Category Archives: LGBTQ

Why the Term ‘Mental Illness’ is Inappropriate

Unveiling mental healthcare mythology

Forget most of what you have been told. You have been poorly informed by the disease model of mental healthcare and influenced by mental health stigma. Mental illness is not abnormal nor the consequence of the subject’s behavior, and there’s a clear demarcation between neurotic and psychotic. Even the term mental illness is inaccurate. Its negative perspectives and implications promulgate perceptions of incompetence, unworthiness, and undesirability. It is the dominant source of stigma, shame, and self-denigration. Realistically, we cannot eliminate the term from current models of healthcare; efforts to amend the language are promising but inadequate.  

One only needs the American Psychological Association’s[1] 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

In political correctness, the word mental defines a person or their behavior as extreme or illogical. In adolescence, anyone unpopular or different was a mental case or a retard. The urban dictionary defines mental as someone silly or stupid. It is often associated withviolent or divisive behavior.Add the word illness or disorder and we have the public stereotype of something dangerous and unpredictable who cannot fend for itself and should be isolated. 

To the early civilizations, mental illnesses were the domain of supernatural forces and demonic possession. Hippocrates and diagnosticians of the 19th century favored the humours (bodily liquids). Lunar influence, sorcery, and witchcraft are timeless culprits. In the early 20th century, it was somatogenic. The biological approach argues that mental disorders are related to the brain’s physical structure and functioning. The pharmacological approach promotes it as an imbalance in brain chemistry. The first Diagnostic and Statistical Manual of Mental Disorders (1952) leaned heavily on environmental and biological causes. 

The term physiological dysfunction distances itself from the hostility of mental illness but even that is inadequate, as is psychophysiological or the Bio-Psycho-Socio-Spiritual model. Dysfunction is the consequence of the simultaneous mutual interaction of mind, body, spirit, and emotions – a complementary condition which, in lesser severity, is discomfort.  

Dysfunction and discomfortare conditions that can result in functional impairment which interferes with or limits one or more major life activities. Both are what used to be called neuroses, and both are correctible through the same basic processes. It’s a matter of severity. Discomfort is a condition that impacts your quality of life, a dysfunction is a diagnosable condition that impacts your quality of life. The disease model of mental healthcare labels the latter a mental illness or disorder. 

Dysfunction is not abnormal but a natural consequence of human development. A recent article in Scientific American speculates mental disorders are so common almost everyone will develop at least one diagnosable disorder at some point in their life.[2] There is nothing abnormal or unusual about them. They are normal facets of human development – evidence of our humanness.  

There are two degrees of dysfunction: neuroses and psychoses. When someone sees, hears, or responds to things that are not actual, they are experiencing a psychotic episode. 3% of Americans have or will experience a psychotic episode in their lives, less than 1% have a psychotic disorder. The rest of us are neurotic. Everyone has moderate-and-above levels of anxiety, stress, and depression. We are all dysfunctional to some extent. 

It’s not your fault. Research shows that 89% of dysfunction onset happens to adolescents or younger who have experienced detachment, exploitation, and or neglect. In rare cases of narcissism and PTSD where onset happens later in life, the susceptibility originates in childhood due to some physical, emotional, or sexual disturbance. 

Anything that interferes with a child’s social development is detrimental to adolescent and adult emotional health. Childhood/adolescent abuse is a generic term to describe a broad spectrum of experiences that interfere with optimal physical, cognitive, emotional, and social development. It could be hereditary, environmental, or due to some traumatic experience. The cumulative evidence that childhood and adolescent occasions and events are the primary causal factor in lifetime emotional instability has been well-established. 

Any number of things are instrumental. Your parents were over-controlling or did not provide emotional validation. Perhaps you were subjected to bullying or come from a broken home. You must recognize that it is never your fault and possibly no one is intentionally responsible. A toddler who senses abandonment when a parent is preoccupied can develop emotional issues

Those who believe dysfunction is a result of some behavior or is god’s punishment for sin are misinformed. Behaviors later in life may impact the severity but they are not responsible for the neurosis itself. You are not accountable for the cards you have been dealt; you are responsible for how you play the hand. You cannot be held accountable for your dysfunction. You did not make it happen; it happened to you. 

You are not your dysfunction; you are someone who has a dysfunction. The current pathographic process considers diagnosis over individual. In groups, we learn to personify the dysfunction to distinguish it from the individual, so that the symptoms are appropriately assigned. A person who breaks his leg does not become the broken limb; she or he is an individual with a broken leg. 

Carl Roger’s study of the cooperation of human system components to maintain physiological equilibrium produced the word complementarity to define simultaneous mutual interaction. All human system components work in concert; they cannot function alone. Integrality describes the inter-cooperation of the human system and the environment and social fields. A disorder is not biologic, hygienic, neurochemical, or psychogenic. It is a collaboration of these, and other approaches administered by the simultaneous collaboration of the mind, body, spirit, and emotions.

There is no legitimate argument against mind-body collaboration in disease and wellness. Spirit is both the core and fluid character qualities of an individual, emotion the expression of those qualities, both in collaboration with and responsive to mind and body.

Embracing the word dysfunction over mental illness will help alleviate the deficit and diagnosis focus of the healthcare system. Changing negative and hostile language to embrace a positive dialogue of acceptance and appreciation will open the floodgates to new perspectives and positively impact the subject’s self-beliefs and image, leading to more disclosure, discussion, and recovery-remission. The self-denigrating aspects of shame will dissipate; mental health stigma becomes less threatening. The concentration on character strengths and attributes, propagated by humanism, positive psychology, and other wellness-focused alliances, will encourage accountability and foster self-reliance, leading to a confident and energized social identity. 

Experts define mental illness as a “diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria” that can “result in functional impairment which substantially interferes with or limits one or more major life activities.” [iv] This ‘defective’ emphasis has been the overriding psychiatric perspective for over a century. By the 1952 publication of DSM-1, the focus had drifted from pathology (the science of the causes and effects of diseases) to pathography (the breakdown of an individual’s problems, categorizing them to facilitate diagnosis). Pathography is the history of an individual’s suffering, focusing on a disease model of human behavior, whereas wellness models emphasize the positive aspects of human functioning. 

Undoubtedly, this sociological model conflicts with moral models that claim dysfunctions are onset controllable, and the dysfunctional are to blame for their symptoms, or that mental illness is God’s punishment for immoral behavior. Again, it is crucial to recognize you are not responsible for your dysfunction. Playing the blame game only distracts from the solution: What are you going to do about it?

[1] APA Dictionary of Psychology. (2020.) Neurosis. American Psychological Association. https://dictionary.apa.org/neurosis

[2] Reuben, A., & Schaefer, J. (2017). Mental Illness Is Far More Common Than We Knew. Scientific American. Retrieved from https://blogs.scientificamerican.com/observations/mental-illness-is- 798 far-more-common-than-we-knew

Proactive Neuroplasticity and Positive Behavioral Change

DRNI accelerates and consolidates learning (and unlearning)

This is a general overview of Dr. Mullen’s Academa.edu course “Neuroscience and Happiness. Neuroplasticity and Positive Behavioral Change.”

Neuroplasticity is the scientific evidence of our brain’s constant adaptation to information. Scientists refer to the process as structural remodeling of the brain. It’s what makes learning and registering new experiences possible. All information notifies our neural pathways to restructure, generating a correlated change in behavior and perspective. 

What is significant is our ability to dramatically accelerate learning by deliberately compelling our brain to repattern its neural circuitry. DRNI or deliberate, repetitive neural information empowers us to proactively transform our thoughts, behaviors, and perspectives, creating healthy new mindsets, skills, and abilities. 

Thanks to advances in technology, researchers can get a never-before-possible look at the brain’s dynamic and malleable inner mechanics.

Three forms of neuroplasticity.

Reactive neuroplasticity is our brain’s natural and indeliberate adaptation to information. We react unconsciously to sensory information and insensible experiences: music, colors, sounds, tactile impressions, phenomena. Whether it negatively or positively processes that information depends upon the content. Examples of positive reactions might be a warm bath, delightful company, a child’s laughter. An adverse reaction might be rush-hour traffic, disappointment, or a hostile gesture

Active neuroplasticity is achieved through intentional cognitive pursuits such as learning, engaging in social interaction, teaching, creating, listening to music—not just hearing it but actively listening to it. 

DRNI (deliberate, repetitive neural information) is proactive neuroplasticity—the conscious, intentional repatterning of our neural network utilizing tools and techniques developed for the process. Proactive neuroplasticity through DRNI is the most potent and effective means of learning

(1) it alleviates symptoms of ‘mental’ disorders and general discomforts that impact our emotional wellbeing and quality of life. A regimen of DRNI can compensate for and overwhelm decades of irrational and harmful thoughts and behaviors.

(2) The calculated regimen of repetitive neural input accelerates and consolidates learning. It facilitates our motivating personal concerns—achieving a goal, eliminating a bad habit or behavior, improving life satisfaction, and relieving stress and self-improvement. 

Recovering from physiological dysfunction and discomfort and achieving motivating personal concerns are facilitated through the same process of DRNI.

Our brain is in constant flux; it never stops realigning to new information. Connections strengthen and weaken, neurons atrophy and others are born, learning replaces unlearning, chemical and electrical energy dissipates and expands, functions shift from one region to another. Proactively stimulating our brain with deliberate, repetitive neural information accelerates and consolidates the process; there is a correlated change in thought, behavior, and perspective, becoming habitual and spontaneous over time.  

Each neural input of information causes a receptor neuron to fire, transmitting chemical and electrical energy, neuron to neuron throughout the nervous system. DRNI expedites the process. Multiple positive DRNI, such as a series of positive personal affirmations (PPAs), cause multiple receptor neurons to fire, dramatically amplifying learning through synaptic neurotransmission. 

Hormonal and chemical neurotransmitters

Our brain rewards us with chemical and hormonal neurotransmissions: GABA for relaxation, serotonin and dopamine for pleasure and motivation, endorphins for euphoria. In addition, it supplies us with chemicals and hormones that facilitate learning, memory, and concentration. 

Life can be difficult; many of us are unsatisfied, unhappy, and nonproductive. When that information filters into our neural system, our neurotransmitters support that negativity. That’s why it’s so hard to break a bad habit and recovery difficult. Conversely, every time we provide positive input, our brain releases those same chemicals and hormones, generating feelings of self-worth and healthy productivity. It generates the motivation, persistence, and perseverance to achieve our potential.

Our brain is an organic reciprocator.

Our human brain does not think; it is an organic reciprocator that allows us to think. Its job is to provide the chemical and electrical maintenance that supports our vital functions: heartbeat, nervous system, and blood–flow. Neural messages tell us when to breathe, stimulate thirst, control our weight and digestion. Our brain does not differentiate rational from irrational thinking, healthy from toxic behaviors. Instead, it reacts to the positive or negative energy of the information. 

Universal abundance

Our brain codes the health or toxicity of information into negative or positive electrical energy. That energy, duplicated by millions of participating neurons, is reciprocated in abundance because a single neuron receptor ultimately engages millions of participating neurons, each with its energy transmissions. Our human brain contains 86 billion nerve cells or neurons arranged in pathways or networks based on that electrical activity. The reciprocating energy from DRNI is vastly more abundant because of the repeated firing of the neuron receptor. Positive energy in, positive energy multiplied millions of times, positive energy reciprocated in abundance. 

Trajectory of Information

Neurons are the core components of our brain and our central nervous system. Inside each neuron is electrical activity. Information stimulates or excites a receptor neuron which fires, stimulating a presynaptic or sensory neuron via an axon or connecting pathway. Sensory neurons transmit the information to the synapse at the junction of the postsynaptic cell or relay neuron. The synapse permits the neurons to interact. The neuron’s hairlike tendrils (dendrites) pick up the synaptic signal and forward that information to the soma or nucleus of the cell body. Continuous electrical and chemical energy impulses engage millions of participating neurons, which transmit the electrical energy to millions of other neurons in multiple interconnected areas of our brain. Finally, the electrical energy converts back into information relayed by the motor neuron to its appropriate destination–our ears, bladder, muscles, and so on. Cognitive information is compartmentalized into the areas of the brain associated with the distinctly human traits of higher thought, language, and human consciousness.

Every input of information, intentional or otherwise, causes a receptor neuron to fire. Each time a neuron fires, it strengthens the axon connection and the neural bond. DRNI expedites the process through deliberate repetition. An increase in learning efficacy arises from the sensory neuron’s repeated and persistent stimulation of the postsynaptic cell. Multiple firings dramatically accelerate and consolidate learning. In addition, DRNI activates long-term potentiation, which increases the strength of the nerve impulses along the connecting pathways, generating more energy. BDNF or brain-derived neurotrophic factors are proteins that neurons need for survival. Deliberate, repetitive neural information generates higher levels of BDNF, which is associated with improved cognitive functioning, mental health, and memory. 

Recovery from dysfunction and discomfort.

Combined statistics show that 89% of neuroses onset at adolescence or earlier. In the rare event conditions like PTSD or clinical narcissism begin later in life, susceptibility originates in childhood as a consequence of childhood physical, emotional, or sexual disturbance(s). Our self- esteem and image develop during childhood, modify by experience, and help form the foundation of our personality. We are who we are because of our core beliefs and the accumulation of our experiences. Since its onset, our dysfunction or discomfort has been feeding our brain irrational thoughts and behaviors. Irrational is anything detrimental to our emotional wellbeing and quality of life.

Simply put, it is not logical or reasonable to cause ourselves harm. These irrational thoughts and behaviors compel us to feed our brains harmful and self-destructive information. The purpose of DRNI is to replace those perceptions of undesirability and unworthiness generated by our childhood disturbance(s). 

Motivating personal concerns

The alternative utilization of DRNI is motivating personal concerns—improving life satisfaction, transforming ourselves, becoming the best that we can be. We all know how difficult it is to change, remove ourselves from hostile environments, and break harmful habits that interfere with optimum functioning. We’re physiologically hard-wired to resist anything that disrupts our equilibrium. Our inertia senses and repels changes, and our brain’s basal ganglia resist any modification in behavior patterns. DRNI empowers us to assume accountability for our emotional wellbeing, productivity, and quality of life, by proactively controlling information input.

Hebbian Learning

Hebbian learning describes how neurons learn by responding to information. Hebb’s rule of neuroplasticity states, neurons that fire together wire together. In other words, the more neurons communicate with one another, the stronger the connection. When multiple neurons wire together, they create more receptor and sensory neurons. Repeated firing strengthens and solidifies the pathways between neurons. Synaptic connections strengthen and consolidate when two or more neurons are activated contiguously. The more repetitions, the quicker and more robust the new connection. The activity of the axon pathway is heightened, urging the synapses to increase and accelerate the release of chemicals and hormones. Conscious repetition of information correlates to more robust learning and unlearning.

An Example Utilizing Social Anxiety Disorder

We are physiologically acclimated to our condition. It has been developing within us since childhood. This is why it is challenging to establish new habits or change our self-image and outlook. Let us use the example of someone with social anxiety disorder. The predominant symptom of SAD is intense apprehension of social interaction—the fear of being judged, negatively evaluated and ridiculed. This causes persistent, pathological anxiety in everyday situations such as dating, interviewing for a position, even answering a question in class. 

Because our brain does not differentiate healthy from toxic information, each time a SAD person avoids a social situation or alienates someone out of fear of rejection, she or he is chemically and hormonally compensated. Self-destructive behaviors are rewarded with GABA for relaxation, dopamine for pleasure and motivation, endorphins for euphoria, and serotonin for a sense of wellbeing. We receive acetylcholine for our negativity, glutamate to support our selective memory, and noradrenaline to meddle with our concentration. Our brain says good job. Here is some more encouragement for your irrational behavior. 

Our neural network naturally adapts and restructures to information, whether reactive to unconscious experience or actively generated by our compulsion to engage and learn. Logic dictates that if our neural network learns from information, its deliberate, repetitive neural input enhances the process. If information naturally strengthens and consolidates neural connections to accelerate learning, then repetition dramatically expedites the process. 

Positive personal affirmations

Positive personal affirmations are rational, reasonable, possible, goal-focused, and first-person present time. Rational because the objective is subverting irrationality. Remember, it is illogical and unreasonable to cause ourselves harm. PPAs are fair and sensible reflections of our aspirations and intentions. The end goal must be possible, or the effort is counter-productive and futile. Goal-focused is self-explanatory; if we do not know our destination, our path will be purposeless meandering. We learn from the experiences, but we do not control them. First-person, present time affirms we are dealing with the here-and-now; DRNI is here-and-now activity. Brevity is also essential. PPAs should be unconditional and to the point. The information at the core of DRNI is calculated and specific to intention. Are we challenging the negative thoughts and behaviors of our dysfunction? Are we reaffirming the character strengths that generate the motivation and perseverance to accomplish? What is our end goal? What is the personal milestone we desire to achieve? The crucial element of DRNI is the content of the intention behind the information. The strength of the message correlates to its durability and learning efficacy. 

So, what is the content of deliberate, repetitive neural information, how is it constructed, and what materials are helpful to its construction?  CBT, positive psychology and other positive approaches collaboratively work to develop the specific, intention-driven content of the positive personal affirmations at the core of DRNI.  

As light is the absence of darkness, so positive is the absence of negativity. Cognitive-behavioral therapy’s overarching objective is to replace irrational and unhealthy thoughts and behaviors with productive and emotionally affirming ones. 

As our understanding of behavioral neuroplasticity evolved, it became clear that the practice of cognitive-behavioral therapy produces changes in human brain activity. Further studies revealed that an effective way to counter the negativity generated by our dysfunction or discomfort is through the cognitive aspect of CBT, the deliberate, repetitious input of positive information. Over time and through repetition, new thoughts and behaviors become habitual and spontaneous. Studies of CBT have shown it to be an effective treatment for various mental illnesses, including depression, social anxiety, generalized anxiety, panic, bipolar and eating disorders, PTSD, OCD, and schizophrenia. CBT’s mechanisms of change are formidable tools in behavioral modification when utilizing repetitive cognitive reinforcement in concert with other approaches. The behavioral aspect supports the process Positive personal affirmations, embraced by us for centuries, are the cognitive aspect of CBT.

Positive psychology is the most viable adjunct to cognitive-behavioral therapy in the processing of DRNI. Although the program functions best in conjunction with other approaches, its focus on the positive aspects of human development and achievement not only improves our self-image and perspectives but greatly enhances overall psychological and physiological health. 

Positive psychology describes motivating personal concerns and recovery as people determining their potential and purpose by constructing and reclaiming a valued and welcoming identity. Its emphasis is on recognizing and regenerating our inherent character strengths, virtues, and attributes, which underscore our creativity, optimism, resilience, empathy, compassion, humor, and life satisfaction. It facilitates this through mindfulness, autobiography, positive writing, gratitude, forgiveness, kindness, and other self-affirming techniques. The overarching objective of positive psychology is to identify our inherent assets and capabilities to achieve our potential to become the best that we can be.

Accepting scientific validity to approaches that support DRNI encourages us to control our dysfunction or discomfort and achieve our motivating personal concerns. Achieving recovery and motivating personal concerns are not overnight achievables, however. The process is simple in theory but challenging due to the commitment and endurance required for the long-term, repetitive process of proactive neuroplasticity. We do not put on tennis shorts and advance to Wimbledon without decades of practice with racket and balls; philharmonics cater to pianists who have spent some time at the keyboard. DRNI requires a calculated regimen of deliberate, repetitive neural information. We can have all the tools we require, but they need to come out of the shed. Not only is DRNI repetitious and tedious, but it also fails to deliver immediate tangible results, causing us to readily concede defeat and abandon hope in this era of instant gratification. 

The programs that ReChanneling utilizes recommend repeating three positive personal affirmations a minimum of 15 times daily. That is about five minutes of your time. 

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops and practicums.

ReChanneling Updates

NEUROSCIENCE AND HAPPINESS. NEUROPLASTICITY AND POSITIVE BEHAVIORAL CHANGE. 90-minute video course for Academia.edu’s new series of academic offerings. It’s an exciting new venture for Academia.edu; they have been most supportive during the process.

MY EXPERIENCE OF A RECHANNLING PRACTICUM A graduate of the 10-hour ReChanneling practicum has created a website partially dedicated to his experiences. He is halfway through the five-week, 10-hour session, sharing his reactions, thoughts, and perspectives in separate posts for each hour of the practicum and including the 4 weekly post-session work-at home. Matty is a graphics and media consultant contractor with ReChanneling, and his recollections are from notes taken during the last in-person practicum before the pandemic. ReChanneling’s practicums are tentatively scheduled to begin again by the end of the year.

ENLISITNG POSITIVE PSYCHOLOGIES TO CHALLENGE LOVE WITHIN SAD’S CULTURE OF MALADAPTIVE SELF-BELIEFS in Claude-Helene Mayer,  Elisabeth Vanderheiden (Eds.) International Handbook of Love Transcultural and Transdisciplinary Perspectives now available at Amazon and other fine booksellers. Chapter can be downloaded from Springer Here.

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops, groups, and practicums.

The Impact of Unresolved Blame and Guilt in Recovery

Blame and guilt are normal emotions that become toxic when unresolved. They collaborate when blame is utilized to avoid personal accountability, and when guilt is a consequence of accepting blame for harming another. They both generate shame until or unless addressed.

Blame

Blame is the act of censuring, holding responsible, or making negative statements about the self, an individual, or group that their action(s) were wrong, and they are socially or morally irresponsible. Blame is threefold: (1) blaming others who have harmed us; (2) blaming ourselves for harming another; (3) blaming ourselves for self-harm. 

Blaming is a natural and healthy response to situations, although the initial act is often distorted. For example, children often blame themselves for household disharmony. A student may blame a failing test grade on their stupidity rather than their lack of preparedness. We blame ourselves for our dysfunction and society for making our life so difficult. We blame ourselves, our parents, our neighbors, god, and anyone caught lurking for inconsequential things or situations beyond anyone’s control.

Most of our blaming is in response to forgettable, harmless situations. Some blaming carries significant emotional weight, especially if the harm is serious or prolonged. We often carry that emotional baggage throughout our life. It is unhealthy and non-conducive to recovery. When we hold onto these feelings, we construct our neural network with anger, hurt, and resentment. To paraphrase Buddha, holding onto anger is holding onto a hot coal with the intent of throwing it at someone else; you’re the one who gets burned. Our transgressors are likely (1) unaware they injured us, (2) have forgotten the injury, (3) take no responsibility for it, (4) or don’t care. The only person negatively impacted is the blaming party.

Those who have harmed us should be held accountable, and we must take responsibility for our own transgressions. To release the negative energy, we must forgive those transgressions and move on. Why is that difficult to do? Because our anger and righteous indignation satisfy us. We also become physiologically addicted to the pleasurable chemicals that reward our hatred and resentment.

Our transgressions against another manifest in guilt and shame—negative baggage that can only be released by accepting responsibility, making amends, and forgiving ourselves.

Self-blame is one of the most toxic forms of self-abuse. Since it is irrational to self-harm, it is caused by our dysfunction. We falsely self-blame for our behaviors and our perceived character deficits caused by our dysfunction. We are not our dysfunction, therefore, any blame must be ascribed to the dysfunction; self-blame is irrational and delusory. When addressed rationally, it can lead to positive change.

Dysfunctions thrive on our self-denigration, self-contempt, and other hyphenated forms of self-abuse. Mindfulness of this supports recovery.

Guilt

Guilt is a psychological term for a natural self-conscious emotion that condemns the self while conscious of being evaluated by another person(s). It is the physiologically harmful feeling of having done something wrong, with an implicit need to correct or amend.

There are multiple levels and factors of guilt. We feel guilt for harming another, and for being the type of person who would affect harm. We feel guilt for harming ourselves. We guilt ourselves for things over which we have no control (cognitively distorted guilt).

The sensation of guilt is a reminder that we have done something wrong that we need to correct or amend. Such actions can remove the overriding vehemence of guilt from our conscience. Guilt is self-focused but highly socially relevant: It supports important interpersonal functions by, for example, encouraging adjusting or repairing valuable relationships and discouraging acts that could damage them. 

Rather than taking responsibility for guilt-provoking actions, we often play the blame game, ascribing the guilt to another entity. Since we subconsciously recognize our attribution, we add the burden of blame to the burden of guilt.

Until or unless we are mindful of our actions that elicited the guilt, and address those actions, we carry that emotional baggage throughout our life. It is unhealthy and non-conducive to self-esteem and recovery. When we hold onto guilt, we pattern our neural network with self-doubt, self-contempt, and self-unworthiness.

The harmful impact of guilt can be resolved by:

  1. Mindfulness (recognition and acceptance) of the act that incurred the guilt.
  2. Recognizing and disputing any cognitively distorting guilt for things we are not responsible for or things over which we have no control.
  3. Making direct amends for acts we are responsible for. Making substitutional amends if direct amends are not possible. 
  4. Then forgiving our self for the act that incurred the guilt. 

When we allow the negativity of guilt to take up valuable space in our brain, it impedes the flow of positive thought and action necessary for recovery. To excise this harmful negativity, we must forgive ourselves (which requires amending or remedying). Years of hanging onto guilt take their toll, and the negative self-image builds and solidifies, and overwhelms anything that hints at self-worth or value. Guilt is considered a ‘sad’ emotion, along with agony, grief, and loneliness, each a debilitating symptom of social anxiety disorder.

By withholding forgiveness, we deny ourselves the ability to function optimally; it is divisive to our wellbeing and disharmonious to our true nature. Forgiving is the only way to expel the hostility. We cannot hope to recover without courageously absolving our self and others whose behavior contributed to our negativity.

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

The Hostility of Mental Health Stigma

Mental Health Stigma (MHS) is the hostile expression of the abject undesirability of a human being who has a mental illness. It is the instrument that brands the mentally dysfunctional (victim) defective due to stereotypes. MHS is purposed to protect the general population from unpredictable and dangerous behaviors by any means necessary. MHS is fomented by prejudice, ignorance, and discrimination. The stigmatized are devalued in the eyes of others and subsequently in their self-image as well.

Between 50 and 65 million U.S. adults and adolescents have a mental illness; 90% of those will be impacted by mental health stigma, a presence that elicits unsupportable levels of shame and jeopardizes the emotional and societal wellbeing of the victim.

Origins and Evolution

The Signaling Event. MHS is triggered by a set of signals or signaling event, i.e., an occasion, experience, news story, encounter where the visibility of behaviors and mannerisms associated with mental illness elicit a reaction.

The Label. Labeling defines the signaling event and distinguishes it from other labels. ‘Woman’ is a label; it is specific, restrictive to gender, and says certain things that distinguish it from other labels. A successful label elicits a strong public reaction. The defining characteristics of the label become the stereotype. Labeling is subject to the labeler’s belief system and, like stereotype and stigma, is reliably inaccurate because of implied expectations of behavior. 

The Stereotype. Labeling gives the signal a moniker for identification; the stereotype defines it and gives it meaning. Stereotyping is a cognitive differentiation of something that piques one’s interest; everyone stereotypes. Mental health stereotyping is distinguishable by pathographic overtone that identifies the victim as unpredictable, potentially violent, and undesirable. 

Ironically, 14th century asylums in Spain and Egypt were built to protect the mentally afflicted from the dangerous and violent members of society.

Mental health labeling and stereotypes support and collaborate with preconceived notions of mental illness, generated by the natural aversion to weakness and difference. This is supported by an ignorant and prejudicial belief system and, on occasion, personal experience. Labels and stereotypes are unbound by truth or evidence; believability is the ultimate criterion.  

Stigma. A stigma is a brand or mark that negatively impacts a person or group by distinguishing and separating that person or group from others. The branding concept originated with the ancient Greek custom of identifying criminals, slaves, or traitors by carving or burning a mark into their skin. Stigma is identified by three types: (1) abominations of the body, (2) moral character stigmas, and (3) tribal stigmas. The first refers to physical deformity or disease; tribal stigmas describe membership in devalued races, ethnicities, or religions; and moral character stigma refers to persons perceived as weak, immoral, duplicitous, dishonest, e.g., criminals, substance addicts, cigarette smokers, and the mentally ill. 

Mental Health Stigma. The objective of a MHSisto protect the general population from the unpredictable and dangerous behaviors associated with mental illness by any means necessary, including deception, misinformation, and fear-baiting. Its ultimate goal is to negatively impact the social reintegration of the victim. 

  • Anticipatory stigma is the expectation of a stigma due to behavior or diagnosis, and subsequent adverse social reaction. This causes a resistance by the potential victim to disclose any physiological aberration.  
  • Stigma-avoidance identifies those who avoid or postpone treatment fearing the associated stigma will discredit them and negatively impact their quality of life. Studies indicate almost one third of the potential victims resist disclosure, impacting the potential for recovery.
  • Family-stigmatization occurs when family members reject a child or sibling because of their mental illness. Throughout history, it was commonly accepted that mental illness was hereditary or the consequence of poor parenting. A 2008 study found 25% to 50% of family members believe disclosure will bring shame to the family. (Courtesy-stigma denotes a supportive family member.)

An active stigma is a parasitic one. If it finds enough suitable hosts, the parasitosis can spread rapidly by traditional means. Studies show the aversion to mental illness is prosocially hard-wired which provides an abundance of hosts.  

Contributing Factors to MHS. The stigma triad of ignorance, prejudice, and discrimination is generated and supported by preconceived notions, general obliviousness, a lack of education, and society’s deep-rooted fear of its susceptibility. The primary attributions to MHS are public opinion, media misrepresentation, visibility, diagnosis, and the disease or pathographic model of mental healthcare. 

How MHS Affects the Victim 

MHS impacts the victim through a series of stigma experiences:

  • Felt stigma. The anticipated or implied threat of a stigma.  
  • Enacted stigma. The activated stigma. 
  • External stigma. Victim holds the perpetrator responsible for the stigma. 
  • Internalized stigma. Victim assumes behavioral responsibility for the stigma.
  • Experienced stigma. Victim’s reaction to the stigma.

The victim anticipates their mannerisms, behaviors or diagnosis will generate a stigma (felt stigma). When the stigma is realized it becomes an enacted stigma. The victim blames the person who originated the stigma (external stigma) or assumes responsibility due to behavior (internalized stigma). When the stigma impacts the victim’s wellbeing, it becomes an experienced stigma

MHS Impact. Mental health stigma can negatively affect the victim’s emotional wellbeing and quality of life by jeopardizing their:

(mind, body, spirit, and emotions)

  • Livelihood
  • Housing
  • Social status
  • Relationships

Solution

Mental health stigma will not be mitigated or eliminated until the mental healthcare community embraces the wellness model over the disease of mental health. The disease model of mental health focuses on the problem; creating a harmful symbiosis of individual and diagnosis. The wellness model https://robertfmullen.com/2020/07/21/the-disease-model-versus-the-wellness-model-of-recovery/

emphasizes the solution. A battle is not won by focusing on incompetence and weakness but by knowing and utilizing our strengths, and attributes. That is how we positively function―with pride and self-reliance and determination―with the awareness of what we are capable. 

Establishing new parameters of wellness calls for a reformation of thought and concept. In 2004, the World Health Organization began promoting the advantages of the wellness over disease perspective, defining health as a state of physical, mental and social well-being and not merely the absence of disease or infirmity. The World Psychiatric Association has aligned with the wellness model and it has become a central focus of international policy. Evolving psychological approaches have become bellwethers for the research and study of the positive character strengths that facilitate the motivation, persistence, and perseverance helpful to recovery. Wellness must become the central focus of mental health for the simple reason that the disease model has provided grossly insufficient results.

A WORKING PLATFORM showing encouraging results for most physiological dysfunctions and discomforts is an integration of positive psychology’s optimum human functioning with CBT’s behavior modification, neuroscience’s network restructuring, and other positivity targeted approaches. including affirmations, autobiography, and methods to regenerate self-esteem and motivation.

This new wellness paradigm, however, should not be a dissolution of medical model approaches but an intense review of their efficacy, and repudiation of the one-size-fits-all stance within the mental health community. 

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Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

The Value of Mindfulness in Recovery

The value of mindfulness in recovery is immeasurable

We share an intimate and unhealthy relationship with our dysfunction or discomfort that manifests in many ways. 

  • The tolerant relationship. We recognize our condition is detrimental to a healthy and productive lifestyle, but we are too lazy or apathetic to address it. 
  • The resigned relationship. We devalue our character strengths and virtues, convincing ourselves any attempt at recovery is futile. We have given up.
  • The self-pitying relationship. We wallow in our misery because it comforts us and confirms our victimization.
  • The assimilate relationship. We acclimate to our condition, adapting and incorporating it into our system. This is the odd relationship where we become our dysfunction.
  • The denial relationship. We refuse to acknowledge the problem, denying its existence, our dismissal so pervasive it subconsciously metastasizes, like unchecked cancer. 

Every physiological dysfunction and discomfort generate a correlated deficiency of self-esteem due to the condition itself, and the corresponding disruption in natural human development. The overwhelming majority of dysfunctional onset happens during adolescence due to a toxic childhood environment caused by physical, emotional, or sexual disturbance. This disturbance manifests in perceptions of abandonment, exploitation, and detachment, engendering a disruption in natural human development which negatively impacts our self-esteem 

Self-esteem is mindfulness (recognition and acceptance) of our value to our self, society, and the world. Self-esteem can be further understood as a complex interrelationship between how we think about ourselves, how we think others perceive us, and how we process or present that information. 

Self-esteem deficits are the consequence of disapproval, criticism, and apathy of influential others—family, colleagues, ministers, teachers. Any number of factors impact self-esteem including our environment, sexual orientation, race and ethnicity, and education. 

  • Our negative self-image is generated by our deficit of self-esteem.
  • Self-esteem administers and is determined by our self-properties. Positive self-properties include self -reliant, -compassionate, -confidant, -worth, etc.  Negative self-properties are self -destructive, -loathing, -denigrating, etc. 
  • Our positive self-properties tell us we are of value, consequential, and desirable.  
  • Our intrinsic self-esteem is never fully depleted or lost; underutilized self-properties can be dormant like the unexercised muscle in our arm or leg. 
  • Self-esteem impacts our mind, body, spirit, and emotions separately and in concert. Mindfulness of this complementarity is important to emotional and behavioral control as we learn to utilize each component. 
  • We rediscover and reinvigorate our self-esteem through exercises designed to help us become mindful of our inherent strengths, virtues, and attributes.  

Neural restructuring. The primary objective or consequence of recovery is the restructuring of our neural network. When neural pathways reshape, there is a correlated change in behavior and perspective. Our brain is not a moral adjudicator, but an organic reciprocator, adapting and correlating to stimuli. 

Every stimulus we input causes a receptive neuron to fire, transmitting a message from neuron to neuron until it generates a reaction. Neural restructuring is the deliberate input of positive stimuli to compensate for years of dysfunctional negative input. Deliberate repetitious stimuli compel neurons to fire repeatedly causing them to wire together. The more repetitions the quicker and stronger the new connection.

Neural restructuring is deliberate plasticity—functionally modifying our neural network through repetitive activation. Plasticity is our brain’s capacity to change with learning—to relearn. Studies in brain plasticity evidence the brain’s ability to change at any age. Behavioral Plasticity is the capacity and degree to which human behavior can be altered by environmental factors such as learning and social experience.  In theory, a higher degree of plasticity makes an organism more flexible to change, whereas a lower degree of plasticity result in an inflexible behavior pattern. Behavioral plasticity enables an organism to change its behavior through learning.

Mindfulness is the state of active, open recognition and acceptance of present realities. It is the act of embracing our flaws as well as our inherent character strengths, virtues, and attributes. Mindfulness is the key to re-engaging our positive self-properties that constitute healthy self-esteem 

True mindfulness of our dysfunction is more than recognition and acceptance; it is embracement. By embracing our flaws as well as our character strengths, virtues, and attributes, we embrace ourselves. Love is linked to positive mental and physical health outcomes. Love motivates recovery. Embracing our dysfunction or discomfort is an act of love.

Our condition is a natural component of human development. It is evidence of our humanness. Think of it as an emotional virus. We are not our dysfunction any more than we are an accidental broken limb. We are individuals with a dysfunction. Embracing it does not mean we don’t want to transform into a healthy and more productive individual; it encourages transformation. 

Embracing is not acquiescence, resignation, or condoning. Acquiescence is accepting our condition and doing nothing to change it. Condoning is accepting it and allowing it to fester. Resignation is defeatism. Embracing is logically accepting ourselves for who we are—human dysfunctional beings abounding in ability and potential. It is embracing our character strengths, virtues, and attributes that facilitate the motivation, persistence, and perseverance to recover. It is embracing our totality. Healthy self-love is a fundamental component of self-esteem; we can never strive towards our potential until we truly learn to embrace ourselves. The value of mindfulness in recovery is immeasurable. 

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

Love, Friendship, and Social Anxiety

Publications

Enlisting Positive Psychologies to Challenge Love within SAD’s Culture of Maladaptive Self-Beliefs in C.-E. Mayer, E. Vanderheiden (eds.) International Handbook of Love: Transcultural and Transdisciplinary Perspectives. Insight into the relationship deficits experienced by people with SAD. Their innate need-for-intimacy is no less dynamic than that of any individual, but their impairment disrupts the ability (means-of-acquisition) to establish affectional bonds in almost any capacity. Now available from Amazon and other fine booksellers. Prepublication draft can be accessed here.

Also

How an Honorable Psychobiography Embraces the Fluidity of Truth in New Trends in Psychobiography, Chap. 5 (pp: 79-95). Springer. doi:10.1007/978-3-030-16953-4-https://link.springer.com/book/10.1007/978-3-030-16953-4

Finding your inherent character strengths, virtues, and attributes that generate the motivation and perseverance to succeed.

The Art of Authenticity: Constantin Stanislavski and Merleau-PontyJournal of Literature and Art Studies, 6 (7):790-803 (2016). doi:10.17265/2159-5836/2016.07.010.  https://www.academia.edu/26811760/The_Art_of_Authenticity

Utilizing Stanislavski’s method for authentic stage acting to address our volatile emotions to deconstruct and better understand and control them. 

Broadening the Parameters of the Psychobiography. The Extraordinariness of the ‘Ordinary’ Extraordinary. Psychobiographical Illustrations on Meaning and Identity in Sociocultural Contexts in Palgrave series, Sociological Psychology of the Lifecourse.

Discovering the inherent character strengths, virtues, and attributes of the unheralded persons who have achieved significant and noteworthy personal milestones.

Holy Stigmata, Anorexia, and Self-Mutilation: Parallels in Pain and Imagining. Journal for the Study of Religions and Ideologies, 9:25, 2010.   (PDF) Holy Stigmata, Anorexia and Self-Mutilation: Parallels in Pain and Imagining (researchgate.net)

Addresses the types of personalities that engage in self-mutilation and how some manipulate their self-inflicted pain for healing and empowerment.

Establishing a Wellness Model for LGBTQ+ Persons with Anxiety and Depression. Academia.edu, Researchgate.com. doi:10.13140/RG.2.2.17550.38728 (PDF) Establishing a Wellness Model for LGBTQ+ Persons with a Mental Dysfunction (researchgate.net)

The wellness model’s emphasis on character strengths, virtues, 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

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

Recovery and The Willful Pursuit of Ignorance

Ignoring it does not make it go away.

The resistance to fully acknowledge our physiological dysfunction (neurosis) is a major impediment to our recovery. Many deliberately choose to remain ignorant of the destructive capability of their dysfunction. We go to enormous lengths to remain oblivious to its symptoms, characteristics, and traits as if, by ignoring them, they don’t exist or will somehow go away. Despite these efforts, the aura of undesirability cannot be muted.

Emphasis must be placed on the importance of fully recognizing and accepting our dysfunctional idiosyncrasies and how they impact our emotional wellbeing and quality of life—mentally, physically, emotionally, and spiritually (MBSE). Deliberate ignorance is tantamount to fixing a malfunctioning computer by ignoring the manual. This resistance, arguably justified by multiple attributions, is meant to protect us from our irrational self-beliefs, but the shield is unsustainable and counterproductive.

The attributions to resistance are correlated internal and external components. The former is implemented by the dysfunction, diagnosis, and the disruption in natural human development. External resistance is generated by the stigma triad of ignorance, prejudice, and discrimination. 

The overarching attributions to internal resistance are personal baggage, mental health stigma, and the natural physiological aversion to change. External attributions fall within the following categories, each informing the others:

  • Public opinion
  • Media misrepresentation
  • Visibility
  • Distancing
  • Diagnosis
  • Mental health stigma

Physiological Aversion. We are hard-wired to dislike change. Our bodies and brains are structured to resist anything that disrupts our equilibrium. Our nervous system monitors our metabolism, temperature, weight, and other survival functions. A new diet or exercise regimen produces physiological changes in our heart rate, metabolism, and respiration, which impact these functions. Inertia senses and resists these changes, making them difficult to maintain. Our brain’s basal ganglia resist any modification in patterns of behavior. Thus, habits like smoking or gambling are hard to break, and new undertakings (e.g., recovery), challenging to maintain.

Personal Baggage. Every physiological dysfunction and discomfort generates an emotional and behavioral identity due to childhood disturbance, and the corresponding disruption in natural human development. Most are more correlational than dissimilar and commonly comorbid. Their impact Is variable and distinguishable by human complexity. Many induce self-destructive decisions like substance abuse or emotional blackmail. Self-perceptions of incompetence, unattractiveness, and worthlessness are buttressed by guilt, blame, and shame. 

Public Opinion. Public aversion to mental illness is hard-wired. Individuals perceived as repugnant or weak in mind or body have suffered since the dawning of humankind. Psychological dysfunction and discomfort are components of natural human development. Scientific American speculates they are so common almost everyone will develop at least one diagnosable disorder at some point in their life. However, much of society views them differently because they see dysfunction in themselves, and it frightens them. That fear generates and is generated by prejudice, ignorance, and discrimination. 

Media Misrepresentation. TV, books, and films exaggerate the symptoms and traits of dysfunction, stereotyping the dysfunctional as annoying, dramatic, and peculiar. Portrayals suggest all persons impacted are unpredictable and dangerous. A 2011 comparative study revealed that nearly half of U.S. stories on mental illness explicitly mention or allude to violence. The media is powerful. Studies show homicide rates go up after televised heavyweight fights, and suicide increases after on-screen portrayals. 

Visibility is the public display of behaviors associated with dysfunctions. Not only are the recipients uneasy or repulsed by such behaviors, but the afflicted are vividly conscious of being observed, whether actual or imagined, and surrender to the GAZE―what psychoanalyst Lacan defines as the anxious state of mind that comes with scrutiny and unwanted attention.

Distancing is the public expression of contempt for the behaviors associated with dysfunction. Social distance varies, obviously, by diagnosis, but also by region, race and ethnicity, political persuasion, educational attainment, and economics. Distancing reflects the feelings a prejudiced group has towards another group; it is the affirmation of undesirability. In stigma research, the extent of social distance correlates to the level of discriminatory behavior. 

Mental Health Stigma is the hostile expression of the abject undesirability of a human being who has a mental illness. It is theinstrument that brands the dysfunctional as socially undesirable due to stereotype. The stigmatized are devalued in the eyes of others and thus in their own self-image as well. MHS is purposed to protect the general population from ‘unpredictable and dangerous’ behaviors by any means necessary. MHS is fomented by prejudice, ignorance, and discrimination. 

Diagnosis. impacted by the DSM, the disease model of mental healthcare, ignorance or ineptitude of mental health professionals, and misdiagnoses.  Diagnosis drives mental health stereotypes. Which dysfunction is the most repulsive, and which poses the most threat? People are concerned about the severity of the dysfunction, whether it is contagious, or whether the dysfunction was caused by certain behaviors. Will the symptoms worsen? Is the dysfunction punishment for sin, implying the more dangerous the symptoms, the worse the offense? Diagnosis is facilitated by the deficit disease model of mental healthcare via the Diagnostic and Statistical Manual of Mental Disorder which focuses on the history of harmful behavior.

The disease model assumes that emotional distress is merely symptomatic of biological illness. The Wellness Model of mental healthcare focuses on the positive aspects of human functioning that promote our wellbeing and recognize our essential and shared humanity. Positive psychologies and the Wellness Model emphasize what is right with us, innately powerful within us, our potential, and determination. Rather than disease and deficit, they emphasize our character strengths, virtues, and attributes. Recovery is not achieved by focusing on incompetence and weakness; it is achieved by embracing and utilizing our inherent strengths and abilities. 

Benefits of the Wellness Model

  • Revising negative and hostile language will encourage new positive perspectives
  • The self-denigrating aspects of shame will dissipate, and stigma becomes less threatening. 
  • The doctor-client knowledge exchange will value the individual over the diagnosis.
  • Realizing neurosis is a natural part of human development will generate social acceptance and accommodation. 
  • Recognizing that they bear no responsibility for onset will revise public opinion that people deserve their neurosis because it is the result of their behavior. 
  • Emphasizing character strengths and virtues will positively impact self-beliefs and image, leading to more disclosure, discussion, and recovery-remission. 
  • Realizing proximity and susceptibility will address the desire to distance and isolate. 
  • Emphasis on value and potential will encourage accountability and foster self-reliance.

Resistance closes the door to possibility. Nothing comes in, nothing goes out. Nonresistance is a prerequisite for recovery. We cannot recover if we do not consider our options. Nonresistance opens our minds and broadens our perspective. Consideration of new possibilities is rewarding and productive; resistance is counterintuitive to recovery.

Resistance v. Repression

RESISTANCE is the deliberate or unconscious attempt to prevent something from happening for any reason whatsoever. REPRESSION is a defense mechanism that prevents certain events, feelings, thoughts, and desires that the conscious mind refuses to accept from entering it. It is the ‘stuff’ that permeates our brain that we cannot address because we have compartmentalized it and misplaced the key. 

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

Social Anxiety Disorder: General Overview

Social anxiety disorder onsets at adolescence. The afflicted are not responsible for their dysfunction.

Social anxiety disorder (SAD) is one of the most common mental disorders, affecting the emotional and mental wellbeing of millions of U.S. adults and adolescents who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. SAD is the second most diagnosed form of anxiety in the United States. Statistics estimate 40 million U.S. adults will experience SAD. The National Institute of Mental Health estimates 9.1% of adolescents (ages 10 to 19) currently experience symptoms, and 1.3% have severe impairment. Statistics are imperfect for LGBTQ+ persons; the Anxiety and Depression Association of America estimates their susceptibility is 1.5-2.5 times higher than that of their straight or gender-conforming counterparts. All statistics are fluid, however; a high percentage of persons who experience SAD refuse treatment, fail to disclose it, or remain ignorant of its symptoms. 

Social anxiety is arguably the most underrated, misunderstood, and misdiagnosed disorder. Debilitating and chronic, SAD attacks on all fronts, negatively affecting the entire body complex. It manifests in mental confusion, emotional instability, physical dysfunction, and spiritual malaise. Emotionally, persons experiencing SAD are depressed and lonely. In social situations, they are physically subject to unwarranted sweating and trembling, hyperventilation, nausea, cramps, dizziness, and muscle spasms. Mentally, thoughts are discordant and irrational. Spiritually, they define themselves as inadequate and insignificant. 

The commitment-to-remedy rate for those experiencing SAD in the first year is less than 6%. This statistic is reflective of symptoms that manifest perceptions of worthlessness and futility. SAD also has lower recovery-remission rates because many of the afflicted are unable to afford treatment due to symptom-induced employment instability. Over 70% of SAD persons are in the lowest economic group.

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

The generic symptom of SAD is intense apprehension—the fear of being judged, negatively evaluated and ridiculed. There is persistent anxiety and fear of social situations such as dating, interviewing for a position, answering a question in class, or dealing with authority. Often, mere functionality in perfunctory situations―eating in front of others, riding a bus, using a public restroom—can be unduly stressful. 

The fear that manifests in social situations is so fierce that many SAD persons believe it is beyond their control, which manifests in perceptions of incompetence and hopelessness. Negative self-evaluation interferes with the desire to pursue a goal, attend school, or do anything that might trigger anxiety. Often, the subject worries about things for weeks before they happen. Subsequentially, they will avoid places, events, or situations where there is the potential for embarrassment or ridicule.

The overriding fear of being found wanting manifests in self-perspectives of inferiority and unattractiveness. SAD persons are unduly concerned they will say something that will reveal their ignorance, real or otherwise. They walk on eggshells, supremely conscious of their awkwardness, surrendering to the GAZE―the anxious state of mind that comes with the maladaptive self-belief they are the uncomfortable center of attention. Their social interactions can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing–every situation reactive to negative self-evaluation. 

‘Maladaptive’ is a term created by Aaron Beck, the ‘father’ of cognitive-behavioral therapy. Although maladaptive self-beliefs can occur with many psychological dysfunctions, they are most common to SAD. A maladaptive self-belief is a negative self-perspective unsupported by reality. SAD persons can find themselves in a supportive and approving environment, but they tell themselves they are unwelcome and the subject of ridicule and contempt. They ‘adapt’ negatively to a positive situation.

SAD persons are often concerned about the visibility of their anxiety and are preoccupied with performance or arousal. SAD persons frequently generate images of themselves performing poorly in feared social situations, and their anticipation of repudiation motivates them to dismiss overtures to offset any possibility of rejection. The SAD subject meticulously avoids situations that might trigger discomfort. The maladaptive perceptions of inferiority and incompetence can generate profound and debilitating guilt and shame.  

SAD is repressive and intractable, imposing irrational thoughts and behavior. 

The key to SAD’s hold on its victims is its uncanny ability to sense vulnerability in the child/adolescent. SAD is like the person who comes to dinner and stays indefinitely. It feeds off its host’s irrationality. It crashes on the couch, surrounded by beer cans drained of hope and potential. It monopolizes the bathroom, creating missed opportunities. It becomes the predominant fixture in the house. After a while, its host not only grows accustomed to having it around but forms a subordinate dependency.

SAD persons crave the companionship but shun social situations for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. People with SAD are prone to low self-esteem and high self-criticism due to the dysfunction itself, and its causal disruption in natural human development.

SAD onset occurs during adolescence and can linger in the system for years or even decades before asserting itself. Any number of situations or events trigger the infection. The SAD person could have been subject to bullying or a broken home. Perhaps parents were overprotective, controlling, or unable to provide emotional validation. In some cases, its cause is perceptual. A child whose parental quality time is interrupted by a phone call can sense abandonment. The SAD person is not accountable for their dysfunction; there is the likelihood no one is intentionally responsible. 

SAD is routinely comorbid with depression and substance abuse. Symptom are similar to those of avoidant personality disorder, panic disorder, generalized anxiety disorder, depression, substance abuse, eating disorders, OCD, and schizophrenia. Coupled with the discrepancies and disparity in its definition, epidemiology, assessment, and treatment, SAD is usually misdiagnosed.

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

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops and practicums.

Dysfunction in the LGBTQ+ Community

Establishing a Wellness Model for LGBTQ+ Persons with Anxiety and Depression and Other Physiological Dysfunctions

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 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.  

Introduction

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 wellbeing 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, anxiety. Adolescent numbers fluctuate between 8 and 18 million (CDC, 2020; NIMH, 2017); the actual number 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 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 dysfunctions, impacting the emotional wellbeing 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 is shared among a group of people who possess a common social identity” (p. 140). Culture impacts,

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 similarly 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 ahistorical 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,” whereas the wellness model focuses “on positive aspects of human functioning” (Mayer & May, 2019, p. 159). 

Studies and researchportray the mental healthcare community 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 stereotype 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 the universality, age of onset, and complementarity of mental illness and clearly differentiating 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. To 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 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. All human system components must work in concert; they cannot function alone. The simultaneous mutual interaction of all human system components—mind, body, spirit, and emotions—is required to sustain and recover from a mental dysfunction. 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 disorder: 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. A neurosis is a condition that negatively impacts our emotional wellbeing 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-Remission

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 disclose a mental disorder, seek treatment, or accept 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 stigma is 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 nonconformity. (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. LGBTQ+ persons share the added onus that their 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, “between 80-100 percent of respondents . . . favoured 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 believe “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 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, 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 images that negatively impact the self-beliefs and image of LGBTQ+ and mentally ill 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 a& 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 DSM’s 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. As well, “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 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 potentials and become the best that they can be. 

Studies support the utilization of positive psychological constructs, theories, and interventions for enhanced understanding and improvement of mental health. 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 over dysfunction, 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-centred 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 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 towards recovery-remission. All “patients with mental disorders deserve better” (Insel, 2013, p. 2). 

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort (neurosis/disorder). Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops and practicums.

References

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