The ascription of biological explanations has also been used in an attempt to destigmatize the experiences of people living with mental health challenges. The suggestion that the causes of such challenges are similar to the causes of physical illnesses such as cancer, diabetes, and influenza is intended to reduce the stigma that surrounds mental disorders. The compassion behind this approach is clear, and the sentiment is laudable. The problem is, it doesn’t seem to work.
Malla, Joober, and Garcia note that “Several well-conducted studies have concluded, almost uniformly, that this strategy—destigmatization by emphasizing the biological aspects of mental health challenges—has not only not worked, but also may have worsened public attitudes and behavior toward those with mental illnesses. Investigations of stigma have shown that those who consider mental disorders as primarily attributable to biological forces, just like other medical disorders, while absolving the mentally ill person of responsibility for their behavior and actions, tend to feel less optimistic about their ability to get better and function well, are less accepting of them and feel less positively toward them.”43 The problem seems to be that in using biology as an explanation for mental disorders, within the minds of the public and for the individual who lives with the experiences, the disorder becomes ontologized and totally defining of the person. People no longer have an illness; now they are an illness. The DSM offers descriptions that function epistemologically rather than ontologically. Biological explanation does the exact opposite. A biological explanation is much deeper, much more personal, much more tied in with the “is-ness” of who and what a person is. Biological explanations are thus seen to have unfortunate side effects.
In his book How to Become a Schizophrenic, John Modrow, a psychiatrist who lives with schizophrenia, offers a powerful insider’s critique of biological explanations and points out a hidden danger:
I cannot think of anything more destructive of one’s sense of worth as a human being than to believe that the inner core of one’s being is sick—that one’s thoughts, values, feelings, and beliefs are merely the meaningless symptoms of a sick mind. Undoubtedly the single most important causal factor behind my mental breakdown was a sense of worth so badly shaken that not even the most florid delusions of grandeur could save it. What the concept of “mental illness” offered me was “scientific proof” that I was utterly worthless, and would always be worthless. It was just the nature of my genes, chemistry and brain processes—something I could do nothing about.44
Schizophrenia is not like measles. One can have measles, but one becomes schizophrenia. Sally Clay addressed the First National Forum on Recovery from Mental Illness as follows: “Those of us who have had the experience called ‘mental illness’ know in our hearts that something profound is missing in these diagnoses. They do not take into account what we have actually endured. Even if the ‘bad’ chemical or the ‘defective’ gene is someday found, madness has its own reality that demands attention.”45 Stigma is a way of stealing someone’s story and forcing the person to accept a false, negative identity. It needs to be fought against. Biological explanations may provide a helpful and nonstigmatizing version of disturbing experiences. However, such explanations can have a shadow side that we miss at our peril.
The point is not that biology may not be formative of mental challenges. We do not yet have the evidence to make such a case across the board, but in time it may emerge. The problem is that biological explanations on their own can be highly reductive, closing down aspects of our experiences and forcing us to interpret them in a very narrow and confined way. In the end, such attempts at destigmatizing “the mental” actually end up reinforcing the idea that there is a problem with that aspect of our humanness, rather than addressing the key issue—that there is no need to stigmatize issues of the mind dualistically. A psychological description is no different from a biological one; it simply addresses different aspects of our humanness—shifting the problem from the mind to the body is nothing more than another manifestation of Cartesian dualism. The unhealthy and inauthentic anthropology that underpins this way of thinking remains fully intact. Biological descriptions are simply too thin to do the work of realigning and clarifying that is necessary for the tasks of destigmatizing and healing.
THE THINNING OF SPIRITUALITY
The final area of thin description emerges from a rather surprising source: the ongoing conversation around the role of spirituality in mental health care. If systems of categorization such as the DSM tend to create diagnoses that can have thinning and objectifying effects, and if biological approaches risk turning people into bodies without persons, then conversations around spirituality reveal that even in the realm of the apparently holistic and spiritual dimensions of care, thin descriptions abound and hold hidden dangers. This may at first sound rather odd. We’re tempted to say: “Surely, spirituality has to do with whole-person care and holistic ways of viewing people.” Well, one might be forgiven for thinking that. However, closer scrutiny of what is actually going on in the realm of the spiritual as it is articulated within mental health care reveals something quite different.
Spirituality in Mental Health Care
I have been a part of the conversations around spirituality and mental health care for many years. In 2001, I wrote a book titled Spirituality and Mental Health Care: Rediscovering a “Forgotten” Dimension.46 Among other things, that book pointed out the lack of research and practical attention being paid to spirituality within mental health care. It suggested that the “forgotten dimension” of spirituality was in fact crucial for good mental health care and indicated ways in which mental health professionals could be encouraged to remember it and, in remembering, become people who care for the spirit as well as minds and bodies.
Since then, the situation has changed significantly. What appeared to have been “forgotten” in 2001 is well and truly remembered today! The literature emerging from the mental health-care professions reveals a burgeoning and vibrant interdisciplinary conversation that explores a variety of issues around spirituality, religion, and mental health. Religious spirituality has been positively associated with the alleviation of depression, anxiety, PTSD (post-traumatic stress disorder), schizophrenia, anorexia, and personality disorder.47 The more generic forms of spirituality are not so closely tied to measurable outcomes, but they are assumed to be fundamental to genuinely person-centered care.48 Some authors even suggest it is essential to our humanness.49 This latter claim is probably not very wise, because highlighting any capacity or desire as fundamental to what it means to be human inevitably means that those who do not have that capacity or share that desire can be viewed as less than human. Nevertheless, the universality of spirituality is certainly a frequently made claim.50 The presence of spirituality is recognized even at the level of policy, with governments insisting that all mental health professionals and indeed all health-care professionals take spirituality seriously.51
At first glance, this seems to be very good news! We may not be clear on what mental disorders are, but we do know what human beings are and what human beings need: they need spiritual care. Alongside the necessary care for mind and body, we also need to care for people’s spirits. One might ask the question: “What could possibly be wrong with this?” Surely this puts things like religion and theology back on the map of professional credibility and offers important new possibilities for