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Mental Illness, Societal Oppression, and My Rebuttal to Bruce Levine

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For nearly two decades, Big Pharma commercials have falsely told Americans that mental illness is associated with a chemical brain imbalance, but the truth is that mental illness and suicidality are associated with poverty, unemployment, and mass incarceration.

This statement implies that the pharmaceutical industry and medical practitioners associated with -- or uncritical of -- the corporate drug manufacturers are lying to us. He does later point out that correlation does not equal causation, but by then he has already strongly implied it does mean causation. According to his byline on Alternet.org, from which Salon posted the article, he is a clinical psychologist and author of at least two books and numerous articles. However, looking over his list of titles it is clear he has an anti-corporate agenda. While I am generally highly skeptical of corporations and critical of the commercialization of the health profession, I found Levine's piece to be disingenuous and irresponsible.

He is right to question the efforts by many in the medical sciences to pathologize mental illness and define it primarily as a biological problem. No doubt, plenty of studies have been influenced by their sources of funding and the general push to make this a biological issue is worrying. But so too is the attempt to make this an entirely sociological matter. Levine's irresponsibility shows most distinctly in his conclusion where he asks why researchers aren't examining societal and cultural factors that lead to mental illness. Even a cursory search for "causes of mental illness" on JSTOR, a database for many research journals, leads one to a library of research examining social and cultural factors for mental illness dating back decades, and not only for mental illness in the United States, but in societies around the globe. Perhaps Levine is asking why researchers in the field of psychology aren't focusing on these factors, but a cursory search of PsychNET, maintained by the American Psychological Association, results in numerous research articles focused on poverty, incarceration, and military service, among other things, as factors in suicide and mental illness. Besides this, he makes his argument by using disproportionate data that points out the rates of mental illness and suicidal thoughts within defined groups and comparing them to overall percentages, while not pointing out that percentages within a defined group will result in a far smaller segment of the overall population in total numbers of people. This is relevant when pointing out how social and cultural forces disproportionately affect the mental health of the poor, of racial or ethnic minorities, of women, or of veterans and LGBTQ people. However, his highly selective use of data is ancillary to his faulty main thesis, that Big Pharma and the commercialized medical profession has lied to us about the main causal factors of mental illness, even though correlation doesn't equal causation.

As I pointed out in a recent blog post, the fundamental principles shaping how our modern society defines mental illness and deals with the mentally ill has a long historical trajectory. Moreover, it is vastly over-simplistic, and just plain wrong, to imply that oppression is the real cause of mental illness and that taking steps to alleviate those various forms of oppression is a far more effective treatment than medication. Levine's thesis misrepresent the facts, because there are still sizeable amounts of people not suffering under multiple forms of oppression and, in fact, are assigned various levels of privilege that do alleviate some of those forms of oppression. But more than that, his thesis falls into the same trap of not acknowledging or really confronting the problem of how the mind affects the body and vice versa.

This problem of mind and body, aka the Cartesian split or mind/body dualism, is literally as old as Western philosophy. It is a problem Aristotle and Plato dealt with, as well as the Pre-Socratics dealing with medicine, and then translated into the Hippocratic and Gallenic texts that formed the basis for our entire modern field of medical science. As I pointed out in my last post, despite the invention of cellular pathology during the 17th century and its resulting affect on all the sciences, we still share basic beliefs that define certain collections of behaviors as mental illness and as "abnormality," we treat this illness as something inherently biological, and believe that medicine can and should be used to treat those who have it. So Levine's hostility toward corporate influences on medicine, however much I agree with them, do not result in any lasting substantive solution. There will still be large numbers of people of all races and classes who are labeled mentally ill. Moreover, he is still insisting that they can and should be treated via some kind of social, political, or medical intervention. For a selected bibliography on this topic, click HERE.

Levine's failure to deal with the mind and body then falls into our contemporary predicament where science has come to define all knowledge, largely because of the capitalist focus on technical knowledge and mechanistic thinking that has come to overshadow other forms of knowledge production, like philosophy or religion. Even Levine's answers are framed by a Marxist paradigm of corporations corrupting our medical and social sciences, and not recognizing that many other disciplines have already engaged in studying these problems.

As with most things, this is a far more complicated issue than saying there is one primary cause or collection of causes of mental illness. We know, through research done by non-Big Pharma funded studies, that veterans have high suicide rates, probably attributable to PTSD and their experiences in the field. We know that LGBT youth are much more likely to experience bullying than their peers, to be homeless, and to attempt suicide, with trans teens being even more likely than gay or lesbian teens. We know that societal alienation and cultural practices of shaming result in higher rates of depression, substance abuse, and risky sexual behavior among gay men, which then leads to skyrocketing rates of STI and HIV transmission. So, yes, we get it, societal and cultural attitudes and practices, then solidified into governmental apparatuses that legalize and reproduce historical forms of structural oppression are contributing factors in the development of behavioral and mood disorders. So, too, is substance abuse among pregnant women, which occurs in more groups than only the poor or racial and ethnic minorities. So, too, is pollution, which probably disproportionately affects poor people given how pollution and industrial zoning affects property values and housing demographics, but isn't exclusive to that.

Perhaps more important, even beyond his policy suggestions that have more to do with social and economic justice, our culture has an unresolved and deeply rooted problem in how we think about and treat mental illness and the mentally ill. This problem has a long historical trajectory. It includes attitudes among our current medical professionals that are not only medieval in quality, but also medieval in origin. We define things primarily by sciences that are ill equipped to handle matters of emotion and the human heart and mind. We have a commercial medical industry that is too heavily tied to big corporations that have a vested interest in selling their products and making money. We also have a society that isn't interested in dealing with people whose behaviors put them outside the ill defined "mainstream" (an ideological and discursive term rather than a concrete group of people) unless that behavior results in extra-ordinary production, i.e. computer geniuses and brilliant engineers. These are problems that won't be solved only by loosening drug laws or dissolving systems of oppression. They may be issues that can never be resolved, because there may be no answer to the problem of the mind/body split, something that involves the very nature of what it means to be human. So, while I applaud his effort, while these are things that should be debated, and while I may even generally be aligned with his politics, his article was fraught with problems and falls into the same ideological trap as those forces he fights against.

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If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.