An inclusive approach to mental health: Not all in the brain

this article was submitted to Beyond Meds by Oxford University Press and was first published on their site

Editor’s note: Beyond Meds takes issue with the unequivocal comment in the below article that medications can take an important role in treatment. As it stands right now that may be the case given there is no infrastructure of care for meaningful alternatives. If there were such an infrastructure in place (something we must work towards) — it’s quite debatable whether medications would have any role at all beyond targeted and brief crisis intervention, perhaps). Until we have such an infrastructure of care that supports profoundly holistic care we cannot know what is possible. What I and many of the authors at Beyond Meds have discovered is that our bodies and minds and spirits seem to work quite well when all our holistically connected pieces are tended to with synergy and care. I and many others like me have found profound healing with such awareness. Medication used for prolonged periods of time simply does not support such deep healing. The rest of the modalities discussed in the article absolutely support growth, healing and transformation. Also in my experience I’ve found that this is true of all psychiatric diagnosis and is certainly not particular to only schizophrenia. 

By Michelle Maiese

For many years, the prevailing view among both cognitive scientists and philosophers has been that the brain is sufficient for cognition, and that once we discover its secrets, we will be able to unravel the mysteries of the mind. Recently however, a growing number of thinkers have begun to challenge this prevailing view that mentality is a purely neural phenomenon. They emphasize, instead, that we are conscious in and through our living bodies. Mentality is not something that happens passively within our brains, but something that we do through dynamic bodily engagement with our surroundings. This shift in perspective has incredibly important implications for the way we treat mental health – and schizophrenia in particular.

In much of the Western world, and particularly in the United States, drugs are a primary mode of treatment for psychological disorders. This reflects the common assumption that mental illness results from faulty brain chemistry. Although it would be difficult to deny that medication can play an important role in treatment, this drug-based approach faces three major limitations:

  1. It is doubtful whether disorders such as schizophrenia are caused by anything neurological (in the straightforward way that heart attacks are caused by arterial blockage). Indeed, many mental, emotional, and behavioural problems do not have clear-cut genetic or chemical causes, but instead result partly from difficult human experiences, stressful events, or other problems in their personal life. When minds “go wrong” it is not simply a matter of mechanical breakdown, and “fixing” neural wiring will not be sufficient to address the underlying causes of disorder.
  1. There is evidence that antipsychotic medications are not sufficiently effective in managing the debilitating symptoms of schizophrenia, such as delusions and hallucinations. Many patients on medication continue to experience psychotic symptoms throughout their lifetimes. In addition, there is a worry that anti-psychotic drugs may cause negative side effects, such as apathy, muscle stiffness, weight gain, and tremors.
  1. By focusing on just one organ of the body (i.e. the brain), drug-centred approaches overlook the role of bodily processes more broadly construed. Once we acknowledge that consciousness and cognition are fully embodied, this pushes us to move beyond narrowly defined, brain-based methods and to seek treatments that transform a subject’s overall neurobiological dynamics.

What can be done?

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click pic for credit

Interventions that target the subject’s whole body, and not just the brain, include yoga, dance-movement therapy, and music therapy – all of which have proven to help schizophrenic subjects re-inhabit their bodies and regain a coherent sense of self.

There is strong evidence that yoga therapy can reduce psychotic symptoms and improve the quality of life of adults with schizophrenia. Through the repeated execution of sequenced movements and postures, as well as enhanced sensory self-awareness, subjects are able to forge more of a felt connection with their bodies and also begin to feel more “at home” in their surroundings. Breathing exercises and meditation can help to make the make body feel more familiar, increase sensitivity to subtle bodily sensations, and minimize feelings of bodily alienation and hallucinations that are commonly found in schizophrenia.

Like yoga, dance/movement therapy centres on the use of movement to foster the integration of bodily sensations and emotions. Through exercises that aim to increase bodily self-awareness (such as sequential warm-ups, patting one’s own body, defining its outer limits, grounding, and reflecting on the movements of others), a sense of self is promoted. In addition, it provides opportunities for increased emotional expression and the controlled, cathartic release of emotions of joy, sorrow, rage, or frustration.

click pic for credit
click pic for credit

Last, but not least, music therapy may have great potential for treating schizophrenia. Subjects can be invited to play or sing, whether through improvisation or the reproduction of songs, or simply listen to recorded or live music. Like dance, music provides subjects with a nonverbal means of expression and can serve as a powerful therapeutic medium for those who are unable or too disturbed to rely on words. Improvising, playing, composing, and listening to music all are thoroughly embodied processes that address symptoms from the bottom-up, by engaging emotions and bodily feelings.

By tackling mental issues with this ‘bottom-up’ method, we are able to bring about changes in higher-level cognition and interpersonal functioning – by evoking emotion and tapping into bodily feelings. Such therapies have a fantastic potential to make subjects more attuned and sensitive to their surroundings, and to foster emotional resonance with others.

It is true that such treatments may take longer, and be more expensive than medication. However, such interventions may be our best hope for bringing about lasting improvements – focusing on the person as a whole, to treat a problem as a whole.

Michelle Maiese is Associate Professor of Philosophy at Emmanuel College in Boston, MA. Her research addresses issues in philosophy of mind, philosophy of psychiatry, and emotion theory. She is the author of several books, including Embodied Selves and Divided Minds – an examination of how research in embodied cognition and enactivism can contribute to our understanding of the nature of self-consciousness, awareness, and the metaphysics of personal identity in cases of psychopathology.It forms part of the International Perspectives in Philosophy and Psychiatry series. 

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*it is potentially dangerous to come off medications without careful planning. Please be sure to be well educated before undertaking any sort of discontinuation of medications. If your MD agrees to help you do so, do not assume they know how to do it well even if they claim to have experience. They are generally not trained in discontinuation and may not know how to recognize withdrawal issues. A lot of withdrawal issues are misdiagnosed to be psychiatric problems. This is why it’s good to educate oneself and find a doctor who is willing to learn with you as your partner in care.  Really all doctors should always be willing to do this as we are all individuals and need to be treated as such. See: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up

For a multitude of ideas about how to create a life filled with safe alternatives to psychiatric drugs visit the drop-down menus at the top of this page. 

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