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.
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