by James Lake
W. W. Norton, 2009
Review by Wendy C. Hamblet,, Ph.D. on Jul 6th 2010
In the Republic, Socrates explains that philosophers have little interest in power. But they take the helm of the ideal state because others less worthy are currently making a mess of it. Something less than ideal is always already going on. This analogy captures the motivation of James Lake, a conventionally trained psychiatrist, who has broadened his professional outlook, beyond the clinical therapeutics traditional to his discipline (pharmacology and psychoanalysis), to appreciate that other things are already going on, whether the medical community knows about them or agrees with them.
Lake sets out, in his Integrative Mental Health Care, from the argument that people are already turning in vast numbers to "complementary and alternative" therapies, from Chinese and Ayurvedic healing treatments, to massage therapy, Reiki, yoga, homeopathy, and a host of other practices and remedies, to self-treat mental health problems. Furthermore, many psychiatrists and psychologists are already complementing their client's treatment program of prescription medications and psychoanalysis with alternative healing techniques. In short, claims Lake, mental health care is already de facto integrative.
However, on the whole the professional psychiatric community has been reluctant to publicly approve alternative and complementary approaches to mental health treatment because the reigning definition of mental illness restricts them to a narrow view of mental disease and a narrow window of justifiable treatments. "The dominant paradigm of Western psychiatry--biological psychiatry--posits that the causes of certain specific symptoms or disorders are dysregulations of specific neurotransmitters or their receptors" (p. 8). Wedded to this paradigm, Western mental health professionals are locked into treatments that manipulate the chemistry of the brain to bring about regulatory balance. That is, they are largely wedded to the exclusive use of prescription medicines to rebalance brain chemistry.
Furthermore, the reigning paradigm--the theory that brain chemistry imbalances are the fundamental cause of mental disorders--has restricted the amount of research performed on unconventional healing modalities. "Where a multibillion dollar industry funds studies on conventional drugs, there is little financial incentive to invest research dollars in natural products that cannot be patented and therefore are not potential sources of future revenues" (p. 8). The research budget for alternative healing treatments is miniscule by comparison to that of the pharmaceutical industry. Therefore, very few broad and high quality studies have been conducted to try to demonstrate the value of alternative healing methods.
The problem with current approaches to mental health care, argues Lake, is that there exists a serious disconnect between biological psychiatry's paradigm of mental ill health as "dysregulations of specific neurotransmitters or their receptors" and the methods currently being used to characterize and diagnose the symptom patterns that make for the professional judgment of discrete "disorders." Conventionally, psychiatric diagnosis rests upon a practice of standardized interviews, which then assess patient symptoms according to established rating scales. The result is an analytic diagnosis about the type and severity of symptoms. Symptoms are then targeted with the latest drugs, and complemented with psychotherapy. So, though the paradigm is biological, and though there are many formal biological assessment tools available to psychiatrists, these tools are rarely employed in everyday clinical practice. Their infrequent use is testimony, according to Lake, of the broad professional admission that mental and emotional symptoms are highly subjective and individualized. Thus the underlying causes or meanings of emotional and mental symptoms can seldom be verified by empirical analysis or statistical methods that measure biological facts.
Because of the ineffectiveness of objective empirical analyses for getting at the root causes of subjective emotional and mental symptoms, even if such analyses were used in clinical practice (which they largely are not), the rigorous biological assessment tools would fail to verify the paradigm upon which they logically rest: they would fail to prove that symptoms are caused by neurotransmitter dysfunction. By extrapolation, they would also fail to prove that improvements in symptoms are caused by pharmacological and psychotherapeutic interventions. Of course this conceptual dilemma plagues nonconventional therapies as well. Therapists can never be certain, or provide skeptics with compelling evidence, that their therapies are causing healing of their clients' emotional and mental disorders.
Diverse healing traditions rest on conflicted assumptions about the causes and meanings of mental illness. Yet none of these traditions is grounded on a firm conceptual base. Conventional psychiatric medicine has had to struggle, since Sigmund Freud, to establish their legitimacy as a science and their value to suffering patients. Perhaps the professional community's dogged reluctance to address the challenge that Lake poses to them in this book--the challenge to consider complementing their current treatment approaches with alternative methodologies--rests in their general reluctance to raise at all the question about therapeutic effectiveness. The challenge to prove that alternative strategies do or do not work hits a little too close to logical insecurities at the home base. Questions about the effectiveness of alternative healing strategies may lead to comparative studies that then reveal the more troubling fallacy that existing diagnostic methods and treatment therapies enjoy scientific certainty.
Despite Lake's frank admission of the conceptual dilemma at the heart of all psychiatric medicine and healing traditions, the integrative mental health care approach he proposes in this book never strays far from the home base of psychiatric conventionality. At no point does he seriously question that psychopharmacology and psychotherapy should remain the foundational methods for treating mental health care, despite the facts that psychotherapy has never been substantiated by strong evidence as an effective treatment for mental disorders, and prescription medications have been overwhelmingly demonstrated in a great many studies across the globe to have greater risks than benefits for many patients. Lake never makes the conceptual leap to the obvious conclusion: that neither of the conventional Western methods for diagnosing and treating mental health disorders provides compelling evidence why their use should be continued.
Something less than ideal is always already going on. Ten per cent of U.S. adults are under conventional psychiatric care, loading up on conventional drugs for depression, anxiety, and other mental health disorders, despite the lack of compelling evidence that the conventional methods have the least positive effect on their well-being. Seventy-two million Americans, one in every three adults, dabble in complementary or alternative therapies to treat or self-treat their mental and emotional problems. Among individuals hospitalized for severe mental and emotional ill health, almost two-thirds had self-treated using a nonconventional modality within the previous year, and a full 80% had not disclosed their self-treatment strategies to their psychiatrist.
Conflict theorists tell us that depression and anxiety go hand in hand with the alienation, isolation and moral compartmentalization that are a general and entirely predictable result of life in advanced capitalist, industrialized societies, as we rat-race toward material success at the expense of communal and individual integrity. The increasing epidemic of mental illness in Western societies should give us all pause about the way we are living our lives. Whether we decide to throw drugs and therapy at our symptoms or to reassess our degraded life styles more holistically is a question to be individually answered, without the aid of compelling evidence for the effectiveness of either response.
Lake's remarkably comprehensive manual, designed for mental health therapists of broad description, remains faithful to his profession's conventional assumptions about the nature of mental illness and the most effective treatment responses. Nevertheless, he painstakingly outlines enlightened approaches to diagnosis, recommends the use of alternative and complementary healing strategies in combination with conventional approaches, and outlines the arenas of risk to be considered in launching into new therapeutic territory. Integrative Mental Health Care is a valuable handbook for any practitioner, and would serve as a helpful text for students of psychiatry and psychology. But it also provides a worthwhile read for any educated adult wishing to better understand the alternatives available to people with mental health challenges.
© 2010 Wendy C. Hamblet
Wendy C. Hamblet, North Carolina A&T State University.