Thinking About Thinking About Mental Illness
In a recent article published in Aeon, clinical psych PhD student Kristopher Nielsen describes a way of thinking about mental disorders as “sticky tendencies” within the framework of embodied enactivism—which is, in turn, a framework to help with trying to understand how we humans function.
I quite like Nielsen’s description. He offered a sensory analogy:
To understand this concept a little more, imagine holding a kitty-litter sized container with both hands. The floor of this container is shaped like a little landscape with hills and valleys. Now imagine placing a marble in the container and moving your hands so that the marble rolls over the landscape. Notice how the marble gets stuck in the valleys and bounces off the hills; how sometimes it falls into patterns or particular tracks across the landscape.Kristopher Nielsen
He goes on to suggest that we might understand mental disorders as places where the marble has trouble getting out of a given spot in the floor—where it gets stuck, so to speak.
This makes a lot of sense to me—it dovetails nicely with the idea of mental disorders as points along a spectrum (for example: we all experience anxiety from time to time, some for frequently than others; it isn’t generalized anxiety disorder unless it reaches a point at which anxiety disrupts and impairs our lives), while perhaps offering a way to help people understand how the near-universal experience of a passing depression might need to be handled differently than the less-common experience of a persistent one.
It also tracks well with my experiential sense that my mood disturbances are very much cases of getting stuck. (Of course, I acknowledge here that confirmation bias is a thing.)
It has also, in a way, helped to clarify a point I’ve had trouble expressing, because it was difficult to translate from my weird, non-verbal way of thinking about abstract things into words, which are pretty darned important to communicating abstract ideas most of the time, which is this:
Outside of the formal field of psychology, we tend to lump all mental “disorders” into one big collection. We unconsciously think of them as functioning the same way—they’re pieces of the machine that have got out of whack somehow.
This can make it very difficult for people to understand things like related and unrelated comorbidities and why a pinpointed therapy or medication might work for one class of disorders, but might not for another.
In the formal field of psychology, on the other hand, we break out groups of disorders based on the idea that they’re somehow related, though we don’t always quite have a sense of how, and sometimes we’re completely wrong have have to move things around, because brains are complicated, yo.
This distinction is often lost in efforts to communicate about mental disorders with the world at large, first because it’s fundamentally kind of a challenging idea to communicate; second because it’s easy and natural and normal to just lose sight of one’s acquired framework. We get so used to seeing things through a certain set of lenses that we forget they’re there, and we fail to include them with our description of the moon (this can also make it much harder for us to see and accept our own errors as new evidence emerges).
Nielsen’s analogy could be immensely helpful, here, if extended just a little further.
For example, we might think of autism as something that changes the substrate and makes the marble roll differently everywhere.
No two substrates will be exactly the same, but on average, NT substrates will be more similar to one-another than to autistic substrates, and vice-versa (there are, of course, other ways of being neurodivergent, and I can think of ways to further layer the analogy that should still work when they overlap).
Perhaps the neurotypical base is smoother, or rougher, or has wider or narrower grooves overall on average, than the autistic one. Regardless, the ball rolls a bit differently on the autistic base than it does on the neurotypical base.
In both cases, however, it’s still possible for the marble to get stuck.
In both cases, the place where the marble gets stuck is real, and once the marble is stuck there, its entire experience is colored by that stuckness. In both cases, the marble might need extra input to get unstuck, though that input might need to look different for a marble in an allistic track than it does for one in an autistic track.
Regardless, as long as we don’t overinvest in the analogy, the ideas of the track, the variations in the topography of the track, and the marble might be really useful in helping people both at large and within the formal field of psychology imagine mental disorders.
This doesn’t directly address the possibility, of course, of many mental disorders being less actual malfunctions than the result of an infinite diversity of minds being force-fitted into a narrowly-defined set of life options—but Nielsen’s model does acknowledge the role of culture and experiences in shaping the tracks in which our mental marbles run, and doesn’t regard the tracks as fixed, changeless entities.
Likewise, as with any model, this one might not be universally useful. For me, it’s a helpful framework; someone else might find it less than useful or even the opposite of useful.
This is why it’s important to offer models, but not to treat them as holy writ. We’re still far from really understanding the human mind, and our failure to acknowledge that can harm both people (who suffer when we try to force-fit them into inaccurate models) and progress (which is stymied when we let ourselves get stuck in our existing models and when we can’t see beyond them).
It’s encouraging to see that researchers and people at large are taking the question of how to think about mental illness seriously. When we think about our thinking, we make room for change.
This kind of change—change that questions assumptions and tries to meet people where they are—has done a lot of good for those of us living with mental illness and those of us who are neurodivergent in ways that might not fight the traditional idea of “mental illness.”
We’ve still got a long way to go, but it’s good to know that people are making the journey.
Posted on 2022/01/18, in adhd, asd, health, life, mental health. Bookmark the permalink. 5 Comments.
Yeah, I saw Nielsen’s piece (I’m an Aeon subscriber) but don’t think his metaphor is a very helpful one.
Firstly I don’t think the concepts of mental illness/disorder themselves are very helpful and I also think there’s often more heat than light generated by applying metaphors to phenomena as complex and socially weighted as those tackled by the mind ‘sciences’.
For example, the model of the brain as a computer in conjunction with the faith based ontological belief the mind is fully emergent from – or even identical to – the brain has resulted in the extension and reification of the metaphor towards some pretty dubious notions, such as that mapping the human connectome will lead us to a comprehensive mind science ‘theory of everything’ or that it may be possible someday to upload minds into computers. Stripping away the ‘brain as computer’ metaphor leaves such conjectures hanging in mid-air with next to no supporting evidence. So care needs to be taken when applying metaphorical descriptions to mental phenomena that they don’t generate explanations and hypotheses well beyond their descriptive capacity.
To me the main value of Nielsen’s essay is in his articulation of a mind that is embodied, embedded and enactive. This helps us to move away from the reductionist models in which the brain is a machine that produce the mind and therefore all problems of the mind can be mapped onto defects of the brain. In fact our mind is a dynamic product of our entire bodies, everything that impinges upon us (our environment) and our own values, meanings and aspirations. Few if any mental dysfunctions can be located entirely within the brain and interventions at the neurological level aren’t likely to be the most effective way to deal with them.
But Nielson’s kitty litter mind is a simplistic metaphor that leads us back towards reductionism – in particular by locating mental dysfunction entirely within the mind, rather than at least partially within the environment. I think it fails even more spectacularly in failing to distinguish mental disorder/illness from normal mental phenomena.
It’s a pretty sloppy fit with current DSM and ICD definitions of mental dysfunction in that the symptoms on their checklists often apply to thoughts, behaviours and emotions that are intermittent or cyclic, rather than ‘valleys’ we mentally ‘fall into’. Also the ‘patterns’ defined by these ‘valleys’ are incredibly sketchy due to the way the disorders/illnesses are diagnosed according to how many of the symptoms can be fitted to the patient. It’s hard to see any symptom pattern when two different people can end up with the same diagnosis despite having no symptoms in common, but this is a recurrent outcome of checklist based diagnoses.
But the most serious weakness of Nielsen’s ‘self-maintaining valleys’ model is that it applies equally to functional and dysfunctional mental phenomena.
The mind doesn’t just fall into patterns of behaviour because it has hills and valleys, it does so in response to external stimuli. What’s more those hills and valleys are carved by external stimuli in the first place. That’s how the mind works. Mind-brain monists like to call it ‘neuroplasticity’, but I prefer ‘learning’.
When you ride your bike or carry out a well rehearsed dance routine your mind is slipping into its own valleys in response to a particular situation just as much as when you fall into depressive rumination or obsessive behaviour. The difference is you don’t perceive the former as dysfunctional (due to your enacted values, meanings and aspirations).
When you don’t like your valleys you call them obsessions or fixations. When you’re more neutral towards them you might call them habits or quirks. When you’re positive towards them they’re skills or practices.
Those valleys are features of your mind that enable you to carry out learned tasks and meet related challenges effectively and efficiently more often than they’re bugs driving you towards thoughts, behaviours and emotions you don’t want.
By pathologising normal mental behaviour Nielsen is falling into a valley very common among mental health professionals. But I’d imagine he sees it as a sign he’s mastering his chosen discipline, not developing a mental disorder.
For what it’s worth, for the most part, I don’t disagree with you, which tells me that I did a terrible job articulating what I do like about Nielsen’s idea (though I chose not to cover the points in which I think it’s lacking, which are many, because I didn’t really feel like I had either the mental clarity or the time to wade in that deeply this morning—those points would be worth their own post). I’ll have to think about it and try again.
I didn’t, by the way, mean that the model in question is in any way a good way to represent the brain, or consciousness in general, or the mind—it’s not, but I also don’t think it was intended to be. What I mostly meant was that it might be a useful way to convey the idea of mental “disorders” as functions of the way we all work, rather than as something somehow alien, which in turn might make it easier for people who currently perceive them as alien to begin to understand them.
I think a lot of people will need to make that leap before they can begin to bridge their way to the idea that maybe many mental “disorders” aren’t actually disorders at all, but variations that don’t fit within the framework of the culture that labels them as such (which nonetheless causes very real experiences of disability).
I got the impression that it wasn’t intended to offer a complete and thoroughgoing picture so much as a window into a different way of imagining mental illness, such as it is, than most people seem to imagine it. I might be mistaken in that regard. I kind of took it as a species of conscious heuristic; a shortcut, the sure, but one intended to bounce us free of our usual groove, and one that might be more useful than whatever the default heuristic has been (at least, in this part of the world).
For what it’s worth, I don’t only label the things I don’t like as obsessions or fixations—which is something I don’t think I thought to mention. Horses, bikes, and ballet are absolutely obsessive fixations for me, and I’d be delusional if I thought they weren’t. If anything, I’d argue that all of the factors that work against building a life as a dancer (or, really, any kind of artist) mean that obsession is kind of the thing that gets you through.
We call it single-minded focus or whatever, but it’s kind if the same thing. We become artists because we essentially don’t really have much choice in the matter. People who have the same skills but not the tendency to get stuck tend to go do other things because, in the western world in 2021, it’s a more effective way not starve. Those of us who are left live our lives as artists despite having other skills because we’re too fixated to be of much use doing something else. (This might sound like a value judgment, but it’s not. Likewise, I’m sure that A] it’s more complicated than that and B] there are exceptions.)
This is kind of what I meant about the substrate being different—both my pleasant and unpleasant fixations are functions of the same system. When I get stuck in a dark and agitated mood, for example, I suspect that it’s at least in large part due to the fact that I’m just really good at getting stuck. To some extent, that’s the same thing that makes me able to do six billion tendus every week without getting bored, but also unable to just quit dancing and go do something that might be more conducive to surviving in the United States.
As always, I’m grateful for your words (I’ll try reread them when I’m more awake!)—they always help me clarify my own thinking and see where I’m failing to communicate effectively.
One more bit—the failure to explicitly include the role of the environment was definitely one of the shortcomings I thought about this morning, but then I wondered if perhaps Nielsen intended that to be part of what shapes the kitty-litter bin and the marble, but didn’t think to mention it. I feel like I should go back and read the article more closely.
He mentions environment in the context of our minds being embedded but then talks about ‘stickiness’ or ‘valleys’ as “patterns of thought, behaviour and emotion into which the human brain-body-environment system has a tendency to fall, and these patterns are hard to change because they are self-maintaining“.
So on one hand they’re something separate from the b-b-e mind which it can fall into but on the other it’s hard to imagine what the ‘sticky patterns’ are if not something inscribed into the b-b-e mind itself. What seems to be missing entirely is recognition that the mind will typically – perhaps exclusively – both inscribe and fall into such patterns as a result of environmental stimuli. In other words they’re learned responses, not just passively self-maintaining grooves in the mental landscape.
Then he says “Depression is depression, in part, because it’s a pattern of thought, behaviour and emotion that the human brain-body-environment system has a tendency to fall into and get stuck in“. Maybe that’s just a clumsy choice of words, but now he seems to be saying there’s something intrinsic about symptoms of a given mental illness which makes them a ‘sticky pattern’ that attracts the b-b-e mind. That’s pretty mysterious to me, especially given the way symptomatic definitions of mental illnesses keep changing over time. As depression is defined as a pattern of persistent symptoms it’s tautological to then call it a sticky pattern. What he’s actually saying is “Depression is depression, in part, because it’s a depression“.
Careful what you say, unless you want to see Attention Fixation Dancing Disorder listed in DSM-6.