AND 

We at Tikkun identify in large measure with many of the
critiques of theory and practice that have
heen developed by social change activists. Nevertheless,
many progressives have found within 
theory, or within variously modi?ed forms of 
analytically hased therapy, an important and potentially
liheratory hasis for their work. The attack from the right
on often comes in the name of a narrow
form of empiricism, a rigid and reductive approach to
science. The attacks from the left, while often articulating
critiques with which we agree, sometimes ignore the

ways that a more sophisticated version of Freudian theories
has already moved far heyond the sexist distortions and
conservatism of more rigidly orthodox Freudianism. Many
people who today practice including those
who use therapies that were developed in conscious op-
position to the Freudian model of treatment, incorporate
insights and interpretations that horrow from elements
of 

The discussions in this section are a response to some
of the more recent attacks on and are part
of Tikkun?s ongoing discussion of these issues.

ls Going Out of Its Mind?

 

Michael]. Bader

sychiatrists and the general public increasingly

understand mental illness in biological terms.

Newspaper articles appear touting the
discovery of a neurobiological or genetic cause of emo-
tional or behavioral problems ranging from schizophrenia
and depression to stuttering, eating disorders, aggression,
cynicism, addictions, and anxiety. Theories that explain
the causes of mental suffering in or social
terms, such as or family systems theory,
are increasingly regarded as pass?. and
social models of mental illness are seen as unduly blaming
families and children alike for problems that neither
are ultimately responsible for. In 1987, the New York
Times ran a special four~part series on schizophrenia
that concluded that ?the old notion that families were
to blame for causing the disease has given way to the
notion that biological factors play a major causative
role.? A month later the Times reported on depression
in similar terms: ?It has become clear that severe
depression can result from a shortage of certain natural
chemicals in parts of the brain.?

Families of the mentally ill have banded together in
organizations such as the National Association of the
Mentally Ill (NAMI) to educate the public about the
biological basis of mental illness, seeking to take the
family ?off the hook.? As one NAMI of?cial recently

 

Michael Bader is the director of the graduate 
program at New College of California and is a 
in private practice. He is a memher of Tikkun?s editorial hoard.

wrote in a letter to the Times, ?Recognition has been long
overdue that this terrible brain disease [schizophrenia]
is the fault neither of the victims nor their families, but
is of neurobiological or genetic origins.? NAMI has
even gone so far as to join with others in attempting to
have the license of a Maryland Peter Breggin,
revoked after Breggin appeared on the ?Oprah Winfrey
Show? arguing against the use of medication
and against the use of the medical model in treating the
mentally ill.

As any mental health professional who has worked
with schizophrenics or with profoundly depressed or
manic patients knows, antidepressant,
and antimanic medication can be of great therapeutic
value. But, in spite of the innumerable ?discoveries?
that the mass media report, we are no closer today than
we were ten years ago to ?curing? patients. In fact, the
?scienti?c? claims are grossly overstated in the interest of
promoting the competitive interests of one professional
This group?s zeal in arguing for a
biological model of mental illness has the effect of di?
rectly or indirectly devaluing attempts to understand the
and social meanings of patients? suffering.

Biological models for understanding the cause and
treatment of mental illness, particularly the more severe
disorders such as schizophrenia and depression, have
gained hegemony in modern American This
marks a dramatic change from the fifties and sixties
when American was dominated by the in-
?uence of a theory and practice that

43

locates the source of in a patient?s
family dynamics. Today, almost every depart-
ment in every major medical school in America is chaired
by someone committed to biomedical research and treat-
ment. In the ?fties and sixties, these same positions
were usually held by One major medical
school in California saw its chairman, an
internationally renowned and clinical re-
searcher, replaced by a whose background
was not in clinical work but in electrophysiologic studies
of the nervous system of slime molds. In earlier years,
the teaching of the techniques of 
therapy was the core of the residency. Today,
by contrast, clinical techniques that emphasize 
pharmacology are considered prize assignments, and
residents are often unable to discuss the 
meaning of a patient?s or family life. At recent
meetings of an organization composed of the directors
of residencies in American medical schools,
serious proposals were debated to make training in
optional to residents since it
has been ?established? that not
is the treatment of choice for so many
patients. Articles are beginning to appear in professional
journals arguing for the merger of and neu-
rology. The pendulum has swung from the total rejection
of neurobiology in the 19405 and 1950s to its celebration
in the 19808.

efore analyzing further the repressive conse?

quences of scientific orientation, I

want to make clear that American 
as an institution has also participated in self-serving prac-
tices under the guise of science. In direct opposition to
Freud?s own beliefs, became the monopoly
of physicians when it was imported to the United States.
This medical emphasis, as Russell Jacoby notes in Social
Amnesia and in The Repression of has cer-
tainly had repressive consequences for 
theory-building in the US. Nevertheless, 
at its best?ea theory of unconscious meaning and con-
flict, of the social construction of internal mental life?is
radically different from and opposed to the biological
reductionism sweeping and our popular cul-
ture. and biological reductionism have
to be analyzed on their own merits and not primarily
on the basis of the political practices of the groups
promoting them-wexcept insofar as these political mo?
tives substantially shape the theoretical claims.

The move toward a biological understanding of mental
illness is related though not reducible to a concerted
effort by the profession to strengthen its
weakening hold on the ?eld of mental health. For com-
plex political and economic reasons, in the last ten

44 TIKKUN VOL. 4, No. 4

years insurers, gOVernment health care planners, and
corporate underwriters have sought to. cut medical
costs, and bene?ts have often been the ?rst
to go. When mental health coverage has been included
in these newer, pared-down health plans, it has often
been limited. In this context, con?icts have arisen as to
which mental health professionals are to be covered.
have fought to restrict various forms
of reimbursement and privilege to medical doctors,
thereby excluding from coverage others who arguably
have equally good or better abilities to deliver some
form of care: providers such as social
workers, and counselors. With the shrinkage of the
health care dollar and the disproportionate cutbacks in
mental health bene?ts, battles over distribution have
intensi?ed and interprofessional rivalries have escalated.
Payers and health planners have raised questions about
the cost effectiveness of high-priced services
when compared to similar, less expensive services offered
by non-M.D.s. Non-M.D.s themselves are increasingly
better organized and are challenging monop-
olistic practices on a greater number of fronts than ever
before. A recent example of this challenge is the attempt
by to gain hospital-admitting privileges
in California, a move opposed by and cur-
rently under judicial review.

With its economic base shrinking and its professional
status under attack, has reacted by attempting
to redefine its boundaries and stake out a privileged
territory that will ensure its safety and supremacy in
the mental health marketplace. has needed
to be accepted by organized medicine, from which it
became estranged during the postAWorld War II years
of hegemony and during the tumultuous
community-mental-health years of the 19605, when forces
within itself attacked the medical model on
behalf of a liberal vision of social change.

This objective has been achieved with the help of the
ideology of biological reductionism. have
been able to argue that their reimbursements shouldn?t
be disproportionately reduced because mental illnesses
have been shown to be as biologically based and as
biologically treatable as any other reimbursable medical
condition. fees should therefore continue
to be greater than those of non-medically?trained
therapists, they claim, because only their training pro-
vides access to and understanding of the latest revelations
concerning the biological foundations of mental illness.

and health-policy planners are construct-
ing new models of service delivery consistent with the
new fiscal constraints of insurers in which all patients
with problems must ?rst be evaluated
and, if necessary, treated by a in case a
biological disorder is involved. This process will insure

 

the centrality of the M.D. in all aspects of mental health
services. Furthermore, as the media increasingly tout
the biological basis for most mental disorders, support
grows for greater funding of ineurobiological and 
pharmacological research. As a result, 
mental health profession most associated with this area
of research?also grows in status.

I do not mean to imply that all or even most 
trists acquire a biological orientation for sel?sh reasons.
I am arguing, however, that the leaders of organized
are quite conscious (as are other mental health
professionals) of their declining status in the market-
place and are promoting and marketing the aspect of
practice?namely, their medical background?
that they believe privileges them over other practitioners.
This approach coincides with a genuine technological
explosion, which has helped buttress the 
claims. Individual may make their treatment
decisions based on good intentions and a ?rm belief
that the patient?s best interests are being served, but
the philosophy and training informing these decisions
are deeply in?uenced by complex political, economic,
and ideological pressures that shape the 
profession as a whole.

CORRESPONDENCE VERSUS CAUSATION

he proponents of biological make

two related claims. First, they argue that mental

illness is caused by biological processes in the
brainlgenetically inherited, most likely) that interact
with the environment to produce the of mental
disorder. The weight assigned to the environment may
vary, but the essence of the claim is that a biological
process or state causes a process or state.
In other words, the biological state is assumed to be
prior to the emotional one, both temporally and onto-
logically. Second, proponents of biological 
claim that since the cause of certain mental illnesses is
biological, the most appropriate and effective treatments
are also biological?involving, in most cases, the use of
medications.

Studies of the neurobiology and pharmacology of
schizophrenia, manic-depressive illness, depression,
anxiety, phobias, obsessive-compulsive disorders, and
so-called borderline conditions ?ll the pages of the
major journals and are routinely reported
on by the print and television media. The brains of
schizophrenics are found to have too much of the
chemical dopamine, a substance that transmits signals
between nerve cells; the brains of depressives have a
de?ciency of or an altered sensitivity to the neuro-
transmitters norepinephrine or serotonin. Specialized
computerized imaging techniques have been developed
to replace X-rays and are used to show that the brains

of schizophrenics have a different size and shape than
normal brains. The newest radiological tool, called the
PET scan (Positron Emission Tomography), can actually
depict which areas of depressed patients? brains are
less metabolically active than the corresponding regions
of normal brains.

 

A theory that says that parents
shouldn?t take any responsibility for
their childrens emotional and
mental prohlems prevents us from
critically confronting the way that
social institutions ravage our lives.

 

As the chemistry and structure of the brains of dis-
turbed patients are analyzed with increasing sophistica-
tion, the claims of those doing the analyzing get more
bold. Ross Baldessarini, a leading 
asserted as long ago as 1977 that ?effective [medical]
treatments now exist for most of the major 
illnesses.? The 1985 edition of the Comprehensive Text-
book of informs us that the ?necessary genetic
component? of schizophrenia and affective disorders
has been discovered and is widely accepted.

It is important to keep in mind that when researchers
or reporters describe a biological hasis for a 
problem they are always implying that the biological is
more ?basic? than the that this more
?fundamental? level of reality produces the behavioral
or reaction. This is biological reductionism,
which suggests that the more we are able to explain
or social behavior on the basis of smaller
and smaller levels of analysis?ultimately leading to the
level of molecular biology and genetics?the closer we
will get to the truth.

This, however, is not the only way of viewing the
relationship between biology and Using a
more cautious or critical perspective, we might say that
it is possible to speak only of correspondence between
these two radically different levels of experience, not
causation. In the most general sense, human 
is a function of the human brain. Consciousness, love,
sadness, and con?ict are all impossible without the
brain. Further, it is probably the case that my brain is
in a different state when I?m writing than when I?m
sleeping or jogging. In other words, there should be
some very general correspondence between brain and
mental state if one takes seriously that we are biological
as well as social beings. But this does not say anything
whatsoever about causality or temporal sequence. It is
not possible to prove that the brain state always precedes
the mental state or vice versa.

AND 45

It is always theoretically possible that the mental
event in question precedes the brain state being de-
scribed. Depression, for instance, might lower brain
activity in certain areas of the brain and thereby account
for the differences found by the PET scan or assays of
brain chemical levels. Researchers like Marian Diamond
have conclusively proven that enriched environments
can increase brain size and complexity. Neuroanatomic
studies of patients with multiple personalities?a syn?
drome widely accepted to be of origin?
demonstrate variations in such brain processes as blood
flow, electrical activity, and neurotransmitter levels among
the different personalities of the same patient. Even the
best studies of the genetic transmission of schizophrenia
and depression, which appear to Suggest that these
disorders may be partially hereditary, have been criticized
on methodological grounds and have not even come
close to demonstrating what is inherited that might
later produce the mental illness in question.

Although the logic of the reductionist argument is
faulty, its purpose is clear. Richard Lewontin, Leon
Kamin, and Steven Rose use an interview from the
February 1981 issue of Today with two leading
researchers to illustrate this purpose. Paul
Wender and Donald Klein argue that ?for each schizo-
phrenic there may be ten times as many people who
have a milder form of the disorder that is genetically . . .
related to the most severe Eight percent of
Americans have a lifelong form of personality disorder
that is genetically produced? and that should concern the
public, which ?is largely unaware that different sorts of
emotional illnesses are now responsive to medications.?
In other words, since schizophrenia has been proven to
be genetic, and since genes affect biology, schizophrenia
and related ?personality disorders? should be treated
with drugs. But as Lewontin, Kamin, and Rose point
out, even if the ?rst statement is true, it doesn?t follow
that biology is the primary cause of schizophrenia, that
social or interpersonal conditions might not be the more
important factor. Furthermore, even if the biological
?derangements? are etiologically signi?cant, we know
that altered and behavior can Change brains,
and so it in no way follows that drug treatments are the
only effective form of treatment.

DRUGS AND THE REDUCTIONIST FALLACY

esearchers often erroneously link theories of
biological causation with the necessity for bio-
logical treatments. The logic is this: Drug 
helps some of schizophrenia?say, agitation.
Drug is?found to interact with metabolic pathway 
in the brain. Therefore, a disorder of metabolic pathway
is deemed an important cause of schizophrenia. In

46 TIKKUN VOL. 4, N0. 4

reality, no such conclusion is logically warranted. Steven
Rose, a radical neurobiologist, offers a good analogy:
aspirin reduces the pain of a broken bone by inhibiting
the of the chemical messenger prostaglandin,
which is found all over the body. In what sense can it
be said that the prostaglandin causes the broken
bone? If aspirin also reduces the pain of a toothache,
does it follow that the ?cause? of a toothache and of a
broken bone are similar? The discovery of how a drug
acts in the brain says nothing clear about the cause of
the it treats, particularly?as is true with psy-
chiatric drugs?if the drug has such a diffuse effect
throughout the brain.

The practitioner and the lay consumer need to put the
actual ef?cacy of these drugs in some kind of perspective.
The medications, for instance, are clearly
effective in reducing the terror, agitation, and aggressive-
ness of an acutely or schizophrenic person,
and are often the precondition for any successful 
therapy to occur. Claims that these drugs ought to be
the ?treatment for schizophrenia? are problematic,
however. For example, it is widely acknowledged that
delusions#the core of schizophrenia?are often not
eliminated by medication, nor are common 
such as apathy or withdrawal. Tranquilization, in other
words, while often important, does not cure the symp-
toms of schizophrenia. In fact, it is increasingly the case
that high doses of medication are used more because
they hold someone together in the absence of adequate
social and services than because they
have an antischizophrenic effect. As mental health serv?
ices become less available, patients are given
medications in doses and for durations that would not
otherwise be advisable. In other words, medications
increasingly ?ll the gap left by therapists and other
mental health providers; they are a kind of ?better than
nothing? solution?a necessity, not a virtue.

Studies that compare the effects of antidepressants
with a placebo on depressed patients show that an
average of 60?70 percent of those treated with medicav
tion improve as compared to 30?40 percent of those
treated with a placebo. This is clearly a signi?cant ?nding
and suggests that these medications are useful. Little
attention, though, is paid to the astonishingly high
placebo rates of depressed patients who get better either
spontaneously or by virtue of the purely 
effects of taking a pill or being the object of research
attention. Further, the possibility exists?but is never
studied?that medication, by physiologically altering
one?s mental state, might be interpreted
by the patient in a manner that then leads to improve-
ment. It seems that to the extent that ?ndings support
a theory of depression, they are not sub-
jected to?the same intense scrutiny.

THE SOCIAL CONSEQUENCES OF BIOLOGICAL
REDUCTIONISM

he biological reductionism sweeping 
has important social and conse-
quences that social critics and professionals alike
need to understand. Every form of medical technology
used by on the mentally ill in the last ?fty
years has been justi?ed on scienti?c grounds. From
insulin coma therapy to electroconvulsive therapy to
dangerous and dehumanizing treatments
have been linked to various discoveries about the bio?
logical basis of mental illness. This model of the mind
locates the problem within the individual, not within
the family or society, and it does so in a way that
suggests limits on the individual?s capacity for self-
transformation. Intended or not, this worldview tends
to justify the dif?culty of changing someone's behavior
on the grounds that the innate behavior is a result of
biological de?ciencies.

This argument understandably falls on welcome ears.
People who have worked with schizophrenic patients
for any length of time confront the apparent intract-
ability of the disorder and naturally look for explanations
that account for the patient?s profound resistance to
change and for their own chronic feelings of professional
failure. Sitting with a depressed person week after week,
and watching one?s empathy, insight, and advice fall on
deaf ears, can lead a therapist to ?nd explanations that
mitigate his or her own feelings of guilt, responsibility,
and ineffectiveness. Crisis clinic workers struggling to
pull together vanishing community resources for their
walk-in patients only to ?nd these patients
returning in identically bad shape two months later need
a theory that accounts for this frustrating recidivism.

A theory that blames genetically transmitted biological
de?ciencies ?ts the bill perfectly. Such a theory implies
that it is not the therapist?s fault for failing to cure the
patient and that the kind of intense emotional involve-
ment that demands is misplaced from
the outset. Instead, the can justify the more
familiar and emotionally distanced role of diagnostician
and pill dispenser, helping the patient and family under-
stand and adapt to the ?illness.? Nonmedical 
therapists, in turn, are given a justi?cation for giving
the responsibility of treating their depressed
or schizophrenic patients. These are
relieved of their own helplessness, their nonmedical
role now being restricted to a focus on secondary
Crisis clinic workers can also
protect themselves by viewing their charges as perma-
nently damaged people who would function better if
they would only take their proper medication. At a
time when the frequency and duration of 

is being drastically reduced by those who ?scally under-
write these services?which makes the work of people
in the mental health professions increasingly dif?cult?
the rationalizations that the ideology of biological re-
ductionism has to offer are particularly helpful.

What is the effect on the patient of this view of
suffering? Biological reductionism is, after all, conveyed
to patients both explicitly and implicitly. In addition to
the increasingly frequent practice of directly teaching
patients about the biology and pharmacology of their
illness, the process of giving a patient medication conveys
multiple and subtle hints about how the therapist views
the patient?s problem. If, for instance, a 
fails to examine the meaning of medication to the patient,
the patient may think the doctor believes that the main
problem is a biological de?ciency.

 

At a time when the frequency and
duration of 
is heing drastically reduced hy those
who ?scally underwrite these
services, the rationalizations that the
ideology of hiological
reductionian has to offer are

particularly helpful.

 

The problems with this attitude become apparent
when one recognizes that patients who are profoundly
depressed or schizophrenic often have powerful fantasies
of being de?cient, damaged, helpless, ?bad,? and incap-
able Of changing their feelings. Biochemical theories
about neurotransmitter ?de?ciencies,? which locate the
main problem in ?things? over which one is helpless, such
as brain chemistry, reinforce these pathogenic fantasies.

Granted, this biological approach can be relieving to
a patient for several reasons. First, it dis-
places a frightening sense of badness and responsibility
onto the patient?s brain. It?s as if the patient?s unconscious
mind were able to say: ?Since I need to punish myself
for being such a horrible and destructive person, it?s a
relief to know that it?s only my brain; and further, if
these medications make me feel bad or unpleasantly
sedate or numb, I?m being properly punished anyway.?
Second, a patient who doesn?t feel fully human, perhaps
because of a lifetime of being treated as such by narcis-
sistic or caregivers, often is terri?ed of human
intimacy and recognition. Being treated in an ?Objective?
way by a doctor whose focus is only chemistry and not
can therefore be reassuring. Third, a patient
who cannot tolerate his or her longing for love and care-

AND 47

taking may ?nd in the medication not a chemical answer
to a chemical de?ciency but a symbolic unconscious
answer to an or emotional emptiness?an
answer that makes the patient feelbetter. After all, the
patient may accept and rely on medication and the
theories that support its use for reasons
that have little to do with the theories of the treating or
research 

The problem is that the grati?cation that some patients
get from biological approaches to their condition may
ultimately point to their resistance to change. When
one?s sense of self is con?rmed, one may easily feel
partially understood and get some relief, while one?s
underlying distortions are left intact.

On a broader scale, biological functions
as an antidote to burdensome feelings of responsibility
that affect people in our culture in various ways. On
an obvious level, if the problem is biological it is
not social. People?s families, work environments, and
economic stress don?t produce severe depression or
their brain physiology does. Further, society
doesn?t need to fault itself or its leaders for cutting
funding for long-term treatment facilities since our
current success with drugs makes such
treatment unnecessary anyway. Biological reductionism
is a twist on blaming the victim: here the victim isn?t even
a person; it is someone?s genes or biology. Consequently,
the victim, as well as the victimizer, is exonerated.

 

These issues of responsibility are starkly revealed in
the growing political and educational lobbies repre-
senting the mentally ill and their families. Groups
such as NAMI and the National Depression and Manic-
Depression Association wield increasing clout in political
and funding circles. In addition to their laudable efforts
to eliminate the social stigma of schizophrenia and
manic-depression, these groups strongly lobby for in-
creased research into the etiology and treatment of
these disorders, provided that the etiology is biological
and the treatment medical. Families are often under-
standably eager to get out from under terrible feelings
of guilt and responsibility, and this movement offers an
effective method. Any theory that contradicts this ap-
proach by saying that families are profound forces in
development, healthy or pathological, is
treated as if it blames the parents.

Both approaches are distortions. The fact that parents
and families can and regularly do pathologically affect
the emotional development of children and are more
than capable of making their children schizophrenic
and depressed does not mean that parents are evil or
that their children are weak failures. As much as 
analysis locates the etiology of in the
family, it also debunks the prevailing morality that sees
people as good or evil, perpetrators or victims. Parents
can also be victims of their own families, and children
have desires and con?icts not purely of
their parents? making. But the movement today that
exonerates everyone, and instead blames genes and
neurotransmitters, views as an enemy seeking
to make families and patients feel like moral failures.

A theory that says that parents shouldn?t take any
responsibility for their children?s emotional and mental
problems prevents us from critically confronting the
way that social institutions ravage our lives. It makes it
dif?cult for us to recognize the most personal and
?interior? forms of alienation in our culture, and the
unconscious distorting and emotional violence within
family life. Contrary to the protests of family groups
and biological ideologues, saying that families hurt
children can convey the greatest sympathy for all parties
involved. Parents, after all, experience and raise their
children in social contexts not always under their control,
and under the in?uence of con?icts and
damage suffered at the hands of their own families.

What we need is an approach to that
neither places the burden only on the family?s shoulders
nor dismisses the notion of family and societal re-
sponsibility altogether. Without such an approach the
exonerating ideology of biological reductionism will
continue to reign, representing another step in the
progressive collapse of critical thinking that marks our
culture today. El