Friday, October 20, 2023

The futile quest for certainty in treating mental illness

Last week at my church we started a five-week course on Mental Health and Pastoral Care. It is being facilitated by a team with different experiences and expertise, including medical, psychological, pastoral, theological, and personal. I like this as mental health is complex and multi-faceted. My role is someone who has struggled with mental health for most of my adult life and has consequently read and thought widely and interacted with a diverse range of sufferers and carers. Previously, I wrote a post giving a theological perspective on mental health and gave a sermon on the Wisdom of Weakness.

A central idea in the course is that of the four-dimensional character of mental health, and the importance of an integrated perspective. 

This is captured in the figure below from Sanctuary Mental Health Ministries.

A specific case of mental illness provokes two practical questions. 

What are the causes of this specific case of mental illness? 

What will be the most effective treatment plan that will lead to healing? 

These are natural and important questions. The problem is that in most cases the answers are not clear.

In contrast, consider most physical medical problems or when technological device fails. An expert can determine the cause of the specific problem: an infection in the left ear, a broken bone in the right arm, an electrical fuse has blown, or the spark plugs in the car engine are not working. Furthermore, the expert can propose and implement a treatment plan that will solve the problem. Given the advanced state of our knowledge, we can be almost certain that the diagnosis is correct, the treatment plan is appropriate, and that the problem will be solved. This certainty reflects the wonders and blessings of science and technology.

The problem is that the success of the sciences in some domains has led to hopes, expectations, and a myth that similar certainty and success are possible in other domains of life. However, the problem is that human brains are much more complex than ears, bones, cars, and electrical circuits. The relationship between consciousness, brain, and body remains a mystery, and people are embedded in networks of human relationships (from family to global cyberspace) and have long and complex personal histories.

This quest for certainty is driven by healthcare professionals, big pharma, governments, and patients. On the positive side, this quest reflects our humanity in our desire to alleviate human suffering. On the negative side, there are significant benefits: financial, professional, social status, and political to be gained by offering certainty, even when it is not justified. In the case of psychiatry as a science,is the issue of its professional hubris are discussed in this book review.

This quest for certainty is also driven by human desires for quick fixes to problems.

One problem with the diagram above representing the four-dimensional model is that some people, both patients and professionals, will want to locate a specific case of mental illness as being at a specific point on the diagram. For almost all cases that is simply not possible. 

1 comment:

  1. Hi . Time we engaged more with non Christians who are talking OUR stuff but not always taking out theology seriously .
    People like JB Peterson and Mary Harrington Her new book " The Three Principles of Reactionary Feminism " seems to finally address in a punchy way the simple unworkableness of just talking about our need for freedom

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