The suicide last summer of the actor and comedian Robin Williams sparked the latest round in our ongoing public discussion of mental illness. Predictably, once speculation about details of his life subsided, the concern shifted to “stigma” (prejudice and discrimination) and how mental illness is misunderstood and misrepresented. Unlike the reality of physical illness, the now-familiar argument runs, the reality of mental illness is denied, shrouded instead in benighted moral judgments. “It is NOT cowardly to suffer or seek help,” tweeted Williams’s daughter on World Mental Health Day in October, giving fresh voice to this widely shared position.
As early as 1961, the Joint Commission on Mental Illness and Health—“the last word of the mental health establishment”—in its final report, Action for Mental Health, lamented how the public had turned “deaf ears” to the psychiatric “cardinal tenet” that the “mentally ill…are sick in the same sense as the physically sick,” and therefore should be understood and treated just as nonjudgmentally as those with somatic afflictions. This tenet, the commission made clear, was not only a scientific truth, but also critical to overcoming negative attitudes and fostering “humane, healing care.”
That rationale has since informed countless public campaigns by government commissions, professional associations, and advocacy organizations to promote mental health “literacy” and improved treatment. Adding a new twist in recent decades, such campaigns now place a central emphasis on neuroscience, both to promote the view that mental health problems arise from neurobiological aberrations and to undermine resistance to the use of neurobiological (i.e., psychopharmaceutical) solutions. Pharmaceutical companies, which actually fund many of these campaigns, advance the same viewpoint.
The strategy of promoting disease theories to the public arose long before the “decade of the brain” (1990–2000), and does not now reflect any actual breakthrough in our understanding of brain abnormalities. While there is constant talk of “revolutionized thinking” and “dramatic improvements in understanding the biology of mental illness,” the reality is far more pedestrian.