“For to him when his thought-organ is tranquil,
To the disciplined one, supreme bliss
Approaches, his passion stilled,
Become (one with) Brahman — stainless. ”
Bhagavad Gita, VI.27
The Mental Illness Epidemic
Perfect mental health is surely a question of semantics. However, when asked about it, any family member of an individual who displays symptoms of mental disease will know what the lack of it means and recount episodes of its awkward and imposing presence, undermining even the most sacred relationships and making daily interaction painful and depleting. SMI (or, serious mental illness), is the all-encompassing category into which the National Institute of Mental Health has amassed all sorts of diseases whose acronyms are becoming more and more known to our society. These are disorders that impact mental and emotional functions in daily life resulting in functional impairment, which substantially interfere with or limit one from participating in life’s major activities.
A study identifies 9.6 million adults aged 18 or older in the U.S. with SMI in 2012. This represented 4.1% of all U.S. adults. A more recent study reveals in 2017 in the U.S., 46.6 million adults over 18 years old (18.9% of all U.S. adults) had a mental illness (i.e. “any mental illness, ” or AMI); 4.5% had a serious mental illness (SMI); and, in the past ten years, 3.1% to 3.9% of adults in the U.S. aged 45 to 64 had serious thoughts of suicide.
With this growing universe of mental illness, patients, mental health practitioners, and professionals in related fields have raised the question of a possible over-diagnosing where our society and professionals might have become slightly ‘trigger-happy’ with the diagnosis and attribution of mental illness status to other states of mind or mystical or spiritually-related experiences that could possibly be confused or misdiagnosed as mental illnesses.
Studies seem to show an increasing array and incidence of mental disorders and the causes of these would constitute a full study on its own. However, this brief study is dedicated to assessing the current treatment protocol, providing an overview of the physiology of mental illness; a succinct glimpse at the part holistic or self-regulatory techniques have played in treatment and a final comment regarding the human experience; and the mystical aspect and how these can relate to mental illness. The intent is to create a dialogue and consider the integrated aspects of human and mystical experiences within the terrain of mental illness.
The Current Predicament
According to the American Psychiatric Association, basic treatment protocol entails psychotherapy, complemented by symptom-targeted pharmacotherapy. In addition, psychiatric management consists of a broad array of ongoing activities and interventions that should be instituted by the psychiatrist such as group or individual therapy. The most common individual psychiatric disorders, according to an article published by Harvard Health Publications, were major depression, alcohol abuse, social anxiety disorder, and conduct disorder. Women were more likely to have anxiety and mood disorders such as mania or depression, while men were more prone to having impulse control disorders such as substance-related disorders, schizophrenia, and borderline personality disorder.
Symptoms are treated initially with a selective serotonin reuptake inhibitor (SSRI) as well as with mood stabilizers (lithium, valproate, carbamazepine); Serotonin nor-epinephrine reuptake inhibitors (SNRIs); Serotonin modulators and stimulators (SMSs); and other well-known and vastly used inhibitors, modulators, stimulators and antipsychotics. In general, the objective is to regulate neurotransmitter-related chemical imbalances, however not all mental illnesses share the same origin.
More current theories relate mental illness and psychiatric disorder to trauma-related circumstances (such as PTSD); intense stress (depression, anxiety, panic etc.); socio-cultural factors (bulimia, anxiety, anorexia etc); as well as genetic proclivity (bi-polar disorder, schizophrenia, obsessive-compulsive disorder, etc.).
All of the above factors are most succinctly summarized in terms of the biopsychosocial model of mental illness. Biological contributions, thoughts and perceptions, social pressures, and environmental stressors, the presence or absence of nurturing and consistency of love, core values, and self-worth are just a few of the things that contribute to making up the psychological uniqueness of every human being on the planet.
According to an article in the Encyclopedia of Mental Health, researchers are actively examining the role of spirituality in mental health and recovery. No one factor can be said to be the sole cause of mental illness; rather, disorders result from a complex set of forces that act upon each person as an individual.
The Physiology of Mental Illness
While, in the past, mental illness and psychiatric disorders were intimately associated with states of demonic possession and negative spiritual influence, scientific research has more tangibly linked these disorders to chemical and hormonal imbalances. Dr. Daniel Amen, a clinical neuroscientist, psychiatrist, and M.D. from Fairfield, CA, has been a precursor in imaging the brain to its corresponding functions and dysfunctions, and has made this information quite accessible to the public in his book, Change Your Brain, Change Your Life.
Dr. Amen relates the deep limbic system at the center of the brain to mood control and human bonding; when this part of the brain is unbalanced, people struggle with mood swings and negativity. The basal ganglia controls the body’s idling speed, so if this part of the brain is overactive, anxiety and panic come in; when it is underactive, difficulty concentrating or focusing can occur. The prefrontal cortex is associated with planning, decision-making, and self-control issues, which correspond with activities like self-supervision, attention, organization, and follow-through.
According to Dr. Amen, learning to supervise the prefrontal cortex leads to better internal supervision. The cingulate allows one to shift between one thought and another and between behaviors, making it responsible for repetitive behaviors. Chronic worrying and obsessive or compulsive behaviors will come into play when there is an imbalance in this system. Lastly, the temporal lobes are associated with memory, understanding and language, facial recognition, and temper control. Temper flares, mood swings, and learning and cognitive issues can present themselves especially when the left temporal lobe is imbalanced. Dr. Amen states it is important to remember that these parts of the brain are interconnected, and affecting or adjusting one system surely affects the others as well.
Likewise, a mystical experience can be mistaken for mental illness and the benefits of mystical experience may, or may not, include a degree of resilience towards psychiatric disorder. Thus, it is important to approach mental illness with an encompassing and accepting attitude respecting both the mystical and mental aspects whose interlacing tentacles can often lead to misdiagnosis and wrong treatment. In his lecture, “The Reality of the Unseen ” (William James’ third lecture contained in his Varieties of Religious Experience), James discusses why faith or belief in the unseen is clung to regardless of any evidence by the religious believer, and how questioning their faith can cause terror or lead to obsessive behavior.
He also relates how easily the mystical experience can be confused with the psychotic one. Having all this in mind, and the various tenets that interwoven compose the diagnosis of mental illness and all its nuances, we can begin to consider the positive effects of implementing self-regulatory tools and analyze to what extent this approach has demonstrated positive results. For instance, meditation and yoga can help manage the symptoms of psychotic behavior without risking worsening the patient’s condition with potent antipsychotics or drugs that many times have somewhat intense side-effects.
“I have lived on the lip of insanity,
wanting to know reasons,
knocking on a door. It opens.
I’ve been knocking from the inside. ”
Self-Regulatory Techniques For Maintaining Mental Health
Matt Bieber has had obsessive-compulsive disorder (OCD) for thirty-three years, and has been writing about it for the past four in his blog. OCD is characterized by intrusive thoughts that trigger intense fears of hurting oneself or suffering and tempts them to engage in rituals to try to make the thought go away. These rituals include placing an object in such a way or repeatedly doing something in a certain exact manner. Often, these fears are presented in a way so as to appear or feel like memories although they have not in fact happened and one can suffer with graphic ‘memories’ complete with visuals and sensations. Bieber states:
My experiences with OCD — shot through with magical thinking as they may be — are in some sense exactly parallel to certain kinds of religious experience. You can’t talk me out of them, just like I could never talk an evangelical out of her conviction that she has a personal relationship with Jesus. And it’s not because either of us is right or wrong. It’s because we can’t help believing what we believe. ”
Bieber’s words illustrate James’ observation in The Reality of the Unseen. Bieber has relied on Buddhist psychology and mindfulness meditation to cope with the crippling effects of this disorder.
Relaxation, concentration, and controlled breath are popular self-regulatory techniques that help induce the physiological states that are conducive to meditation. Some other self-regulatory techniques include guided imagery, abdominal breathing, chanting, and mindfulness. Within the meditation techniques, different traditions practice different styles that technically have the same objective and lead to the same reproducible physiological state that ultimately leads one to a state of unengaged awareness. (This is purely a personal assessment of the place where meditation leads the meditator, but samÄdhi would be the appropriate yogic term.)
Among these the most popular from the Buddhist tradition are Mindfulness Meditation (or Vipassana) and Zazen (or sitting meditation). From the Hindu tradition emerges the meditation of Vedanta, or transcendental meditation, and the more energy-focused Kundalini meditation. From the Taoist meditative tradition comes the practice of Qi-gong, which can lead to the same physiological state of awareness.
Aside from these, Pranayama, or the practice of controlling the breath, offers a direct link to the autonomic nervous system (ANS). The ANS functions as a control system largely below the level of consciousness, regulating the internal organs, improving oxygenation, mental alertness, sensory retraction (pratyahara), and mental one-pointedness. The benefits of a consistent asana practice help to develop and improve spinal strength and flexibility, lung capacity, balance, circulation, and concentration.
Current Research and Results
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the growing compendium of standard classifications for mental disorders used by mental health professionals in the United States. According to Matthew Mientka in his article, “Are We Over-Diagnosing ‘Normal’? ” “the DSM describes everything from mild melancholy to full-blown delusions replete with auditory hallucinations ”; its diagnoses have increased in volume over the past few years, which has would-be patients and even a handful of mental health practitioners raising an eyebrow at the phenomenon.
Dr. Bernard Carroll, a former chairman of Duke University’s psychiatry department, cites the 40-fold increase in bipolar disorder diagnoses among children during the past generation:
You’ve got all these young kids running around with this diagnosis, yet many of them have never, ever had a manic episode, which is the hallmark of bipolar disorder.
Dr. Carroll, now the scientific director of the Pacific Behavioral Research Foundation, continues: “Many of these kids have never had anything other than irritability [and] yet they’re exposed to anti-convulsants, anti-psychotic drugs, which have serious long-term side effects in the form of obesity, metabolic syndrome, diabetes and some movement disorders … ”
So, how have meditation and self-regulatory techniques impacted this scenario so far? According to the National Center for Complementary and Alternative Medicine, 34-45% of the U.S. population uses some form of CAM in treating a mental disorder. Of these, 64% indicated using solely prayer or other spiritual practices, and over 50% indicated that it was the only alternative therapy used. Aside from some quite generalized data published by the eventual institution, no statistic was found regarding how age-old therapies such as controlled breathing (Pranayama) or different styles of meditation impact the institutional scenario, but plenty of research backs its efficacy in psychiatric treatment.Â
Despite the fact there is plenty of research being conducted in renowned institutions throughout our country, the break seems to be in getting a tried method on the radar of insurance companies who will cover such treatments and therefore broadening accessibility. Recently, researchers from Duke University Medical Center conducted a study in order “to explore the widely held belief that practicing yoga can relieve mental stress, ” reports Alexandra Sifferlin.
The team reviewed more than 100 studies on the effect of yoga and mental health, according to lead study author Dr. P. Murali Doraiswamy, a professor of psychiatry and medicine at Duke University Medical Center. “Mentally, people feel calmer, sharper, maybe more content. We thought it’s time to see if we could pull all [the literature] together…to see if there’s enough evidence that the benefits individual people notice can be used to help people with mental illness. ”
Findings suggest that yoga has positive effects for people experiencing mild depression and sleep problems; for patients using medication, yoga improves the symptoms of psychiatric disorders like schizophrenia and ADHD. However, many of the studies involve too few subjects to draw sound conclusive assertions. Sifferlin notes, “some of the studies included in the analysis even suggested that yoga might affect the body in ways similar to antidepressants and psychotherapy. ” Others conclude that the regular practice of yoga boosts the level of serotonin and other neurotransmitters leading to a better mood overall. Additionally, the regular use of yoga helps reduce inflammation and oxidative stress, and leads to a healthier balance of lipids and growth factors, similar to regular exercise.
According to the Complementary & Alternative Medicine for Mental Health, yoga has been used “to lessen the effects of schizophrenia. ” In a 2007 randomized, observer-blind trial, subjects were split into two groups: the yoga group and the physical training (exercise) group. At the end of four months, subjects in the yoga group showed significantly less psychopathology than those in the exercise group. Additionally, they expressed significantly greater social and occupational functioning and quality of life.
Though there has been growing interest in this type of research, clinics that receive public funding and accept social security patients do not typically offer these alternative therapies as part of their in-house protocol. The default model for mental health care cycles the patients through levels of assessment, levels of lockdown treatment and institutionalizations, which unfortunately leads 80% (Source: NIMH) of patients shuffling through a revolving door system that does little to address the disease at its root.
While many skeptics bring up issues of profitability and corrupt drug-regulating institutions within the existing system, the expectation is that with the heavier volume of research and funding that has become available in this field, this scenario might soon undergo a shift that will incorporate self-regulating techniques to the mÃ©lange.
The Mental Health Industry & The Human Experience
How can I go forward when I don’t know which way I am facing?
While emotion regulation is an essential (and traditionally underemphasized) feature of mental health, the answer to effectively treating mental illness lies somewhere in the ability to blend technology, mind, and spirit with the goal of promoting healing. The World Health Organization in Geneva, Switzerland published through their Mental Health and Substance Dependence Department a document that takes into consideration the spiritual, religious and personal beliefs in a short-form instrument for assessing these aspects regarding quality of life.
Recognizing that the human experience includes striving for meaning, hopefulness and purpose, it can be understood as a spiritual experience. However, another aspect of shared human experience includes the experience of psychological distress and alienation from oneself and the community, otherwise characterized as mental illness. The study affirms:
“Until recently the health professions have largely followed a medical model, which seeks to treat patients by focusing onmedicines and surgery, and gives less importance to beliefsand to faith — in healing, in the physician, and in thedoctor-patient relationship. This reductionism or mechanistic view of patients as being only a material body is no longer satisfactory. Patients and physicians have begun to realize the value of elements such as faith, hope, and compassion in the healing process. The value of such ‘spiritual’ elements in health and quality of life has led to research in this field in an attempt to move towards a more holistic view of health that includes a non-material dimension (emphasizing the seamless connections between mind and body).“
For fickle is the thought-organ, Ká¹›á¹£á¹‡a,
Impetuous, mighty, and hard;
The restraining of it, I conceive,
Is very difficult, as of the wind.
Bhagavad Gita, VI.34
The Road Ahead
In becoming more aware of how to care for the human psyche and its conditions, it seems that the protocol for treating mental illness would benefit from evolving into a system that understands and encompasses the dimensions of the human experience more fully (i.e. spirituality, belief system, culture, and environment all accounted for and acknowledged in its relevance) rather than administering prescriptions for symptoms.
In this scenario, the health insurance network would include access to healthcare providers that are equipped to explore these dimensions and support the individual in finding self-regulatory mechanisms that could be implemented and integrated into his/her daily routine. What stands in the way of this happening is a confluence of related factors resulting from possible “over-medicalizing” and “over-diagnosing ” of mental illness, due to a breech between what research has shown and popular knowledge of these results. Additionally, a very likely “over-prescribing ” of substances has occurred that carry serious side-effects with them. All of this goes without opening up the ‘can of worms’ that comes behind the motivations for each of these factors.
These interconnected factors exemplify a separation between man and his own condition, which occurs even though quite possibly man would benefit from his own participation in the healing process, making him less of a patient but an active partner in the journey. The way forward seems to encompass many changes involving connectedness and social integration; at the crux of these, I would dare to offer that the empowerment of the individual is likely the sole grandest journey — it is echoed throughout sacred and scientific literature over centuries calling us to discover and harness the power within ourselves.
But your vision will become clear only when you can look into your own heart. Without, everything seems discordant; only within does it coalesce into unity. Who looks outside dreams; who looks inside awakes.
Paula Smeaton is a Brazilian-born researcher, yogini and meditation facilitator. She has worked and volunteered in the mental health field as a counselor at The Trevor Project — a nonprofit organization in West Hollywood dedicated to providing LGBTQ youth in crisis with a lifeline 24/7. She facilitated yoga and meditation sessions at Gateways Mental Hospital in downtown Los Angeles for seven years.
Paula holds a bachelor’s degree in Sociology from the Universidade Federal SÃ£o Carlos in SÃ£o Paulo, Brazil and an M.A. in Yoga Studies from Loyola Marymount University in Los Angeles. She currently travels the globe in search of natural therapies, oils, and practices to aggregate to her workshops. She is available for wellness consultations online and in person.