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This reposts an article recently published on Where the Light Gets In. The conventional pathographic model of mental health focuses on the diagnosis rather than the individual, which reduces us to a label. It is crucial to impress upon the client that they are not defined by their diagnoses but by their character strengths, virtues, and attributes. The Wellness Model of Mental Health recognizes that we do not recover from distress by focusing on our defects and deficiencies but on our strengths and assets.
When we label individuals or groups, we reduce them to a single, usually negative, characteristic or descriptor based on an event or behavior. As a result, we view them (or ourselves) through the label and filter out evidence that contradicts that stereotype. Labeling by diagnoses has a similar outcome.
Arbitrarily evaluating someone based on an isolated incidents or behavior is likely an inaccurate representation of that individual. One negative behavior or incident does not define someone’s character. Rather than focus on a label, it is more authentic to value the positive contributions of the person or group. We can then relate with compassionate insight, recognizing the diversity of human thought and experience.
Additionally, attempting to distinguish symptoms and identifying specific etiological and risk factors in emotional malfunction leads to speculation, errors, and misdiagnosis. This likely results in faulty treatment programs and adverse medications.
It is important to recognize that the person experiencing an emotional malfunction knows more about its personal impact than their diagnostician or therapist. This does not imply that error is inevitable, although it happens often with social anxiety disorder. It just posits the possibility.A healthy collaboration of client awareness and a doctor patient mutual dynamic is crucial to proper evaluation. In the wise words of Hippocrates, the pioneer of modern medicine. “If you are not your own doctor, you are a fool.”
Five to one, one in five. No one here gets out alive…
Margaret November 3, 2023 Where the Light Gets In
The good days are finally outweighing the bad. And it’s been a long time coming.
I don’t doubt the role medication plays in this… in fact, I’d go as far as to say they’re probably the only reason my mood remains relatively stable. In a pre-emptive strike, my medication was increased recently.
I say “pre-emptive,” but in truth, I’d noticed the beginnings of a wobble. I’ve essentially re-entered the world as an actual adulting adult again. That’s not without its pressures. I didn’t really want to hang around and find out if weebles wobble enough that they eventually do fall down, so I did the only sensible thing and went back to my psych team to tell them that I was under a bit more stress than I’d previously been and I’d like to protect myself against the impact of that and the upcoming winter months. I had enough niggly signs that they agreed it was best to up the dose and add in some extra support.
To some, that might seem cowardly or lazy. Why should I think that just because I’m dealing with normal life stressors, that warrants upping my medication? Well, because I know my own limits. I know that whilst my mood wasn’t deteriorating, there is absolutely the potential for it to do so as I emerge into the world again.
Am I under any more pressure than anyone else? No. Am I, for whatever reason, less able to cope with those pressures than most people… yes. I recognize that. I accept it. And for the sake of my family, I have to be accountable for my own emotional and mental wellbeing.
I have deliberately shied away from talking about labels and diagnoses. This is the one area I really struggle with because it feels like I have more letters after my name than I can even count.
The one I struggle most with is “bipolar.” That’s a hefty label to carry around.
When you’re given a diagnosis, most psychiatrists are so risk-averse that nobody ever actually removes a previous diagnosis from your notes, even if there are questions over it.
When you’re given a diagnosis, most psychiatrists are so risk-averse that nobody ever actually removes a previous diagnosis from your notes, even if there are questions over it. Even if they don’t believe it fits. Even if there isn’t enough evidence for it to stand anymore.
Bipolar is the one I hate with a fervour matched only by my hatred of Nigel Farage. In the same breath that I was given the diagnosis, I was told that the condition has a one in five mortality rate, and that’s why I was being kept such a close eye on.
That’s a terrifying statistic to live with. I have a higher chance of dying from the illness I have than if I’d been diagnosed with some cancers.
True to form, this diagnosis simply fuelled my fear and anxiety. And when I’m anxious, I obsess. The intrusive thoughts ramp up and become harder to manage.
In the wake of being told those figures, I became sure that The Doors song “Five to One” was prophetic. That the lyrics (I refer you to this cleverly titled blog…) were a precursor to a fate that I was powerless to avoid. Despite the fact that being one of the four in five is statistically more likely, I convinced myself I’d been given a death sentence. And so, that one line in the song played on a loop in my head. It went round and round so often in my head that there was barely any room for anything else.
I cursed the doctor for their thoughtless delivery. I cursed a God I didn’t even believe in for his cruelty. I grieved for a life I was now sure would be cut short. I was waiting for the death knell to sound, and yet, somehow, it felt as though it was ringing in my ears every single day. Except that the death knell was clearly Jim Morrison in this case.
Why do I hate the label of “bipolar” so much? Well, because I feel like it doesn’t fit. It feels like a lazy way of neatly packaging up a whole truckload of trauma into one nice, neat little word, It feels like a medical cop-out.
The same doctor who delivered the death knell also told me that “bipolar disorder is the closest thing the psychiatric world has to high blood pressure. They know what medications work, the know how to control it and what works without exception” – except that’s pure bollocks.
I say it’s bollocks because there is no clinical test for the disorder… nothing in your blood that can be measured, nothing in a brain scan that will be evident. There is not a single medical marker other than your psychiatric evaluation – which isn’t so much an evaluation as a run through your life history.
I’ve never met a male with the diagnosis, although I’m aware they do exist. What I have seen, however, are scores of women with histories of sexual, physical, or emotional abuse with the diagnosis. I’ve seen dozens of women who are untreated peri or full-blown menopausal with the diagnosis.
And it leaves me wondering if the label is a cop-out for writing a woman off without actually hearing her.
I’ve variously been told in my life that I suffer from psychotic depression, that I have Emotionally Unstable Personality Disorder (having someone tell you that your personality is a disorder is pretty shit too by the way…), that I have OCD traits, anxiety (okay, this one I agree with). I don’t know that any of these labels are helpful for anything other than permitting me to access mental health support.
The thing is, those labels are all over my medical notes. So now I have to practically be dying before I’ll se a GP for a physical ailment, lest they put it down to my mental health…
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 neuroscience and psychology including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to regenerate self-esteem. All donations support scholarships for groups, workshops, and practicums.
Subscriber numbers generate contributions that support scholarships for workshops.
The distinction between social anxiety disorder and social anxiety is a matter of severity; reference to one includes the other. The recovery tools and techniques provided are applicable to most emotional malfunctions including depression, substance abuse, panic disorder, ADHD, PTSD, generalized anxiety, and issues of self-esteem and motivation. These malfunctions originate homogeneously, their trajectories differentiated by environment, experience, and the diversity of human thought and behavior.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI – deliberate, repetitive, neural information.” – WeVoice (Madrid, Málaga)
The Character Resume
“Human greatness does not lie in wealth or power, but in character and goodness. People are just people, and all people have faults and shortcomings, but all of us are born with a basic goodness.” – Anne Frank
A character resume is a written compilation of our positive qualities, achievements, and memories. Mindfully retrieving and cataloging these qualities compels us to embrace our value, confirming we are desirable, consequential, and worthy.
Mindfulness is recognition, cognition, and acceptance of reality, as opposed to an opinion or belief lacking evidence or foundation. Self-esteem is mindfulness of our value to self, society, and the world. The trajectory of our negative self-beliefs disrupts the development of our positive self-qualities. This, then, erodes mindfulness of our inherent and acquired character strengths, virtues, and attributes. Fortunately, these qualities are not erased but misplaced, lost, stolen, or compartmentalized away from our consciousness.
The definition of recovery is regaining possession or control of something stolen or lost. In social anxiety and comorbidities, what has been stolen or lost is our emotional well-being and quality of life.
Insufficient Satisfaction of Needs
Self-esteem can further be 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 and subsequent negative self-beliefs disrupt our emotional development by denying us satisfaction of certain fundamental needs.
Core beliefs of abandonment, detachment, exploitation, and neglect subvert certain biological, physiological, and emotional support. This lacuna negatively impacts our self-esteem which we express by undervaluing our positive qualities. Again, this does not signify obliteration, but diminishment or latency due to inactivity or suppression.
In his examination of anxiety and depression, Aaron Beck, the pioneer of cognitive-behavioral therapy, maintained that social anxiety provokes feelings of helplessness, hopelessness, and unworthiness. The concept of undesirability revealed itself in our SAD recovery workshops. Until we commit to recovery, we continue to be manipulated by these destructive self-beliefs.
Again, to emphasize Sun Tzu’s words of wisdom, “If you know the enemy and know yourself, you need not fear the result of a hundred battles.” I am continually amazed at how little SAD persons know their symptoms. It is as if, by ignoring them, they do not exist or will somehow go away. Ignorance is a major impediment to recovery. How can we fix something if we do not know why it malfunctions? How do we regenerate our character qualities if we remain blissfully unaware of what they are? Thus, the value of the character resume.
An objective of recovery is to become mindful of our inherent and acquired character strengths, virtues, attributes, and achievements. This includes mutual consideration of our shortfalls, as well. Again, we are repairing our brokenness.
Elements of a Character Resume
What goes into our character resume? The simple answer is anything and everything that stimulates a positive personal response including our successes, achievements, contributions, personal milestones, talents, charitable deeds, and happy memories.
How does building a character resume support our recovery?
Overwhelming Negativity
Childhood disturbance generates negative core beliefs that influence our intermediate attitudes, rules, and assumptions. These attributions produce a cognitive bias that compels us to misinterpret information and make self-destructive decisions. Since we humans are hard-wired with a negativity bias, we already respond more favorably to adversity. Add our SAD symptomatology and our neural network is replete with toxic information.
We convey this in our thoughts, behaviors, and the words we use to express them.
Throughout our lives, we are consumed and conditioned by adversity. SAD sustains itself through our negative self-beliefs and image. By the age of sixteen, we have heard the word no from our parents, roughly, 135,000 times. Some of us use the same unfortunate characterizations repeatedly. It is not just the words we say aloud in criticism and conversations. The self-annihilating words we silently call ourselves support our adverse thoughts and behaviors.
Additionally, we are continuously impacted by outside negative forces over which we have limited to no control, such as life’s vicissitudes, physical deterioration, and subjected hostilities.
Our neural network is replete with negative information. A character resume is a constant, visual reminder of our value and significance.
Utilizing Our Character Resume
The primary goal of recovery from social anxiety is the moderation of our irrational fears and anxieties. This is achieved through a three-pronged approach.
Replace or overwhelm our negative thoughts and behaviors with healthy, productive ones.
Produce rapid, concentrated neurological stimulation to overwhelm the negative abundance of our neural network.
Regenerate our self-esteem through mindfulness of our assets.
These comprise our overall strategy.
Replace
The goal is to replace or overwhelm our adverse thoughts and behaviors with positive ones. Our character resume is constructed with our positive qualities, achievements, and memories. It is these attributions that replace the abundance of negative self-beliefs acquired throughout life. These qualities that were lost, misplaced, or compartmentalized, are retrieved and recognized through recovery approaches, e.g., personal introspection and inventory, memory work, cognitive comprehension, and other tools and techniques. They are subsequently input into our character resume.
Restructure
Proactive neuroplasticity producesrapid, neurological stimulation to change the polarity of our neural network. 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. DRNI is the deliberate, repetitive, neural input of Information. A deliberate act is a premeditated one; we initiate and control the process. Repetition accelerates and consolidates neural renewal and connectivity. Information that is sound, reasonable, goal-focused, and unconditional determines its strength and integrity. The information we assemble in our character resume generates the most efficient words and statements to accelerate and consolidate the process of neural restructuring.
Regenerate
Regenerate means to renew or restore something, especially after it has been damaged or lost. The qualities that comprise our self-esteem have been misplaced, lost, stolen, or compartmentalized away from our consciousness due to the disruption in our psychological development.
The process of regeneration in recovery is supported by clinically practical tools and techniques designed for the process. Also, the three goals or strategies of recovery – replace, restructure, and regenerate – are complementary and mutually interactive.
What Goes Into our Character Resume?
Some of the entries into our character resume include our positive personal affirmations, rational response to our ANTs, affirmative visualizations, character strengths, virtues, and attributes rediscovered through various exercises, retrievable happy memories, and self-esteem attributes from various inventories.
One additional and equally important benefit of a character resume is the constant and renewed reminder of what we have complied on the written page. It is an invaluable resource to moderate those situations that may continue to generate automatic negative thoughts, behaviors, and other adverse self-beliefs.
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.
Subscriber numbers generate contributions that support scholarships for workshops.
As part of our broader outreach into the community, ReChanneling is now accepting guest posts and reflections on social anxiety disorder and comorbidities for publication on our website. Listening to and sharing the experiences and expertise of others broadens our perspective and those of our readers. Many of the ideas that eventually become an integral part of recovery come from the thoughts and contributions of colleagues and clients in our groups and workshops. Furthermore, by supplementing our own articles and reviews with other ideas, opinions, and experiences, we better serve the community by providing a full and comprehensive overview of emotional malfunction and methods of recovery.
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 self-modification, positive psychology, and techniques designed to regenerate self-esteem.
Topics should focus on (a) mental health, (b) social anxiety disorder, (c) anxiety, depression, and comorbidities, or (d) self-empowerment. Guest posts following these criteria can be submitted to one of two categories.
1. Scholarly articles and reviews
original and not posted anywhere on the internet. This avoids duplicate content that can confuse search engines. However, you can link your article or items within your article to previously posted and similar information. You will also provide links to your own website or other accounts as you deem appropriate.
well-written, using a writing tool like Grammarly; and proofread. If we feel it might require editing, we will do so with your permission and pending your final approval.
2. Personal reflections and experiences
Share your experiences with social anxiety and other emotional malfunctions. How you cope with symptoms and situations, and methods of recovery. These reflections and contributions are of enormous benefit to others who are going through similar situations.
Submissions should be emailed to rmullenphd@gmail.com. If you have questions or need additional information, please use the following link.
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.
Subscriber numbers generate contributions that support scholarships for workshops.
The distinction between social anxiety disorder and social anxiety is a matter of severity; reference to one includes the other. The recovery tools and techniques provided are applicable to most emotional malfunctions including depression, substance abuse, ADHD, PTSD, generalized anxiety, and issues of self-esteem and motivation. These malfunctions originate homogeneously, their trajectories differentiated by environment, experience, and the diversity of human thought and behavior.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI — deliberate, repetitive, neural information.” — WeVoice (Madrid, Málaga)
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.
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.
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, Málaga)
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 to the Wellness Model
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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