On the Verge of a Nervous Breakthrough?: Interpreting Mental Illness

A highway patrol officer straddles a woman who lies on her back by the side of a highway. His arm lifts high into the air, then, with what looks like substantial force, he strikes her in the face with his clenched fist. He does this over and over again.

Early in July, news programs around the country quickly spread the story of a California Highway Patrol officer caught on videotape violently beating Marlene Pinnock, a 51-year-old homeless, presumably mentally ill, woman, along the side of a freeway in Los Angeles. The California Highway Patrol claimed that the officer was only trying to stop the woman from walking out into traffic, yet journalists across the U.S. decried, in one writer’s words, “the lack of training given to law enforcement officers to handle such people, even though officers all too often are society’s frontline mental health care providers.”

I’d like to suggest that the brutal beating of Marlene Pinnock signals more than a deficiency in police ability to handle people perceived to be mentally ill. In fact, the intensity of the violence in this incident reflects larger cultural attitudes towards mental illness that have developed over the last several decades, attitudes that see mental illness as primarily rooted not in psychosocial interactions but in genetics and in the neurochemical processes of the brain. One might think that defining mental illness as above all neurobiological would help remove personal blame and thus stigma from those who experience it. A 2010 study, however, shows that the more interviewees believed mental illness to be rooted in neurobiological systems, the higher the odds were that they would stigmatize those defined as mentally ill.[1] One explanation for this might be that “such people,” as the journalist above refers to them, are seen as being fundamentally, unreachably different.

The National Institute of Mental Health (NIMH), the primary source of funding for research into mental illness, promotes a focus on brain neurochemistry in its 2008 strategic plan, which is still active in 2014. This strategic plan is based on a historiography of mental health research in which the achievements of the past few decades lead logically to the brain science projects being done in the present. These in turn point to the neurophysiological and genetics discoveries of the future, which will produce wonderfully effective new medicines. In this narrative, “a critical acceleration began in the 1970’s and 1980’s when researchers began making rapid strides toward understanding the science of human behavior and the ways in which medicines can be used to treat illnesses. In the 1990’s, the “Decade of the Brain” yielded insights into fundamental aspects of how the brain works, including new ways of visualizing the brain with imaging technologies.” By asserting that these advances “have set the stage for the current era which might be called the ‘Decade of Discovery,’” the NIMH’s historical narrative suggests that only now, with the invention of technologies “scarcely imagined 10 years ago,” are scientists finally on the verge of “breakthroughs for people with mental disorders.”[2]

Ignoring altogether investigations of mental illness that explore social, political, and economic injustice and inequality, the NIMH’s strategic plan depends on the premise that “the elaboration of observed behavior, which includes such aspects as cognition, emotions, social interactions, learning, motivation, and perception, are the observable ‘tips of the iceberg’ in reflecting the expanse of complexity further revealed in studying genes, proteins, cells, systems, and circuits.”[3] This language rhetorically subordinates behavior to neurobiological systems, where the true, “complex” sources of mental illness lie. If these sources can be fully understood, new treatments—presumably chemical ones—can be developed that will have a positive effect on the visible behavior (the “tips of the iceberg”) of the mentally ill. The iceberg metaphor makes clear that the brain sciences, rather than the social sciences or humanities, offer the more complex, more promising, more serious field of study.

To further underscore the focus on brain science, in a listing of prioritized areas within the “Division of Neuroscience and Basic Behavioral Science”, NIMH encourages plans for global health research on “genetic variants, epigenetic mechanisms, and gene-environment interactions that influence vulnerability to mental disorders, endophenotypes, and pharmacologic response profiles.” As Ethan Watters points out in Crazy Like Us, mental illness around the globe can represent a gold mine for pharmaceutical companies.[4] While the NIMH language may nod to cultural variation, in the end, a Western scientific model, with its focus on functional brain imaging and genetic analysis, is being put forward as the best frame for understanding and then treating mental illness worldwide.

Remarkably absent from this list of research foci is study of the relationship between mental illness and sociopolitical-environmental factors such as poverty, food insecurity, exposure to war, displacement, or family disruptions caused by any of these powerful forces.

In contrast, if we look back at the NIMH of the 1960s, we’ll find encouragement of a wide range of research interests. A 1962 newsletter of the American Anthropological Association includes an announcement urging anthropologists to apply for NIMH funding. “Areas of interest to the anthropologist” included “field studies in the cultural definition, perception and treatment of disease, including the study of the total social therapeutic milieu in which illness occurs, the use of native drugs and the collection of adequate samples for pharmacological evaluation, the relationship between therapist (shaman or other practitioner) and patient, and similar phenomena subject to cultural variation.”

Although I’m not saying we should return to studying mental illness as they did in 1962, reflecting on the history of changes in NIMH funding priorities leads me to wonder whether thinking of a mentally ill woman as having a different kind of brain made it somehow easier for that officer to raise his fist and bring it down again and again, striking Marlene Pinnock’s face.

In this case the fact that she is African American and a woman intersects with these contemporary meanings of mental illness. When one activist says, “this latest beating has provoked the same anger and rage from community residents as the King beating,” he redefines her supposed “mental illness” as more than a brain disease, giving her a social context and a history beyond her individual body and the particular encounter between two specific people. How does such a redefinition, with its implied reference to collective trauma, fit within NIMH’s funding priorities? To put it bluntly, it doesn’t.

With an almost $1.5 billion annual budget, NIMH is a major force in mental illness research in the United States, a position that also gives it tremendous influence on public perceptions of mental health and illness. I’m not suggesting that NIMH is directly responsible for what happened to Marlene Pinnock. However, I think all of us have a responsibility to look clearly at the fact that conceptions of severe mental illness as brain disease do not necessarily remove the stigma from those perceived as mentally ill and in fact may have the opposite effect, dehumanizing them as much as if we still believed, as was common in the middle ages, that the evil spirits need to be beaten out of them.

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[1] Pescosolido, Bernice A; Martin, Jack L.; Long J Scott; Medine, Tait R; Phelan, Jo C; et al., “’A Disease Like Any Other’? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence,” The American Journal of Psychiatry 167.11 (Nov 2010): 1321-30.

[2] National Institute of Mental Health Strategic Plan (National Institutes of Health Publication 08-6368, 2008), ii.

[3] National Institute of Mental Health Strategic Plan (National Institutes of Health Publication 08-6368, 2008), iv-v.

[4] Ethan Watters Crazy Like Us: the Globalization of the American Psyche (New York: Free Press, 2010), 4-5.

Further Reading

Angell, Marcia. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Random House, 2004.

Boevink, Wilma A. “From Being a Disorder to Dealing with Life: An Experiential Exploration of the Association between Trauma and Psychosis.” Schizophrenia Bulletin 32:1 (2006): 17-19.

Hornstein, Gail A. Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness. New York: Rodale, 2009.

Jenkins, Janis Hunter, and Robert John Barrett, eds. Schizophrenia, Culture, and Subjectivity: the Edge of Experience. Cambridge: Cambridge University Press, 2004.

Raoul, Valerie, et al., eds. Unfitting Stories: Narrative Approaches to Disease, Disability, and Trauma. Waterloo, Ontario, Canada: Wilfred Laurier University Press, 2007.

Ross, Colin A. Schizophrenia: Innovations in Diagnosis and Treatment. New York: Haworth Press, 2004.

Schiller, Lori and Amanda Bennett. The Quiet Room: A Journey Out of the Torment of Madness. New York: Grand Central, 1994.

Shorter, Edward. A History of Psychiatry from the Era of the Asylum to the Age of Prozac. New York: John Wiley and Sons, 1997.

Whitaker, Robert. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Crown, 2010.

Woods, Angela. The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory. New York: Oxford University Press, 2011.

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Featured image caption: Mental Burnout. (Four Bricks Tall/Flickr)