All in the Mind

Abstract

Suspending belief in a medical approach to mental health difficulties and viewing them primarily as disturbances of social order takes one into territory that is unfamiliar to most who are grounded in the medical approach. Conventions identifying psychiatry with the rest of medicine make it difficult to think of as essentially a response to disturbances of social existence, even if that is what frontline experiences suggest. The logic of medicine is very much that of the engineer who interprets whatever might be the difficulty—a smoky car exhaust, unreliable electrical power, wet or dampness in the wrong place—as evidence of a material problem. They draw attention to the engine, the power line or the roof in pursuit of a fault that can provide a sufficient explanation for the problem, in terms of what happens when engines, power lines or roofs don’t operate as intended. This is the process of diagnosis through which a difficulty or inconvenience is translated into the consequences of a clearly defined dysfunction, in medical terms a pathology resulting from a disease. Chapters 2 and 4 discussed how and why that may not be the best way to consider mental health difficulties and their treatment. Mental health difficulties are poorly served by the application of a mechanistic logic because they cannot be sufficiently explained by a generally accepted and agreed understanding of how human beings or their brains actually function, what might be the cause when they don’t function satisfactorily and even how medical treatments work when they do.