Empowerment, wellbeing, and appreciation for the intrinsic value and potential of humankind.

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Social Anxiety Disorder

SAD is the most common psychiatric disorder in the U.S. after major depression and alcohol abuse.

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Social anxiety disorder (SAD) is one of the most common mental disorders affecting the emotional and mental wellbeing of over 15 million U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. SAD is the second most diagnosed form of anxiety in the United States.[i] The National Institute of Mental Health[iii] report 31.1% of U.S. adults experience some anxiety disorder at some time in their lives. Statistics are imperfect for the LGBTQ community; the Anxiety and Depression Association of America estimates their rate is 1.5-2.5 times higher “than that of their straight or gender-conforming counterparts.”[iv]

SAD is the most common psychiatric disorder in the U.S. after major depression and alcohol abuse.[v] It is also arguably the most underrated and misunderstood. A “debilitating and chronic” affliction, SAD “wreaks havoc on those who suffer from it.”[vi] SAD attacks all fronts, negatively affecting the entire body complex, delivering mental confusion, emotional instability, physical dysfunction, and spiritual malaise. Emotionally, persons experiencing SAD feel depressed and lonely. In social situations, they are physically subject to unwarranted sweating and trembling, hyperventilation, nausea, cramps, dizziness, and muscle spasms. Mentally, thoughts are discordant and irrational. Spiritually, they define themselves as inadequate and insignificant. Approximately, only 5% of SAD persons commit to early recovery, reflective of symptoms that manifest maladaptive self-beliefs of worthlessness and futility. SAD has lower recovery-remission rates because many are unable to afford treatment due to SAD induced “impairments in financial and employment stability.”[vii] Over 70% of SAD persons “are in the lowest economic group.”[viii]

Feeling anxious or apprehensive in certain situations is normal; most individuals are nervous speaking in front of a group and anxious when pulled over on the freeway. The typical individual recognizes the ordinariness of a situation and accords it appropriate attention. The SAD person anticipates it, takes it personally, dramatizes it, and obsesses on its negative implications. Social anxiety disorder is a pathological form of everyday anxiety. The clinical term “disorder” identifies extreme or excessive impairment that negatively affects functionality.

The superficial overview of SAD is intense apprehension—the fear of being judged, negatively evaluated and ridiculed. There is persistent anxiety or fear of social situations such as dating, interviewing for a position, answering a question in class, or dealing with authority. Often, mere functionality in perfunctory situations―eating in front of others, riding a bus, using a public restroom—can be unduly stressful. The overriding fear of being found wanting manifests in perspectives of inadequacy and unattractiveness. SAD persons are unduly concerned they will say something that will reveal their ignorance, real or otherwise. They walk on eggshells, supremely conscious of their awkwardness, surrendering to the GAZE―the anxious state of mind that comes with the maladaptive self-belief they are the center of attention. Their movements can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing, and every situation is reactive to negative self-evaluation. They are apprehensive of potential “negative evaluation by others,” concerned about “the visibility of anxiety, and preoccupation with performance or arousal.”[ix] SAD persons frequently generate images of themselves performing poorly in feared social situations, and their anticipation of repudiation motivates them to dismiss overtures to offset any possibility of rejection. SAD is repressive and intractable, imposing irrational thought and behavior. It establishes its authority through its subjects’ defeatist measures produced by distorted and unsound interpretations of actuality that govern perspectives of personal attractiveness, intelligence, competence, and other errant beliefs.

SAD persons crave others’ company but shun social situations for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. People with social anxiety disorder are prone to low self-esteem and high self-criticism.

Anxiety and other personality disorders are branches of the same tree. There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression and substance-abuse.

For over 50 years, cognitive-behavioral therapy has been the go-to treatment for SAD. Only recently have experts determined that CBT is ineffective unless combined with a broader approach to account for the disorder’s complexity and the individual personality. A SAD subject subsisting on paranoia sustained by negative self-evaluation is better served by multiple non-traditional and supported approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation with CBT, positive psychology, and neural restructuring serving as the foundational platform for integration.

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[i] MHA (2019). The State of Mental Health Care in America. (Online.) Mental Health Association.  https://www.mhanational.org /issues/state-mental-health-america.

[ii] ADAA. (2019a). Facts and Statistics. (Online.) Anxiety and Depression Association of America https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq [iii] (NIMH, 2017)

[iii] NIMH (2017). Social Anxiety Disorder. (Online.) National Institute of Mental Health). https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml

[iv] Brenner, B. (2019). Understanding Anxiety and Depression for LGBTQ People. (Online.)  Anxiety and Depression Association of Americahttps://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq.

[v] Heshmat, S. (2014). Social Anxiety Disorder (SAD). SAD is a risk factor for addiction. Psychology Today. https://www.psychologytoday.com/us/blog/science-choice/201410/social-anxiety-disorder-sad

[vi] ADAA. (2019a). Facts and Statistics. (Online.) Anxiety and Depression Association of America https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq

[vii] Gregory. B., Wong, Q. J. J., Craig, D., Marker, C. D., & Peters, L. (2018). Maladaptive Self-Beliefs During Cognitive Behavioural Therapy for social anxiety disorder: A Test of Temporal Precedence. Cognitive Therapy and Research, 42(3): 261–272 (2018). doi.org/10.1007/s10608-017-9882-5

[viii] Nardi, A. E. (2003). The social and economic burden of social anxiety disorder. BMJ, 327 (2003).doi:10.1136/bmj.327.7414.515

[ix] Tsitsas, G. D., & Paschali, A. A. (2014). A Cognitive-Behavior Therapy Applied to a Social Anxiety Disorder and a Specific Phobia, Case Study. Health Psychology Research, 2(3): 1603 (2014). doi:10.4081/hpr.2014.1603.

SAD persons crave others’ company but shun social situations for fear of being found out as unlikeable or unattractive.

Diagnosing Your Disorder. (It’s likely you’ve been misdiagnosed)

It is difficult to get a proper mental health diagnosis even with a knowledgeable and caring clinician

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One reason why it is crucial for us to understand the causes and symptoms of our disorder is the likelihood of misdiagnoses. It is time to recognize: we know more about the impact of our condition than our doctors. Psychiatrists may have extensive knowledge of medication, and psychologists, treatment programs, but that expertise is useless if the client is misdiagnosed and mismanaged. Mental health misdiagnosis is a cautionary phenomenon. Even mainstream medical authorities have begun to “criticize the poor reliability, validity, utility and humanity of conventional psychiatric diagnosis.” [i] A recent Canadian study reported, of 289 participants in 67 clinics meeting DSM-IV criteria for social anxiety disorder, 76.4% were improperly diagnosed.[ii] The Anxiety Institute in Phoenix reports an estimated 8.2% of clients had generalized anxiety, but just 0.5% were correctly diagnosed.[iii] Experts cite the mental health community’s difficulty distinguishing different disorders or identifying specific etiological risk factors due to the DSM’s failing reliability statistics. This failure in psychological diagnosis is like being hospitalized for strep throat and losing a leg. 

The DSM changes drastically from one edition to the next, even though the APA swears by its credibility. One study[iv] cites therapist Zimmerman’s[v] concern that criteria are “added, removed, and rewritten, without evidence that the new approach is better than the prior one.” [vi] A recent study points out that DSM-IV listed nine possible symptoms or traits for narcissistic personality disorder; DSM-V contains only two.[vii]  

The massive number of revisions, substitutions, and changes from one DSM to the next is never universally accepted. Psychiatrists, psychologists, and researchers who specialize or survive by funding are justifiably protective of their territory. Even under the best circumstance with a knowledgeable and caring clinician, it is difficult to get a proper diagnosis. Currently there are eight or nine types of depression, four or five different anxiety disorders, five types of stress response (three of them are PTSD), nine forms of obsessive-compulsive disorders, and ten personality disorders.

Bipolar personality disorder, a psychosis, shares characteristics and symptoms with avoidant, social anxiety, obsessive-compulsive, and post-traumatic stress disorders (neuroses). Psychologists cite the “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” of social anxiety.[viii] A researcher for this BLOG paper received three different depression diagnoses (including bipolar) and ADHD. Social anxiety was never considered, although he met nine of ten criteria for the disorder.

Adding to misdiagnosis is the prevalence of disorder comorbidity, which is especially concerning if the first diagnosis is inaccurate. The Anxiety and Depression Association of America [ix] reports many disorders are related to social anxiety, including major depression, panic disorder, alcohol abuse, PTSD,[x] avoidant personality disorder, generalized anxiety disorder, substance abuse, eating disorders,[xi] schizophrenia,[xii] ADHD, and agoraphobia.[xiii] Anxiety and depression are commonly comorbid. “Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety.” [xiv] Three types or clusters categorize 10 personality disorders: 3 focus on the bizarre and eccentric, 4 on the dramatic; and 3 on the anxious and fearful; each cluster shares traits and symptoms. The diagnostic criteria for one disorder are common to others. For example, dependent personality has characteristics and symptoms mirroring social anxiety, avoidant personality, and histrionic personality disorders.[xv] One misdiagnosis is bad enough, not to mention two, resulting in “in worse treatment outcomes.” [xvi]

Thomas Insel,[xvii] director of the National Institute of Mental Health, has been “re-orienting [the organization’s] research away from DSM categories,” declaring that traditional psychiatric diagnoses have outlived their usefulness,  A program of recovery cannot be entertained if the problem is misdiagnosed. A recent article in Scientific American[xviii] suggests replacing traditional diagnoses with easily understandable descriptions of the issues. 

A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and the design and planning of services. However, this BLOG balks at throwing out the baby with the bathwater, positing that the DSM could be utilized as a part of a more thorough analysis focusing on the character strengths that generate motivation and persistence/perseverance towards recovery-remission. 

Etiology and diagnosis drive the disease model. Which disorder do people find most repulsive, and which poses the most threat? What behaviors contribute to the disorder? How progressive is it? How effective are treatments? It is important to recognize how these attributions affect public perception, treatment options, and self-belief and image. Imagine being treated for the wrong condition. Not only does it defeat the purpose of the treatment, but it is also potentially dangerous. Firsthand, we know the impact of our disorder on our emotional wellbeing and quality of life far better than the clinician, whose relationship is one of power over communication. Self-diagnosis is a slippery slope, but a client armed with the knowledge of the traits and characteristics of their disorder, and its impact would have a far better possibility of appropriate diagnosis and treatment. Equally important is recognizing the extent of our strengths and abilities to counter and defeat the symptoms of our disorder. The disease model of mental health tells us the problem; the wellness model emphasizes the solution.


[i] Kinderman, P. (2014). Why We Need to Abandon the Disease-Model of Mental Health Care. [Online.] Scientific American. https://blogs.scientificamerican.com/mind-guest-blog/why-we-need-to-abandon-the-disease-model-of-mental-health-care/  .

[ii] Chapdelaine A., Carrier J-D., Fournier L., Duhoux A. Roberge P. (2018) Treatment adequacy for social anxiety disorder in primary care patients. PLoS ONE 13(11) (2018). doi.org/ 10.1371/journal.pone.0206357.

[iii] Richards, T.A. (2014). Overcoming Social Anxiety Disorder: Step by Step. [Online.] Phoenix, AZ: The Social Anxiety Institute Press.

[iv] Lynam, D. R. & Vachon, D. D. (2012). Antisocial Personality Disorder in DSM-5: Missteps and Missed Opportunities. Personality Disorders: Theory, Research, and Treatment, 3(4) 483– 495 (2012). doi:10.1037/per0000006

[v] Zimmerman, M. (2011). Is there adequate empirical justification for radically revising the personality disorders section for DSM-5? Personality Disorders: Theory, Research, and Treatment. Advance online publication. doi:10.1037/a0022108

[vi] Stein, D. J., Fineberg, N. A., Bienvenu, O. J., Denys, D., Lochner, C., Nestadt, G., Leckman, J. F., Rauch, S. L., & Phillips, K. A. (2010). Should OCD be classified as an anxiety disorder in DSM-V? Depression and Anxiety, 6:495-506 (2010). doi:10.1002/da.20699.

[vii] Lynam, D. R. & Vachon, D. D. (2012). Antisocial Personality Disorder in DSM-5: Missteps and Missed Opportunities. Personality Disorders: Theory, Research, and Treatment, 3(4) 483– 495 (2012). doi:10.1037/per0000006

[viii] Nagata, T., Suzuki, F., Teo, A.R. (2015).Generalized Social Anxiety Disorder: A still‐neglected anxiety disorder 3 decades since Liebowitz’s review. Psychiatry and Clinical Neurosciences, 69(12): 724-740 (2015).  doi.org/10.1111/pcn.12327

[ix] ADAA (Anxiety and Depression Association of America). (2019). [Online.] Facts and Statistics. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq.

[x] Koyuncu, A., İnce, E. , Ertekin, E., & Tükel R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context 2019, 8. doi:10.7573/dic.212573; Lyliard, R. B. (2001). Social anxiety disorder: comorbidity and its implications. Journal of Clinical Psychiatry, 62(Suppl1): 17-24 (2001).

[xi] Cuncic, A. (2018). How Social Anxiety Affects Dating and Intimate Relationships. [Online.] verywellmind. https://www.verywellmind.com/adaa-survey-results-romantic-relationships-3024769; Koyuncu, A., İnce, E. , Ertekin, E., & Tükel R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context 2019, 8. doi:10.7573/dic.212573

[xii] Cuncic, A. (2018). How Social Anxiety Affects Dating and Intimate Relationships. [Online,] verywellmind. https://www.verywellmind.com/adaa survey-results-romantic-relationships-3024769; Vrbova, K., Prasko, J., Ociskova, M., & Holubova, M. (2017). Comorbidity of schizophrenia and social phobia – impact on quality of life, hope, and personality traits: a cross sectional study. Neuropsychiatric Disease and Treatment, 13: 2073-2083. doi: 10.2147/NDT.S141749

[xiii] Koyuncu, A., İnce, E. , Ertekin, E., & Tükel R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context 2019, 8. doi:10.7573/dic.212573

[xiv] Salcedo, B. (2018). The Comorbidity of Anxiety and Depression. (Online). National Alliance on Mental Illness.  https://www.nami.org/Blogs/NAMI-Blog/January-2018/The-Comorbidity-of-Anxiety-and-Depression 

[xv] DPD. (2007). Dependent personality disorder.  [Online.] Harvard Health Online.

[xvi] Koyuncu, A., İnce, E. , Ertekin, E., & Tükel R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context 2019, 8. doi:10.7573/dic.212573

[xvii]  Insel, T. (2013). Post by Former NIMH Director Thomas Insel: Transforming Diagnosis. [Online.] Washington, DC: National Institute of Mental Health. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

[xviii] Kinderman, P. (2014). Why We Need to Abandon the Disease-Model of Mental Health Care. [Online] Scientific American. https://blogs.scientificamerican.com/mind-guest-blog/why-we-need-to-abandon-the-disease-model-of-mental-health-care/ 

Our Role in Recovery

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The fact that we are not accountable for the childhood/adolescent exploitation that led to our psychophysiological malfunction does not absolve us of the adult responsibility to do something about it.

Many of us avoid learning about the causes and symptoms of our disorder as if ignoring it will make it go away. When we see evidence that the traits and characterizations of the disorder match our own, it somehow makes it more concrete, more real. It makes us accountable. Although all the relevant data is readily available from credible sources, including the National Institute of Mental Health, Johns Hopkins, the Mayo Clinic, remaining uninformed perceptually abrogates responsibility.

When something is broken, it is deconstructed to analyze the problem. We isolate the components and acquaint ourselves with their objectives. Equal effort is required for the brokenness in us. We must study the traits and symptoms of our disorder, and recognize how they affect our thoughts and behaviors. For us to have any chance at recovery, we need to know what we are recovering from. Replacing or repairing defects is fruitless without knowing what those defects are and how they function. Before a football team faces their opponent, they watch hours of film, review stats, and practice. If an actor wishes to give a good performance, it is prudent to learn the character’s lines before getting on stage. Our disorder is our enemy; it is unhealthy, and it hurts us. Our deliberate ignorance is denial, and that is a deal-breaker. Our disorder will continue to impact our emotional wellbeing and quality of life until we recognize, accept, and confront it.

Recovery-remission is a psychological construct. The revelation we are not responsible for the disorder sets the foundation for recovery. Understanding that we alone are the agents of change begins the construct. Counselors and programs provide the blueprint, but we erect the edifice. The disease model tells us what is wrong with us. We do not need to hear that. Our disorder is not something that can be excised like a tumor, so what is the point of telling us what is wrong with us? The wellness model’s focus and by extension, positive psychology and other optimistic approaches, is on our virtues and strengths.

One group of psychologists describes recovery as “people (re-) engaging in their life on the basis of their own goals and strengths, and finding meaning and purpose through constructing and reclaiming a valued identity and valued social roles.” [i] Enduring recovery grounds itself on our knowledge of our disorder and the implementation of our character strengths and virtues to recover from it.


[i] Schrank, B., Brownell, T., Tylee, A., & Slade, M. (2014). Psychology: An Approach to Supporting Recovery in Mental Illness. East Asian Arch Psychiatry, 24, 95-103 (2014).

The Wellness Model versus the Disease Model of Recovery

The Disease Model tells us the problem; the Wellness Model emphasizes the solution.

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Establishing new parameters of wellness in mental health calls for nothing less than a reformation of thought and concept. In 2004, the World Health Organization (WHO, 2004) began promoting the advantages of a wellness over disease perspective, declaring health, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Slade, 2010, p. 1). The World Psychiatric Association has aligned with the wellness model, submitting that “the promotion of well-being is among the goals of the mental health system” (Schrank et al., 2014, p. 98). Wellbeing has become a central focus of international policy (Slade, 2010). Concurrently, some psychological approaches have become bellwethers for research and study of the positive character strengths that facilitate the motivation and persistence/perseverance helpful to persons with mental illness who aspire towards recovery-remission. Wellbeing must become the central focus of mental health for the simple reason that the disease model has provided grossly insufficient results. As clinical psychologist Kinderman (2014) writes in Scientific American “We need wholesale and radical change, not only in how we understand mental health problems, but also in how we design and commission mental health services” (p. 1). This radical change, however, should not be a dissolution of approaches but an intense review of their efficacy, and repudiation of the one-size-fits-all stance within the mental health community. Certain fundamentals like language, perspective, and diagnosis demand drastic adjustment.

The hurdles are formidable, beginning with a consensus definition of mental illness and its origins. The Diagnostic and Statistical Manual of Mental Disorders (DSM) abandoned the word neurosis in 1980 but it remains the go-to term in the mental health community. One only needs the American Psychological Association (APA, 2020) definition of neurosis to comprehend the pathographic focus of the disease model. Neurosis is,

any one of a variety of mental disorders characterized by significant anxiety or other distressing emotional symptoms, such as persistent and irrational fears, obsessive thoughts, compulsive acts, dissociative states, and somatic and depressive reactions. The symptoms do not involve gross personality disorganization, total lack of insight, or loss of contact with reality (compare psychosis). In psychoanalysis, neuroses are generally viewed as exaggerated, unconscious methods of coping with internal conflicts and the anxiety they produce. Most of the disorders that used to be called neuroses are now classified as anxiety disorders.

Health experts define mental illness as a “diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria” that can “result in functional impairment which substantially interferes with or limits one or more major life activities” (Salzer et al., 2018, p. 3; SAMSHA, 2017). Any disorder that results in 30 or more days of role impairment at work, home, or in social relationships seriously impacts one’s emotional wellbeing and quality of life. Congress defines serious mental illness as a “functional impairment that substantially interferes with or limits one or more major life activities.” The two mental illnesses called psychosis are borderline personality disorder and forms of schizophrenia. Everything else is a neurosis or disorder. 

The pathographic or disease model of mental healthcare has been the modus operandi of society for centuries. Granted, there have been interruptions in the disease perspective philosophically and culturally. However, it has been the overriding psychological perspective for over a century, remerging with Freud and continuing through medical models with insular focuses on biological and neurological origins of mental illness. The chief propagator of the wellness model has been positive psychology which originated with Maslow’s (1943) seminal text on humanism and was legitimatized by Seligman as APA president in 1998. The study and research of the character strengths that generate the motivation and persistence/perseverance of a mentally ill individual in recovery-remission is of enormous benefit to psychology and individual mental health.

References

APA. (2020). Neurosis. Dictionary of Psychology. American Psychological Association. Washington, DC: American Psychological Association.  https://dictionary.apa.org/neurosis  Accessed 05 April 2020.

Kinderman, P. (2014). Why We Need to Abandon the Disease-Model of Mental Health Care. [Online Article.] Scientific American. https://blogs.scientificamerican.com/mind-guest-blog/why-we-need-to-abandon-the-disease-model-of-mental-health-care/ 

Maslow, A. (1943). A Theory of Human Motivation. Psychological Review, 50 (4), 370–396 (1943).

Salzer, M. S., Brusilovskiy, E., & Townley, G. (2018). National Estimates of Recovery-Remission from Serious Mental Illness. Psychiatric Services, 69(5) 523-528 (2018). https://doi.org/10.1176/appi.ps.201700401

SAMSHA. (2017).  2017 National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration.  (Rockville, MD: SAMHSA. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#:~:text=Serious%20 mental%20illness%20(SMI)%20is,or%20more%20major%20life%20activities.

Schrank, B., Brownell, T., Tylee, A., & Slade, M. (2014). Psychology: An Approach to Supporting Recovery in Mental Illness. East Asian Arch Psychiatry, 24, 95-103 (2014).

Slade, M. (2010). Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Service Research 10 (26), 1-17 (2010). https://doi.org/10.1186/1472-6963-10-26 10(26)

Personality

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We talk a lot about personality in this Blog as it directly impacts and is impacted by our dysfunction and recovery methods. Freud argued that our personality is formed through conflicts among the id, ego, and superego. Since then, there have been as many definitions of personality as there are psychoanalytic theories. For purposes of this Blog, let us simplify what we mean by personality.

Our personality is generated by everything and anything experienced by us in our lifetime. Our reaction to every teaching, opinion, belief, and influence develops our personality. It is our current being and our expression of that being. It reflects our self-qualities, character strengths, and weaknesses. It is formed by our core-beliefs and developed by our social, cultural, and environmental experiences. It is constant yet fluid, singular yet multiple. It is our inimitable way of thinking, feeling, and behaving. It is who we are, who we think we are, and who we are trying to become. We are our personalities.

What is a Disorder?

Our disorder is facilitated by our mind, body, spirit, and emotions working in concert.

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Mental illness has been attributed to supernatural forces, demonic possession. the humours , lunar influence, emotions, sorcery, and witchcraft. In the 20th century, it was somatogenic,  psychogenic, and pharmacological. The Diagnostic and Statistical Manual of Mental Disorders leans towards environmental and biological causes. To maintain homeostasis, all components of the human being must work in concert; they cannot function alone. ‘Complementarity’ is mutual simultaneous interaction; integrality incorporates the environmental and social fields. A disorder is not biologic, hygienic, neurochemic, or psychogenic, but a collaboration of models administered by the mind, body, spirit, and emotions (MBSE) working in concert.

DSM-III abandoned the word neurosis in 1980 but it remains the go-to term in the mental health community. Neurosis was defined as “a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress [depression, anxiety, obsessive behavior, hypochondria] but not a radical loss of touch with reality (psychosis).” Let us examine that definition more closely. First, the word relatively means in comparison to something else. A mild mental illness compared to what? The bubonic plague? Second, who determines that it is a mild mental illness? Certainly, not those impacted by it. 

If our disorder impacts our emotional wellbeing and quality of life, then it is serious, and congress defines serious mental illness as a “functional impairment that substantially interferes with or limits one or more major life activities.” (And if anyone knows more about serious mental illness, it is the U. S. Congress.)

We all have disorders. They come in different intensities and affect each of us individually. There are at least nine clinical types of depression, five significant forms of anxiety, and four types of obsessive-compulsive disorder; their impacts can be mild, moderate, or severe. Some people adapt quite nicely and get on with their lives. Others incorporate it into their personalities―the cranky boss, clinging partner, temperamental neighbor. We designed this Blog for those of us whose lives are negatively impacted by their complication. 

Two things you must understand and accept as we go forward. You are not alone; you are in the majority. Every statistic in the world supports that. Most importantly, IT’S NOT YOUR FAULT! Disorders and their symptoms generally infect during childhood and adolescence.

Research shows that the onset of most disorders (if not all) happens to adolescents who have experienced detachment, exploitation, and or neglect, whether the cause is hereditary, environmental, or the result of some traumatic event. Environmental can refer to your school, your upbringing, your peers―anything that negatively affected you, intentional or not, factual, or perceived.

Anything that interferes with a child’s social development is detrimental to adolescent and adult emotional health. In any case, it is not your fault. It may not be anyone’s fault. It just happened.  The cumulative evidence that childhood and adolescent occasions and events are the primary causal factor in lifetime emotional instability has been well-established.

This exploitation interferes with the optimal physical, cognitive, emotional, and social development of the child. Most importantly, it affects our self-esteem, which administrates all our positive self-qualities (self-respect, -reliance, -compassion, -worth, and so on). These are the intangible qualities that make up our character, our goodness, our spirit. Our emotions are reactive to―and, in turn, impact―our body, mind, and spirit. They all work together in concert. If one is affected, all are affected. 

Again, it is crucial to recognize we are not responsible for our disorder. Quite possibly, no one is at fault. Playing the blame game only distracts from the solution: What are we going to do about it?

How Our Disorder Impacts Our Quality of Life.

Seventy-five million adults and adolescents have diagnosable anxiety and depression.

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A disorder that interferes with our emotional wellbeing and quality of life was once called a neurosis. Neurosis was the term used to describe abnormal psychological processes. Our complications are not abnormal or odd, but part of everyday life. Due to its medical starkness, neurosis implied something off-putting or dangerous. The words are ostracizing. Many who have a disorder cannot admit to it nor seek help because of the perceived shame and stigma implied by the phrase, mental illness.  

Neuroses are now diagnosed as depressive or anxiety disorders. They are disorders involving symptoms of stress evidenced by depression, anxiety, or obsessive behavior.

Seventy-five million adults and adolescents have diagnosable anxiety and depression. More than half of go without treatment. OCD impacts 2.2 million. Millions of us have issues of self-esteem or lack motivation. Sometimes it is not easy to get out of bed in the morning.

The number of adolescents with depression and anxiety has doubled in the last decade. They are a primary cause of the 56% increase in adolescent suicide. The LGBTQ community is 1.5 to 2.5 times as susceptible to social anxiety disorder than that of their straight or gender-conforming counterparts. The numbers are staggering. 

For many of us, these debilitating and chromic issues wreak havoc on our daily lives. They attack all fronts, negatively affecting the entire body complex. We are subject to mental confusion, emotional instability, physical dysfunction, and spiritual malaise.

Why are we subject to these disorders? Where did they originate? Any number of things might have caused it, but we were likely infected during our childhood or adolescence. It may or may not have been a significant event; you probably do not remember it.

The only higher power you need already resides within you

It could be hereditary, environmental, or the result of some traumatic experience. Some might cite emotional distress as the cause; another attribute it to being bullied; a third to over permissive parenting. It often lays dormant until manifesting during times of emotional crisis or when life offers more than we think we can handle. 

We may be depressed for long periods, have panic attacks, be compulsive, or unmotivated. We may be self-abusing with food, alcohol, or pharmaceuticals. We may feel incompetent or worthless. Depression, anxiety, low self-esteem, lack of motivation, and other disorders subsist by our emotional reactions to events, situations, and circumstances. The subject who understands her or his disorder, and recognizes the power to heal comes from within, is likely to recover. 

This BLOG provides the blueprint; you construct the edifice. We do not counsel you; this is a practicum. In counseling, we depend upon another for relief; a practicum teaches us how to heal yourself. We are in control of the transformation

Before recovery, our disorder controls our thoughts and behaviors. That is unnatural; that is not our inheritance. Reverse the process. This BLOG is committed to teaching you how to take control of your disorder to live a more healthy, productive, and satisfying life.

Why One-Size-Fits-All Approaches Fail

Recovery programs must reflect our unique and individual personalities.

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Personal recovery is an individual process. Just as there is no one right way to do or experience recovery, so also what helps us at one time in our life may not help us at another. Recovery programs must learn to appreciate the individuality of their subjects. The insularity of cognitive-behavioral therapy, positive psychology, and other approaches cannot address the dynamic complexities of our personality.

It is arrogant of recovery programs to lump us into a single niche. Stereotyping is what people do when they are not interested in getting to know the individual. Judging by public opinion, a person with a Malfunction would be stereotyped as an unpredictable, potentially violent, and undesirable individual―a claim supported by the stigma triad of ignorance, prejudice, and discrimination. We are unique individuals with unique personalities who happen to be impacted by a disorder. 


Your program of recovery should be one specifically designed for your unique needs.

Programs that boast of a specialized combination of other programs are also ineffectual unless they adapt their approach to fit the individual. Recovery programs complain that it is unproductive, time-consuming, and challenging. If that is the case, they have no business working with people who seek their advice. 

Let us use the example of cognitive-behavioral therapy. It is the most highly utilized program of recovery in the world. It is usually the first question asked at a counseling session. Are you familiar with cognitive behavioral therapy? Almost 90 percent of the approaches empirically supported by the American Psychological Association involve cognitive-behavioral treatments. Six years minimum of specialized education, and that is their opening gambit? Would you be comfortable with a general practitioner who only treats clients for the mumps?

There are at least 65 psychology programs and types of therapy. A program is never static but develops through client trust, cultural assimilation, and therapeutic innovation. Our cultural environment, heritage, background, and associations reflect our wants, choices, and aspirations. If they are not given consideration, then we are not valued.

We are better served by an integration of multiple traditional and non-traditional approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation. Do not settle for someone else’s recovery program; demand one specifically designed for your unique needs.

Restructuring Our Neural Network

When we restructure our neural pathways, there is a correlated change in our behavior and perspective.

Science confirms our neural pathways are constantly realigning. Our disorder has been feeding our brain irrational thoughts and concepts since its onset. What is irrational? Irrational is anything detrimental to our emotional wellbeing and quality of life. Simply put, it is irrational to hurt yourself.

Our brain cannot differentiate between rational and irrational. It does not think; it provides the means for us to think. Our brain is an organic reciprocator. Its job is to provide the chemical and electrical neurotransmitters and hormones that maintain our heartbeat, nervous system, and blood–flow. They tell us when to breathe. They stimulate thirst, control our weight and digestion. They establish and affect our behavior, moods, memories, and so on. 

Hundreds-of-billions of nerve cells (neurons) arranged in pathways or networks make up our brains. Inside each of these neurons, there is electrical activity. Every stimulus we experience causes its receptive neuron to fire, transmitting a message from neuron to neuron until it generates a reaction. A stimulus occurs at every experience―a muscle movement, a decision, a memory, emotion, reaction, noise, the prick of a needle, a twitch―every part of our living being. Because of our disorder, we have structured our brain around unhealthy feelings, thoughts, and behaviors. Our brain sustains this irrationality by naturally releasing pleasurable chemicals (serotonin, dopamine, norepinephrine). It does not know any better; it just works off our input. 

Neural restructuring is our brain’s capacity to change with learn­ing; functions performed by our neurotransmitters are learning functions. This process is called Hebbian learning, and this is important. Our brain learns at an incredibly accelerated rate, and what has been learned can be unlearned. A conscious input of healthy thought patterns reverses the trend. As our brain reciprocates our positive activities, our neural network restructures itself accordingly. We unlearn our unhealthy beliefs and behaviors and replace them with healthy ones. Over time, through deliberate repetition, healthy, rational thoughts and behaviors become habitual and spontaneous. 

An essential element in subverting our disorder is the deliberate restructuring of our neural network.

Neural restructuring is science, not hyperbole. The power of our words, thoughts, and actions is life-altering. We all can change the direction of our lives through Hebbian relearning, but the restructuring does not happen overnight, which is it must begin on day one of our commitment to recovery.