The Mental Health Guessing Guide
Healing brains is a job for medical personnel. If you need brain surgery, you need a surgeon. You wouldn’t let your therapist, priest, or marriage counselor poke around in there.
But what, for example, is a headache? Is that a brain problem or a mind problem? Is it sometimes one and sometimes the other? If so, when do you turn to a doctor and when do you turn to someone else?
And what, for example, is sadness? Is that ever a brain problem or is that always a mind problem? If it’s a brain problem, what sort of problem is it? If it’s a mind problem, to whom do you turn to for help?
If we can’t answer this basic question, which are brain problems and which are mind problems, will we ever get a handle on “mental health?” No. Without that answer, we will never be able to create best practices, we will never correctly train “mental health professionals,” and we will never adequately serve people who suffer.
But can that question be answered? Let’s say for the moment that it can’t (which may be the fact). How should we then proceed to try to help people when we don’t know whether they are suffering from a brain problem or a mind problem? There look to be three basic approaches: first call it a brain problem (and seek out a doctor); first call it a mind problem (and seek out a therapist or some other non-medical practitioner); or try to work on both “problems” simultaneously.
In practice, the latter approach is probably the approach most often used. You see a psychiatrist or other medical doctor for medication, as if it was a brain problem, and you see a therapist, as if it were a mind problem. This is never explained to you explicitly: no one ever says, “We have no idea if this is a brain problem or a mind problem and we don’t know how to know if it’s one or the other. So we’ll act like it’s both, okay?”
If you were told that, how would you react?
What if you were told by your psychiatrist, “It’s my best guess that you have a brain problem, which is why I am suggesting medication.” And what if you were told by your therapist, “It’s my best guess that you have a mind problem, so that’s why we’re talking.” How would you react?
I think you would reply, “Hm.” I think that if mental health professionals told the truth, their customers would say, “Really?” This change would prove a good thing for mental health consumers, if not for the professionals who profess to serve them.
If this began to happen, mental health consumers might begin to say, “Since we are just guessing, I would like to go with this guess.” They might decide that they have faith in Western medical practitioners and are willing to go along with the “brain problem” guess. Or they might decide that talk before chemicals makes sense to them and so might go along with the “mind problem” guess. Or they might decide that getting two-for-one doubles their odds of healing and go for the “it’s both at once” guess. Whatever guess and choice they made, they would be clear that they were guessing and choosing.
Wouldn’t that be a good thing?
How might that not be a good thing? Well, mental health customers might lose the benefits of the placebo effect. If a great percentage of what makes chemicals work is their placebo effect, losing that percentage is a significant loss. And who knows what percentage of the value of talk therapy is also the placebo effect? So we have those losses to consider.
Further, if they are suffering from a mind problem and not a brain problem, why wouldn’t half not believing in your provider not cause a further mind problem? If you’re already sad or anxious and your provider says, “I’m just guessing,” won’t that make you sadder or more anxious? Again, this might prove a real downside to telling consumers the truth of the matter.
But can’t we picture a gigantic upside? Your provider says, “I’m just guessing, so let’s experiment” and so you must move from passive recipient of expert (or inexpert) help to active co-experimenter. Mental health becomes a new “guessing game,” a search for correct personal answers to emotional distress. Suddenly you are obliged to bring curiosity and creativity to the enterprise of bettering your life. Yes, certainly, that may prove really hard if you are sad, anxious, and all the rest. But imagine the possible payoff: nothing less than actual distress relief!
So I am making two invitations. One is the invitation that mental health providers admit that they are just guessing (and not guessing all that well). The second is that mental health consumers embrace this guessing game as their best chance at emotional health. Finally a guessing game of some moment! What a breath of fresh air that would bring.
What this also invites is the idea of “best guesses.” Wouldn’t that be fascinating to consider? What can we tease from the brain problem world and the mind problem world that amount to an array of best guesses and even a system for guessing? Instead of a DSM we would have a “Mental Health Guessing Guide”—the MHGG. Wouldn’t that prove a useful and exciting development? The Mental Health Guessing Guide: ponder that for a moment.