The Biomedical Model
Let us ring in the new year with the latest scientific discovery. Last week science writer, Jenny Chen, writes an article in The Atlantic, “Childhood Guilt, Adult Depression?” and within days links and commentary were published all over the web. Prominent news sites like the Chicago Sun-Times, International Psychologists, and Huffington Post, to name but a few, open a forum of discussion on these new facts that have been heroically revealed in the medical field and suddenly everyone proclaims, “Ahh, now I understand!” And all I can see between the lines of those who are in support of the validity of this research are the words, “Please tell me what to think!” Unfortunately most people are quite content being told what to think about their own brains. They have long ago bought into the idea that we have no free will and that biology determines everything.
I am opposed to the biomedical model in determining psychiatric problems in people. Although the model is considered the leading approach for modern mental health care today, it focuses purely on biology. In physical illnesses this approach can be appropriate for determining much pathology, but in psychology it is simplistic and lacking. There is a litany of limitations to this perspective. The biomedical model strictly adheres to nature over nurture. It does not take into account other factors that play a role such as social structures, environmental causes, cultural differences, or individually subjective aspects in the analysis, and it does not care to do so.
Although lately this approach to psychology is all the rage, it greatly underestimates the complexity of human behavior. It is reductionist in its nature by oversimplifying the vastly complex brain system and its interaction with its environment. It implies that a person is nothing more than the sum of her parts. It supports deterministic thinking, which allows very little room for free will and personal responsibility. When we assume that these areas are predictive and therefore unchangeable, we are dooming our children to a future with no hope, restricting their freedom of mind and heart.
Using both nature and nurture as factors inside an analysis is the only way to make any kind of statement about human behavior. Unfortunately the answers are never neat and orderly as much as biological scientists want them to be.
The Study: Conclusions and Problems
The research was based on brain scans of 145 children in the range of ages 7-13. The caregivers were given surveys measuring symptoms of excessive guilt in their children such as constantly apologizing for a minor misbehavior or feeling guilty for things that happened a long time ago. The results are in. Said Joan Luby, one of the authors of the study, “In the kids who had high levels of guilt, even the kids who weren’t necessarily depressed, they had smaller anterior insula volume, and that smaller anterior insula volume is predictive of later occurrence of depression. This research suggests that early childhood experiences impact the way the brain develops.” Predictive? The size of a part of a person’s brain makes an accurate case for a child’s future? Wow, what a conclusion.
In order to measure the research in this kind of comparative psychology, scientists use scans of brains from people who are mentally ill and compare them with brains of those they deem as normal. But exactly whose brains qualify as normal? When compared to the abnormal brains are the normal ones normal in every area? Surely this brain belongs to a person with some kind of problem. Out of all abnormal behaviors, and according to the DSM there are over 300 of them, it is almost mathematically certain that this normal brain must suffer from some kind of mental problem. Does this other mental problem also show up in the imaging taking place? Or has that not been yet mapped out? Whatever the case may be, making comparisons in brain sizes in order to make a prediction about a kid’s future doesn’t sound like science to me. Yet it has a lot of things in common with fortune telling.
Brain scan research has extremely low ecological validity because it is organized in artificial settings that lack realism, unlike research of high ecological validity conducted in settings in natural environments. Since this research has barely any connection with a situation found in a real-life setting, do these studies measure what they are supposed to be measuring?
The researchers have dealt with the issue of excessive guilt. But how much guilt is too much? Guilt in itself is not a bad thing. Simply, it is the feeling of having committed a wrong or failed in an obligation. Guilt can be a tool to self-regulate one’s behavior, and in the past we believed it played a role in revealing a person’s conscience. Guilt may certainly be overemphasized in some families, and something that may feel guilty in one family may not provoke the same feeling in another; both states of mind, however, may be valid. The emotion of guilt by its very nature is not always rational. And children being as innocent and impressionable as they are, are more emotional than logical.
One of the gravest errors in predictions based on biological experiments in psychology is that the direction of causality cannot be inferred. Are children predisposed to depression likely to experience excessive guilt or does the appearance of excessive guilt cause mental illness to emerge? Michelle New, a psychologist and associate professor at the George Washington University Medical School in Washington, D.C., doesn’t believe it matters in the clinical setting. “It’s not like that symptom is going to go away,” she said. “What’s important is that we practice early intervention and prevention.”
A “symptom” like guilt cannot go away? In my personal experience this “symptom” of guilt, (I always labeled it a feeling), dissipated when I apologized for something I did that was wrong, or I made a plea through a prayer to God asking for his forgiveness, or after much personal analysis of my flawed behavior I rose to the mature realization that in order to let go of the guilt, I needed to forgive myself and move on. But according to this researcher, if I had a particular brain imaging as a child, my symptom of guilt simply will not go away, and I’d be better off to bring in the mental health professionals in kindergarten so as to give me early intervention to not think a certain way.
We must empower our children by teaching them skills to cope in life by managing their feelings, however difficult they may be, not giving them the hopeless idea that they have no inherent ability to take care of their emotional states. We should be helping them become self-reliant and confident by believing in themselves, not ashamed of their defective anatomy creating dependence upon external institutions and long-term medical assistance.
According to Jenny Chen, New believes that, “…this research could help pinpoint specific brain anatomy to identify children who are at high risk for later-life mental disorders. New states, ‘This research is really new and exciting because you can look at changes in the brain, and it shows that early intervention is really important. Dismissing early symptomatology is dangerous,’ she said. New explained that mental disorders are often latent between the ages of four and 12, and so being able to identify children at high risk for mood disorders helps parents and mental-health professionals engage in preventative measures earlier in life.”
I love the word “pinpoint” because that is exactly what they are doing with this approach to helping children. Putting them in a box, pigeon-holing, and tagging children as young as seven with a label held down by a pin just the way entomologists do to pretty and ugly beetles alike in the drawers of classified things in the American Museum of Natural History.
In New York State, early intervention governmental assisted programs are offered in everything from occupational therapy to physical therapy, from speech therapy to social behavior therapy, and are highly sought after from parents who are worried about the slightest behavior in their children off the benchmark chart. I never submitted to this excessive worry on every level. Some things I believed were important issues to be addressed, and other things I believed would take care of themselves over the course of time in my son’s natural development. I sought after speech therapy for him when I saw after the first year in nursery school he was still suffering from being misunderstood amongst his teachers and peers, which was directly affecting his interaction with others.
But the program facilities wanted to overschedule Jack’s day with other early intervention measures too. I finally put a stop to the invasive and endless testing when they suggested Jack be given physical therapy because I answered a question on a survey that stated that he couldn’t catch a ball from three feet away. Maybe a few times he did, but that wasn’t an option on the multiple choice. I felt the intrusion of judgment to be rather unfair and simplistic, especially when my son inherited genes from my husband who still had trouble catching a ball. Needless to say my husband never aced gym class or became a ball player, but instead he is a highly successful banker. I wonder what would have happened if my husband received early intervention instead.
Similar to the way psychologists push governmental early intervention programs so that they have continued monetary support, New tries to validate biological research by putting the guilt trip on parents with her warnings that not responding to these early “symptoms” is dangerous. Did I endanger my son for not giving him physical therapy at age 3? I think not. Intuitively, I withheld pressure and instead waited for him to feel a little more coordinated with his body. An extra year or two later than his peers he eventually threw himself into gymnastics, an activity he has committed to for years. In addition, at the ripe old age of 8 he is on the peewee basketball team, and gym is his favorite subject.
The biomedical point of view helps promote the mental health industry and helps it thrive in many facets. The pharmaceutical industry develops new drugs each year to take care of new symptoms that crop up with each revised issue of the DSM. Psychiatrists continue to have customers increasingly younger due to the latest vogue idea of early intervention, and while everyone is happier and mentally stable, as a society we are becoming more and more imprisoned and less interested in matters of the soul.
In a dead robotic world teaching us that human feelings are nothing other than chemicals and our minds are made up of little more than cells and tissue, maybe we need some of these depressed, manic, and anxious folk to open their mouths to share the truth with people. Wake them up out of the coma the psychiatric community is convincing us to believe, namely, that by using the biological model they are helping change the stigma of mental illness.
Unfortunately, the mental illness awareness community of today is the strongest promoter of the biomedical psychiatric model. Yet this very philosophy further perpetuates the stigma by suggesting there is fundamentally something wrong with us on the deepest level of our DNA. They assert the model is scientific with many empirical studies to support it, but the realm of the mind branches from more than just our biology.
It’s in the language. Declaring that a person is not in charge of their own future due to their unfortunate heredity especially in regard to unpredictable future feelings and thoughts, is crippling and disempowering. This is yet another message to all children and their parents to lock their kids into thinking they are mentally ill way before anything should ever occur. It creates a restricted mind and does so at the earliest age.
Fostering the self-fulfilling prophecy, these beliefs become our reality because we act as if they are already true. Having expectations that we will see certain outcomes affects our behavior toward ourselves and each other. Thus, when any feedback returns to us that supports our preconceived notions, our original suppositions are reinforced making it difficult to recognize information to the contrary. A person’s life cannot be determined by computer imaging. Our worlds are shaped by our choices, lifestyles, upbringings, points of view, world beliefs, socioeconomic backgrounds–the list is extensive. Beyond the way our brains look in a scan, what resides inside is much more important.
Funny, this style of identifying physical constructs and then predicting certain character traits or propensity of future behaviors is very reminiscent of the 18th century notion of physiognomy, a pseudoscience that was fueled by the belief in racial superiority. This outdated view assessed the nature of one’s character or personality based on a person’s outer appearance, especially the shape of the head and face, to explain why these inferior and superior characteristics existed.
Scientists made comparisons between the races they chose as normal and the races they deemed as inferior helping them make “scientific conclusions” on such matters. Just as in days past scientists are now trying to prove that certain mental types are more healthy and normal than others, not by comparing forehead shapes but rather, brain sizes. Today we have the ability to look inside the person’s head with brain images measuring physical structures in the brain, an organ that we know so little about that much of the work that brain scientists are doing is based on speculation. Most scientists can admit that alongside the growing data in this area are widening gaps of understanding.
While brain scientists make sweeping conclusions on a grand scale, they work on a tiny scale analyzing networks of cells in labs of low ecological validity. Identity, personality, memory, all the things that define a human being, do not only grow out of the way our brains appear, but out of experiences we each have, out of our consciousness, and out of our relationship with the Divine.
Strange. In a day when we believe we have progressed as a species, we are somehow convinced that the size of one’s anterior insula alone, a small part of the brain’s physical structure, actually determines future feelings and behavior years before something should ever be provoked. Scientists do not know why these parts are bigger, and it may not even matter all that much. They are simply making observations about something material and extrapolating from that a conclusion about something immaterial. Mental things and physical things are in two different genres, apples and oranges. This so-called science uses biology in a way that could never thoroughly explain issues that are non-local inside the heart.
Robbing Our Future Choices
Why are we obsessed with preventing future states of mind? What are we afraid of? In the name of controlling the depressed kids of tomorrow by shaping the way they feel today, we are taking them away from being the authors of their own lives and instead making them patients. We are all in a state of healing, possibly some more than others. But have we stopped to consider that maybe these kids of tomorrow with small anterior insulas have special gifts not yet known to us to help shape a beautiful future world? Who are we to stop those gifts from growing and blossoming? Is it all in the name of biological psychology?
In my opinion preventing future mental illness has a lot more to do with making the right choices in life, thereby reinforcing those thoughts associated with such states of mind. For me personally, I lost mental grounding when I was impatient, when I had become arrogant and selfish, when I lost faith in something larger than myself and held little respect for others in my life. If I had practiced the opposite: patience, selflessness, faith, and respect for others, my life’s detour may never have materialized. I never at any point believed that the size of select parts of my brain had any factor in it.
It is the brave new world, my friends. The truth hurts whether you want to believe it or not. Tell me what to think, and I will be ok. If I am made to disengage myself from messy emotions, maybe I can avoid a further messy situation like depression in the future.
But let’s not get too wrapped up in the packaging. Life is life. It’s most often unpredictable. My brain may house my emotional activity, but it does not experience the feelings in the way my heart does.