In his new book, Meaning Systems and Mental Health Culture: Critical Perspectives on Contemporary Counseling and Psychotherapy, James T. Hansen argues that although meaning systems are central to the human experience, they have been largely ignored in present-day mental health culture.
Drawing on numerous historical and philosophical examples, Hansen outlines the ways in which meaning systems shape the way we come to understand ourselves, others, and the world around us. He makes the convincing case that because they are the omnipresent shaping forces of life, meaning systems should be a primary consideration when attempting to alleviate psychological suffering.
Hansen begins by defining meaning systems: “Meaning systems are the ways in which people structure and makes sense of the world on individual, social and cultural levels.” Meaning-making is an individual process, the assumptive world we create, a social process, where the meaning-creation process happens between people and not solely within them, and is highly influenced by the culture in which we live. And all meaning systems are central to the healing process.
However, Hansen writes, “The meaning market is clearly not free; it is highly regulated by meaning monopolies.” One such monopoly is the medical model, which reduces problems to symptoms, thereby stripping away the meanings that animate psychological suffering. When people are simply classified into a set of symptoms that match a psychological diagnosis, not only are they severely objectified, but they may fulfill the prophecies foretold by their disorders.
And yet there can be many reasons that helping professions continue to rely on the medical model, despite its disenfranchisement of individual realities. The medical model does attempt to make complex life circumstances and histories fit into easy-to-identify categories. Favoring universal laws and concrete truths over the more complex real-life human problems like poverty, immigration, loss, and financial stress, the medical model seeks to quickly diagnose, treat, and move on.
The medical model also provides incentives for professionals in the helping field, since being the expert in the room offers a sense of authority and power. Hansen writes, “Symptom-based diagnostic expansionism and false diagnostic homogeneities are not simply an accidental by-product of descriptive psychiatric ideology. Rather, there are strong professional incentives for widening the diagnostic net. The pharmaceutical industry, for instance, is a major financial beneficiary of psychiatric expansionism.” In other words, for those who provide medication for all those diagnoses — namely the pharmaceutical industry — more diagnosable disorders lead to the need for more prescription medication to treat all those disorders, and the pharmaceutical companies profit.
And yet, psychiatric expansionism doesn’t just over-diagnose and overprescribe. It narrows the definition of normal. Hansen describes what could be called homo-normalis (HN) as a person who is unflappable in the face of life changes, would never fall prey to adjustment disorder, and would be immune to developing “emotional or behavioral symptoms in response to identifiable stressors.” HNs would never display behavior that deviates markedly from the expectations of their culture. “Clearly,” Hansen writes, “HN is not a civil rights leader, agent of social change, or person who challenges the status-quo in any realm.”
Perhaps even more troubling, however, is that psychiatric expansionism overlooks the potential for psychological growth that exists in distress. By reducing the many psychological, cultural, and relational dimensions of life to quickly diagnosed and quickly medicated problems — what is known as biological reductionism — people are often encouraged to anesthetize their psychological pain rather than experience and grow from it. Further, the defensive use of psychiatric diagnostics to avoid facing troubling realities is not only used by therapists and their clients but has also been adopted by the larger culture. And yet, Hansen tells us, “there is good evidence that antidepressant medication may be no more effective than a placebo for mild and moderate depression.”
Instead of relying on diagnostics and psychiatric medications to overcome troubling life events, what those in the helping professions really need, Hansen argues, is training in the “common factors of therapy”, such as developing healing relationships. Hansen writes, “The outcome research strongly suggests that relational factors, which are common to all therapeutic systems, are primarily responsible for outcomes, not isolated techniques.” What is also needed is a separation between the mental health field and the medical model, as Hansen explains, “A connection between talk therapy and the field of medicine is no more sensible than a connection between talk therapy and personal finance.”
Lastly, as oppose to following the culture, the mental health field should follow the evidence. And what the evidence clearly says is that when an appreciation for meaning systems and helping relationships is at the center for those in helping professions, not just is the mental health field itself made better, but the client is given the opportunity for psychological growth.
Meaning Systems and Mental Health Culture: Critical Perspectives on Counseling and Psychotherapy
Lexington Books, February 2016
Hardcover, 200 Pages