dotCommonweal

A blog by the magazine's editors and contributors

.

The Pain of Being Human

In all the discussion regarding Charles Taylor's monumental book, A Secular Age, I find relatively little attention paid to his use of the notion of "excarnation." It's as though commentators are eager to embrace his account of the positive aspects of secularization and fearful lest his analysis of modernity's dark side might give solace to proponents of a "counter-cultural" stance.As I understand it, Taylor means by "excarnation" the avoidance or denial of those dimensions of humanity that threaten our sense of being autonomous individuals. Hence we construct "buffered selves" for whom binding commitments, communal loyalties, mortality itself must be therapeutically held at bay.Though it never uses the word, "excarnation," a poignant, intensely personal article in yesterday's New York Times seems to diagnose the condition well. Here's an excerpt:

Ours is an age in which the airwaves and media are one large drug emporium that claims to fix everything from sleep to sex. I fear that being human is itself fast becoming a condition. Its as if we are trying to contain grief, and the absolute pain of a loss like mine. We have become increasingly disassociated and estranged from the patterns of life and death, uncomfortable with the messiness of our own humanity, aging and, ultimately, mortality.

Comments

Commenting Guidelines

Fr. Imbelli,Thanks for calling attention to Ted Gup's op-ed, which is very powerful.Coincidentally, Gary Gutting, whose essay "On Being Catholic" we were discussing just the other day, had made a very similar critique a couple of months ago.

[P]sychiatric practice makes essential use of moral (and other evaluative) judgments. Why is this dangerous? Because, first of all, psychiatrists as such have no special knowledge about how people should live. They can, from their clinical experience, give us crucial information about the likely psychological consequences of living in various ways (for sexual pleasure, for ones children, for a political cause). But they have no special insight into what sorts of consequences make for a good human life. It is, therefore, dangerous to make them privileged judges of what syndromes should be labeled mental illnesses.

You can read the rest here.

Interesting article and timely with the release of the DSM V slated for release in May of this year. I have worked in the mental health field for over 20 years and have seen many of the various twists and turns of the field; from clients, some of whom have become virulently anti-psychiatry and formed advocacy groups, to good psychiatrists, poor ones, good social workers, poor ones, etc.. etc.It is interesting that much of what clients were expressing almost 20 years ago is now being picked up among the mainstream and official hierarchy of the mental health profession. Szasz was dismissed as a crank by many colleagues but he, along with Foucualt and Porter, offered important critiques.There was an interesting article in CNN on a subject that is debated in mental health frequently; namely over-diagnosis. The problem is confounded by advances in pharmotechnology and the increasing use of various forms of SSRI's and anti-anxiety medication to treat people who otherwise would not fit the clinical criteria as outlined in the DSM - IV.It is not unusual for physicians to prescribe anti-depressants or anti-anxiety for people who do not technically have a psychiatric diagnosis. And I have also noticed waves of diangnoses that seem to be all the rage; PTSD and its corrolarly on the far end of the spectrum, personality disorder were popular; trauma is another one; and the ever favourite "concurrent disorder" (substance abuse AND a mental illness).And when it comes to children, there is incresing controversy around the use of diagnostic labels. 10 years ago, child psychiatrists would be very, very hesistant to label or diagnose, now it seems that it is more prevalent. According to the CNN article.Dr. Carrol. chair of psychiatry at Duke University noticed with alarm the growing incidence of bi-polar in children.

"You've got all these young kids running around with this diagnosis, yet many of them have never, ever had a manic episode, which is the hallmark of bipolar disorder," said Carroll, now the scientific director of the Pacific Behavioral Research Foundation. "Many of these kids," he continued, "have never had anything other than irritability. Yet they're exposed to anti-convulsants, anti-psychotic drugs, which have serious long-term side effects in the form of obesity, metabolic syndrome, diabetes and some movement disorders ... that can leave a person extremely disfigured physically."

Finally, there is this quote that sums up the fact that people frequently recover from mental illness (a loaded term!)

"The DSM-5, in many ways, reflects the politics of psychiatry these days," said Dr. Joel Paris, author of "Prescriptions for the Mind: A Critical View of Contemporary Psychiatry," a psychiatry professor at McGill University and researcher at Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec. "Everybody has a kind of investment in certain diagnoses. Those who are studying a particular disorder often are saying, 'Well, this is much more common than you think they are. Oh, the prevalence is very high.' But we risk losing legitimacy because of over-diagnosis. ... The fact is that most people get by with bad patches in their lives. They recover."

Matthew:

But they have no special insight into what sorts of consequences make for a good human life. It is, therefore, dangerous to make them privileged judges of what syndromes should be labeled mental illnesses.

I don't think that anyone is makng them "privieged judges" (or at least that is changing now more). Most of the anti-anxieiteis and anti-depressants are not, in fact, prescribed by psychiatrists. They are prescribed by GP's. I think like any other profession, they can provide direction and advice and, as I mentioned above, a critical posture, is helpful for them and for ALL scientists and people.Notwithstanding my critique above (I know psychiatrists and am on friendly terms so I am not at all in the "anti" camp), I think psyhciatrists DO, in fact, have insight into potential causality and therefore treatment including changes to social policy and drug laws. They are not infallible, obviously, but I think there is expertis that is useful. For example, take the issue of addiction (to alcohol, drugs, sex, shopping, etc.). Gabor Mate wrote a good book, In the Realm of the Hungry Ghosts". Mate is a psychiatrist who has worked with hardcore drug addicts in Vancouver for decades. One observation he makes, is that of the women he sees addicted to heroin and involved in prostitution, evey single one had a history of childhood sexual abuse. While correlation is not causation, this is important information.As a result of his experience and study, he has found that there is NO such thing as an instantly addictive drug. In fact, most people who try drugs do not become addicted. Nor is there a genetic pre-disposition. Take the case of native Americans. They overwhelmingly represent the highest proportion of substance abuse problems at least in many parts of Canada. Yet, there is evidence of drugs prior to contact and you do not hear stories of reams of people "addicted". That only occurs after contact, after dislocation from communities, after the development of reserves, residential schools and so on.Consequently, he locates addiction in the reward centres of the brain that are wired in certain ways to respond to stimulus. And it does not matter what that stimulus is. It could be shopping or it could be drugs. The substance is not the issue, at issue is the neuro-psychiatric mechanisms which is identical for any form of addiction. This is why the longer an addiction persists, the more difficult it is to stop. We get more "hardwired".Furthermore, Mate argues, why do we single out illegal drugs as the big problem and build massive jails to house people who abuse them. Alcohol and tobacco are substance that have far more lethal effect. What about workaholism? Workaholism damages families and relationships too. The solution is a compassionate society that treats drug addiction as a health and not criminal issue! It is in teaching things like mindfullness, etc.

Here's the other side of that coin, a curmudgeonly article about the over-niceness of most contemporary poetry and its abandonment of its function of diagnosing moral good and evil. Says author David Yezzi, "Poetry has become so docile, so domesticated, its like a spayed housecat lolling in a warm patch of sun."http://www.newcriterion.com/articles.cfm/The-bitter-fool-7599So what discipline, if any, does have the function of diagnosing moral good and evil in individuals' lives? Should only priests in confession evaluate actual moral failure and success? And how to distinguish moral success and failure from non-moral success and failure? Is the alcoholic who refuses to try to help him/herself a sinner or sick? Who decides?

As one who's stood by helplessly as people I respect and love are dogged by real mental illnesses (which can easily be described as "demons") while mental health professionals can't seem to even diagnose them correctly, much less provide treatment or cure, I've come to loathe whatever it is that's driving uber-trained psychiatrists and psychologists to abandon these ill to county or state warehouses for the hopeless and take up instead careers as "therapists" and "life coaches" to the seemingly millions of mildly neurotic (i.e., self-involved and whiny) Americans who speak glowingly of their "shrinks" and the magic pills (SSRIs) that do little more than ID the patients who give good patient reviews, since only those who don't really need them think they work. If that sounds cynical, it may be, but it's a cynicism based on reality IMHO. The mental health profession is in such a bad state, critiquing their moral judgment is barely half of what's required.

Mea culpa: I shouldn't have labeled all mildly neurotic Americans who consult therapists as "self-involved" or "whiny." Clearly, most need effective treatment as well. (FWIW, I still don't believe SSRIs provide anything beyond the placebo effect.) However, I stand behind the rest. Our mental health system is broken, and the professionals who should know what to do simply don't.

Beverky:YEP!I know exactly what you mean. And tied to that is crushing poverty and marginalization. Resources being spent on the "worried well" could be better spent creating affordble housing, increasing rates of disability pensions and so on. I would add that social asistance rates are way too low, affordable housing is difficult to access.

As the population ages, morbidity and death rates will rise, and the costs of health care will throw more of the sick and elderly into at-home care. Many of us have faced this already. It can be a very isolating, sad experience, sometimes exacerbated by acquaintances and friends or employers who just don't want to hear about it and demand that we compartmentalize and deal.If we don't want people running to Big Pharma or the psychiatric trade and getting "excarnated," what's the anodyne? Faith? Church? Does anybody in our parish communities really want to hear about these problems any more than friends or employers? Perhaps good questions to ask.

I find it deeply offensive for people to belittle the suffering of others and suggest that they are misguided or self-indulgent to seek help in the form of psychotherapy or psychiatric drugs. You are perfectly free to consider your own problems the ordinary physical or psychological aches and pains of being human, but until you have lived in the skin of the people you criticize, you can't claim to know that they are the "mildly neurotic" or "worried well." Exactly why someone suffering from depression should be treated and someone suffering from grief should just tough it out escapes me. There is no treatment or psychiatric drug that is going to cause the pain of losing a loved one to vanish into thin air. Psychiatric drugs simply cannot make you feel and believe that things are okay when they are not. I think there are many more people who could benefit from seeing a (good) psychiatrists but would not dream of going than there are people who go but do not really need it. I can't think of any "unnecessary" drugs, and certainly not SSRIs. They work not merely for depression but for a number of other serious conditions such as anxiety, panic disorder, and obsessive-compulsive disorder. Of the drugs advertised on television, I am wary of the smoking-cessation drugs because of the long list of side effects. On the other hand, I don't smoke, and I think the risk may be worth it for those who want to quit but need help. If you scoff at drugs to help people sleep, you have probably never experienced serious insomnia, and you should pray you never do. The number of school children diagnosed with ADHD and the number of prescriptions for drugs like Aderall are cause for concern, but I wonder if that doesn't tell us something about school. While I have great sympathy for the man who lost his son to drugs, I wonder if he is not doing what a great many of us would try to do, which is to make some kind of sense of a tragedy by finding someone or something to blame for it. (Many people in such circumstances look for someone to sue.) Among my earliest memories are ones of takingor trying to get out of takingprescription drugs (and getting shots at the doctor!). I am thankful for just about every drug that has ever been prescribed for me. But that has not and will not in any way tempt me to take heroin.

"We have become increasingly disassociated and estranged from the patterns of life and death"I noticed it in the US. When I was in mourning, people tried to cheer me up by pointing to the bright side of things. I got the sense that sadness was not acceptable. I will always remember the well-meaning but inane comment of the person who pointed out that at least the weather outside was sunny! Are medical drugs being taken because the person is suffering and wants relief, or because there is social pressure from other people's reluctance to see that person's sadness?

"I noticed it in the US. When I was in mourning, people tried to cheer me up by pointing to the bright side of things."Interesting observation. Even Americans know that they have inadequate leave time for births, deaths, funerals, illness, or even just vacation. But we are the land of can-do fixits, do-overs, makeovers, reinvention of the self, and "the sun'll come out tomorrow." Age, infirmity, impotence, grief, illness, senility, disfigurement--these are problems that must be solved. They are not normal transformative events in which we might more deeply plumb our lives as human beings or children of God. In my view, there's desperation behind all that cheerfulness. Look at the way we've pinked up breast cancer with ribbons and sequins and cute hats and shirts and jewelry, the way we haul out celebrity sufferers, with their armies of beauticians and physical therapists and insistence that you better not let cancer "get you down" or "win" ... or even make you look ugly.Sorry for the rant; I think there are certainly folks who can benefit from psychiatric help or psychotropic drugs. But, in my view, they're not the crazy ones. The crazy ones are the ones who are too frightened to be anything but relentlessly bright and brittle.

We don't fault oncologists because they don't know how to cure pancreatic cancers. Why is it right to fault psychiatrists when they don't know how to cure all severe clinical depression or schizophrenia? Yes, some therapists are not very effective. The solution is to get an effective one. Or, sadly, face the fact that in some cases nothing more can be done. But this is theological problem or an existential one, not a medical one. Yes, the American mental health care system is inadequate. And it's going to stay that way until we the people are willing to pay for a better one.

Freud said that the best psychoanalysis could do was transform neurotic misery into ordinary unhappiness. If there is a legal psychiatric drug or a therapy that can alleviate the pain of being human, I have never heard of it.

If I remember correctly Freud didn't even try to treat schizophrenic patients because he realized that his psychoanalytic method wouldn't help.