horning mental illnesses into biological diseases (I suspect) will prove to be a foolish error historically. It's wishful thinking.
It's true that yes, biochemically, the brain's abnormal activity often correlates with subjective experience. But a) the subjective nature of the condition is what makes it so damn tricky and b) we don't know what's causing what. It could easily be the case that an individual (organism) in a bad (social) environment leads to a biochemically abnormal brain state. Treating the brain state is like playing whack-a-mole. There could also be complex feedback loops. We don't know. We're throwing shit at the wall right now.
Though there is good evidence for the basic nervous system strengthening properties of SSRI's, there's also very compelling evidence that SSRI's have absolutely zero impact in credible, controlled studies. From my personal experience and observations, I believe SSRI's can be good at 'stopping the bleeding', which sits well with why they are often known for having a dampening effect. But that will only get you so far, because there's no set way of determining what 'cured' is. There's no such thing as normal in the same way that it's normal to be free of strep throat. Functioning and succeeding in society has positive qualities, but can sometimes be at the expense of individualized growth and healthiness.
The point is, mental life is really complicated, and possibly wrapped up in broader, deeper things like spirituality, love, and economic and social conditions. Your bio-reductionist view (which isn't an insult, it's simply the view of much of the middle to upper middle class) doesn't match reality in my experience. I've found that most people suffer deeply with modern conditions (the less neurotic they are, the less they're aware of the causes of their malcontent) because there are fewer sources of authority, purpose, or truth. A la carte medicine and treatments won't solve that.
Besides all that, the drug industry just stinks of hypocrisy and deserves its popular skepticism. If a sufferer is to experiment with drug treatments, ayahuasca (and similar) should be legal and just as available as XYZ SSRI's.
If that makes me part of the problem, I guess it's not clear to me what the problem is.