Social policy

Attawapiskat: There’s more to mental illness than biology

Health care system ignores social determinants of mental health
Photo: dailyinvention

First Nations communities have been clear about the reasons for the ongoing suicide crisis. Community leaders have singled out the effects of historical trauma, unemployment, loss of autonomy, loss of traditional lifestyles, and poor living conditions as the major causes.

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Youth in Attawapiskat wrote up a wish list in response to the crisis. They thought having a clean swimming pool they could use, and maybe even a YMCA, might stop the rash of suicides. Their desires are heartbreakingly simple, and they make a lot of sense.

Colonialism is a public health problem

Attawapiskat: Let's make it better together

Except that in Canada suicide is largely treated as a symptom of mental illness. It is regarded as a medical problem, one whose genesis is located in the brain itself. We treat mental illness with drugs and therapists, not by investing in communities.

Maybe it’s time to listen to what First Nations leaders are trying to tell us, not only for their benefit, but also for our own.

We treat mental illness with drugs and therapists, not by investing in communities.

Since the 1970s, there has been a growing movement towards treating severe mental disorders as biological. This movement was given more support when George H.W. Bush signed a presidential declaration proclaiming the 1990s to be the decade of the brain. Since then, mental health research agendas in Canada and the United States have been dominated by a biological approach to understanding mental illness.

There is good evidence to suggest that even severe mental disorders like schizophrenia are caused by more than brain illness. However, biologically based research agendas have coloured our understanding of mental illness. They’ve also stalled the development and implementation of other treatment and prevention approaches.

The decade of the brain produced great advances in the field of neuroscience and brain imaging. Neuroscience has been used to explain everything from the appeal of video games, to a love of chocolate, shopping and obesity. But critics have accused neuroscience of reductionism. They’ve said its failings lie in its microscopic focus.

The renowned British psychologist and neuroscientist David Marr used the example of a bird’s flight to show the problems neuroscientists encounter when they try to understand mental illness. You can’t figure out why a bird flies, explained Marr, if all you do is look at the structure of its feathers.

You can’t figure out why a bird flies, explained Marr, if all you do is look at the structure of its feathers.

One thing all scientists agree on is that the brain is an organ that responds to its environment. And yet, we’ve ignored this environment in our efforts to understand mental health and behaviour for the past thirty years.

As a result, mental health care is primarily focused on finding medical solutions for mental health problems, instead of social and cultural ones. While brain research provides pharmaceutical companies with the tools to create drugs that may alleviate suffering, it does nothing to address some of the known root causes of mental illness.

There is a lot of evidence to suggest that mental health has social determinants. For example, someone’s vulnerability for schizophrenia, one of the biological model’s prime examples of mental illnesses, increases with social phenomena, like being an immigrant.

The Canadian Mental Health Association agrees. They state that in order to alleviate mental suffering for the 1 out of 5 Canadians who experience mental health problems, “It is of major importance that action is taken to improve the conditions of everyday life.”

When we favour medical solutions to the exclusion of socio-cultural ones, all Canadians lose out.

Along with a far greater investment in psychosocial services and psychological therapies for those suffering from mental illness, we need to start focusing our energies on resolving some of the environmental causes of mental health issues.

If we can improve work, home and school environments, and begin to seriously address social inequality and discrimination, all Canadians will benefit from improved mental health and well-being.

When we favour medical solutions to the exclusion of socio-cultural ones, all Canadians lose out.

Mental health care needs to stop focusing so exclusively on band-aid solutions. First Nations leaders have told us that having vibrant, autonomous, economically stable communities will foster greater mental health. And, their claims are backed up by decades of research in the field of social psychiatry. We would do well to listen to the hard earned wisdom of our First Peoples, and reshape our mental health care system accordingly.

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