Doctors may need to go beyond medicine in mental illness

Editor—Mike Shooter's narrative is remarkable for the fact that as a patient he developed his own form of treatment.¹ Implicit in his account is a recognition of the shortcomings of the medical model of mental illness.

Advocates for mentally ill people seek the removal of stigma. They emphasise the role of biology in generating the experiences of madness. They hope that seeing mental conditions as brain disorders and not as reflections on the sufferer's personal make up will alleviate shame and societal disapproval. As one advocate put it, “depression is something you have, not something you are.” But Shooter finds benefit in saying “I have to challenge the assumptions I make.” This implies a third way of thinking about depression and manic depression, not as something we are, not as something we have, but as something we do. This outlook deserves exploration.

I have written elsewhere about being picked up by police late at night wandering the beach in my underwear thinking I was Elijah the prophet, looking for the coming of the Messiah.²,³ My sense of this incident, now nine years past, was that it was the most profound and meaningful healing experience imaginable; I had never felt more sane and purposeful.

Sometimes mania has an importance that cannot be captured by medical paradigms that focus on brain disorders. Biological models remove self knowledge and moral agency from the picture. Let us enlarge our frames of reference for manic depression, so we can remove stigma not just from the diagnosis of mania but from the experiences themselves.