The language of distress

One of the hurdles critics of biopsychiatry constantly face is the argument that they deny or discount human experience and suffering. People describe their own experiences or those of their relatives and friends in elaborate detail, and demand to know how we could be so cruel as to claim that their “illnesses” aren’t “real.” Not only are the suffering and the experiences tangible, but equally evident is how they seem so clearly to fit with the current diagnostic categories. How can we fail to accept the reality of these illnesses?

I’ve pointed out several times that unless people read more extensively in the critical literature, they won’t understand the perspective of the critics and our repeated assertions that we don’t deny human suffering will sound hollow. Reading this recent article, I was immediately reminded of Ethan Watters’ book Crazy Like Us, which I’d earlier included in my list of readings in psychiatry and social justice.* Scrolling up, I discovered that this is because the article’s written by Watters. In the book (in greater depth, of course) and the article, he draws attention to the cultural-political shaping of psychological “symptoms.” “Viewed over history,” he argues,

mental health symptoms begin to look less like immutable biological facts and more like a kind of language. Someone in need of communicating his or her inchoate psychological pain has a limited vocabulary of symptoms to choose from. From a distance, we can see how the flawed certainties of Victorian-era healers created a sense of inevitability around the symptoms of hysteria. There is no reason to believe that the same isn’t happening today. Healers have theories about how the mind functions and then discover the symptoms that conform to those theories. Because patients usually seek help when they are in need of guidance about the workings of their minds, they are uniquely susceptible to being influenced by the psychiatric certainties of the moment. There is really no getting around this dynamic. Even Insel’s supposedly objective laboratory scientists would, no doubt, inadvertently define which symptoms our troubled minds gravitate toward. The human unconscious is adept at speaking the language of distress that will be understood. [my emphasis]

Since we’re cultural animals, our sociocultural environment affects not only the existence of distress but the particular ways in which it’s experienced and expressed. I’ve been interested to read people’s descriptions of their experiences with psychic distress in which these experiences are characterized in precisely the current “clinical” terms of biopsychiatry. One account I came across recently described a person’s feeling that her brain chemicals were obstructing her ability to be happy. While the chemical imbalance notion is scientifically unsound and there’s no evidence of a brain disorder of depression, I don’t doubt that this was an honest description of her sense of what she’s experiencing. The point is that culture runs very deep, below the level of labeling experience and into the formation of experience itself.

*As I’ve said before, none of these books is perfect, and citing Watters’ book – or his article, for that matter – doesn’t constitute an endorsement of every single argument he makes (or an agreement with the use of the language of “healers” and “patients”).