THE 1990’s: DECADE OF THE BRAIN?

by Mickey Skidmore, ACSW

With the hoopla of the new millennia well behind us, and the promise of a new decade and century before us, perhaps it is fitting that we reflect on the decade of the 1990’s. The decade of the `90’s saw unprecedented technological and scientific advances in the fields of medicine and health care. Even those struggling with mental afflictions enjoyed certain pharmaceutical breakthroughs. However, these advances have contributed to paradoxical message which continues to disenfranchise the behavioral-mental health domain.

In the 1990’s the medical model strengthened its hold on the delivery systems of behavioral mental health care (to borrow a category from the medical model – psychiatry). Furthermore, insurance and managed care companies both complicated and reinforced this paradigm. Political systems lost (or never found) the will to allocate adequate or appropriate resources to address this large and growing aspect of health care. Nor did they stop insurance legislation from their continual efforts to derail mental health parity among standard health care. And thus social systems began breaking down. One need only refer to the recent feature stories and headlines of the Charlotte Observer, the Raleigh News & Observer and others to see the sad state of disorganization, convolution, and mismanagement of the North Carolina state mental health system – overwhelming evidence of a meltdown.

Mental health patients are unlike any medical patient in this regard – when something is terribly wrong, impacting their lives in adverse ways, they seek understanding – often a label (diagnosis), which provides some type of hope for treatment to resolve or improve their condition. In my encounters with hospitalized psychiatric patients during the past decade, I have heard some version of the following exchange thousands of times: “my doctor says I have a chemical imbalance of the brain.”

In the defense of psychiatrists, it should be noted that they (along with other disciplines) have not escaped the violence of reductionism. Although trained as psychiatrists, due to the variables mentioned earlier, they are often reduced to psycho-pharmacologists or psycho-neuro-pharmacologists – seeing patients for 15 minute intervals and dismissing them with a handful of prescriptions intended to address vastly complicated and multifaceted mental afflictions. Pharmaceutical companies have contributed heavily to this trend also, marketing and advertising their “magic bullets” to the public at large. Unfortunately, the message being received is also one which is reduced and oversimplified – all you have to do is take this pill for your mental disorder.

I submit that this message undermines the entire behavioral mental health treatment process. It encourages patients to not take any personal responsibility for change. Furthermore, it is disrespectful to clients in that it disregards their internal, social and spiritual resources that often are as important as any chemical prescribed to assist them. Persons with mental afflictions deserve to be more completely informed about their condition and their treatment options rather than be told a partial truth (“you have a chemical imbalance of the brain”). As vastly complex as the human mind and body is, with few exceptions, it is simply unreasonable to conclude there is one single determinant to explain the complexities of a mental illness. In short, it is an approach that is non-wholistic in nature – one which fragments the human essence. In my own training as a clinician, I was taught to see and treat clients wholistically. Yet the strangle hold of the current health care delivery systems in effect prevents such approaches.

As we advance through this new millenium we must come to terms with the fact that we can no longer separate the mind from the body. This is a concept that has been expressed throughout previous centuries – an idea that at some level has collectively been embraced and is intuitively sound. As we press forward we must return to a behavioral mental health care delivery system with Gestalt underpinnings. We must embrace the biochemical breakthroughs in our understanding of mental illness and recognize the contributions medicine can offer to a more comprehensive treatment process. We must muster the political will to commit appropriate resources to a segment of our health care population that has been woefully and shamefully neglected. We must fight the violent and cruel trend of reductionism in favor of seeing and treating the whole person.

Perhaps by striving for this path, we can look back on this millenium as the century of the “whole person.”