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Featuring Vice President of the EBF and Professor of Social Work, Daniel Liechty

Becker and Mental Illness

Is There Anything Worth Keeping?

Daniel Liechty

Daniel Liechty

With all of the advances we have today in understanding mental illness, does anything Ernest Becker had to say about it still hold water? Why not just ignore it altogether?

That is an interesting question. Between our time and Becker’s we have experienced what has been called a “cognitive revolution” in brain research and neuroscience, overturning many of the theories and assumptions about mental illness held for decades. A number of those overturned assumptions were part of Becker’s work as well. Yet I do maintain it would be a big mistake to now simply ignore Becker’s ideas. After all, the subtitle to my book Transference and Transcendence (1995) is Ernest Becker’s Contribution to Psychotherapy. I continue to highly value that contribution. Thank you for the opportunity to briefly explain why.

First of all, Ernest Becker was not asking the same kind of questions as those being asked by our contemporary neuroscientific researchers. Modern neuroscience is animated primarily by questions of brain functioning. Ernest Becker, trained in anthropology and the human sciences, was animated primarily by questions of how the mind functions. That is a very important distinction, easily lost in eager enthusiasm over fMRI screens and images of serotonin spewing back and forth through synaptic gaps. Furthermore, although many neuroscientific researchers and their philosophical hangers like to ignore this distinction (as Marvin Minsky put it, “mind is simply what brain does”) this is simply too facile. The relationship between mind and brain continues as a live issue in the field of mental health.

Ernest Becker started out his career teaching in a medical school department of psychiatry, and his important writings focused on mental illness per se stem from that early period. Direct analysis of mental health issues moved steadily to the periphery of his interests after that time. During that early period, he pursued two main ideas. The first of these ideas reflects the influence of Thomas Szasz, then a senior faculty member in the department in which Becker taught. This is the idea that mental “illness” is a more or less unfortunate metaphor, which both justified and supported the “medical model” approach, placing “mental health” under the unquestioned overall oversight of medical doctors. Becker strived to present a view of mental illness and mental health as “problems of living” that occur not so much within the confines of the individual skull, but rather within a very broad interactive context of self-concept, immediate relationships, and political and cultural meaning systems. Seen in this light, physicians have no more insight into patient care than those from many other professions who put diligent study into human problems of living. (It comes as no surprise that Becker was fired by the medical school!)

Our ongoing assumption that mental health/illness is “of course” mainly a field of medicine is based on that metaphor and needs to be reexamined. It is very difficult to rethink those deeply held assumptions of one’s own culture, but imagine this: you come upon a society much like our own, but one that uses the metaphor mental “wealth/poverty” instead of health/illness. In that society everyone “of course” thinks that mental wealth/health is an economic problem, and that it falls naturally to economists to be the overseers of the treatment system. Granted there are economic aspects to problems of living, and an intelligent economist specialized in the care of mental poverty, drawing on the paradigms of cost/benefit analysis, could probably do many sufferers a lot of good. Even so, the overall assumption that economists qua economists should be in charge of the treatment system likely would strike you as odd logic. Becker was encouraging us to find the medical model of the treatment system equally odd.

The second major idea Becker pursued during this period was to reimagine two major mental “illnesses” of his time (depression and schizophrenia) within a nonmedical, relational, problems of living frame of reference. Here he emphasized the place of life-meaning as a cultural product, and its relationship to language. Specifically, “normal” human life is maintained by an ongoing sense of positive self-regard (self-esteem) grounded in the proper use of language within a specific cultural setting. As Becker pictured it, this balance can falter in either of two main directions. On the one hand, we can become so mired in the established meaning system of culture that we in effect lose the language/narrative/self-talk we need to see ourselves as free agents within that system. On the other hand, we can become so lost in language games themselves that the grounded connection of language to the cultural meaning system is lost, and we end up desperately spewing out word-salads in a frantic attempt to find that lost connection. The former problem of living Becker linked to states of depression, while the latter he linked to schizophrenia.

Obviously there is much missing from this picture of both depression and schizophrenia highlighted now by new knowledge about brain chemistry and neurobiology. Yet it is important we notice a couple of things before we toss out the Becker with the bathwater. The first is that even with all of our sophistication about brain chemistry and neurobiology, any honest researcher would admit there is still more that we don’t understand about depression and schizophrenia than what we do understand. Therefore, it would be premature to summarily dismiss anything in the literature that stems from serious empirical observation and description.

Secondly, Becker situates depression and schizophrenia as ends of a continuum, with a very large middle section of “normality.” There are no clear boundaries along the continuum. Each step along the continuum blends into the next, thus “normality” comes to be seen mainly as a question of what is tolerated within a cultural context. This conception of the issues has an inherently liberationist bias, encouraging us to continually expand our spheres of toleration, of seeing ourselves in each other, rather than dividing ourselves up into categorical camps. This has direct application to other areas of “social problems” such as race, religion, gender and sexual orientation. That alone makes this conception worthy of ongoing consideration.

Thirdly, the picture Becker paints here does fit better into a humanistic, literary, philosophical and human sciences from of reference than it does into a framework of the physical sciences, including brain chemistry and neurobiology. It is worth reminding ourselves again, however, that honest researchers in these fields are not those who making sweeping claims for their results, pushing all else off the table of consideration. If the question before me were one of the mechanics of brain functioning, Ernest Becker’s ideas may not be too helpful. Read him for self-expansion and enjoyment, but leave him largely out of the laboratory. But if the question before me were one of a problem of living, for example, why I have reacted as I have in the midst of a critical life event, such as the sudden death of a parent or close loved one, all of the learned tomes on my bookshelf on brain chemistry and hormonal imbalances are unlikely to be as valuable in helping me understand my situation as would be the literary, philosophical and humanistic depictions of what may be going on with me. Likewise psychotherapists, situated on the front lines of helping people deal with their problems of living, will find themselves mainly drawing on such sources for insight into what may be going on in the lives of their clients, though certainly a competent psychotherapist in our time will also have at least a toe in the secondary sources related to brain science and neurobiology as well.

The pharmaceutical industry, as well as the major insurance companies, push strongly for the medical model of mental illness, and fund such research generously. They have a product to sell and this approach promises also to keep the treatment within defined (therefore more easily monetized) parameters. Yet the medical model has not proven to be more effective or valuable in terms of actual outcomes at all. One might even argue that exactly in the pervasive sense of life disenchantment, moral relativism, cultural malaise and deepening divisions we see in western culture, we are reaping the whirlwind of generations encouraged to view themselves mainly in the mechanistic depiction of the medical model (especially as that model has dovetailed easily with a consumer-capitalist view of ourselves as greedy self-seekers on every front.) In this context, I see a deep immersion in the ideas of Ernest Becker (as well as Otto Rank, Erich Fromm, Rollo May and others who were Becker’s own immediate influences, even yes, Thomas Szasz) as more important than ever.