Crises Of Our Times
By Jonathan Bauman, MD
As we move through the holiday season, thankful that our recent elections are behind us, we remain faced with several crises that challenge our abilities to find a sense of peace and gratitude. Though kids are in school, adults have returned to places of work, and patrons have returned to restaurants and theaters, we are still faced with multiple crises. A nasty, though somewhat weakening, pandemic virus still threatens us, along with the fear that Covid-19 could mutate and strengthen, or some other virus could emerge. Economic insecurity is prevalent. We are still faced with a brutal war in Ukraine with an uncertain outcome. Worldwide natural disasters related to the effects of climate change are frequent occurrences. Despite results of the recent election, there remains considerable uncertainty about the direction and survival of our democracy. And, of course, we are also faced with a continuing and well-documented mental health crisis. The confluence of such circumstances raises an interesting question: when is a Mental Health Crisis not just a crisis of mental health?
A series of opinion pieces was recently published in the New York Times (Sept. 20, 2022). The lead article, “Mental Health Is Political,” by Dr. Danielle Carr, Assistant Professor at UCLA’s Institute for Society & Genetics, was particularly thought provoking, so much so that I posted it on Facebook for friends and family to see. In the article Dr. Carr asks, “What if the cure for our current mental health crisis is not more mental health care?” It harkened me back to my recent blog post, in which I quoted Dr. Tom Insel from an interview about his recent book on his years as director of NIMH. In essence, Insel confessed that all the years of top-notch genetic and neurobiological research produced no benefits for the sickest patients – those with schizophrenia and bipolar disorder. He lamented that while the problem (of mental health care) is medical, the solutions are social, relational, environmental, and political.
In her essay, Dr. Carr writes that a crisis that affects mental health is not the same as a crisis of mental health, and in order to come up with solutions, we have to first ask, “a crisis of what?” She describes what social scientists call reification, a process where people or organizations invested in a problem swap out a political problem for a scientific or technical one. For example, she describes the “medicalization” of problems such as obesity or diabetes, where the solution is not more treatment but efforts on a societal level to change nutritional behaviors that are related to poverty and lack of access to resources. Finding agreement and the political will to tackle such issues is a much more difficult challenge, making it attractive to push the solutions onto others – in this case doctors.
Carr writes that medicalization shifts the terms of how we figure out what caused a problem and how to fix it. It puts the focus on the individual’s body rather than on systemic environmental conditions. I would add, as an example, passage of the recent legislation regarding gun violence. The political parties were able to agree on financial enhancements to deal with the mental health aspects of gun violence. While this may be of some benefit to a limited number of mentally ill people, it will have little effect on the root causes of gun violence, namely easy access to guns and little firearm regulation, on which our political parties have long disagreed.
Of course environmental stress caused by the pandemic, economic insecurity, deterioration of our social fabric, etc. may have effects on one’s physical and mental well-being. As Carr points out, these are entirely predictable reactions. But are such problems a medical/mental health crisis, or a political crisis with medical effects?
We are dealing here with complicated issues that are not easily solved. They can often feel demoralizing, depressing, and downright scary. As citizens, we can choose to support efforts toward making appropriate systemic changes. As mental health professionals, we are in the fortunate position of being able to help individual patients with effective treatments that can ameliorate distress. Though our work with our patients doesn’t solve systemic problems, we can find comfort and gratitude in having the opportunity to make the world a better place one person at a time. Happy Holidays.