By EW Wilder
Sometimes, science is simply looking in the wrong place.
If we accept the notion that scientific inquiry itself is a social phenomenon, then it becomes easy to see why certain things are studied while others are not. The male gender bias in studies of heart disease are legendary, so I won't go deeply into them here, but they should have been cautionary: any time research money flows, the question that should be asked is “What cultural biases are inherent to the request?”
In mental health, one of those biases is in favor of a strictly biological model; that is, if your woes are experiential, they are necessarily a problem with your brain.
If you reel at what seems to be such a broad-sweeping generalization on my part, witness a recent report on NPR on some current efforts to use biomarkers to determine if a person is mentally ill. (Listen to this one, as the written synopsis does not give the full report.) The part about PTSD is the most illustrative, with researchers pouring millions into brain scans and computer programs that are supposed to “detect” PTSD. That the military is a large part of this research isn't surprising, but it should be: the people they're studying were in combat after all.
Which goes back to my point: if you have a combat veteran who is complaining about being unable to sleep, feeling constantly sad, being unable to concentrate, and flying into sudden rages, you could spend millions trying to figure out what was wrong. Or you could just ask him.
Our culture somehow discounts the idea that somebody's story of trauma and that the disruption to their lives that this can lead to are “real” (even though we frequently see the effects directly) unless and until there is some “objective” measure: a biomarker, a study, a brain scan.
There are two phenomena at work, and they represent the major streams of American life. One is the rationalist tradition that hies from the Age of Reason. This movement, in many ways, created our nation; the so-called “Founding Fathers” were rationalists, many of them deists, and even such notions as the idea that free people ought to be governed by bodies in which occurred reasoned debate (instead of by the caprices of a king) is a testament to this fact.
Rationalism is great; it has brought us the computers you're reading this on. It brought us modern sanitation and antibiotics and refrigeration. It made sense out of a seeable universe that just seemed to be jacking with us heretofore. But it also has a bad habit of blinding us to the more obvious cultural constants that create our lives: maybe the people who “have PTSD” have simply learned to adapt to an impossibly violent and stressful environment, and maybe those adaptations are ill-matched to a life of cheeseburgers and traffic lights. Maybe those who are labeled “bipolar” have lost their sense of balance because they have had to adapt to unbalanced lives. Maybe depressed people have damn good reasons to be very, very sad.
But the fact that these adaptations have profound effects on the lives of those who experience them and that those effects impact the abilities of people to meet the expectations of our society mean that they have a moral component, not just a medical one. This is where the other major stream of American life comes into play: Puritanism.
No matter what our official religious affiliation may be, even if we have none, American culture still is Puritan in the sense that it associates productivity with value; if you don't work, you're still stigmatized, particularly if your ailment isn't readily visible. That many employers view being unemployed as, itself, a strike against a job applicant shows how deep this cultural assumption is. Further, your engagement with work must always be a happy one: management books are all about how to reinforce upon the workforce how wonderful it is to be at work, even if your entire life seems to be crumbling around you. The reason managers insist that their employees all read Who Moved My Cheese? and The 7 Habits of Highly Effective People is that they believe that employees have an obligation, as an expectation of their employment, to always adapt and always produce. There is no room for (and considerable opprobrium in) merely being human.
This also helps explain why, despite the protestations of psychiatrists, including a prominent one in the NPR report, the disease model of mental illness actually increases stigma, rather than reducing it. If your problems have to do with your life, that's something you can change, but if your problems have to do with your brain, you are, for the moral purposes of a nation that associates productivity with being a good person, damaged goods.
My main problem with the search for biomarkers when it comes to those who go through extreme psychological states is not that it's a waste of money and time. If they are doing basic research, it's well worth doing. The brain's job is to adapt to and learn from the environment, and I'm sure they could find all sorts of interesting things about how the brain does that.
My problem is that they will miss the problems that underly the causes of the brain's adaptations to these states: a culture that does not merely countenance, but often reinforces psychological damage, that fails to address the social inequities and poor policies--both foreign and domestic--that perpetuate violence and despair, and that prevents healing by blaming the suffering and keeping in place schools, social spaces, and workplaces that are essentially inhumane.
We would rather spend millions over and over again to keep parsing out the biological details than spend the billions once to solve what we already know in our hearts, but will not admit in our heads, ails us.