Mental Health Treatments: A Way for the Institution of Medicine to Ignore the Real Contributors to Psychiatric Disorder

Psychiatric disorders have always existed, however, with the rise of discourse surrounding mental health, they have become more acknowledged and cared for. Definitionally, a mental disorder is a clinically significant disturbance in behavior, cognitive function, or emotional regulation. This disturbance can potentially impact an individual’s daily function which classifies it as a disease that requires treatment of some kind. Serious mental illness (SMI) is considered when an individual’s function is severely impaired by the illness, and any mental illness (AMI) is when a person is experiencing any lower level of mental illness. Mental health conditions include depression, anxiety, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), neurodevelopmental disorders, and many more. An estimated one in five adults in the United States are experiencing an AMI, while an estimated 5.5% experience an SMI. Of those experiencing AMI, less than half receive medical treatment while 65% of those with an SMI receive medical treatment. At a base level, treatment for psychological disorders is typically pharmacotherapy, such as Adderall for ADHD or Lexapro for depression. Another common treatment is psychotherapy, which often works in tandem with medication. When all else fails, extreme surgical procedures can be performed, including deep brain stimulation (DBS) and other neuromodulation therapies. All of the practiced treatments aim to treat the biological symptoms of the illness rather than attempting to scrutinize the social and environmental factors contributing to these diseases. The institution of medicine, and its key players, use extreme psychiatric disorder treatments such as neurosurgical procedures to avoid confronting the social underpinnings of mental health that are deeply rooted in society.

To begin considering this claim, the existence of mental illness, and what exactly that implies, should be investigated. Firstly, what is illness? Illness can be seen as any deviation from the health of the body or mind - an abnormality. The idea of good and normal health is something that has been taught to us since childhood, to the point where we have a collective understanding of what health means. But, who decided what health is in the first place? Each individual has a different body and mind, varying DNA, and differing personalities. Why would our definition of health be the same if everyone is so different? The short answer is that the social institution of medicine agreed on a ‘normal’ physiology of the body and mind which has since become the precedent of health in society. When investigating health through a sociological perspective such as this, we can categorize the idea of health as a social construct. 

A social construction is an idea that has been created, accepted, and applied by the people in society. In “You May Ask Yourself: An Introduction to Thinking Like a Sociologist” by Dalton Conley, it is further defined as, “an entity that exists because people behave as if it exists and whose existence is perpetuated as people and social institutions act in accordance with the widely agreed-upon formal rules or informal norms of behavior associated with that entity”. Social constructs are known to have two criteria; they must change over time and they must change between groups. Referring back to health, it becomes obvious that it acts as a social construct because 1) it was created and maintained under a social institution and 2) it meets the criteria. Though health is a widely accepted term, different populations have various ideas of health depending on a number of factors such as resources, culture, beliefs, etc. Similarly, the concept of health changes over time, based on available resources, medical innovations, current outbreaks, etc. As a social construction, health thrives under the institution of medicine. To clarify, a social institution is an entity that manages the norms placed on social interactions and the roles of its key players. Concerning medicine, the doctors, staff, and patients are the key players, and their roles in social interactions are governed by the norms set in place by the institution. This does not mean that the institution of medicine directly tells individuals what to say, do, or think. Rather, through policies and established norms, a sort of social script tends to form that implicitly guides individuals on how to act in a given social interaction. The institution of medicine created the norms of a doctor’s visit, the social hierarchy within hospital staff, and the definition of health, among many others. 

The people with power within the institution get to decide what is an illness and what the treatment for said illness is. Their purpose is to promote health, and to prevent, diagnose, and treat illness. However, it tends to focus on the wellness of the group rather than an individual which translates into a sole focus on biological wellbeing in lieu of other contributors such as social determinants of health. A social determinant of health refers to a nonmedical factor that directly influences one’s health. These include an individual’s values, behaviors, attitudes, social status, disadvantages, etc. Studies show that social disadvantage is a major determinant of one’s health over the course of their life and has a strongly adverse effect. There are many ways that social status comes into play in one’s health, and when examining these outcomes, it is clear that lower social status leads to decreased health outcomes, especially in relation to psychiatric disorders.

Social standing is the most important social determinant of health because it seems to have the largest effect on the body. When comparing health outcomes to socioeconomic status, there is a direct correlation between the two which shows that people with lower socioeconomic status have decreased health outcomes. Similarly, there is a correlation between income and health, education and health, and housing and health. Stress levels may be the largest contributor to these health disparities. People of lower socioeconomic status in the United States tend to be people of color, most of whom are black. As a black individual in the US, one would face a tremendous amount of discrimination which comes from an extended history of racism in society. Additionally, black people are socioeconomically the poorest group in the United States on average. Low social status, comes with a colossal amount of stress; stress regarding income, family, proper nutrition, racism/discrimination, and the list goes on. These higher stress levels are one of the major factors that link lower health outcomes to lower statuses. 

Stress such as this can affect an individual’s physiology as well as their mental health. For example, an individual who experiences high stress will provoke high cortisol production which causes major health issues when built up over time. These issues include weight gain, high blood sugar, and increased anxiety. Stress also causes changes in telomere length, usually the shortening of the telomeres, which causes depression and other mental illnesses. Stressors like these are introduced to an individual in childhood through direct effects of parental socioeconomic status. Researchers studying low SES vs. mental health problems in children have shown that negative life events and other stressors are directly related to socioeconomic position and lower parental education and parental income are associated with higher stress levels in adolescents. This shows that social determinants of health, such as socioeconomic status, can affect the children as much as it affects the parents, in which childhood stress creates lifelong health issues. 

Social determinants of health not only affect the presence of psychiatric disorders but also their severity. ADHD is a commonly diagnosed psychiatric disorder that is characterized by difficulty paying attention and hyperactivity. These symptoms are labeled as a problem often found during school, which is a social construct governed by the institution of education. School itself is a social construct, and the existence of the ADHD diagnosis suggests that it is a problem to not be able to perform well in this socially constructed institution. This further proves that health is socialized and any deviance from the expectations associated with it is seen as an illness. To exacerbate the problem further, those diagnosed with ADHD are prescribed medication to treat it. Adderall is a medication that decreases hyperactivity, increases focus, and suppresses one’s appetite. Long-term effects of Adderall use include structural changes in the brain and changes in emotion regulation. These include mood swings, depression, panic attacks, seizures, and more. In addition to these physiological changes, many people including those with ADHD, struggle with self-identity of their medicated self. Adults who take medication like Adderall every day, have a hard time forming their identity and sense of self. This loss of identity can lead to depression, anxiety, and other psychiatric disorders. Not only is the diagnosis of ADHD socially constructed, but the common treatment for it can cause physiological changes that affect physical and mental health because an individual couldn’t focus in grade school.

Social determinants like these directly affect an individual’s health despite being nonmedical. Doctors and staff alike turn to medical procedures and protocols to treat illnesses caused or exacerbated by social processes set in place by social institutions. There are various potential reasons for their ignorance. For example, it is easier to see illness as products of biological differences that require medical treatment than to address the social issues that affect health just as clearly. Medical treatments and procedures also make up the majority of income for the institution of medicine. Though there would still be a very important role of medicine, they may not have as many patients that require life-long medication and treatments for some psychiatric disorders and, therefore, would not profit as much financially. We refer to these actions as medicalizing distress.

Psychiatry inspects individual treatments and interventions for one’s distress. It has and continues to introduce new psychiatric disorders while the threshold for these disorders becomes lower and lower. By using categorized surveys and symptom checklists, an increasing number of people are getting diagnosed and treated while ignoring outside stressors, consequently, medicalizing a variety of completely normal responses to environmental stress. The medicalization of distress is not a new concept. Throughout history, there have been many excessive treatments attempted for various psychiatric disorders. These procedures included extreme practices such as electroconvulsive therapy and neurosurgery in the 1950s. Researchers hypothesized that abnormal behavior came from dysfunctional communication in the brain, which led to the invention of the prefrontal lobotomy. The lobotomy is infamous for its drastic nature of severing the ties between the frontal lobe (the decision-making portion of the brain) and the remainder of the brain. It was thought that this would help cure depression among other psychiatric disorders. With the failure of the lobotomy and the turn to medicine, neuromodulation approaches to psychiatric disorders have become much less popular but they still exist. 

The most recent neurosurgical approach is deep brain stimulation (DBS) which gained traction in the early 21st century. The procedure is reserved for people with major depressive disorder (MDD) and those with OCD and involves implanting electrodes into the brain. These electrodes produce electrical impulses that affect brain activity and communication. Essentially, it is a lobotomy that is reversible and can be adjusted. Due to how extreme the procedure is, patients have to apply to receive it and meet a list of criteria to even be considered. Once an individual has received permission and undergone the surgery, they must meet with their doctor biweekly for a few months and follow up consistently for the remainder of their lives. 

DBS is just one example of the extreme lengths that doctors and scientists have gone through to treat psychiatric disorders in lieu of tending to psychosocial issues. The medicalization of distress has skyrocketed so high, that individuals with normal reactions to environmental stressors are diagnosed with anxiety or depression, and individuals with long-term anxiety or depression, likely from socioeconomic stressors, are being treated for severe cases of psychiatric disorders. Treatments and procedures create lifelong dependency on hospitals and other medical staff through continued follow-ups, psychotherapy, or prescription refills. These extensive treatments put a further toll on the individual emotionally and financially. Medication dependency can also lead to misuse or abuse, especially when started at a young age. This is in part due to the exposure to the medication itself, but also to the concept of the medicated self and self-identity – where adolescents get so used to being medicated that they form their sense of self around that which ties their identity with the medication, ensuring that they stay dependent on said medication. The lifelong effects of these common treatments suggest that they should not be as common as they are. As part of a hugely important social institution, medical professionals should be concerned with finding the true cause of one’s psychiatric disorder to not subject them to a life full of medical bills, new psychiatric problems, and the same socioeconomic problems that may have contributed to the symptoms in the first place. 

Instead, healthcare professionals view and treat health as an individual issue, which reduces populational health to a biomedical perspective and reflects a poor understanding of health by the professionals. The various social elements such as psychological, environmental, social, and economic factors that correspond with mental illnesses such as anxiety and depression call for a multifaceted approach to public health. An approach where medical professionals shift their lens of health by recognizing that it is a social construct and can be affected by many nonmedical or biological factors. Once the understanding has shifted, professionals can advocate for social changes on the basis of public health. With help from the institution of medicine, public health and social equality activists can have a stronger voice and stance for their movement. By creating more equality within social determinants of mental health, individuals will be less reliant on psychotherapies and pharmacotherapies and no longer be subject to extreme treatments such as DBS.

Unfortunately, this is not the reality because medical treatment is easier and more beneficial for medical professionals than addressing the root of the problems. Therefore, medical professionals and staff resort to using extreme treatments for psychiatric disorders to avoid confronting the social underpinnings of mental health.