A few questions about ‘mental disorders’
How many times have you seen a video on Facebook about mental disorder? How about an over-reaching headline on the same topic, something like “Depression: Solved by science”?
Such communications can be great. They package complex issues into bite-size pieces and keep the public informed about a vital research topic. They also have a dark side.
By oversimplifying things, and showing us lots of images of brains, these kinds of communications instil us, the viewers and readers, with confidence. Confidence that science understands mental disorders and that neuroscience in particular will soon solve them.
Unfortunately this confidence is not warranted. Psychiatry is effectively in crisis, at least in regards to its diagnostic system. The DSM-5 (the Holy Bible big-bad-list of official mental disorders) is riddled with issues and confidence in it is waning. One brief example: there are currently so many criteria for post-traumatic stress disorder that you can meet those criteria in 636,120 different ways.
In 2013, Thomas Insel, then director of the National Institute of Mental Health (NIMH) in the US, put it plain when he said: “Patients with mental disorders deserve better.”
Responding to such issues, many researchers are putting their confidence in neuroscience. Insel himself wrote the above statement while releasing the NIMH’s solution to the diagnostic crisis: a research funding framework called RDoC. RDoC explicitly focuses on understanding the brain, putting topics like culture and values largely to the side. Why? Because the first of RDoC’s stated core assumptions is that mental disorders are brain disorders.
Don’t get me wrong, studying the brain has huge potential, but this is a big assumption. The truth is that the fundamental question “What is mental disorder?” is still hotly debated. It is this question that interests me.
I’ve been working from a school of thought known as 3e Cognition (or sometimes ‘enactive embodiment’). I’ll spare you the details. Effectively, 3e Cognition takes the emphasis off the brain alone and instead considers the whole person – as a brain and body system – trying to survive and flourish within their physical and social environment.
This view recognises the importance of the brain but allows for a more comprehensive perspective; through the brain and body and out to culture and environment. Taking such a perspective, it is difficult to see how mental disorders can simply be brain disorders, as per the assumptions of RDoC. With its broader perspective, the assumptions of 3e Cognition seem a much better basis from which to seek to understand mental disorder.
It can also help us determine what counts as mental disorder and what doesn’t. If you have a heart attack, we can all easily agree this is a bad thing. But the story is different when it comes to mental disorder.
If you are seeing things that aren’t there, this may be psychosis. Alternatively, it might be a valued spiritual experience. These two options are likely to look the same in the brain. But if you consider the person’s culture and values, these are very different things.
I have been trying to show that 3e thinking can help with this distinction. It allows us to talk about the biological stuff going on but also the individual’s values and culture. All under a single scientifically minded framework.
For example, say ‘Mary’ is seeing visions of her dead grandmother. Is this mental illness? 3e thinking would encourage us to ask, “Is this working for this person?” Perhaps Mary values these experiences, perhaps it is helping her with other difficulties in her life.
My PhD has so far been concerned with trying to understand what the concept of mental disorder looks like from a 3e perspective. As I move into the second half of my project, I am starting to shift my focus to the question ‘If this is what mental disorders are, then how should we best seek to explain them?’
The field of mental health is at a crossroads. We have acknowledged many issues in the way we recognise and understand disorder. We need to respond to this, but blind confidence is dangerous in the face of complexity. If we only focus on the brain, I’m sure we will discover some amazing things, but our understanding of mental disorders will remain incomplete, and we will thereby be doing a disservice to those that suffer them.
Kristopher Nielsen is a member of the Explanation of Psychopathology and Crime research lab at Victoria University of Wellington. This article is an adaptation of his presentation as a finalist in the University’s Three Minute Thesis competition. You can read more about his thinking on 3e Cognition here.
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