Subscriber numbers generate contributions that support scholarships for workshops.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI – deliberate, repetitive, neural information.” – WeVoice (Madrid)
This is a draft of Chapter Nine – “Constructing Our Neural Information” in ReChanneling’s upcoming book on moderating social anxiety disorder and its comorbidities. We present this as an opportunity for readers to share their ideas and constructive criticism – suggestions gratefully considered and evaluated as we work to ensure the most beneficial product to those with emotional malfunction (which is all of us to some degree). Please forward your comments in the form provided below.
<9> Constructing Our Neural Information
“The problems are solved, not by giving new information, but by arranging what we have known since long.” ― Ludwig Wittgenstein
A comprehensive recovery program has three primary goals: (1) To replace or overwhelm our negative thoughts and behaviors with healthy, productive ones, (2) to produce rapid, neurological stimulation to change the polarity of our neural network, and (3) to regenerate our self-esteem.
Proactive neuroplasticity is our ability to govern our emotional well-being through DRNI – the deliberate, repetitive, neural input of information. What is significant is how we dramatically accelerate and consolidate learning by consciously compelling our brain to repattern its neural circuitry. DRNI empowers us to proactively transform our thoughts and behaviors, creating healthy new mindsets, skills, and abilities.
Before delving into the construction of our neural information, let’s break DRNI down into its components so we fully understand the purpose and the process.
Deliberate. A deliberate act is a premeditated one; we initiate and control the process. Let’s review the three forms of neuroplasticity. Reactive neuroplasticity is our brain’s natural adaption to externally driven information that impacts our neural network. Active neuroplasticity is cognitive pursuits such as dancing, yoga, or assembling a puzzle. It is not a deliberate manipulation of our neural network and is often impulsive. To be proactive is to intentionally cause something to happen rather than respond to it after it has happened. Proactive neuroplasticity is the deliberate act of reconstructing our neural network. Its purpose is to overwhelm or replace negative and toxic neural input with healthy positive information. As psychoanalyst Otto Rank confirms in Art and the Artist, “positively willed control takes the place of negative inhibition.
Repetition is the act or an instance of repeating or being repeated – in this case, our neural information. Common synonyms of repetitive include monotonous, tedious, and mind-numbing. The process can be off-putting unless we remain mindful of its purpose, which is the positive realignment of our neural network. Proactive neural Information consists of short, self-affirming, and self-motivating statements we commit to memory and repeat to expedite learning and unlearning.
Neural input is the stimuli that impact our brain and compel its circuits to realign and create new neurons. The gateway to information, receptor neurons do not react to every stimulus. Our brain receives around two million bits of data per second but is capable of processing roughly 126 bits, so it is important to provide substantial information.
Multiple tools assist in our recovery, and we identify them throughout this book. Coping mechanisms moderate our situational fears, graded exposure eases our transition into society, and cognitive comprehension corrects our irrational assumptions. In this chapter, our focus is on the rapid and concentrated neurological stimulation that compels a sensory neuron to spark, initiating a neural chain reaction. The more repetitions, the more durable the circuits.
Neural stimuli are sensory – sights, sounds, tactile impressions; mental in the form of memory, experience, and ideas; and emotional incited by images, words, and music. The purpose of inputting neural information in proactive neuroplasticity is to overwhelm or replace toxic with healthy information in the form of positive electrical energy. The content and motive of our information determine the positive or negative polarity of its energy – the size, amount, or degree of that which passes from one atom to another in the course of its chain reaction.
We begin the process of DRNI by identifying the goal of our information. What is our intention? What do we want to achieve? Are we challenging our anxieties about a social event? Are we asking for a raise? Are we confronting the family conspiracist at Thanksgiving dinner? A firm, specific goal enables the process.
Then we identify the actions or measurable steps needed to achieve the goal. Our goal is the outcome we want to achieve; the objectives are the means necessary to achieve the desired outcome. Goals and objectives work in tandem. If our goal is to challenge a feared-situation, what is our strategy, and what coping mechanisms will make that happen.
Now we construct our information – the self-empowering statement(s) that support our goal and objectives. To ensure its integrity, the information is sound in its construction. Meeting the following eight guidelines will establish an effective neural response. The best information is rational, reasonable, possible, positive, goal-focused, unconditional, concise, and in first-person present or future form.
Rational. Our overarching objective in recovery is to subvert the negative self-beliefs and image that stem from our core and intermediate beliefs influenced by childhood disturbance and onset. We manifest these self-defeating perspectives in our automatic negative thoughts (ANTs). For the most part, our assumptions are illogical and cognitively distorted. Countering them requires devising a rational response. If our ANT corresponds to our SAD-indued fear of ridicule or criticism, a rebuttal might be an affirmation of our significance – mindfulness of the value of our contributions.
Reasonable. Unreasonable means without reason, which is a definition of insanity. We are either sensible and of sound judgment or are cognitively impaired. Unreasonable aspirations and expectations impact the soundness of our information. “I will publish my first novel” is an unreasonable expectation if we choose to remain illiterate.
Possible means it is within our power or capacity to achieve it. Because our social anxiety attacks our confidence and self-esteem, we tend to subvert our inherent and achieved attributes, which limits our recognition of possibility.
Positive. For our purposes positive means we eliminate negative thoughts, words, or statements from our information. Rather than stating, “I will not be afraid,” preferable statements could be “I am confident,” or “I will be courageous.”
Goal-Focused. If we do not know our destination, the path will be unfocused and meandering. We focus the content of our information on our goals and objectives. For SAD persons, our overarching goal is moderating our fears, anxieties, and ANTs.
Unconditional. Our commitment to the content of our information must be unequivocal. Any undertaking contingent upon something or someone else weakens its resolution and potential. Saying “I might do something” means “I may or may not do something.” How comfortable are we when someone says, “I might consider paying you for your work?”
First-Person Present or Future. Our information is a self-affirming and self-motivating commitment to our current or future. The past is important to intention but irrevocable. “I can do this.” Future time as self-fulfilling prophecy is also fine: “I will succeed,” for example.
Concise. We express our information in succinct statements purposed to initiate the rapid, concentrated, neurological stimulation that transmits the electrical energy from one atom to another in the course of its chain reaction. Brevity also makes it easier to commit our PPAs to memory because information changes as it evolves in recovery.
The importance of productive neural input is indisputable. It expedites and integrates our three primary goals, each complementary to the others. The deliberate and considered replacement of our negative thoughts and beliefs with healthy, productive ones assists in changing the energy polarity of our neural network and simultaneously helps regenerate our self-esteem.
WHY IS YOUR SUPPORT SO IMPORTANT? ReChanneling develops and implements programs to (1) moderate symptoms of emotional malfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.
Subscriber numbers generate contributions that support scholarships for workshops.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI – deliberate, repetitive, neural information.” – WeVoice (Madrid)
This is a draft of Chapter Five – “The Trajectory of Our Self-Annihilation” in ReChanneling’s upcoming book on moderating social anxiety disorder and its comorbidities. We present this as an opportunity for readers to share their ideas and constructive criticism – suggestions gratefully considered and evaluated as we work to ensure the most beneficial product to those with emotional malfunction (which is all of us to some degree). Please forward your comments in the form provided below.
<5> The Trajectory of Our Self-Annihilation
“Maybe the journey isn’t so much about becoming anything. Maybe it is about un-becoming everything that isn’t really you, so you can be who you were meant to be in the first place.” — Paul Coelho
While we remain conjoined with our social anxiety disorder, we continue to view ourselves as helpless, hopeless, undesirable, and worthless. These become our core self-beliefs as a result of childhood disturbance. By dissociating ourselves from our condition, we perceive things more rationally. It is SAD that compels us to think irrationally, and it is this compulsion that causes us to view ourselves as helpless, hopeless, undesirable, and worthless. In my experience developing and implementing programs to challenge the self-annihilation of those living with SAD, I have identified the overarching integrant. We are lost. Like the preverbal wandering lamb, our flanks are exposed to the wolves of our irrationality.
We are the personification of the fabled protagonist wandering, helpless and hopeless, in the forest. Our hunger for safety and comfort drives us to grasp onto anything that offers sustenance, no matter how destructive to our well-being. We encounter the house of candy and voraciously consume it even though our instincts advise us of the likelihood of villainy within.
Mindful we are not accountable for having SAD should relieve us of the unjustifiable shame and guilt we have relied upon to rationalize our condition. Since we are not at fault for having SAD, we should no longer feel the need to beat ourselves for our condition. Yet we continue to do so. Why is that? The answer is obvious. While we are not accountable for the cards we have been dealt, we are responsible for how we play the hand we have been given. In essence, our resistance to recovery continues the cycle of guilt and shame that causes us to continually beat ourselves up.
It is a common refrain that those who do not learn history are doomed to repeat it. That is especially true for social anxiety because we find ourselves trapped in a vicious cycle of irrational fears and avoidance of social interaction. Contrary to what SAD tells us, we are not stupid. We know, after decades of denial, that our thoughts and behaviors are self-destructive yet feel doomed to repeat them ad nauseam. Then we beat ourselves up for our failure to escape this prison of self-abuse. We hate our life, and we hate ourselves for putting up with it.
So, in this chapter, we are going to learn the history of our negative thoughts and behaviors so we can put an end to this endless cycle of fear that alienates us from our true nature. We will see the development of our self-destructive proclivities as a series of stages. It is not a perfectly linear trajectory. It is a collaboration of associated events. For example, the onset of SAD corresponds to our negative intermediate beliefs which are associated with our perceptions of childhood disturbance. Like the simultaneous mutual interaction of mind, body, spirit, and emotions in all human endeavors, each stage in our trajectory complements, influences, and overlaps.
The negative cycle we are in may have convinced us that there is something wrong with us. That is untrue. The only thing we may be doing wrong is viewing ourselves and the world inaccurately.
Core Beliefs
It begins with our core beliefs that underscore our understanding of self. Core beliefs are our deeply held convictions that determine how we see ourselves in the world. We formulate them in childhood in response to information, experiences, inferences, and deductions, and by accepting what we are told as true. They mold the unquestioned underlying themes that govern our perceptions, and they, ostensibly, remain as our belief system throughout life. When we decline to question our core beliefs, we act upon them as though they are real and true.
Core beliefs are more rigid in individuals with SAD because we tend to store information supported by our negative beliefs, ignoring evidence that contradicts it. This produces a cognitive bias – a subconscious error in thinking that leads us to misinterpret information, impacting the accuracy of our perspectives and decisions.
During the development of our core beliefs, we are subject to a childhood disturbance – a broad and generic term for something that interferes with our optimal physical, cognitive, emotional, or social development. The word disturbance generates images of overt and tragic abuse, but this is not necessarily the case. As explained in Chapter One, any number of things can be defined as childhood disturbance. It can be intentional or accidental, real or imagined. (The suggestibility and emotional creativeness of the pre-adolescent is legendary.) I gave you the example of the toddler who senses abandonment when her or his parental quality time is interrupted by a phone call. It is safe to posit that every child perceives disturbances daily. They are universal and indiscriminate.
Negative Core Beliefs
This confluence of developing core beliefs and childhood disturbance generates negative core beliefs about the self (I am abandoned) and others (you abandoned me). Feelings of detachment, neglect, and exploitation are also common consequences of childhood disturbance. It is our self-oriented negative core beliefs that compel us to view ourselves in these four ways. As helpless (I am weak, I am incompetent); hopeless (nothing can be done about it); undesirable (no one will like me); and worthless (I don’t deserve to be happy). Our other-oriented negative core beliefs view people as demeaning, dismissive, malicious, and manipulative. Other-oriented self-beliefs incentivize us to blame others for our condition, avoiding personal accountability. We hold others responsible for our feelings of helplessness, hopelessness, undesirability, and worthlessness.
Emotional Malfunction
The next step in our trajectory is the onset of emotional malfunction as a result of childhood disturbance. Roughly 90% of onset happens during adolescence. Two exceptions are narcissistic personality disorder and later-life PTSD. The symptoms and characteristics of emotional malfunction often remain dormant, manifesting later in life. The susceptibility to onset originates in childhood – emotional viruses that sense vulnerability. Experts tell us that SAD infects around the age of thirteen due to a combination of genetic and environmental factors. Researchers recently discovered a specific serotonin transporter gene called “SLC6A4” that is strongly correlated with SAD. Whatever the causes, it is our perception of childhood disturbance that produces the susceptibility to infection.
Self-esteem is mindfulness of our value to ourselves, society, and the world. It can be further understood as a complex interrelationship between how we think about ourselves, how we think others perceive us, and how we process and present that information. Maslow’s hierarchy of needs reveals how childhood disturbance disrupts our natural development. The orderly flow of social and emotional development requires satisfying fundamental human needs. Childhood perceptions of abandonment, detachment, exploitation, and neglect subvert certain biological, physiological, and emotional needs like familial support, healthy relationships, and a sense of safety and belongingness. This lacuna negatively impacts our self-esteem which we express by our undervaluation or regression of our positive self-qualities. This does not signify a deficit, but latency and dormancy – underdevelopment of our character strengths and attributes due to inactivity.
Negative Intermediate Beliefs
The confluence of SAD and the disruption in self-esteem generate life-consistent negative self-beliefs sustained by cognitively distorted thoughts and behaviors. The onset of SAD happens during the development of our intermediate beliefs. These establish our attitudes, rules, and assumptions. Attitudes refer to our emotions, convictions, and behaviors. Rules are the principles or regulations that influence our behaviors. Our assumptions are what we believe to be true or real. Despite similarcore beliefs, we each have varying intermediate beliefs developed by information and experience, e.g., social, cultural, and environmental – the same things that make up our personality.
Negative Self-Beliefs and Image
These SAD-induced attitudes, rules, and assumptions result in distorted and maladaptive understandings of the self and the world. In psychology, experts present two forms of behavior – adaptive and maladaptive. Adaptive behavior is behavior that is positive and functional. Maladaptive behaviors distort our perception and we ‘adapt’ negatively (maladapt) to stimuli or situations. To analogize, if the room is sunny and welcoming, SAD tells us it is dark and unapproving.
Automatic Negative Thoughts and Behaviors
We articulate our fears through preprogrammed, self-fulfilling prophecies called ANTs. Automatic Negative Thoughts (ANTs) are involuntary, anxiety-provoking assumptions that spontaneously appear in response to the places or circumstances that provoke our anxiety. Examples include the classroom, a job interview, a social event, and the family dinner. Malfunctional assumptions caused by our negative self-beliefs impact the content of our ANTs. Even when we know our fears and apprehensions are irrational, their emotional impact is so great, they run roughshod over any healthy, rational response. We will delve deeper into all of this as we progress. Then, together we will develop a targeted plan to dramatically moderate your social anxiety.
We briefly discussed how SAD utilizes propaganda to convince us of the validity of our self-destructive thoughts and behaviors. Propaganda is the distribution of biased and misleading information. SAD utilizes propaganda to convince us of the validity of our self-annihilating thoughts and behaviors. We manifest the effectiveness of SAD propaganda through our maladaptive behaviors and cognitively distorted responses to our fears.
Cognitive distortions are the exaggerated or irrational thought patterns involved in the perpetuation of our anxiety and depression. Everyone engages in cognitive distortions and is usually unaware of doing so. They reinforce or justify our toxic behaviors. They twist our thinking, painting an inaccurate picture of our self in the world. We distort reality to avoid or validate our irrational attitudes, rules, and assumptions.
Part of our counteroffensive is recognizing these cognitive distortions to challenge and counteract them. Throughout this book, we will analyze and discuss each of the thirteen cognitive distortions most applicable to SAD and analyze how we utilize them to reinforce and justify our irrational thoughts and behaviors.
The bulk of this chapter focuses on the origins and trajectory of our life-negative self-beliefs, illustrating the slow but inexorable progression of the SAD army on our emotional well-being. We are now beginning to understand SAD’s tactical advantage. This will help us forge the tools and techniques to (1) defend ourselves and (2) overwhelm or conquer our fears and avoidance of social connectedness. In Chapter Seven, we will look at some of these tools both scientific and psychological.
One of the repercussions of living with SAD is our self-annihilation – our compulsion to beat ourselves up for our difficulties rather than embrace our character strengths, virtues, and achievements. You are challenging your social anxiety. That is positive neural information, the cornerstone of proactive neuroplasticity. Acknowledge your determination, take credit for it, and give your psyche a hearty pat on the back.
“If you do not change direction, you may end up where you are heading.” — Lao Tzu
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Comments. Suggestions. Constructive Criticism.
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WHY IS YOUR SUPPORT SO IMPORTANT? ReChanneling develops and implements programs to (1) moderate symptoms of emotional malfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to regenerate self-esteem. All donations support scholarships for groups, workshops, and practicums.
Numbers generate contributions that support scholarships for workshops.
Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI—deliberate, repetitive, neural information. Alfonso Paredes, CEO, WeVoice.
Situation: The set of circumstances ̶ the facts, conditions, and incidents affecting us at a particular time in a particular place. For social anxiety disorder and other emotional dysfunctions, a Situation is an occasion or event that generates anxiety or stress such that it impacts our emotional well-being and quality of life. Examples include restaurants, the classroom, job interviews, speaking in front of a group, and socializing with strangers.
Fears and apprehensions: The stress-provoking feelings developed by our life-consistent negative self-beliefs and images. Examples include the fears of saying or doing something stupid; being criticized or rejected; being the center of attention; engaging in conversation.
Automatic Negative Thoughts (ANTs): Spontaneous conscious or subconscious expressions of our fears and apprehensions. ANTs are ostensibly irrational and self-defeating. Examples include “I am incompetent, “I will say or do something stupid,” ” No one will like me,” “No one will talk to me.”
An essential factor in recovery is learning how to moderate our situational fears and anxieties that precipitate our automatic negative thoughts (ANTs). There are as many different situations as there are persons negatively impacted. They fall into two primary categories: anticipated and unexpected.
Anticipated and Recurring Situations are those we know, in advance, will evoke our fears and corresponding ANTs.
Unexpected Situations are those anxiety-provoking Situations we do not anticipate, and those that suddenly get out of hand.
Structured Plan for Feared Situations
Identify the Feared Situation
Identify the Associated Fear(s)
Unmask the Corresponding ANT(s)
Examine and Analyze Our Fear(s) and Corresponding ANT(s)
Generate Rational Responses
Reconstruct Our Thought Patterns
Create a Plan to Challenge Our Feared Situation
Practice the Plan in Non-Threatening Simulated Situations (including Affirmative Visualization)
In Unexpected Situations, sudden and unpredicted stress can be moderated with certain coping skills. Their primary objective is to reduce the influx of the fear and anxiety-provoking hormones, cortisol and adrenaline, and provide a modicum of control over our fears and corresponding ANTs. It also provides us the opportunity to identify and challenge them going forward.
Not all coping skills provided below work in Unexpected Situations but are better suited for Anticipated and Recurring Situations where we have time to devise a more specific and comprehensive approach.
Affirmative Visualization. By visualizing a positive outcome prior to the Situation, we experience behaving a certain way in a realistic scenario and, through repetition, attain an authentic shift in our behavior and perspective. It is a form of proactive neuroplasticity, and all the neural benefits of that science are accrued by Affirmative Visualization. Just as our neural network cannot distinguish between toxic and healthy information, it also does not distinguish whether we are physically experiencing something or imagining it.
Character Focus. Focusing on a personal character strength or attribute rechannels our emotional angst to mental deliberation, disrupting our ANTs. It’s also beneficial to work on strengths and attributes that we would like to refine or build upon. A valuable tool in In a recovery workshop is developing our Character Resume – a list of our strengths, virtues, and achievements, recognition of which has been subverted by our social anxiety and lacuna of self-esteem.
Controlled Breathing. This abbreviated breathing exercise takes roughly a minute. Place one hand on your abdomen, just above your navel, and the other hand in the center of your chest.
Open your mouth and sigh gently, as if mildly irritated. Allow the muscles in your upper body and shoulders to drop down and relax as you gently exhale.
Close your mouth for a few moments.
Slowly inhale through your nose, keeping your lips closed. Push your stomach out as you do this to pull air in.
Pause for a few moments – as long as is comfortable, then open your lips and gently exhale through your mouth while pulling your stomach in.
Repeat several times.
Deliberate Slow-Talk. Speaking slowly and calmly slows our physiological responses, alleviates rapid heartbeat, and lowers blood pressure. It is also helpful to incorporate the 5-second rule, i.e., pause any response for five thoughtful seconds. Not only do these coping skills reduce the flow of cortisol and adrenaline, but it also presents the appearance of someone who is thoughtful and confident.
Distractions. Objects that momentarily rechannel our attention from the emotions of our ANTs. Examples: a picture on the wall, a vase, a trophy on the bookshelf. When confronted by emotional angst, we turn our attention, momentarily, to a Distraction. Recommendation: Three Distractions.
Diversions. Distractions are objects that momentarily rechannel our attention away from the emotional angst of our ANTs. Diversions are activities that perform the same function. A common Diversion is snapping a rubber band encircling our wrist. Other examples: Carry a pushpin or other physical deterrent in our pocket; character analyze people in the room; place a tiny object in our shoe. Recommendation: Three Diversions.
Persona. Sixty percent of communication is represented by our body language. Our Persona helps establish our body language. Persona is the social face we present to our situation, designed to make a positive impression while concealing our social anxiety. It determines how we carry ourselves, the timbre of our voice, the shoes we wear (boots, sneakers, high heels), and the attitude we present. Personas are not other-selves but various aspects of our personality. We have multiple Personas subject to our mood, temperament, and circumstance. We present ourselves differently depending upon the context of the situation, e.g., a sports event versus an interview for a job or a family dinner versus a sorority bash. Deliberately choosing a Persona dramatically alters our perspective, attitude, and presentation.
Positive Personal Affirmations. Brief, prepared personal statements that help us focus on goals and objectives. Deliberately repeating PPAs is an extremely valuable asset to our recovery and our neural restructuring.
Progressive Muscle Relaxation (PMR). This quick and discreet process of muscle relation takes roughly a minute. Each component is held for roughly 10 seconds.
Raise your shoulders up toward your ears… tighten the muscles there. Hold. Release.
Tighten your hands into fists. Very, very tight… as if you are squeezing a rubber ball very tightly in each hand. Hold. Release.
Your forehead – Raise your eyebrows, feeling the tight muscles in your forehead. Hold. Now scrunch your eyes closed. Hold it. Relax.
Your jaw – Tightly close your mouth, clamping your jaw shut. Your lips will also be tight. Hold it. Release
Breathe in deeply through your nose. Hold it. Release the air through your mouth. Repeat at least three times.
Projected Positive Outcome. Because of our years of life-consistent negative self-beliefs and images, we tend to set unreasonable expectations. The key to recovery, however, is progress, not perfection. We already know the projected negative outcome of a Situation is succumbing to our ANTs. Setting moderate expectations can better guarantee a positive outcome. What would be a reasonable expectation for success? What would satisfy our efforts? Our Projected Positive Outcome should be rational, possible, unconditional, problem-focused, and reasonably attainable.
ProjectedSUDS Rating. Notwithstanding our SUDS evaluation before the situation happens, it is even more important to moderate our expectations. We tend to set unreasonable ones to compensate for our years of self-disappointment and, if our expectations are not met, we justify our irrational negative self-beliefs and image. Remember, all of this is subjective, which means we control the process from anticipation to result. If we evaluate our initial SUDs Rating at 70, a reasonable and attainable Projected SUDS Rating might be 65 or 60.
Purpose. Our overarching goal in recovery is to moderate our fears and anxieties. However, we rarely expose ourselves to situations for the sole purpose of challenging our social anxiety. We have alternative motivations. So, why are we there? What do we seek or hope to accomplish? Ancillary goals are normal and healthy as long as they support our primary goal, however, it is best to limit our expectations.
Rational Responses. It is always prudent to ask ourselves: How logical is my fear?What is the worst that can happen? The answer to that is usually a rational response.
Self-Affirmations. Situationally specific, self-empowering statements designed to improve our self-confidence while fueling our neural network with positive information. Examples: I deserve to be here. I am as significant as anyone else in the room. I am valuable. I will be successful.
Strategy is our structured plan of action to achieve our goal – that of moderating our fears and anxieties. Objectives are the measurable steps or actions we take to achieve our goal. Strategies and alterable to fit the situation; our primary goal is inflexible. Our strategy is the blueprint of what we anticipate and have determined will happen during our feared-situation. It is a compilation of our coping mechanisms and other skills we have acquired in recovery. It is our script, and we are the producers, actors, and technicians. In Chapter Twenty-Three we will chart each of the coping mechanisms we utilize, and create a narrative strategy as our master blueprint.
Utilizing some or all of these coping skills can provide a dramatic moderation of our fears, apprehensions, and corresponding ANTs. While the process may be challenging due to our life-consistent negative self-beliefs, and images, the scientifically supported power of suggestion tells us that by imitating confidence, competence, and a positive outlook, we can attain an authentic shift in our behavior and perspective. Fake it ’till you make it.
WHY IS YOUR SUPPORT SO IMPORTANT? ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.
Subscriber numbers generate contributions that support scholarships for workshops.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI — deliberate, repetitive, neural information.” — WeVoice (Madrid)
Common Symptoms of Social Anxiety Disorder
Courtesy of Mayo Clinic
Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.
In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety, and avoidance that interfere with relationships, daily routines, work, school, or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.
Emotional and behavioral symptoms
Signs and symptoms of social anxiety disorder can include constant:
Fear of situations in which you may be judged negatively
Worry about embarrassing or humiliating yourself
Intense fear of interacting or talking with strangers
Fear that others will notice that you look anxious
Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling, or having a shaky voice
Avoidance of doing things or speaking to people out of fear of embarrassment
Avoidance of situations where you might be the center of attention
Anxiety in anticipation of a feared activity or event
Intense fear or anxiety during social situations
Analysis of your performance and identification of flaws in your interactions after a social situation
The expectation of the worst possible consequences from a negative experience during a social situation
Physical Symptoms
Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:
10. Misunderstood by others (including therapists): No one else understands what it feels like to have social anxiety. Social anxiety remains a relatively misunderstood anxiety disorder, so it comes as no surprise that we feel at a loss when it comes to overcoming it. Many therapists lack the required knowledge to diagnose the disorder properly, and very few structured cognitive-behavioral therapy groups exist in the world.
9. Restricted from living a “normal” life: We feel our options in life are limited. Because we feel unable to engage in common, everyday activities, we feel trapped. A sense of helplessness and lack of control often accompany the feelings of being stuck or trapped.
8. Trapped (in a vicious cycle): We realize that our thoughts and actions don’t make rational sense, but we feel doomed to repeat them anyway. We don’t know any other way to handle scenarios in our lives. It is difficult for us to change our habits because we don’t know how.
7. Alienated: We feel alienated and isolated from our peers and families. We feel like we “don’t fit in” because no one understands us. The more we think this way, the more isolated we become. It’s a self-fulfilling prophecy. We identify with the word “loner.”
6. Hypersensitive to criticism and evaluation: We interpret things in a negatively skewed way. Our brain’s default position is irrational and negative. Even a minor misunderstanding can lead to a lengthy period of self-criticism. Sometimes others try to offer us advice, and we can take it the wrong way. We avoid events or activities where we can be judged, and this contributes to our lack of experience and sociability.
5. Depression over perceived failures: We replay events in our heads over and over, replaying how we “failed miserably” in our own perception. We’re certain that others noticed our anxiety. We may go our entire lives thinking back and re-living a “failed” experience, e.g., a public presentation, a bad date, or a missed opportunity. We keep replaying these things in our minds over and over again, which only reinforces our feelings of failure and defeat.
4. Dread and worry over upcoming events: We obsess about upcoming events, and “negatively predict” the outcomes. Worrying about the future focuses our attention on our shortcomings. We may experience anticipatory anxiety for weeks because we feel the event will cripple us. Worrying causes more worry, and it becomes a vicious cycle. Our fear and anxiety is built up to gigantic proportions, the more time we spend worrying about the future. We make mountains out of molehills.
3. Uncertainty, hesitation, lack of confidence: We generally have low self-esteem. We hold ourselves back and avoid situations in life. We don’t participate in conversations as much as we could. We avoid situations because we fear being criticized and rejected by others. The fear of disapproval is so strong that we don’t get enough life experience in social situations, due to our habit of avoidance.
2. Fear of being the center of attention: Being put on the spot or made the center of attention is another primary symptom of social anxiety disorder. The thought of giving a presentation in front of a group of people cripples us with anxiety and fear. We worry that everyone will notice our anxiety, even though we are good at hiding it. We may display physiological symptoms of anxiety including sweating, blushing, shaking of the hands or legs, neck twitches, and weakening of the voice.
1. Self-Consciousness: Social anxiety makes us too aware of what we’re doing and how we’re acting around others. We feel like we’re under a microscope and everyone is judging us negatively. As a result, we pay too much attention to ourselves and worry about everyone seeming to observe and notice us. We worry about what we say, how we look, and how we move. We are obsessed with how we’re perceived.
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Establishing a Wellness Model for LGBTQ+ Persons with Anxiety, Depression, and Comorbid Emotional Dysfunction
Robert F. Mullen, Ph.D. Director/ReChanneling
Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond.
65 million U.S. adults and 18.5 million adolescents have major depression and anxiety. Estimates show that 60% of those with anxiety also have depression symptoms, and both are comorbid with substance abuse. The LBGTQ+ community is 1.5-2.5 times more likely to have anxiety and depression than their straight or gender-conforming counterparts. Similar numbers hold for LGBTQ+ persons with other mental and emotional disorders. Anxiety and depression are the primary causes of the 56% increase in adolescent suicide over the last decade. High school LGBTQ+ students are almost five times as likely to attempt suicide than their heterosexual peers, and 40% of transgender adults have attempted suicide in their lifetime.
Wellness must become the central focus of mental health because the disease model has provided grossly unsatisfactory results. Rather than obsessing on disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance essential to recovery. Psychological science is there, but it needs positive implementation through program integration, positive evaluation, transparency, and information management. Empathy and communication must supersede etiology and misdiagnosis.
Wellness impacts more than mental health; it is a paradigmatic perspective that seeks to promote a state of complete physical, mental, and social well-being. This paper will show how the wellness model’s sociological emphasis on character strengths and attributes not only positively impacts the self-beliefs and image of a mentally ill person but resonates in sexual and gender-based identities and portends well, the recovery-remission of an LGBTQ+ person with a mental illness.
To illustrate the wellness model’s potential impact, this paper focuses on LGBTQ+ persons with anxiety and depression disorders, which comprise 42% of diagnosable dysfunctions in the current Diagnostic and Statistical Manual of Mental Disorders (DSM). It posits what is learned can be applied to the remaining 58% of mental disorders that impact an LGBTQ+ person’s emotional well-being and quality of life. “There is an urgent need to develop and disseminate tailored evidence-based interventions that improve the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. (Wilkerson et al., 2016, p. 358).
Depression and anxiety are the two most common forms of mental dysfunction impacting millions of U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. Johns Hopkins (2020) reports that around 25 million U.S. adults have a depressive illness, and 45 million have anxiety. Adolescent numbers fluctuate between 8 and 18 million (CDC, 2020; NIMH, 2017); the actual number is indeterminate. Statistics are even less reliable for the LGBTQ+ community because large-scale mental health studies rarely include sexual and gender identity (NAMI, 2020b). “Federally funded surveys only recently have begun to identify sexual minorities in their data collections” (Medley et al., 2020, p. 1). Experts estimate the infection rate in the LBGTQ+ community is 1.5 to 2.5 times higher “than that of their straight or gender-conforming counterparts” (Brenner, 2019, p. 1).
Depressive illnesses tend to co-occur with anxiety and substance abuse (Johns Hopkins, 2020). “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” (Salcedo, 2018, p. 1). Anxiety and depression are the primary causes of the 56% increase in adolescent suicide over the last decade (Curtin & Heron, 2019). “High school students who identify as lesbian, gay or bisexual are almost five times as likely to attempt suicide compared to their heterosexual peers,” and “40% of transgender adults have attempted suicide in their lifetime” (NAMI, 2020b, p. 1).
Anxiety is the most common mental dysfunction, impacting the emotional well-being and quality of life of adults and children who find themselves caught up in a densely interconnected network of fear, worry, and apprehension. The psychological and sociological toll can be overwhelming. Physically, anxiety can cause sweating, trembling, fatigue, and rapid heartbeat, lower the immune system and increase the risk of heart disease risk. Persons with depression may experience a lack of interest and enjoyment of daily activities, significant weight fluctuation, insomnia or excessive sleeping, enervation, inability to concentrate, feelings of worthlessness, guilt, and recurrent thoughts of death or suicide. Anxious and depressed persons frequently generate images of themselves performing poorly in social situations (Hirsch & Clark, 2004; Hulme et al., 2012) for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. Symptoms can be repressive and intractable, imposing irrational thought and behavior (Richards, 2014; Zimmerman et al., 2010) that govern perspectives of personal attractiveness, intelligence, and competence (Ades & Dias, 2013). Over time, these self-beliefs become automatic negative thoughts (Amen, 1998) that determine initial reactions to situations or circumstances.
Mental Health and LGBTQ+ Culture
Halloran and Kashima (2006) define culture as “an interrelated set of values, tools, and practices that are shared among a group of people who possess a common social identity” (p. 140). Culture determines how mental illness is perceived or diagnosed, how services are organized, and how they’re funded. It also affects how patients express their symptoms…and how they cope in the range of their community and family supports. (Daw, 2001, p. 1)
Studies and research indicate that mental health culture is underscored by the same interrelated attributions to mental health stigma: public opinion, media representation, family rejection, distancing, and the diagnosis itself. These attributions are also LGBTQ+ cultural influences along with heterosexualism and victimization. Both are impacted by history, while the disease model remains the primary contributor to mental health culture.
LGBTQ+ culture is defined by its sexual and gender identity as distinct from the heterosexual and cisgender community (NAMI, 2020b). Subcultures within the community comprise “a diverse set of groups, including distinct groups based on sexual orientation and gender identity” (Lewis et al., 2017, p. 861), each struggling to develop their recognition. LGBTQ+’s social identity is shaped by oppression and its role in overcoming it. The community faces “numerous challenges and instances of heterosexism and homophobia in their daily lives” (UW-Madison, 2020, p. 1), including “discrimination, prejudice, denial of civil and human rights, harassment, and family rejection” (NAMI, 2020b, p. 1). The contrast in social culture is underscored by 26 countries with legalized same-sex marriage versus 73 countries where homosexual activity between consenting adults is illegal (Equaldex, 2020) and 8 countries where it is punishable by death (ILGA, 2019). LGBTQ+ people worldwide are confronted by “violence, arbitrary arrest, imprisonment, torture, and execution, according to Amnesty International” (WEF, 2018, p. 1). Because of this cultural disparity, this paper limits its focus to LGBTQ+ mental health issues in the United States.
Transition
Working within a wellness model of mental health has become a central focus of international policy (Slade, 2010). As psychologist Kinderman (2014) writes, “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). Decades of pathographic focus in psychological research and studies, negative diagnostic attributions, stereotyping and stigma, public and institution resistance, and a doctor-client power dominance factor in the need to transition to a wellness paradigm.
Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond. Rather than obsessing on disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance to recovery. Psychological science is there but needs implementation through program integration, positive evaluation, transparency, and information management. Empathy and communication must supersede etiology. This paper does not endorse a total dissolution of medical model approaches, but a review of their efficacy and the psychological effectiveness of their pathographic dominance is highly warranted.
Redefining Mental Health
Government agencies 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). This ‘defective’ emphasis has been the overriding psychiatric perspective for centuries.
The pathographic or disease perspective of diagnosis and recovery focuses on the history of an individual’s suffering to facilitate diagnosis. Schioldann (2003, p. 303) defines pathography as a historical biography from a medical, psychological, and psychiatric viewpoint. It analyses a single individual’s biological heredity, development, personality, life history and mental and physical pathology, within the socio-cultural context of his/her time, in order to evaluate the impact of these factors upon his/her decision-making, performance, and achievements. (Kőváry, 2011, p. 742)
One only needs the American Psychological Association’s (APA, 2020) definition of neurosis to comprehend the mental health community’s pathographic focus. The 90-word overview contains the following words: distressing, irrational, obsessive, compulsive, dissociative, depressive, exaggerated, unconscious, conflicts, anxiety, disorders. DSM-3 abandoned the word ‘neurosis’ in 1980, but it remains the go-to term in the mental health community. Coined by a Scottish physician in 1776, neurosis defined itself as functional derangement of the nervous system. Pathography focuses “on a deficit, disease model of human behaviour (sic),” whereas the wellness model focuses “on positive aspects of human functioning” (Mayer & May, 2019, p. 159).
Studies and research portray the mental healthcare community as drowning in pessimism (Henderson et al., 2014; Khesht-Masjedi et al., 2017; Pryor et al., 2009). “There is evidence to indicate the problem may be endemic in the medical health community” (Gray, 2002, p. 3), and universally systemic (Knaak et al., 2017). Noted psychologist Alison Gray (2002) argues that more disordered persons would seek treatment if psychiatric services were less stigmatized and stigmatizing. Patients commonly report instances where a staff member was inordinately rude or dismissive. They cite coercive measures, excessive wait times, paternalistic or demeaning attitudes, treatment programs revolving around drugs with undesirable side effects, stigmatizing language, and general therapeutic pessimism (Henderson et al., 2014; Huggett et al., 2018). Clients with more severe complications or illnesses are often deemed “difficult, manipulative, and less deserving of care” (Knaak et al., 2017, p. 2). Nurses and clinicians cite a lack of collegial support, insufficient knowledge and training, and the fear of client self-harm (Henderson et al., 2014), leading them to over-diagnose and over-prescribe (Huggett et al., 2018).
Transitioning from the disease model’s pathographic language to the optimistic and encouraging language of wellness models is everyone’s responsibility in the mental health community―its institutions, associations, practitioners, researchers, media, and clients. In the growing opinion of clinical psychologists, empathy and communication must take precedence over etiology.
We must move away from the disease model, which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognizes our essential and shared humanity. Our mental health is largely dependent on our understanding of the world and our thoughts about ourselves, other people, the future, and the world. (Kinderman, 2014, p. 3
Language and Perspective
Language generates and supports perspective, and linguists agree that the relationship between language and power is mutual (Ng & Deng, 2017). Language influences thought and action. Terms like incapacity, deceit, unempathetic, manipulative, and irresponsible describe DSM-5 traits for various disorders. The argument is not that these descriptions are invalid; they are overwhelmingly negative and perceptually hostile. Judging by public opinion, media representation, and mental health stereotypes and stigma, these words help frame the perception of a person with a mental disorder (DeMare, 2016; Pinfold et al., 2005; Pryor et al., 2009).
Realistically, we cannot eliminate the word ‘mental’ from the culture. The disease model’s guide for 70 years is called the Diagnostic and Statistical Manual of Mental Disorders. Unfortunately, the word ‘mental’ is a limited description of a disorder, and its negative implications support perceptions of incompetence, unworthiness, and undesirability. It is the dominant source of stigma, shame, and self-denigration. Psychologically, the word mental defines a person or their behavior as somehow extreme or illogical. Adolescents derisively assign the term to the unpopular, different, and socially inept. The urban dictionary defines mental as someone silly or stupid.
Hostile and demeaning language is pervasive throughout mental healthcare promulgated by the disease or medical model’s pathographic undercurrent. This perspective influences public opinion, study and research, media representation, the doctor-patient power structure, community interrelationships, and client self-beliefs and image. Transitioning from the disease model to wellness models requires constructing a more reasonable mental health perspective by addressing misunderstanding, misinformation, and the overriding focus of the disease model on diagnosis, disorder, deficit, and denigration.
Misinformation is generated by the psychological community’s difficulty finding agreement due to changing criteria, “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata et al., 2015, p. 724), and the intractability of the American Psychiatric Association. There are four common misconceptions about mental disorders. They are (1) abnormal and selective, (2) a consequence of behavior, (3) solely mental, and (4) psychotic. These are corrected by universality, age of onset, complementary, and the clear differentiation of psychosis from neurosis.
Universality. A recent article in Scientific American speculates that “mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life” (Reuben & Schaefer, 2017, p. 1). It is a part of natural human development. One-in-four individuals have a diagnosable mental disorder. According to the World Health Organization, nearly two-thirds of people who believe they have a mental disorder reject or refuse to disclose their condition. Include those who dispute or chose to remain oblivious to their dysfunction, and we can conclude that mental disorders are common, undiscriminating, and universally impacting.
Age of Onset. The onset of a disorder is a consequence of early psychophysiological disturbance, according to Mayoclinic (2019). Perhaps parental behaviors are overprotective or controlling or do not provide emotional validation (Cuncic, 2018). The receptive juvenile might be the product of bullying, abuse, or a broken home. “LGBT youths experience greater stressors from childhood into early adulthood, such as child abuse and unstable housing, that exacerbate mental health problems” (Mustanski et al., 2016, p. 527). LGBTQ+ youth experience disproportionately high rates of verbal and physical harassment and other types of peer victimization (Berlan et al., 2010; Reisner et al., 2015). “Gender minority youth had approximately four-fold higher odds of experiencing any bullying or harassment in the past year” (Reisner et al., 2015, pp. 35-36).
Childhood/adolescent exploitation or abuse are generic terms to describe a broad spectrum of experiences that interfere with a youth’s optimal physical, cognitive, emotional, and social development (Steele, 1995). Any number of situations or events can trigger the susceptibility to onset; it could be hereditary, environmental, or some traumatic experience (Mayoclinic, 2019; NIH, 2019). Statistically, the LGBTQ+ community is at “a higher risk than their heterosexual counterparts for traumatic life experiences such as childhood physical, psychological, and sexual abuse” (Bandermann, 2014, p. 3).
Despite the implication of intentionality in the words’ abuse’ and ‘exploitation,’ a toddler might sense abandonment and develop emotional issues when a parent is preoccupied (Lancer, 2019). The child/adolescent is not accountable for their dysfunction; there is the likelihood no one is intentionally responsible. Similarly, with the scientific affirmation that, while sexual and gender-based identities may have a genetic or biological basis, they are not chosen, and the LGBTQ+ person is not accountable; unlike mental illness, there is no implicit or explicit responsible party.
Undoubtedly, this sociological model conflicts with moral models that claim, “mental illness is onset controllable, and persons with mental illness are to blame for their symptoms” (Corrigan 2006, p. 53), and sexual and gender-based orientation is a choice.
Complementarity. In early civilizations, mental illness was the domain of supernatural forces and demonic possession. Hippocrates and diagnosticians of the 19th century looked at the relative proportions of bodily fluids. Lunar influence, sorcery, and witchcraft are timeless culprits. In the early 20th century, it was somatogenic. The biological approach argues that neuroses are related to the brain’s physical functioning (McLeod, 2018), while pharmacology promotes it as a chemical or hormonal imbalance. Carl Roger’s study of the cooperation of human system components to maintain physiological equilibrium produced the word ‘complementarity’ to define simultaneous mutual interaction. Mind, body, spirit, and emotions work in concert. The same mutual interaction is evident in sexual and gender-based identities as it is in all persons.
Psychosis and Neurosis. There are two degrees of mental disorders: neuroses and psychoses. When someone sees, hears, or responds to things that are not actual, they are having a psychotic episode. While few persons experience psychosis, everyone has moderate-and-above levels of anxiety, stress, and depression. Neurosis is a condition that negatively impacts our emotional well-being and quality of life but does not necessarily impair or interfere with normal day-to-day functions. Since the overwhelming majority of mental disorders are neuroses, humans are all dysfunctional to some extent.
“Language reveals power, reflects power, maintains existing dominance, unites and divides . . . and creates influence.” (Ng & Deng, 2017, p. 15). The similar impact of the wellness model on the mentally ill and the LGBTQ+ person is evident. Revising negative and hostile language to embrace a positive dialogue of encouragement and appreciation generates new perspectives that positively contribute to self-beliefs and image, leading to more disclosure, discussion, and, in the case of mental illness, recovery-remission. The self-denigrating aspects of shame should dissipate; stigma becomes less threatening.
Accepting that mental illness and sexual and gender-based identities are ubiquitous and non-discriminating should make it easier to embrace the subject within the family structure. Realizing their proximity and general susceptibility should mitigate the desire to distance and isolate. Accepting their social pervasiveness should alleviate the prejudice, ignorance, and discrimination attached to mental illness (Khesht-Masjedi et al., 2017; Pescosolido, 2013; Pinfold et al., 2005; Wood & Irons, 2017), as well as sexual and gender-based identities (Adamczyk & Liao, 2018; Dodge et al., 2016; Lewis et al., 2017). Recognizing that neither the mentally ill nor the LGBTQ+ person is accountable disputes the belief that they are weak or amoral and their condition a reflection of behavior. (Condition is herein defined as the state of something with regard to its quality.)
Resistance to Recovery
The term stigma-avoidance defines those who fear that public disclosure could, potentially, stigmatize and discredit them. Statistics from the National Bureau of Economic Research “find that survey respondents under-report mental health conditions 36% of the time when asked about diagnosis” (Bharadwaj et al., 2017, p. 3). A recent study by Salzer et al. (2018) reveals that only one-third of disordered persons were in recovery-remission in 2017. The lower recovery-remission rates may be partly due to the inability to afford treatment due to anxiety-induced financial and employment instability (Gregory et al., 2018). More than 70% of social anxiety disorder patients, for example, are in the lowest economic group (Nardi, 2003).
The LGBTQ+ community’s resistance to disclosing a mental disorder, seeking treatment, or accepting a diagnosis is due to the same attributions that underscore general reticence: stigmatization, victimization, public opinion, media representation, family rejection, and the diagnosis itself.
Stigmatization
Mental health stigmais the hostile expression of the abject undesirability of the afflicted. 90% of survey respondents with a mental disorder claim they have been impacted by mental health stigma (NAMI 2020a). Stigmatization is deliberate and proactive, distinguishable by pathographic overtones intended to shame and isolate (Pryor et al., 2009). Disclosure of a mental disorder jeopardizes livelihoods, relationships, social standing, housing, and quality of life (Huggett et al., 2018; Pinfold et al., 2005; Sowislo et al., 2016; Wood & Irons, 2017). “The deleterious effects of stigma and prejudice on the health of sexual minority individuals have been well-documented across both physiological and psychological domains” (Dodge et al., 2016, p. 1).
For LGBTQ youth, the minority stress theory posits that their health is affected by the degree to which their social environment stigmatizes sexual and gender minorities and the extent to which LGBTQ+ youth in these environments are expected to hide their non-conformity. (Wilkerson et al., 2016, p. 359)
Mental health stigma is expressed within three categories:
Tribal stigma devalues.
Moral character stigma implies amorality and weakness.
Abominations of the body stigma refers to physical deformity or disease (Pryor et al., 2009).
Mental disorder occupies the last two categories. Ignorance equates a mental disorder with weakness or contributing behavior, while the medical model focuses on the disease and deformity aspect. The LGBTQ+ community’s sexual and gender-based identity is socially and culturally tribal.
Victimization
“Community-based samples of LGBT youths have shown that as many as 30% may experience psychological distress at clinically significant levels” (Mustanski et al., 2016, p. 527). A study of the effects of cumulative victimization on LGBTQ+ youth’s mental health found that they “experience greater mental health problems, such as depression, anxiety, suicide attempts, and posttraumatic stress disorder (PTSD) . . . than do heterosexual and cisgender individuals” (Mustanski et al., 2016, p. 527). Contributors include internalized homophobia, stigma consciousness, identity concealment, and experiences of heterosexism and victimization. (Heterosexism is the sociological term for discrimination or prejudice against gay people by heterosexuals who assume heterosexuality is the normal sexual orientation). Sexual and gender-identity minorities are disproportionally subject to bullying, harassment, and other peer victimization (Berlan et al., 2010; Reisner et al., 2015). The LGBTQ+ community is “one of the most targeted communities by perpetrators of hate crimes in the country” (NAMI, 2020b, p. 1).
Because of the greater risk of victimization in LGBT individuals compared with heterosexuals starting as early as adolescence, research is needed that examines how trajectories of sexual orientation-based victimization across development influence the risk for mental health problems for LGBT people. (Mustanski et al., 2016, p. 528)
Public Opinion
“Although recognition, attributions, and service use may reflect prejudice associated with mental illness, the heart of stigma lies in social acceptance” (Pescosolido, 2013, p. 8). The image of the dangerous, unpredictable, mentally ill person is still widely endorsed by the public (Corrigan & Watson, 2002; Pinfold et al., 2005). Stuart and Arboleda-Flórez (2012) analysis of two surveys (1990/2006) on public perception found, that “between 80-100 percent of respondents . . . favored involuntary hospitalization for that disorder when they thought that violence was an issue” (p. 7).
Attitudes toward sexual and gender-based identity became substantially more accepting between the 1970s, the most significant shift among 18- to 29-year-olds (Adamczyk & Liao, 2018; Dodge et al., 2016). “It is clear that Americans have become more accepting of same-sex sexual behavior and relationships, but it is unclear how universal those changes are and whether they are due to age, time period, or cohort” (Twenge et al., 2016, p. 10).
Persons tend to be more supportive, in part, “because gay men and lesbians are then seen as less responsible for their orientation” (Adamczyk & Liao, 2018, p. 4). An overwhelming share (92%) of the U.S. LGBTQ+ community believes “society has become more accepting of them in the past decade and expect it to grow even more accepting in the decade ahead” (Pew, 2020, p 1). However, many rights and benefits afforded to LGBTQ+ individuals depend on region, race and ethnicity, political persuasion, educational attainment, economics, and religiosity (Adamczyk & Liao, 2018; Dodge et al., 2016; UW-Madison, 2020). Religion is strongly associated with negative beliefs about the justifiability of LGBTQ+ “sexual behavior and marriage” (Twenge et al., 2016, p. 8). The degree of intolerance is denominational and subject to the frequency of attendance. Jews and moderate-to-liberal protestants are more tolerant than Baptists, fundamentalists, and Catholics (Adamczyk & Liao, 2018; Schnabel, 2016). The Pew (2020) study shows that 29% of LGBTQ+ persons have felt unwelcome in a place of worship;
Heterosexual women consistently demonstrate more positive attitudes toward sexual and gender minority groups than heterosexual men who are “traditionally expected to more rigidly conform to gender explicitly heteronormative norms and stereotypes” (Dodge et al., 2016, p. 4). Attitudes toward lesbians and gay men are significantly more positive than attitudes toward transgender people (Adamcyzk & Liao, 2018; Lewis et al., 2017), whereas “bisexual individuals commonly report experiencing stigma, prejudice, and discrimination from both heterosexual and gay/lesbian individuals” (Dodge et al., 2016, p. 1).
Education and interpersonal contact mitigate prejudicial attitudes and behaviors towards both the mentally disordered and LGBTQ+ individuals. Contact-based education has emerged as the most influential factor in public attitude and behavior towards people with mental health problems (Pinfold et al., 2005; Corrigan, 2006). “Multiple studies have found that knowing someone who is LGBTQ+ is associated with more supportive attitudes” (Adamczyk & Liao, 2018, p. 10), and “may increase knowledge, reduce anxiety, and increase empathy” (Lewis et al., 2017, p. 862). This benefit has not crossed over to transgender people, likely, because “personal contact is relatively small” (Lewis et al., 2017 p. 871).
According to the Pew Research Center (Pew, 2020), 30% of the LGBTQ+ community reported they have been threatened or physically attacked, 21% treated unfairly by an employer, and 58% the target of slurs or jokes. Heterosexism inflicts itself on individual, familial, institutional, employment, political, and cultural levels, and openly occurs in educational, career, religious, and social settings (Bandermann, 2014; Lewis et al., 2017).
While public opinion has drastically improved for the LGBTQ+ community, the perception of the dangerous and unpredictable mentally disordered person who should be isolated has not changed substantially in decades (Stuart & Arboleta-Flórez, 2012). A primary goal of wellness models is mitigating mental health stigma by changing the public perspective.
Media Representation
A 2011 study revealed that nearly half of U.S. media stories on mental illness mention or allude to violence (Pescosolido, 2013). News and social media, propelled by far-right politics, fundamentalism, and other fringe organizations, contribute to discrimination and prejudice. Analysis of film, television, and tabloid presentations identify three common misconceptions: people with mental illness are homicidal maniacs, they have childlike perceptions of the world that should be marveled at, or they are rebellious, free spirits (Corrigan, 2006). Portrayals of sexual and gender-based identity in the latter half of the 20th century were, generally, stereotypical exaggerations. “Beginning in the 1990s, some highly likable gay and lesbian television and media characters began to appear in the media” (Adamczyk & Liao, 2018, p. 10). Still, there is an abundance of gay-themed portrayals designed to arouse feelings of shock, betrayal, and titillation. Media coverage commonly promotes disinformation that negatively impacts the self-beliefs and image of LGBTQ+ persons.
Family Rejection
Family stigmatization is the rejection of an LGBTQ+ or mentally dysfunctional child or sibling. A 2008 literature review found around 38% of family members “attempt to hide their relationship in order to avoid bringing shame to the family” (Stuart & Arboleda-Flórez, 2012, p. 8). Another study showed that 34% of LGBTQ+ persons reported rejection by family members, 49% reported unfair treatment, and “52% were subject to anti-gay remarks from family members” (Bandermann, 2014, p. 3). The implication of familial undesirability impacts a mentally disordered and LGBTQ+ person’s sense of positive self, a devaluation more potentially “life-limiting, and disabling than the illness itself” (Stuart & Arboleda-Flórez, 2012, p. 3). “The difficulties of living with psychiatric distress are magnified by the experience of rejection” (Gray, 2002), which can lead to psychological and physiological health issues, substance abuse, and addiction.
Etiology and Misdiagnoses
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 the disorder, and how effective are treatments? (Corrigan, 2006). It is essential to recognize how these attributions affect public perception, treatment options, and client self-beliefs and image.
“Until the 1950s, most homosexual persons studied by psychologists and others were prisoners or mental patients, so it was easy to conclude that these were linked” (McFarland, 2018, p. 1). In 1973, the APA announced homosexuality was no longer an illness. DSM diagnostic criteria change dramatically from one edition to the next. Lynam and Vachon (2012) cite therapists’ concern that criteria are “added, removed, and rewritten, without evidence that the new approach is better than the prior one” (p. 483). The social fears described in the DSM-II in 1968 became social phobia in the DSM-III (1980), and social anxiety disorder in 1994’s DSM-IV, resulting in the nickname, the ‘neglected anxiety disorder.’
Revisions, substitutions, and contradictions between DSMs are never universally accepted. Even under the best circumstance with a knowledgeable and caring clinician, it is difficult to obtain a proper mental disorder diagnosis. In addition to the nine types of depression, four anxieties, and eight obsessive-compulsive disorders, the current DSM lists five types of stress response and ten personality disorders, each sharing similar traits and symptomatology with varying degrees of impact. Bipolar personality disorder, for example, shares characteristics and symptoms with generalized anxiety disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder (Sagman & Tohen, 2009). The most common comorbidities associated with anxiety are major depression, panic disorder, posttraumatic stress disorder, and alcohol abuse/dependence. For example, social anxiety disorder is often comorbid with avoidant personality disorder, eating disorders, schizophrenia (Cuncic, 2018; Vrbova et al., 2017), ADHD, and agoraphobia (Koyuncu et al., 2019).
The Social Anxiety Institute (Richards, 2019) reports that an estimated 8.2% of patients had generalized anxiety, but just 0.5% were correctly diagnosed. A recent Canadian study by Chapdelaine et al. (2018) reported, of 289 participants in 67 clinics meeting DSM-4 criteria for social anxiety disorder, 76.4% were improperly diagnosed.
Self-Esteem
Maslow’s (1943/1954) hierarchy of needs reveals how childhood disturbance can disrupt natural human development. Healthy growth requires satisfying fundamental physiological and psychological needs. The experience of detachment, exploitation, or neglect may disenable the subject from satisfying their physiological and safety needs and or the need to belong and experience love, which can impact the acquisition of self-esteem.
If the child is criticized, overly controlled, or not given the opportunity to assert itself, it begins to feel insecure in its ability to survive, and may then become overly dependent on others, develop low self-esteem, and experience a sense of shame or doubt in its own abilities. (Vanderheiden & Mayer, 2017, p. 15)
Research on persons with depression and anxiety reveals how the disease model “diminishes hope, self-esteem, self-efficacy, empowerment, and quality of life.” (Garg and Raj, 2019, p. 124). LGBTQ+ youth rejected because of their identity have much lower self-esteem, are more isolated, and have less support than those accepted by their families (House, 2018).
Self-esteem determines one’s relation to self, to others, and the world. Self-esteem is the umbrella for all the positive self-qualities that structure optimal functioning, e.g., self -respect -resilience, -efficacy, -reliance, -compassion, -value, -worth, and other intrinsic wholesome attributes. Self-esteem provides the recognition that one is consequential and worthy of love. A grassroots poll by Unite UK (2016) found that 62% of LGBTQ+ persons believe they have low self-esteem. Exposure to historical alienation, ambiguous public opinion, adolescent bullying, heterosexualism, and other harmful elements, in time, will have an impact on an LGBTQ+ person’s self-beliefs and image (Unite UK, 2016).
Recovery
Recovery is an individual process. Humans have unique DNA and disparate sensibilities, memories, and abilities. One-size-fits-all approaches are inadequate to fully address the personality’s dynamic complexity and its owner’s uniqueness. Mental illness is ubiquitous and non-discriminating; dysfunction embraces every walk of life. Indeed, “the LGBTQ+ community encompasses a wide range of individuals with separate and overlapping challenges regarding their mental health” (NAMI, 2020b, p. 1).
Recovery is “about seeing people beyond their problems – their abilities, possibilities, interests, and dreams – and recovering the social roles and relationships that give life value and meaning” (Slade, 2010, p. 2). Recovery programs must be fluid, integrating multiple traditional and non-traditional approaches developed through client trust, cultural assimilation, and therapeutic innovation. Any analysis must consider the subject’s environment, hermeneutics, history, and autobiography in conjunction with their wants, beliefs, and aspirations. Otherwise, the personality complexity is not valued, and the treatment is inadequate.
Positive Psychology and the Wellness Model
In 2004, the World Health Organization began promoting the advantages of the wellness 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 states, “the promotion of well-being is among the mental health system” (Schrank et al., 2014, p. 98). As psychologists point out, “psychological well-being is viewed as not only the absence of mental disorder but also the presence of positive psychological resources” (Sin & Lyubomirsky, 2009, p. 468).
The wellness model’s chief facilitator is positive psychology (PP), which originated with Maslow’s (1943/1954) seminal texts on humanism; APA president Seligman legitimized it in 1998. Positive psychology and other optimistic approaches focus on the inherent ability, “not only to endure and survive but also to flourish” (Mayer & May 2019, p. 160).
Positive psychology is a relatively new field (since 1998) that, ostensibly, complements rather than replaces traditional psychology. Defined as the science of optimal functioning, PP’s objective is “to study, identify and amplify the strengths and capacities that individuals, families, and society need to thrive” (Carruthers & Hood, 2004, p. 30). Cultural psychologist Levesque (2011) describes optimal functioning as the study of how individuals attempt to achieve their potential and become the best they can be.
Studies support the utilization of positive psychological constructs, theories, and interventions for enhanced mental health understanding and improvement. PP interventions have “improved wellbeing and decreased psychological distress in mildly depressed individuals, in patients with mood and depressive disorders, [and] in patients with psychotic disorders” (Chakhssi et al., 2018, p. 16). As Carruthers and Hood (2004) point out, “The things that allow people to experience deep happiness, wisdom, and psychological, physical and social wellbeing are the same strengths that buffer against stress and physical and mental illness” (p. 30).
The academic discipline of positive psychology continues to develop evidence-based interventions that focus on eliciting positive feelings, cognitions, or behaviors (Schotanus-Dijkstra et al., 2018). Positive psychology offers promising interventions “to support recovery in people with common mental illness, and preliminary evidence suggests it can also be helpful for people with more severe mental illness” (Schrank et al., 2014, p. 99).
Positive Psychology 2.0.
One of the early challenges of positive psychology was its inattention to the negative aspects of character. Recognizing this, psychologists advocated a more holistic approach to embrace the dialectical opposition of human experience. As one psychologist put it, “people are not just pessimists or optimists. They have complex personality structures” (Miller, 2008, p. 598). Positive Psychology 2.0 (PP 2.0) evolved as a correction to the singular focus on optimism to embrace a more inclusive and balanced perspective (Rashid et al., 2014).
The disease model of mental health bases recovery on the remission of symptoms or the suspension of substantial interference or limitation (ADAMHA, 2012; Salzer et al., 2018). The wellness model maintains that individuals with a mental disorder can live satisfying and fulfilling lives regardless of symptoms or impairments associated with the diagnosis (Slade, 2010). Schrank et al. (2014) describe 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” (p. 98). By emphasizing wellness, the positive psychology movement aims to destigmatize mental illness by emphasizing “the positive while managing and transforming the negative to increase wellbeing” (Mayer & May, 2019, p. 163). Perkins and Repper (2003, p. 3) write:
People with mental illness who are in recovery are those who are actively engaged in working away from Floundering (through hope-supporting relationships) and Languishing (by developing a positive identity), and towards Struggling (through Framing and self-managing the mental illness) and Flourishing (by developing valued social roles).
Concluding Thoughts
Thomas Insel (2013), director of the National Institute of Mental Health, is “re-orienting its research away from DSM categories” (p. 2), declaring that traditional psychiatric diagnoses have outlived their usefulness (Kinderman, 2014). NIMH is transforming diagnosis based on emerging research data and a doctor-patient communication dynamic rather than on the current symptom-based categories. Kinderman (2014) 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. (1)
In mental health, recovery-remission is a realized, long-term mitigation of symptoms. Wellness impacts more than mental health; it is a paradigmatic perspective that seeks to promote a state of complete physical, mental, and social well-being. Its sociological emphasis on optimal human functioning, designed to counter the pathographic focus of other models, not only positively impacts the self-beliefs and image of a mentally ill person but resonates in sexual and gender-based identities and portends well, the recovery-remission of an LGBTQ+ person with a mental illness.
There are many approaches to recovery. Psychology textbook author, Farreras (2020) cites 400 different schools of psychotherapy. Mayer and May (2019) characterize current positive psychology as “a balanced, interactive, meaning-centered and cross-cultural perspective” (p. 156) that considers equally “positive emotions and strengths and negative symptoms and disorders” (Rashid et al., 2014, p. 162). Positive psychology works best in conjunction with other programs (CBT, for example), and its mental health interventions have proved successful in mitigating symptoms of depression, anxiety, and other disorders. “Growing research suggests that a positive psychological outlook not only improves ‘life outcomes’ but enhances health directly” (Easterbrook, 2001, p. 23).
Training in prosocial behavior and emotional literacy might be useful supplements to specific interventions. Behavioral exercises enhance the execution of resilient and generous social skills. Positive personal affirmations have enormous subjective value as well. Data supports mindfulness and acceptance-based interventions to re-engage and regenerate positive thoughts, feelings, and memories. Castella et al. (2014) suggest motivational enhancement strategies to help clients overcome resistance. Ritter et al. (2013) tout the benefits of positive autobiography to counter destructive thoughts and behaviors. The importance of considering the nuanced and unique dynamics inherent in the relationships among emotional expression, intimacy, and overall relationship satisfaction for dysfunctional individuals and LGBTQ+ persons, should be thoroughly investigated (Montesi et al., 2013).
However, this paper balks at throwing out the baby with the bathwater, positing that the current diagnostic system should be utilized as a part of a more thorough analysis that embraces communication and emphasizes the character strengths that generate motivation, persistence, and perseverance toward recovery-remission. All “patients with mental disorders deserve better” (Insel, 2013, p. 2).
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WHY IS YOUR SUPPORT SO IMPORTANT? ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.
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