Book Review - "Healing, our path from Mental Illness to Mental Health"

 

 Another American Expert says "Our house is on fire!"

Yet another leading American mental health expert is saying,  "America is in Big Trouble!"

(Much of what author Thomas Insel says in this book agrees with another American expert, Bessel Van Der Kolk in "The Body Keeps the Score" (See my recent review here)).

Thomas Insel defines mental illness as disorders of the mind manifested in how we think, feel and behave (p. xi). His basic premise is that while Americans have  grown in their understanding of mental illnesses, this knowledge has not resulted in any improvements on the ground, whether in terms of suicide rates, addiction or schizophrenia. 

His conclusion, after talking to people and groups all around the country is that the whole present approach of psychiatry is wrong, "Mental illnesses are different from other illnesses. Our current approach is a disaster on many fronts." (p.xix).

A wise psychiatrist working on skid row told him that what people need is People, Place and Purpose (PPP), and the road to recovery requires much more than clinics and hospitals. Professional help only contributes to around 10% of what is needed. Because we don't include PPP in our treatment people with mental illness end up in prison, homeless and suicidal.

Tragically, Insel thinks that the problem can be solved without divine help, "All that's lacking is commitment." (p. xx). "Our house is on fire, but we can put the fire out. We know the way, if we can summon the will." (p. xxix). 

PART 1 - A Crisis of Care

Here are a few sobering stats, I doubt if the stuation in the UK is much different:

• 47,000 people take their own lives in the USA every year, equivalent to a daily mass shooting of 129 people, every day, every year, or one person every 11 minutes. 
• Disability from mental health issues increased by over 40% from 1990-2016
• "outcomes for people with mental illness have not changed significantly" (p.18) 
• "more people are getting more treatment than ever, yet death and disability continue to rise. How can more treament be associated with worse outcomes?" (p.19)
  

Insel acknowledges that modern mental illnesses have been part of the condition of mankind for all time, but he thinks that the difference today is simply that we are not attending to the issue, it's that we do not care. Most mental illnesses begin before the age of 25 (p. 18). Hospitalization does not solve these problems. What works "most of all is social support" (i.e. friends, family, community, p.14). 

1- Medications - do they work? 500 million prescriptions in the USA for antidepressants and antipsychotics and "no sign of better outomes" (p.45)

2 - Pscychotherapies - do they work? Many therapists are using out of date therapies. "Matched with the right problem all of these approaches help. Talking with an empathetic friend or pastor can help a well." (p.53)

3 - Neurotherapeutics - can they help? Sometimes, although we still "understand very little about how the brain works." (p.43)

4 - Rehabilitatiative Treatments (whole-person care) - do they work? Insel argues that treatments 1-3 are not cures though they may help. For long-term recovery people need support from - guess what? - ordinary people; they need people who will help them rebuild their lives. 

So what's missing? What's wrong? Symptoms are not being addressed, treatment focusses on short term success, the specific needs of the patient are often not thought through and therapy is focussed on relief rather than recovery. It's easy to relieve symptoms, much harder to heal. The "bible" of psychiatry, the DSM, is based on diagnosing symptoms and therefore the solutions are inevitably based on symptom relief.  

At root, we don't care enough as a society. We have many examples of community cure, therapies that work, but not enough committment. This lament comes from both Insel and Van Der Kolk.

PART 2 - Overcoming barriers to change

Insel suggests how the problems in the system can be solved. Jails have become defacto mental hospitals holding large numbers of people not yet gone to trial with mental health issues - the nation needs to sort this one out. More care, more mental health providers (p. 98), higher quality care, better training, better accountability, more precisely targetted help, all this will solve the problem. Get on with it governments and local authorities. 

Insel acknowledges that the stigma of mental illness is still an enormous barrier to folks seeking help (p.144).

Insel fails to mention is that professionalism often puts people off. It's families and communties who know each other who need to look after one another - not distant experts.  He acknowledges the role of the family by citing Germany where "families are funded and even trained to take care of their son or daughter with mental illness." (p.156)

Insel argues that a radical change in outlook is needed:

"Recovery is not just relief of symptoms, it's finding connection, sanctuary, and meaning not defined or delimited by mental illness." (p. 160

1 - People, the crisis of connection. But how are we going to get this without the Gospel and the community that arises from it, called the church? From research it's clear that "social isolation can be devastating: social attachment can be curative." (p.162). "Millions of people risked exposure to the virus rather than face loneliness." (p.163) "Of all the things that we psychiatrists and pscychologists do not acknowledge about people with SMI (serious mental illness), loneliness may be at the top. I rarely hear patients talk about it in clinic." (p. 167)

2- Place - how is the world going to create the safe place that both the family and the church should provide? 

3- Purpose - finding the why. Again, how can the world help us work out why we are here? 

"The three Ps - people, place and pupose - are the keys to recovery" (p.175) So how can the state create a new intentional community?

PART 3 - The Way Forward

We need simpler solutions, says Insel. We need to use technology. There are clever software programs that will evaluate our personal language year on year and detect subtle changes in mental health. Mobile phones can also keep track! Cure by monitoring (Big Brother?). Telepsychiatry - a shrink at the end of Zoom. Virtual therapists! (Apparently people are more honest with virtual therapists because they don't feel judged!)

Then there's prevention. Healthcare, the "repair shop", only accounts for around 10% of what is needed for a good life which is the highway, so to speak. "Healthcare alone might explain only 10 percent of the variance in outcomes." (p. 221), that is between those who enjoy a good life and those who do not. Our immediate surroundings, where we live and who we live with, etc. account for 70% (p.221). [Not sure where the other 20% comes from]. 

Insel acknowledges that one of our greatest problems today is our failure to "support families and children." (p. 237) "What matters is not only what they do in Washington but what we do at home." (p. 243). Insel quotes American senator, Hubert Humphrey, "The moral test of governement is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life - the sick, the needy and the handicapped." (p. 243) 

"When I started this journey to resolve the mental health crisis, I believed that technology would provide the answers we need... Years listening... left me convinced that the problems are more complex and the solutions far simpler than most of us realise." (p. 244)

 Reflections on an imporant book

Insel is able to diagnose the societel mess the West is in, at least outwardly. He observes that some contemporary discoveries and therapies can do a limited amount of good. What he cannot see is the deep spiritual malaises that lie behind the crisis.

Our crisis on all three fronts, People, Place and Purpose, is a spiritual crisis. 

People - Designed to live in deep community with others, our sin separates husband from wife through divorce, and thus messes children. Our sin separates one man from another through hatred and unforgiveness.

Place - Our sin makes the family an unsafe place and our societies an unwelcoming place. 

Purpose - Without living for the glory of God we have no ultimate reasons to live, we may have temporary shallow ones, such as career and  family, but all earthly purposes either fail or fade. 

The family (one man and one woman united for life) is God's place for the next generation to grow up in security. The Church is God's place where the outsider should find a home and be welcomed in. Heaven is the hope and destination for troubled souls, where all our tears will be wiped away.

This book should make every believer passionate about sharing the Gospel with a broken world, for only the Gospel of Jesus Christ has the answers for the ailments of our broken world.