Hyperinflation of mental diseases - The way we people see ourselves?steemCreated with Sketch.

in #steemstem5 years ago (edited)

Mental disorders going mainstream?

Kindly let me help you or you will drown, said the monkey, putting the fish savley up the tree.
Alan Watts (min. 16:52)

Psychiatry should not be in the business of inadvertently manufacturing mental disorders, is what I sometimes think when I read all the warnings and direct and indirect ads in the media.

The soft sciences - psychology amongst them - leave much more room for interpretation than the hard sciences do. Mathematics, for example, is not very susceptible to problems with the definition of terminology.

This is quite different in the field of psychology, where terms are used which by their nature are spongy, uncertain, unclear and not definable in totality.

Allen Frances, an American psychiatrist, whom I am going to cite several times, said about a seemingly slight wording change:

Unintended consequences are particularly unpredictable and consequential in forensic settings. Years after the DSM‐IV was completed, we learned about the enormous and unintended impact of a seemingly slight wording change we had made only for technical reasons in the section on paraphilias. A misreading of our intentions in making the change had led to great confusion25‐with forensic evaluators using the diagnosis of paraphilia not otherwise specified (NOS) to justify the sometimes inappropriate lifetime psychiatric commitment of rapists who had no real mental disorder. The lesson is that even small changes can have destructive unanticipated forensic consequences.
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The scientists are not always in agreement and the explanation of the meaning of terms is a source of controversy.

... psychiatric diagnoses do not constitute natural illness entities. They are categories without natural boundaries. Because most human behavior is located along a continuum, no clear cut-off point exists to separate good health from illness and, as such, to define a point where the need for treatment exactly starts. Contrary to the situation in clinical practice, disease at the general-population level exists overall as a continuum rather than as an all-or-none phenomenon. This is also true for physiological processes. Thus, blood pressure and glucose tolerance are continuously distributed characteristics within the general-population.

2

I was a little surprised to read here that there is a "biomedical model" which is based on the fact that mental disorders are brain diseases and that therefore pharmacological treatment is emphasized to "combat suspected biological anomalies".
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It is said that since this biologically oriented approach has existed, the use of psychiatric drugs has increased dramatically. It seems, for example, that mental disorders are regarded as brain diseases caused by chemical imbalance. There is a complaint that this has led to a reduction in psychotherapy.

In this Interview published in Psychotherapy Networker, which I recommend to read, Frances was asked what he thinks of the decision from Thomas Insel, the former director of NIMH (National Institute of Mental Health), who said that they weren’t going to use DSM V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) as the template for funding psychiatric research.

While Frances welcomed this decision he argued that an exaggerated promise of neuroscience and genetics is in the air, that biological progress in psychiatric treatment is postulated and promoted by NIMH. But even more than 30 years of research have not made patients feel better. There would be no biological test for mental illness, the treatment would not be better than 60 years ago. He also made a connection between the care of people in communities, such as homelessness, and the correlation with prison inmates who would harbor psychiatric patients.

However, with all the power and diagnostic certainty and available drug therapy, one indeed would have to ask oneself: Where are the treatment successes actually to be seen?

Is it just the scientists arguing with the practitioners?

But the reason for this article is that I was wondering myself for quite some time:

Is there a mass phenomenon of talking ourselves sick?

I would like to anticipate the answer by making a steep comparison. I make the assertion that theft is taken into account in a shop. The phenomenon of theft exists without question. But are we dealing with serious mass theft, an overwhelming number of long-fingers? Do we have to reckon with a world where we have to worry about kleptomaniacs all over the place?

In this article I would therefore like to compare two things:

  • Firstly, the fact that there have always been eccentrics, dissenters, border crossers and narcissists etc. among us humans. That in no way makes them a pathological species.

  • In the same way, there have always been madmen who have repeatedly killed or attacked their fellow human beings for long periods of time and without any apparent reason, who have hurt or neglected themselves and/or who deviate much from what is acceptable in a group of people.

I have made a wide excursion to approach the above question and I invite everyone who wants to go the long way with me. You need time and good will to read this long piece. Enjoy!


Where did it all start?

How can I actually justify or suspect the presence of a plethora of mental illnesses?

In the field of psychiatry there are two workbooks of reference which represent the Pschyrembel - some call it the bibles - of mental illnesses:

One is the ICD (6-11) and the other is the DSM (I-V).

Psychiatry is a rather quite young medical discipline, psychiatry evolved into its present form at the beginning of the nineteenth century (1). From its beginning there has been a discussion about the classification of mental disorders. The modern classification systems originated during the middle of the last century. In 1949 a section on mental disorders was added to the International Classification of Diseases (ICD) of the World Health Organization (WHO). The first Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association was published in 1952 and listed 106 mental disorders (2).

The 1960s saw persistent attacks on the field of psychiatry from so-called anti-psychiatrists [e.g., (3)]. During that time these opponents assumed that the main purpose of psychiatric classification was to discipline maladjusted individuals. This “Zeitgeist” was best expressed in the movie “One Flew over the Cuckoo’s Nest,” which portrayed a repressive psychiatric system intent on enforcing “normal” behavior through electroshocks.

Despite all of the social criticism, psychiatric professionals continued to elaborate on the original classification system, resulting in a second and third version of the DSM. These revisions were accompanied by a continuous increase in the number of mental disorders. For example, DSM-III contained 265 diagnostic categories while DSM-IV, introduced in 1994, listed 297 psychiatric disorders. Accordingly, revisions of the ICD were published.

The DSM-IV (Diagnostic and Statistical Manual of Psychological Disorders, German: Saß et al., 1996) contains about 1000 criteria for recording 395 disorders. It is the classification system of the American Psychiatric Association (APA) which was published in English in 1994. Since version III (1980), the DSM has been a descriptive approach that is almost independent of theoretical and etiological assumptions.
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Early man - how were "crazy people" recognized?

One could say that somewhere at the beginning of the contemplation of people, for example, there was only one attribution: A person is adapted or unadapted. Then one could say that this still rather unspecific term was given the attribute "crazy" or "normal". Or in classical medicine of "sick" or "healthy". Which do not serve a clarification either.

If I start from a horde of prehistoric people, one could say that someone who behaved unadjustedly, such as a strong young man who refused to participate in the hunt, did not have any sexual relationship with a woman, and preferred to take care of the children rather than his natural qualities of physical strength and operational ability, would have been able to maintain his untypical behavior undisturbed only if the rest of the group had simply let him do this.

How disturbed or undisturbed this group system would be to look depends on how all participants of the group behaved and not just on how an individual participant behaved.

It would be reasonable to say that as long as the survival of the group was not endangered by the individual's deviant behavior, the other participants would see it the same way, the individual young man would continue to be able to pursue his special interest in caring for the little ones undisturbed.

This young man would not have to think that his behaviour would be inappropriate or disruptive if the group tolerated his behaviour. He might even be completely ignorant and not conscious of his peculiarity.

Of course, it is conceivable that his unusual behaviour would still be noticed, for example by the children, who are usually observing all adults (learning and coping from adult role models) and discussing deviations from the norm. A child could ask the young man why he does not go hunting like all other young men.

But it might just as well be that the children don't ask curiously either, when they experience that nobody else from the adults takes offence at the fact that there is something unusual in the group, because neither the women nor the elderly evaluate or thematise it in any way.

Our young man would then merge with the tasks that remain in his work with the children and women that he demands and that are assigned to him, so as to merge fluently with the group and not further impair its dynamics.

This example should make it clear that non-conformity or illness or madness never only has to do with the individual person and diagnoses cannot be made on the basis of questioning and testing the person about his or her individual inner life alone, but as well of looking at the whole system and the framework in which the individual moves.

Are Troublemakers the drivers for progress & trends?

I would like to say something about the young troublemaker: The fact that people have always shown a behaviour that has not been completely adapted to an existing group is certainly a fact that we all accept.

One could also positively regard a disturbing person in a group as someone who sets a new trend, who draws attention to something new and who can be regarded as a kind of pioneer who tries something unusual, especially because of his behaviour that sets himself apart from the rest of the group.

That a group system can be disturbed in its balance and functionality is not a question at all and it is probably a kind of invisible art to be able to deal with whether one really wants to disturb oneself with the troublemaker or not, whether this person is subjectively regarded as a danger or as harmless. It seems to be a tightrope walk and in reality is not so easy to judge, even if I take such a simple community as a hunter-gatherer clan.

Death for trend scouts who got up too early?

But to stick to the example, I could now integrate a character who is very disturbed by the young man's behaviour and who provokes physical battles with him again and again. The young man, for example, is constantly beaten by another, somewhat older man and forced to take part in the hunt. This in turn affects the hunt itself, because the young man has only moderate hunting successes or does not really support the group.

It's not you alone who decides on your sanity

Now the whole dynamic could change and the non-conformity could lead to the young man simply being killed in order to be rid of this disturbance for good. But it could also be that the group dynamics lead to the one who is constantly looking for a fight with the young man being targeted and trying to influence his behavior. Is it more likely that our man will be left behind because his behavior is new and still unfamiliar, while the other's behavior or intentions are based on what is accustomed and adapted?

Countless scenarios, however, can now be integrated and it is not easy to draw conclusions or make frivolous assumptions. It always depends on the individual case and it could just as well have been that our young man finds something new through his presence in the women's group, that benefits the whole group, thus being a benefit for survival. For example, by discovering a substance and mixing it with another substance that lets fire burn longer. Then he would probably be more tolerated than if there was no visible benefit to the group from his deviant behavior.

Tributes for eccentrics

Maybe, just maybe, even the shamans have grown out of the dissenters, precisely because they were regarded as eccentrics and the group tended to try to integrate eccentrics by giving them a new task. Without killing anybody or expulsion from the tribe. However I look at it, it seems that people only contributed to further developments and innovations through recurring violations of a norm, and that this turned out well in one case and less well in another, depending on how the rest of the group perceived this new behavior.

Always assuming that the behaviour of an individual did not deviate too much from the known norm and could thus be seen, integrated. Thus, it is conceivable to assume that the clan members showed a certain tolerance towards an eccentric if the situation and circumstances allowed the observation of an individual's strange or not entirely adapted behaviour over a longer period of time and agreed that it was not an attitude endangering the group. For only different and new forms of thinking and using tools, materials found in the environment, can help to replace or improve the familiar with something different, possibly better.

To recognize a really crazy person: How difficult is that actually?

I have tried to show how deviant behaviour from the group can develop positively and negatively. I could of course have chosen a somewhat more blatant example, such as the fact that our young man stops speaking, is clearly visible and noticeably not involved in everyday life at all, and is so strangely that one could without question claim that the young man has gone mad and is now stressing the group more than unburdening it.

Which makes me wonder for our present times: Are there actually so many patients in my society (or western/modern societies) who show a clear disrupted behavior that justifies the research effort, the number of clinics, the payment of the employees, the operation of the building facilities and the raising of further research funds? How many really conspicuous patients are there who put this into perspective?

I don't know how the prehistoric people dealt with it. It's not my subject for discussion here either. One could also ask oneself whether the deviant behaviour of the young man was caused by external influences, for example that he seriously injured his head or that other biological causes could be used. From a modern point of view, we finally do this and ask about physical events, physical illnesses, etc., and how they are caused.

What is normality?

I wanted to demonstrate how difficult it is to represent a norm (hence, normality). Finally, clinical psychology has not answered this question either, since it is indeed impossible to find a conclusive definition. In this context, people have asked themselves what "mental health" actually is.

Psychiatric diagnoses are, firstly, conceptualized along the medical illness model. Medical diagnoses arise from symptoms or signs that indicate an underlying somatic disorder. By contrast, psychiatric researchers have not yet been able to find a biological substrate or laboratory marker for identifying mental disorders. Instead, biological studies within the field of psychiatry have presented only overwhelming evidence for mean differences between persons with a certain diagnosis and so-called healthy controls (N.B., a “healthy” person is generally defined as one who is not utilizing a mental health care system). With regard to biological markers, however, a strong overlap exists between mentally ill persons under investigation and healthy controls, making it impossible to separate the ill from the healthy. Thus, all psychiatric diagnoses to-date have relied exclusively upon clinical assessments.

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Maybe it is the absence of disturbances?

But if a group is not disturbed, be it by its members or by other influences such as climatic and nutritional factors, one has to ask oneself: How does progress and change actually happen?

Reality is that disturbing things happen

One need not regard disturbances and problems therefore unilaterally as unwelcome, even badly, but as happening for real. A problem becomes only then an insurmountable hurdle, if it experiences complete refusal.

For me it becomes clear that the group pressure must not be too weak on the one hand, because otherwise perhaps everyone simply did what they want and on the other hand must not be too strong, because the coercion of the norm can have an unfavorable, even damaging effect and prevent progressive development.

If I look at it this way, I cannot help but wonder at the abilities of people and admire them at the same time, because we have managed not only to secure our survival over a long period of time, but also to enable life in large communities, created by constant technological progress. Of course, with its entire bundle of downsides.

The downside here is the overuse of mental disorders in connection with:
thoughts
speech
media
interests
markets

How does a group of several million people actually behave?

Today, however, the question of the utility of the individual is much less easy to answer than it is in this manageable group from earlier times - we live in big cities. One could easily think that mental disorders make a person as a whole unfit for the community, and by putting a great focus on the "sick" and their diseases, coming to the conclusion that the whole country has gone more or less crazy. Especially, as I mentioned, when you look at the abundance of diagnoses and the extent of research, the number of patients and the markets that have evolved as a result.

The "healthy" are dependent on being provided with enough "sick people".

Holistically speaking: those who can be found as helpers and practitioners on the one hand have an army of patients and needy in front of them. Like a film that draws many viewers with an actor who is considered an attractor, to make a daring comparison.


Von Hans Georg Pfannmüller - Nachlass des Urhebers, CC BY-SA 3.0 de, https://commons.wikimedia.org/w/index.php?curid=22744616

As if by a kind of "invisible hand", the people fertilise and serve each other mutually, as the created markets (help systems, health insurances, clinics, research facilities etc etc.) also create their "customers" and vice versa the diseases, sensitivities, education and the public concern with the topic "disease" and "psyche" generate new and further blossoms in diagnostics.

We like to find a main culprit and the big pharmaceutical industry certainly has its significant share in the hysteria (haha) through aggressive advertising in the consumer markets as well as among the doctors (incentives) themselves. The pharmaceutical industry would therefore be far less large if it weren't for the medical profession's vicarious agents and their livelihoods. This in turn interacts with the population, which follows advice and pays attention to the campaigns.

In short, needs create a variance of activities and applications to serve them. And once they have been served, new problems and paths, new markets and mutual service are found. Hasn't a culture already developed that takes pills?

I quote one paragraph from The strange absence of things in the “culture” of the DSM-V on "US National Library of Medicine National Institutes of Health", written by Stefan Ecks, PhD:

Clearly, the medicalization critique is a kind of cultural critique. It is less obvious that the biopsychiatric argument against the DSM-V also comes from a culturalist position. When Insel finds that the DSM is based on a “consensus” rather than objective measures, he is making the same point that Frances and the critics of medicalization have been making all along: that the DSM is produced by a human, all-too-human community of psychiatrists, and that their ideas about psychopathology are mere conventions.

Neither group of critics seem to have noticed, however, that the DSM-V might find a defence against these attacks in its culture sections. Could the authors not turn around and say that both the “medicalization” and the “lack of validity” allegations have already been acknowledged and answered because everything is now “culture,” including the DSM?

But who actually needed whom and what first is not always quite clear. How much does a "healthy person" need that a "sick person" shows normal behaviour again, i.e. doesn't disturb his view of the world too much in the sense of what he considers to be healthy?

How seriously ill is severely ill?

If a "severe disorder" is assumed, then probably because a mentally severely disturbed person does not suffer from his disorder all alone, but also because the others around him do it. How much does a person who sees his view of the world shaken by another person's mental inappropriateness actually foster a worsening or bettering of suffering? And can someone who as a psychologist cares for patients put his own picture of the world aside when he meets patients who, for example, damage themselves?

Let us only assume for a moment that cutting oneself would not cause any excitement at all in the environment of a cutting person. Rather, the act would be perceived as a normal expression of grief, as if one were surrendering to a symbolic act that pursues a certain intention. If no one found anything strange about it and instead showed complete acceptance, how would it affect those who cut themselves?

I would like to stress that the results of psychological clinical research should be considered in such a way that what they deal with are "severe mental disorders". This seems to me to be neglected, especially when it comes to the sheer mass of available publications of non-technical texts. It seems that we have a high concentration and fascination with disturbances.

Indeed, psychology serves a very rich material for hobby psychologists, websites, novels, movies, literature and theater in general. Who has ever read or heard so much about mathematics in the popular media?

Must a mildly shaken mentality be treated (therapeutically, pharmacologically)?

The criticism that the DSM V, for example, has to put up with has to do with reliability and validity, it's "primarily concerned with the signs and symptoms of mental disorders, rather than the underlying causes" and what interests are being looked at.

... wouldn't it be nice to diagnose and treat early cognitive failure before it becomes dementia? But then almost everyone over sixty might qualify to receive a probably useless, but highly promoted treatment. This is a drug company's dream come true.
Allan Frances

Strengthen individual responsibility - can be done by everyone

I would think that people who come to my counselling and bring their own diagnosis with them because they feel treated unfairly or have other social problems with the topics of work and school problems of their children have already become too deeply involved in the psychological media palaver and advertisement everywhere.

A third category of DSM‐V innovation would create a whole new series of so‐called "behavioral addictions" to shopping, sex, food, videogames, the Internet, and so on. Each of these proposals has received little research attention, and they all have the potential for dangerous unintended consequences, by inappropriately medicalizing behavioral problems, reducing individual responsibility, and complicating disability, insurance, and forensic evaluations. None of these suggestions are remotely ready for prime time as officially recognized mental disorders.
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I notice a tendency that has to do with how much people accept each other going through a difficult phase in which they identify problems with their health, their work and their social environment and how they classify these problems.

When you hear people talking about oneself or about others it is observable that ...

... normal age becomes a disease (i. e. forgetfulness)
... attention deficits relate to the single deficit and are not attributed to the framework where they happen
... mourning is confused with melancholia (sadness over a period of time because of a loss)
... tantrums easily turn into psychiatric disorder
... gluttony becomes mental illness
... turning passions into addictions

It is quite obvious that psychiatric classification is not only a matter of academic debate but also has a direct impact on the lives of the affected and their families. However, if we continue to cling to the current categorical approach, we will never be able to abandon this discussion and will instead create an inflation of mental illness by lowering the threshold of psychiatric diagnoses or, because of restrictive diagnostic criteria, miss those who are truly mentally ill.

"Flood the world with new false positives" - Mister Frances is even more direct:

Undoubtedly, the most reckless suggestion for DSM‐V is that it include many new categories to capture the milder subthreshhold versions of the existing more severe official disorders. The beneficial intended purpose is to reduce the frequency of false negative missed cases, thus improving early case finding and promoting preventive treatments.
Unfortunately, however, the DSM‐V Task Force has failed to adequately consider the potentially disastrous unintended consequence that DSM‐V may flood the world with new false positives. The reported rates of DSM‐V mental disorders would skyrocket, especially since there are many more people at the boundary than those who present with the more severe and clearly "clinical" disorders. The result would be a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatments

1

In my consultation I experience that people come to me who have a long medical history and are convinced that they are seriously ill. When I asked a client the other day why she considered herself to be seriously ill because she seemed to me to be in possession of her full powers, she replied: "That's the problem. Everyone I consult confirms this, but no one sees that I am really suffering." On the other hand, I meet clients, who have undergone severe traumatic events (attempted murder on them with visible scars on the body, looking at a car accident in which a family member died) who don't even have a permanent family doctor. This information I get from complete strangers in a first meeting. If I should pick between the two I'd refer the latter to a therapist, which I indeed did.

But if someone can articulate himself clearly, give reasonable answers to questions, read, calculate and write, answer his mail, take care of his finances, pay the rent on time and also take care of the needs of a child, provide food on the table and have some contact with his social environment, I ask myself: where is the severity of a mental disease to be found?

I would think that we humans are diverse in our form of expression and lifestyle. We are sometimes big eccentrics, egoists and tainted with prejudices. But we also fit into communities that are so anonymous that one might wonder how we don't get lost in them.


Eccentric or Lunatic?

By Unknown - , Public Domain, https://commons.wikimedia.org/w/index.php?curid=10838558

But eccentricity, exaggeration, worrying, feeling unwell, grieving: all these are not (necessarily) serious illnesses or harbingers of a mental disorder. Even though the potential to harm others, just like wanting to comfort others, lies dormant in everyone, it is precisely for this reason that it is important to ask oneself: What am I going to do with it when I tune in to the headlines and processing of supposed epidemics? What form of self-responsibility do I want to exercise?

Just because it has become so easy to get a diagnosis, do I have to agree with the experts who classify me or my relatives?

How quickly do I actually want to say "yes" to a diagnosis or intelligence test?

I should also be aware that if I describe classic symptoms to a doctor, they will get a diagnosis that not only provides the hoped-for break from too difficult a life situation, but also that I am exposed to a stigma and being medicated. It also has influence on my insurances.

The fact is that we humans never let each other be undisturbed. Who wants to avoid the pressure of the employment offices (or others) and does not feel up to the demands, can indeed choose the way out, provided by a psychological diagnosis, so that no demands can be made. But this can grow into a self-fulfilling prophecy.

Sometimes I have said to a client: "The system gives you only two ways as a working person: One is to look for a job, the other is to develop a medical history. Illness does protect you from exposure to demands. At the same time, however, there is a danger that you will have more to do with it than you would actually like. What do you want?"

I think we are all familiar with the situation in which you sat in the doctor's office in the morning to get sick leave because you were reluctant to go to work or school that day. For my part, I know that in order to be credible, I actually began to feel very bad, the night before I slept badly, I rolled around. That I pushed a little depression in the waiting room not to have to lie. How much we humans can put ourselves in an emotional position is quite obvious.

In principle one could say to the doctor frankly and freely: You know, I just don't want to go to work today and have my reasons for it.

Cure or endure?

I meet clients who tell me that they have been taking antidepressants for years without being in therapeutic treatment.

I am assuming that it is now well known that pure medication is not the cure. But when people educate themselves by not tolerating the slightest unevenness in their mental condition and preferring to prescribe a mood enhancer, that is of course still their own decision to do so. I explain that pills only relieve symptoms, but never heal.

If a doctor does not comply with this obligation, others can do so.

Be your own agent

The question that everyone can ask himself is: How long will I take pharmaceuticals for? Do I want to get better? Do I want to look for other ways to fathom the cause of my discomfort? How much time and energy do I want to invest in my personal maturity development? How impatient do I get when others take their times out, suffer or rant about things, appear as eccentrics?

How much am I a mouthful of the headlines and scaremongering that is spread, and thus an equal disseminator?

Final words

If I now distance myself a few steps, what do I see? Do I have to worry that the mental health of my fellow men will be affected by superficially and artificially created procedures?

Is it really that clear where the perpetrators are and where the victims can be found? Doesn't one system feed one another here? One needs not to have a sophisticated education in order to notice that taking pills over a longer period does not cure. In the same way one would visit a doctor when having headaches for weeks to have a screening of his head and not staying with Paracetamol all the time.

Stay cool and rational

In any case, it seems appropriate to me not to get excited, but to find my own position.

If I don't allow myself, as someone who suffers, to take enough time for grief, conflict resolution, and reflective examination of my life situation because I think I need to function, that's a problem.

We all know that there are not enough places for therapy and that these should indeed be reserved for those who need it most. Here in Germany there are many contact stations that can be approached before a therapist is consulted. There are self-help groups which, in my opinion, have been pushed into the background and there are numerous social stations.

Know your resources and strengths

My work is based here. I see it as my task to strengthen people in their potentials and to uncover their resources with them. As far as I only confirm a client in his helplessness, I am guilty because I then carry out my work purely as an end in itself. It is important to take my work seriously and to recognize where I can be helpful. To see myself alone as a throughput station referring to specialists would not do justice to my work. Rather, I can help to address the help to self-help and to relate the client's work/activity and social environment to it. In doing so, I take a fact-oriented approach. In fact, the main part of my work is to lead them out of the victim's perspective and to give them a different perspective on their personal situation.

In the course of time I have had very good experiences with this and very few clients haven't been willing to take responsibility for their health, finances, working environment and social contacts. Those who do not show this willingness are indeed referred to therapists.

Trust

For this I clearly prefer a world view - quite consciously: To trust people more than is believed in the medial cacophony. Why? In my opinion, what works in a one-on-one relationship also works for the many: If I am interested in insinuating that the other has good intentions, that I want to experience him courageously, with integrity and wisely, then this works at least as well as if I feel and think the opposite. I don't think one should underestimate how much power this inner attitude has: it alone can lead to someone transforming a previously unfair intention into a sincere one.

For one thing I know for sure: to trust someone to trust himself is one of the most encouraging offers we can make to each other.

Thank you for reading.


References & Sources:

Allen Frances : https://en.wikipedia.org/wiki/Allen_Frances

[1] Publication by Allen Frances: http://www.maartensz.org/me/RESOURCES/DSM-5/Frances_DSM-5.pdf

[2] Front Public Health. 2013; 1: 68. Published online 2013 Dec 9. What is Normal? The Impact of Psychiatric Classification on Mental Health Practice and Research by Wulf Rössler: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859926/

[3] The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research by Brett J. Deacon. University of Wyoming, Department of Psychology, Dept. 3415, 1000 E. University Ave., Laramie, WY 82071, USA: http://jonabram.web.unc.edu/files/2013/09/Deacon_biomedical_model_2013.pdf

[Interview] The Debate Over DSM-5: A Step Backward: An Interview with Allen Frances - By Rich Simon. March/April 2014: https://www.psychotherapynetworker.org/magazine/article/119/the-debate-over-dsm-5-a-step-backward

[DSM:] https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorder

US National Library of Medicine National Institutes of Health, "The strange absence of things in the “culture” of the DSM-V" by Stefan Ecks, PhD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732970/

Please, disturb - a tribute to annoyances: https://steemit.com/steemstem/@erh.germany/please-disturb-a-tribute-to-annoyances

Beschwerden über Fehlverhalten in der Psychotherapie. Ziele, Ergebnis und Entwicklungsmöglichkeiten von Aufklärungs- und Öffentlichkeitsarbeit:
https://www.db-thueringen.de/servlets/MCRFileNodeServlet/dbt_derivate_00040321/Dissertation_Welther.pdf

Cracked: Why Psychiatry is Doing More Harm Than Good: Google books

American Psychiatric AssociationResponse to Frances Commentary on DSM-V6/29/2009: https://de.scribd.com/document/16953085/PsychTimes-FrancesResponse-062909-FINAL

http://carlatpsychiatry.blogspot.com/2009/06/psychiatrys-dsm-v-process-now-bar-room.html


Title picture: own creation by @erh.germany
Stickmen: Pixabay


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Oh, Erika, it is apparent that not only your work, but your life experience has influenced this long reflection on mental illness. As you probably remember, I taught at a school where every student carried a psychiatric diagnosis. So, this is a subject I have considered many times.
As I read your piece, particularly those areas that address individuals who are distinct from a group, I thought of all the 'witches' that were burned throughout history. In many cases these people were just 'different' in a way that troubled those around them.
I thought of the 'snake pits' in which those diagnosed as insane were confined, sometimes for their whole lives.
And I though of Thomas Szasz, who suggested mental illness might just be a bureaucratic construct.
I thought especially of the Rosenhan study, in which undercover investigators convinced psychiatrists to admit them to an institution for 'treatment'.
It is clear to me that the DSM, to a large extent, exists to justify payments from insurance companies and government agencies. In order to receive compensation for 'treatment' of a patient, the provider needs a diagnostic code. The more codes there are, the more possibilities there are for treatment justification.
Despite this cynical perspective on the DSM, I have to assert that mental illness does exist. What is that? If someone cannot cope with everyday responsibilities, if there is a sense of anguish--then intervention by the medical community might be appropriate. Unfortunately, a clear understanding of how to diagnose and treat mental illness does not exist.
I"m with Dr. Insel--hard science needs to buttress the soft science of psychiatry. We need to understand the biological basis (what is actually going on in the brain when a person can't cope) while never ignoring the subjective experience of someone who is suffering.

Thank you for coming and the link drops, I will have a look at them:)

Yes, without a doubt there are mental disorders.

I know an old lady who took care of her husband for all her life. He was mentally poor, a silent, unintelligent man who would not have survived alone. This woman, to whom in our modern world one would undoubtedly acknowledge her great sacrifice, who acted as protector and commander of her husband, does not have a bad life when asked (her man, incidentally, did not take psychotropic drugs).

For these particular cases, when a man is unable to carry out his duties, mankind has created a huge arsenal, an industry, research and funding. So that, in the event of the worst case, we have a way of helping people who are so incapable of living. I know of few families in which a member has such a serious personality disorder that one must assume total incapacity for life.

We have taken precautions for a minority. Of course, it would be an economic miscalculation for this small part of the population to make such an effort, and so it (inevitably?) happens that milder cases of incapacity and inappropriateness serve the dominant dimension of a helper culture that earns its living. The babbling imbecile, physically and mentally disturbed, who cannot feed himself, dress himself, wash himself: this is less frequent. But it was for these cases in the first place that people stood up to research, help and find causes. Which makes sense.

However, a research institution needs purpose because the few in number are not economically interesting. We recognize that this medical industry has already taken up space and has become too big to fall, so to speak.

The hunt for the cure for an illness will never have a final end, because things are permanently intertwined as causes and effects and what causes healing or improvement on the one hand, causes aggravation and illness on the other hand - often with delays and unforeseen. No matter whether one takes the biological approach or the soft sciences make an effort.

Diseases are like dishes. If you have just finished washing one dish, the next is already waiting.

Apart from that, I am interested in finding answers and personal decision-making aids that combine science and philosophy plus wisdom.

I am so much in sympathy with your point of view, while not being in complete agreement. I only worked at my school ( for adolescents with psychiatric illness) for 8 years, but that was enough time to become thoroughly acquainted with issues related to mental illness. My feeling eventually grew to be that many of the students needed to be where they were mostly because they required a rest from the pressures of life. The school gave them a chance to grow in peace. It seemed to me, however, that by being grouped with others who were diagnosed with mental illness, there was almost an incentive to be mentally ill. After all, they were all adolescents. The inclination toward group identification is very strong at that age. So, in a way, their protective environment worked to exaggerate symptoms.
Of course, there's no easy solution to the question of mental illness. Always we want to help people who are suffering. We want to save lives--depression kills and that's a fact. Yet, it is not helpful to pathologize symptoms of distress that arise from ordinary circumstances. @abigail-dantes, I believe addressed this when she looked at the difference between circumstantial depression (grief at the loss of a loved one) and clinical depression.
You raise many important points in this blog. It was a good read and obviously one that prompted me to think.

As much as I appreciate disagreement, since it often points me to things I don't necessarily encounter myself, I don't recognize where you contradict me?

I see it just like you do.

I have drawn this very long arc in my article to make it clear that the ever-increasing concern with mental illness, the technologicalisation and industrialisation of medicine are producing their own psychological and social blossoms, which - because in the communities, due to gainful employment, people are not sufficiently available and people feel isolated as a result, for example, can trigger depression.

Thus what helps on the one hand is what causes suffering on the other. To put it briefly: from a tribal society, to an agrarian society, to an extended family, nuclear family and single households, where the feeling of security through a familiar group (relevant in familiarity, number and diversity) is missing. I remember the concept of "anonymity", which I first heard in my childhood and which somehow already appeared to me at that time as something existing.

I agree with you about your experience with the students. I see the protection and intermission time that people need as a necessity, but just like you I also see the tendency that people who are among their equals are beginning to take advantage of this status and it is a balancing act for all pedagogues and other practitioners not to comply with it. Depression is by no means a disease in which you are no longer in control of your senses. You can read, write, calculate, give rational answers and ask reasonable questions, you are mobile and able to go from A to B alone. Depression sufferers absolutely need physical activity, physical touch, a good daily structure in which they have a duty, tasks in the company of others and a positive prospect of improvement.

Unfortunately, next to what works and helps, I also experience that those who work with the diagnosed people are also involved in increasing helplessness/illness without knowing it. You have to be hellishly careful not to get carried away as a helper in exaggerating your role and promoting unconscious dependency (guess you can confirm that?). In my opinion this requires years of practice and work with people and constant reflection and work on one's own affairs.

I have been doing my work for about seven years and have advised well over one thousand clients during this time (poor ones who were my beginner clients:). In every difficult case I sought the advice of colleagues, exchanged with my confidants and read a lot and reflected inwardly. I am a practitioner through and through. In addition a quite strong follower of systemics (which is also somehow engaged to parts of Asian philosophy). I don't want to say too much, but I was also on the other side and am familiar with the clinical.

If you browse through my article again, you may notice this passage that is consistent with what you mention in Abis's former article:

I notice a tendency that has to do with how much people accept each other going through a difficult phase in which they identify problems with their health, their work and their social environment and how they classify these problems.

When you hear people talking about oneself or about others it is observable that ...
... normal age becomes a disease (i. e. forgetfulness)
... attention deficits relate to the single deficit and are not attributed to the framework where they happen
... mourning is confused with melancholia (sadness over a period of time because of a loss)
etc.

I think my position does not necessarily reach the dimension of contradiction, but rather one of degree. I do give greater latitude I think toward acceptance of mental illness as a defined condition and treatment as a necessary intervention, sometimes. I think I would allow for more conditions to be treated than you might. My own experience with students was instructive.
I was always skeptical of ADHD as a diagnosis--saw it more as an attempt to control unruly students. Then I had a girl in my class--quite unruly. More than that, simply unsettled, in and out of school. I had her for a couple of years. In the third year she was prescribed medication specifically for ADHD. The girl was suddenly at peace. She was at least 16 by that time, close to graduation, and yet this intervention allowed her to study, finish her requirements and simply be more comfortable in her own skin. It was an amazing transformation, not one I appreciated because it made my life easier as a teacher, but one I appreciated because it made the student's life easier.
There was another student who was very smart, very sociable, very agreeable. Unfortunately, she had a little chemical imbalance and from time to time this would assert itself. One episode forced her to discontinue her studies and go for intensive therapy and drug intervention. She was diagnosed as bipolar (this had been previously diagnosed). That's a name, a diagnosis, that allows certain treatment. In her case, it worked. She recovered and went on to a successful university career, but her acceptance of this chemical issue, and willingness to treat it, would be necessary for the rest of her life.
There are so many examples--I'll stop here. I wish psychiatry was more science-based. I wish psychiatrists really understood why their interventions work, and don't work. I don't think they do. But sometimes it's all we have.

I think your blog is great. You raise a number of issues others are not willing to address. That takes courage. Shining the light on any topic can only serve to inform and advance discussion.

Oh, I see! :)
It's true, my willingness to allow more diagnoses - especially those of mild form to medicalize - is actually more limited to yours if that's what you're saying. I think everyone has their role and mission in life and mine is that I am very critical of what is generally postulated to be successful and subsequently exaggerated. Thank you for addressing the point. As far as acute need is concerned, I have nothing against medication. It satisfies the distress and is a bridge to use a calm mind again. But if people don't also come to encourage someone, trust him, then the drugs are often not as promising as one would like them to be. You know cases where you describe it positively, I know cases where I describe it negatively. The thing is: you can agree with both of us, we speak from our subjective experiences and preferences. The subjective element in each of us may be there, has its justification. You are basically at an advantage with your greater tolerance;-) because you will agree with me that we live in a world where swallowing pills is made very easy and already happens frivolously. Among other treatments and methods that the biological approach pursues and is far more productive than the psychological one. Since I don't think this scene needs much defense, since the lobby is very strong anyway, I take a counter-position that is needed in my eyes.

Sometimes science is not the final conclusion and outside of it there are possibilities and insights of a very special kind.
Have a good day, I'm going to bed now. Tomorrow the twins have their birthday and I'm off on my journey again.


edit:
Through systemic teaching and what I learned there, I have had surprising experiences working with people for myself. The resource-orientated one in revealing the accustomed helplessness and the learned mistrust of oneself as a mental construct without imposing anything on people, quite simply by encouraging the good and strong qualities of another, is a good deed. I love my work and value it very much. A lot of time and patience is sometimes such a fantastic medicine.

One-on-one work is not even so unusual here, because more and more people find their livelihood in the niches between patients and doctors/therapists, schools and parents, offices and beneficiaries, couples and courts. Here in our country there are countless counselling centres in the public sector.

Of course, it is very badly paid and my fee is a joke. But I don't mind that much. I like to do that and want to live off it and be able to afford something from time to time. I am much freer and more independent than the people in the clinics or the permanent employees in the facilities. In all my life I have never been able to work so freely and enjoy so much trust from my customers (the institutes that commission me).

🎂 🎂
🎁
🙂

HaHa, thanx, I will give it to my brothers.
Hug for you!

💟 ☘

This issue touches me somewhat deeply. My brother suffered some form of abuse throughout his childhood. It was not called 'abuse' but 'discipline' where we come from. It translated into beatings with belts because he was being rebellious. He grew up to need psychological help and psychiatric meds. My mother never told me this, my brother did. To this day I am still angry at her about it, but will not confront her to protect my brother's secret. Now, he's into drugs, nothing 'hard' but it's still a method for escaping.
My point being, societies can be ill too... When society forces you into taking a medication that will take half of your uniqueness and anull it, only for the benefit of itself, then society is ill, society is intollerant, society is not inclusive of its members, but has forgotten what it really is.

That being said, I once watched a video about a young man who had what medicine calls mental disorders. In his search for a cure, he was led into shamanism and discovered that disorders like his would've caused him to be chosen as a shaman in ancient spiritual practices. So what he had is neither new nor a completely bad thing. It's a contextual issue.

Finally, I wanted to show you this video, which changed for me the way I see the world, or western world, actually. Maybe you will enjoy it!

https://drive.google.com/open?id=1lbj2kMgkqdbWyL24qDZMvdvR4_63T8Ef

I cannot answer you, I got sick and must stay in bed. Just wanted to let you know.

I hope you get well soon :) thank you for taking time to tell me (but you shouldn't have!!!)

Hi, Erica! What an interesting and provocative subject you have chosen for your article. I have given thought to most of the aspects you discussed, although there is not a single answer to all of it (as always). Thus, I completely agree with some of your statements and partly disagree with others :D

I was a little surprised to read here that there is a "biomedical model" which is based on the fact that mental disorders are brain diseases and that therefore pharmacological treatment is emphasized to "combat suspected biological anomalies".

Well, what else could they be? After all, we are our brains and biochemicals. However, pharmacology has not advanced enough to have a real treatment of the imbalanced chemicals. But, I see what you mean here. We are prone to maintaining a certain set of "symptoms" due to our behavior and thinking models (if we take the CBT perspective) or the system relations (if we take the Systemic perspective). So, if one is depressed and doesn't change his thinking and behavior pattern or systemic relations, he will never be "cured" by the antidepressants he takes. He will simply need to take them till the rest of his life. This is mainly because his lifestyle (e.g. thinking pattern, system relations or in order words - the internal and external stimuli) will get him back to the decreased levels of serotonin eventually.

However, it is extremely important to state that antidepressants are crucially beneficial in cases of severe depression. Furthermore, depression has its different stages and not all of them require pharmacological treatment but there are stages and cases which require it.

How much does a "healthy person" need that a "sick person" shows normal behaviour again, i.e. doesn't disturb his view of the world too much in the sense of what he considers to be healthy?

I think that it is not about the "healthy people" disturbed by the "mad people". It is more about what the suffering people with a mental disorder go through. I think there is a very romanticized picture of the mad living in their own wonderland and "forced" to be "normal" by the "normal". I worked for two years with people suffering from schizophrenia and, unfortunately, these were not happy people. Sadly, hallucinations are never "pleasant". You will never have lovely visual hallucinations about you lying on the beach with a nice cocktail. No, you will hallucinate your worst nightmares coming true - like being stabbed to death... again and again. The voices in your head will never talk flattering things. Instead, they will scream and say that they are going to kill all your family. If you have olfaction hallucinations you will never smell flowers. No, you will smell dead bodies instead.

That is how these people suffer. And pills do help them. Some get rid of their hallucinations, others don't, but are hugely relieved. I have only worked with the second group.

I agree with you that having "a diagnose" could be an excuse to deal with your life and issues. In the mental care center I used to work with the described patients a young man voluntarily enrolled because he assumed that he is mentally ill. He used to visit a psychoanalyst who perhaps confirmed this (don't they see pathology everywhere?). His problem (I will call him Mark) was that he couldn't stand being around people at work and felt very very annoyed with them to the point that he couldn't go to work. Mark was a very clever young IT specialist who preferred to spend his time with our talking to themselves patiants instead of dealing with his issues. It was really convenient for him because he was their favorite. His opinion was extremely important to the rest of the patients and he could really influence them. He liked this role. But this place wasn't for him for sure. Was he mad? No, of course not. His behavior was odd though. His coping style was ineffective. Did he need pills? No, he didn't. Did he need therapy? Yes, sure he did.

So, we have both examples here. People who benefit from having a diagnosis and taking pills and a person who uses it as an excuse.

I am not into DSM-V, either. I think they went too far. I agree with you that it's very easy to "earn yourself" a diagnosis these days. I think this is happening with autism. Suddenly, everyone is autistic. I ran over "autistic people" on Youtube who are reflecting on their autism?!?!?! What is that? One of the autism markers is not having a theory of mind? Reflection upon yourself and others??? What kind of autism is this? I think that any odd behaviour is called autistic or ADHD these days.

Hey Valeria,
thanks for visiting my blog:=)

we are our brain and our biochemicals.

That would be the easiest thing, wouldn't it? If we saw ourselves that way, then everything that constitutes a human being could be explained biologically.

The purpose of this article was to draw attention to the fact that the pill industry is on a triumphal march anyway and that such cases, in which there is a severe mental disorder, are relegated to the background and the practices and practitioners are populated by mildly disturbed clients and patients who take away the places those who need it more urgently. The practices here in Germany are full and emergency patients can either only be hospitalized or have to wait a year for a place.

Allen Frances indicated that the mild cases could grow into more severe ones once they are diagnosed and medicated. What do you think?

But I was really surprised that the view that brain defects or genetic causes are the main cause of madness is (again?) so expansive and the therapist's rank runs out.

antidepressants are crucially beneficial in cases of severe depression.

This is not a question that I discuss controversially. It is right what you say. It is well known among the general public that antidepressants are very helpful in acute distress.

Thank you for sharing your experience in this area.
Greetings from rainy Germany

Allen Frances indicated that the mild cases could grow into more severe ones once they are diagnosed and medicated. What do you think?

I am very surprised by this. I don't know what exactly he was implying and I am not competent in medication at all. I should read about it further.

Greetings from rainy Germany

Is it rainy, already? We are having a wonderfully warm and sunny autumn here :)

Greetings from Bulgaria! :)

wow ... quite the read ... i think in psychiatry its very important to NOT state a diagnosis , especially for people with extreme pathology, as they will "settle" into it most likely, and just like a label, be able to use as an excuse, PLUS the self-fulfilling prophecies ofcourse since "what you gonna do ... i AM after all ... etc..."

So imo the best psychologist makes as little suggestion as possible and the best psychiatrist never tells the subject (patient?) what "they have" lol

once it's categorized it's no longer evolving anyway

:-) Thanks for putting up with this long read and offer your view. You made a good point.

Yes, it's like fixing a thing (in the sense of manifestation) that wasn't fixed that way before and becomes permanent as a construct of the mind. It is funny that we usually reject a negative categorization, but welcome a positive statement. Which is fixed in the same way. If we want to be consistent, we would reject all solid sounding attributes, wouldn't we? We prefer these attributes only when they serve our way of wanting something, and we don't prefer them when we don't want something.

I have never heard of a clinical case where someone with a serious pathology has not been medicated at the same time. That raises the question: What was there first? The diagnosis or the available drug? As soon as the market offers a variety of drugs, the ground is prepared for the question of which method, diagnosis and which drug would suit this particular patient. In addition, you can get prescriptions for psychotropic drugs from all kinds of doctors, not just psychiatrists. If one follows the biological approach and sees mental disorder as a chemical imbalance, a drug chemical will inevitably have to compensate for it. There is also the question of what kind of mind a doctor is: is he an advocate of nature or nurture? The same applies to the patient.

All in all, I think we are dealing with a circular phenomenon: people serve each other in their respective functions, are helpers and help recipients alike, and permanently exchange roles in this circle.

So what do you think: Do we talk ourselves sick and does that make a difference to you as to how you decide to live?

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Wow, so ein langer Artikel zu einem Thema, zu dem ich mich auch um Kopf und Kragen diskutieren könnte.
Und ich hab grad nur die Hälfte meiner Vote Power, kann ihn also nicht rechtzeitig angemessen entlohnen. :(

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