Spirit and soul in mental health: going beyond the medical model. Andrew Baxter, April 2003.
In January 2000, after a long period of depression and mental confusion, I suffered a psychotic breakdown, or spiritual crisis, which led to my
encounter with the psychiatric services as a patient at Ridge Lee mental hospital in Lancaster for five months. Over the past three years, I have been struggling with
the aftermath of this, going through a whole range of difficult mental states and experiences. From July 2000 to October 2001, I was staying as a resident at
Lothlorien Therapeutic Community in South West Scotland; the positive, healing, environment there gradually helped me start to feel better in myself. I have now
returned to Lancaster, and over the last eighteen months have been starting to pick up the pieces of my life again. I am writing this because, although the
psychiatric treatment I have received has been helpful to me in some ways, it has only been a small part of my journey, and I have come to the view that the medical
model of mental health on which it is based offers only a limited perspective on mental illness. I hope that by sketching an outline of a broader view of mental
health, and by telling some of the ways in which I have learned to help myself cope with the chaos of my own mind, I may in some way help future people going through
the same kind of troubles. Although what I have to say is in some places critical of the psychiatric services, it is not meant to disparage the good motivation of
individuals within them; I am more trying to point out problems with the system and world view which they are working within.
The target of my criticisms here is what I am calling the medical model of mental health; although there may be relatively few people who hold to this dogmatically
in its purest form, I suspect that this bundle of views holds strong sway over the collective imagination and traditions of practice of the psychiatric profession,
and thus acts to marginalise alternative therapeutic approaches and self-help methods, to the detriment of patients. So, to give a clear sense of what it is that I am
criticising, the medical model is the view that:
- Psychiatric problems are fundamentally due to disturbances in the brain chemistry of individual patients.
- This disturbance is primarily caused by processes internal to the patient's own biochemistry.
- Patients are best helped by trained doctors who understand the workings of the brain and can prescribe drugs which correct this chemical imbalance.
- The primary purpose of communication between doctor and patient is for the doctor to pick out symptoms of the illness and trace these back to determine what kind
of chemical imbalance is responsible for the illness, and thus which class of psychiatric drugs are best prescribed. E.g. low mood and loss of motivation indicate a
depressive illness; delusory ideas and bizarre experiences indicate a psychotic condition.
- The patient's reported experiences and belief system are to be treated with professional scepticism, as the product of a disturbed mind.
I realise that I am not the first person to criticise the above view, and that there have been ongoing debates within psychiatry about this for a number of years;
however I am trying to write this as much as possible from my own experience, so as to communicate my own view of what I have been through to the people I have met
personally in the psychiatric system, rather than engage in the wider debates.
In saying what I have to say below, I am not suggesting that people do not have troubles in their lives, and that these troubles may at times reach a proportion
where we find it difficult to live our lives and need some sort of outside help; rather that by locating these troubles firstly within the individual patient, and
secondly and even more narrowly in the states of activation of various neurochemical circuits in their brains, the medical model as described above shows an
unfortunate and in some cases actually harmful or repressive failure of imagination on the part of the psychiatric profession.
I will now set out in point form some of the problems that I see with the medical model. This document was originally intended as the introduction to a longer
piece in which I would expand on each of the points in more detail with examples from my own experience, and then describe some of the things which have helped me
recover some degree of stability of mind and well-being; however for now I will leave these points as they are.
- We are (to a degree) creatures of our environment. Mental illness is not just something happening inside the brain of the person considered to be ill, but
is also a product of their relationship with the circumstances of their lives, including things like relationships with other people, housing, work, access to nature
and many other things. Changes in this environment can produce dramatic and occasionally sudden shifts in mental state, (and presumably in the related biochemical
processes of the brain), as I have experienced at Lothlorien for example. Trying to treat mental illness solely through biochemical means fails the patient in two
ways: firstly because this approach tends to discount a variety of positive ways in which people can be helped to make changes in the environmental circumstances
which their suffering is enmeshed in. Secondly, by treating these wider problems as being located solely in a patient's mind/brain, the psychiatrist can collude in
the scapegoating of an individual person with the stigma of being 'mad' or 'ill' when their troubles may be caused by abusive relationships, stressful work
conditions, lack of social interaction, lack of contact with the natural world, or a variety of other problems (which I would argue can only fully be treated by
beginning to address a wider social and spiritual malaise of our western capitalist-technological society).
- 'None but ourselves can free our minds' The medical model places the responsibility for cure, and the power in the doctor-patient relationship, firmly
in the hands of the doctor. However, a crucial factor in overcoming mental illness is developing an inner attitude of mind and strength of spirit which allows you
to cope with difficult mental states and take the steps needed for your own recovery. Though others can encourage this, it ultimately has to come from the patient
themselves. The teachings of various spiritual traditions can be of help in fostering this; however this is not straightforward, as spirituality taken in the wrong
way can also be harmful, and many people make sucessful recoveries without this.
- Connecting the inner and outer worlds. An alternative way of looking at mental illness is as a breakdown in the usual connection between the patient's
private inner world of mind, imagination, and feeling, and the shared outer physical and social reality that they find themselves in. The tendency of the medical
model is to focus on analysing the patient's speech and behaviour in the outer world without inquiring into the inner movements of mind, soul and spirit that give
rise to that behaviour. This ignores the fact that being able to express what is inside you into the world, and have it heard with respect and understanding, is an
important part of mental well being. Also, by being willing to be curious about the patient's inner life, mental health professionals may be better able to unravel
the human meaning which can lie at the bottom of many apparently bizarre behaviours and reported experiences.
- A twist in the shape of your life. People, as people rather than bags of chemicals, have memories regretful and joyful, dreams and fears for the future,
emotional attachments, likes, loves, wishes, entrenched patterns of behaviour and ways of relating to people: all the things that make us human. We have each built
up these aspects of ourselves through the particular course that our life has taken. Healing comes through a process of looking at yourself and the patterns of
your life and making the choice to try and direct your life along new ways. Treating mental illness purely as a biochemical problem ignores this human dimension.
- Alternative medical approaches. There are other medical traditions than the western psychopharmaceutical one, for example Traditional Chinese Medicine,
medical herbalism and shamanic healing. These work on different principles to ours, and can be of benefit in treating mental health problems. I have recently started
seeing someone for shiatsu (like acupuncture but using hand pressure rather than needles), and have found this very effective in bringing me out of psychotic states
of mind and back to a sense of being grounded and centered and connected with everyday life. Within medical herbalism, there are tonic herbs which go beyond the
simple regulatory effect of most pharmaceutical medicines and instead work to nourish and strengthen particular organ systems rather than merely stimulating or
- The mind-body relationship. There is a fundamental mystery in how it is that the bags of blood and bones that we live ourselves through are capable of
supporting sentient awareness and human consciousness. Western philosophy and science has taken one path in conceptualising this relationship, and thus shaping the
form of our medical tradition: there are others, for example the Chinese philosophy which talks of a third level of life energy, or chi, which stands between mind
(or spirit) and body, connecting the two. A danger with the medical approach is that by reducing consciousness to brain-chemistry, it ignores this deep mystery of
- Drug side-effects. While antipsychotic drugs can be effective in suppressing distressing symptoms, they have the side effect of making you emotionally
numb and taking away your clarity of thought and freedom of spirit, leaving you in a 'zombie-like' state of being. Similarly, while antidepressants can be useful
in restoring motivation and mental energy to a severely depressed person, I have found that the 'high' they produce is a kind of superficial buzz which cuts you
off from your deeper emotions in a way which masks genuine feelings of sadness and despair which need to be resolved before true healing can come about. I have
been off all my medication for about two and a half months now, and although I have found it a very rough ride at times, finding myself in some very difficult
psychotic states, I have also found that there are times when I have much more energy and insight to face up to what is really wrong in my life and start to do
something about it, and I still believe that I have made the right decision in coming off the drugs.
- The doctor-patient relationship. The nature of the clinical relationship is such that doctors tend to only see a snapshot view of the patient, taken in the
very particular environment of a medical consultation. The way the patient presents themselves, and thus the treatment that is prescribed, can be heavily influenced
by the social dynamics of this encounter. In a different environment, the patient may feel and act quite differently, but these other sides of a person's life are
likely to remain invisible to the doctor. Consultations also tend to be quite heavily directed by the doctor, according to their view of what they need to find out
to diagnose and treat the patient. This means that the doctor only gets to know about those aspects of the patient's troubles that are deemed relevant in the
medical model rather than getting a more holistic picture, and that the patient, when they try to talk about those parts of their experience that are most
important to themselves, can end up feeling that they are not being heard, and consequently come to resent and distrust the doctor. Finally, the accepted role of
the psychiatrist as a kind of brain detective/mechanic results in the patient being treated as a technical object to be operated on rather than a human subject to
be communicated with. This takes away from the patient's sense of their own free agency, which may be quite fragile as it is, and removes the possibility of a
genuine encounter in which the doctor may promote healing through their authentic human presence, in addition to the technical knowledge that they are in command
- Symptoms are not sickness. Many observable 'symptoms', which may be taken by an outside observer as showing a patient's loss of a normal sense of self
and thus indicative of mental illness, can also be understood as (possibly confused) attempts on the part of the patient to preserve a fragile sense of
self, either in reaction to an external environment which threatens to destroy this, or more positively as ways of expressing what is within them in order to bring
about their own healing. A simple personal example of this is that when at times I have found the way I am talked to by mental health professionals prying or
intrusive or putting me into a position which I do not like, I have tended to fall silent and stare into space for long periods. In the extreme case, this is
catatonia. Other people in the same position might mumble irrelevantly or be moved to incoherent rage. To give another example, one of the ways I have been
starting to heal myself is through Chinese taoist meditation and healing exercises (like yoga but Chinese rather than Indian in origin). One of these exercises,
which is recommended as an antidote to psychic fear and for building up the qualities of free will and curiosity, is to find a private place, take off your clothes
and imagine yourself as a monkey and move around in that manner. I have personally found this to be helpful and effective, but if I were to do the same thing not
from having read a book about taoism but simply from my own instinct towards self-healing, say on the open ward of a mental hospital, I might well find myself
drugged up on the locked ward without further ado.
- The spiritual dimension of mental illness. Some of the states and experiences 'mentally ill' people go through are distorted versions of experiences had
by people following one of the traditional spiritual paths, involving opening up to dimensions of experience beyond the personal self. Lacking the framework of
such a path, and the guidance and company of others who are travelling it, they are experienced as disturbing and frightening rather than as stages in a process of
spiritual growth. The medical model tends to discount such experiences, treating them merely as symptoms to be treated. This diminishes and devalues the inner life
of mentally ill people and also the genuine insights and contributions we may have towards the wider world.
- Guardians of consensus reality. The role of psychiatrists and mental health nurses as healers and care-givers cannot be separated from another more
difficult and sometimes hidden role as the guardians and police-persons of our culture's consensus reality. By this I mean those beliefs, experiences, dreams, ways
of feeling and seeing the world, and ways of behaving and interacting that are considered comprehensible and acceptably sane in the mainstream of our western
culture. Psychiatrists are empowered by law to section people whose behaviour they consider departs from these norms in a way which makes them a danger to
themselves or others and commit them for forcible treatment in a mental hospital. Equally, in assessing a patient's 'illness' and deciding on treatment,
psychiatrists will use their ideas of what is real and what kind of behaviour is sane in deciding whether, and what kind of, treatment is warranted. While it may
be necessary to have people in society with this kind of determining power (I personally have ambivalent views on this), I would argue firstly that this power can
be and sometimes is used in a way which violates the human rights of patients, and secondly that in cases where this power may be justified, the apparent certainty
of psychiatric professionals that, as representatives of the world-view of western science and the biomedical tradition, they know what can be considered real and
what is fantasy or delusion, leads to an unfortunate failure of imagination in how to relate to and treat mentally disturbed people.