Beyond Mental Illness


If you want to change the world, you have to change the metaphor.
Joseph Campbell

Why is mental illness appearing earlier and with more severe symptoms than 20 years ago? Why is autism increasing at such an alarming rate? Why is the average life span of a mentally ill patient 25 years less than the rest of us? An increasingly sophisticated, skeptical and alarmed public wants to know. These days we need far less than six degrees of separation before we find children, grandchildren, parents, husbands, wives, friends and colleagues who are suffering from mental illness. Mental illness touches all of us.
Even though we mental health professionals claim progress in assessing and treating those who are called mentally ill—after all, we no longer house most of our mental patients in institutions—government statistics report a fourfold per capita increase in patient care episodes since the 1950s, when modern psychotropic drugs were first introduced. Too many are suffering. Too many are being managed. Too few are being definitively treated. Such is the state of mental health care in this country in this, the second decade of the 21st century. This care is based on the latest version of the Diagnostic and Statistical Manual (DSM). It is called the DSM-5. For the foreseeable future, this book will define mental illness.
Mental health professionals use terms like “wellness,” “resilience” and “recovery” to describe the promise of mental health care. The words foster public relations and secure funding for grants. However, they obscure reality. Current treatments ameliorate. They do not treat. Too many patients are chronically ill for life.
In my 28-year Air Force career as a clinical social worker I provided services to clients in inpatient and outpatient psychiatric treatment settings. I managed child and spousal abuse prevention and treatment programs. I served as the Chief of Mental Health Services in a community of 15,000 at Clark Air Base, Philippines. I served as Social Work Consultant to the Pacific Air Force Surgeon, advising mental health professionals throughout the region regarding their programs. I worked in the Department of Social Services for the State of California, Behavioral Health Services for Nevada County and Municipal Probation Services in Seattle. After a long career in the mental health industry, I have seen enough suicides and murders to appreciate the limitations of our craft.
I have dealt with “mental” illness professionally, in diverse settings, and also in my own family. I grew up with a father who was diagnosed with a mental disorder. I am the father of an adult son diagnosed with a chronic mental illness. I have professionally and personally experienced a gap between the promise and the reality of mental health care. I write to help bridge that gap. This book, an exploration into the future of mental health care, is the third in the “Transformation Trilogy.”
The first book, “Too Good to be True? Nutrients Quiet the Unquiet Brain,” was published in 2003. This true medical detective story describes my family’s four-generation bipolar odyssey and explored new ways to assess and treat bipolar disorder. The second, Ten Ways to Keep Your Brain from Screaming ‘Ouch!,’ was published in 2013. It describes practical interventions to prevent brain dysfunction.
This third book challenges the prevailing mental illness paradigm of the DSM-5 and offers ideas for a new one. Part I, “How We Got Here,” examines the evolution of psychiatric diagnoses, the influence of corporate/government practices and the promise of personalized care. Part II, “Where We Are Going,” explores a future where the traditional mental disorders are viewed as biobehavioral syndromes. It describes innovative “out-of-the-box” diagnostic terms for the layman while providing meticulously researched treatable biomarkers for the health care professional.
The prototypical diagnoses created for this book are designed to pique your interest. They describe, in layman’s terms, what a biomedical-based diagnostic system might look like in the future. Professional equivalents are in parentheses. No professional bodies have recognized or accepted these terms as discrete diagnoses. I present them as if they are valid biomedical disorders because my research supports that they are. After reading this book I think you will agree that if the goal is definitive treatment rather than management, the disorders in this book are more biologically accurate and more clinically useful than the mental disorders of the DSM-5.
This book contains useful treatment ideas but it is not a treatment manual or a psychiatric textbook. It is not meant to replace the DSM-5, but it does portray a future where accurate biomedical diagnoses lead to effective treatments. I believe that psychiatric diagnoses will eventually move us from “mental” towards physical, that is, beyond mental illness.
I once told the leader of an alternative mental health care movement that my son’s brain was broken. He told me that my statement was discriminatory. I told him it was a biological fact. What we call mental illness is biological. Psychological stress, that is, stress of the psyche, is the body’s biological stress response. It plays a role in biobehavioral syndromes. Dr Avi Peled from Israel writes the obvious, but often neglected, truth, that the brain is physical. It is subject to understanding through mathematics and physics. He argues that a re-conceptualization of mental disorders as real brain disorders is needed. Such a system would not only provide a diagnostic system based on etiology but also provide a means to develop curative interventions. Moving beyond mental illness is happening slowly—much too slowly.
Ongoing discoveries about the brain challenge our perceptions of, and responses to, “mental” illness. Existing diagnoses impede our ability to integrate that knowledge. As the literature attests, no one knows what causes the major psychiatric disorders. However, the measurable and treatable biological conditions that cause symptoms are becoming increasingly understood. A diagnostic system based on biomedical assessment offers a path toward curative treatments. This book is written to invite both healthcare providers and patients to question assumptions that we in the mental health industry and in the public have taken for granted for far too many years. My research includes hundreds of academic, highly technical reports. These reports, as befits academic writing, are narrow in scope. This book translates these exciting discoveries in brain research so that health care providers, patients and their families can benefit from them.
The theme in all three books is this: “To transform your life or the lives of your patients, first transform your labels.” The Transformation Trilogy envisions a future when health care providers perform personalized biomedical assessments. They will treat the biomedical conditions that contribute to what most of us still call mental disorders. They will move beyond mental illness.
Some of the topics are outside the traditional boundaries of a book on mental health issues. A broader perspective of the forces promoting health and sickness is needed in order to understanding the declining health, including brain health, in the citizens of this country. You will not find the traditional separation between physical and mental illness in this book. Instead, we will use a biomedical perspective, shifting frequently as we reframe traditional mental disorders and the physical disorders linked to them.
These books approach assessment and treatment from a different perspective—a radically different perspective compared to the one that shaped my professional life. As a provider and consumer of mental health services, I know too well the limitations of our current service delivery system. You may be wondering why a clinical social worker would wander so far from his area of expertise to write a book such as this, especially when the brain and its pathways are so complex. In seeking help for my father, and then my son, I, like millions across the country, felt hopeless and powerless. I had to rely on health care providers who were often less than helpful. I searched for answers to the questions beyond the DSM series. I applied the social work perspective of “person in situation” to a broader context, the mental health professional in the culture. So, I have written a book designed to be populist enough for patients and their families and academically rigorous enough for mental health professionals.
A tipping point is coming. When it occurs, fewer will be managed and more will be definitively treated. Fewer will suffer. They will be treated for what is biologically wrong with them, not their behavior-based labels. I hope that this book will contribute towards a tipping point when the managed “mental” diseases of today give way to the cured biobehavioral syndromes of tomorrow. If you are as concerned as I am about the assessment and treatment of your patients, loved ones, or yourself, this book will be of use to you.