Category Archives: ReChanneling

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Our Role in Recovery

http://ReChanneling.org

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

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

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

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

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


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

The Wellness Model versus the Disease Model of Recovery

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

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

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

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

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

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

References

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

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

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

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

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

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

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

What is a ‘Mental’ Disorder?

Wellness Model of Mental Health

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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. Lunar influence and sorcery and witchcraft are timeless culprits. In the early 20th century, it was somatogenic.[i] The biological approach argues that “mental disorders are related to the brain’s physical structure and functioning.” [ii] The pharmacological approach promotes it as an imbalance in brain chemistry. The 1st Diagnostic and Statistical Manual of Mental Illness (1952) was produced to address the influx of veteran shell shock (PTSD) and leaned heavily on environmental and biological causes. 

One only needs the American Psychological Association’s [iii] 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. The 3rd 

The 3rd Diagnostic and Statistical Manual of Mental Disorders abandoned the word ‘neurosis’ in 1980, but it remains the go-to term in the mental health community. Its etymology is the Greek neuron ‘nerve’ and the modern Latin osis ‘abnormal condition.’ Coined by a Scottish physician in 1776, neurosis was then defined as functional derangement arising from disorders of the nervous system. 

U.S. 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.” [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). ‘Pathos’ is the Greek word for ‘suffering’ and the root of pathetic, and ‘graphy’ is its biographic rendering. Pathography is the history of an individual’s suffering, aka, a morbid biography. Pathography focuses “on a deficit, disease model of human behaviour,” whereas the wellness model focuses “on positive aspects of human functioning.” [v]

Realistically, most terms for mental illness cannot be eliminated from the culture. Unfortunately, the negative implications of the term and its derivatives promulgate perceptions of incompetence, ineptitude, and undesirability. It is the dominant source of stigma, shame, and self-denigration. In deference to a wellness paradigm, we choose the word ‘disorder’―defined as a correctable inability to function healthily or satisfactorily―over historical terms of pathographic influence.

There are four stages to any illness: susceptibility, onset, gestation, and manifestation. A disorder onsets (client is infected) and manifests (client is affected)―there can be no disagreement about that. Childhood/adolescent exploitation creates the susceptibility to the onset of a disorder, and the holism of the host―mind, body, spirit, and emotions―nurtures it. 

Carl Roger’s study of homeodynamics, or 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. Integrality describes the inter-cooperation of the human system and the environment and social fields. A disorder is not biologic, hygienic, neurochemic, or psychogenic, but a collaboration of these and other approaches administered by the mind, body, spirit, and emotions (MBSE) working in concert. 

There is no legitimate argument against mind-body collaboration in disease and wellness. Emotions are reactive to the mind and body; spirit’s participation merits explanation. First, spirit is not ‘super,’ but it is a natural component of human development. While some suggest spirit as the seat of emotions and character, the three are distinct entities. Spirit forms the definitive or typical elements in the character of a person. Emotions are the expressions of those qualities, responsive to the mind and body.[vi] 

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

Research shows that the onset of disorders happens, ostensibly, to adolescents or younger who have experienced detachment, exploitation, and or neglect. Childhood/adolescent susceptibility to all disorders is plausible because, statistically, 89% of onset happens during adolescence.[vii] However, because symptoms can remain dormant until they manifest in the adult, statistics are indeterminate. This paper posits that childhood/adolescent-onset or susceptibility to onset is total. Claims or ‘evidence’ that onsets occur later in life do not impact the argument that susceptibility to onset originates during childhood/adolescence. 

Anything that interferes with a child’s social development is detrimental to adolescent and adult emotional health. Childhood/adolescent exploitation or abuse is a generic term to describe a broad spectrum of experiences that interfere with their optimal physical, cognitive, emotional, and social development.[viii] Any number of situations or events can trigger the susceptibility to onset; it could be hereditary, environmental, or some traumatic experience.[ix] Inheritability is rare and susceptible to other factors, and traumatic experience is environmental.

The cumulative evidence that childhood and adolescent occasions and events are the primary causal factor in lifetime emotional instability has been well-established. This exploitation interferes with the optimal physical, cognitive, emotional, and social development of the child. Most importantly, it affects our self-esteem, which administrates all our positive self-qualities (self-respect, -reliance, -compassion, -worth, and so on). These are the intangible qualities that make up our character, our goodness, our spirit. Our self-esteem is reactive to―and, in turn, impacts―our body, mind, and emotions. They all work together in concert. If one is affected, all are affected. 

Despite the implication of intentionality in the words’ abuse.’ and ‘exploitation,’ much can be perceptual. A toddler who senses abandonment when a parent is preoccupied could develop emotional issues[x] Onset or susceptibility to onset should never be considered the child/adolescent’s fault and may be no one’s fault.

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,” [xi] or that mental illness is God’s punishment for sin or amoral behavior. Again, it is crucial to recognize we are not responsible for our disorder. Quite possibly, no one is at fault. Playing the blame game only distracts from the solution: What are we going to do about it?

References

[i] Bertolote, J. (2008). The roots of the concept of mental health. World Psychiatry, 7(2): 113-116 (2008). doi:10.1002/j.2051-5545.2008.tb00172.x; Farreras, I. G. (2020). History of mental illness. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers. http://noba.to/65w3s7ex

[ii] McLeod, S. (2018). The Medical Model. (Online.) Simply Psychology. https://www.simplypsychology.org/medical-model.html

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

[iv] Salzer, M. S., Brusilovskiy, E., & Townley, G. (2018). National Estimates of Recovery-Remission from Serious Mental Illness. Psychiatric Services, 69(5) 523-528 (2018). https://doi.org/10.1176/appi.ps.201700401; SAMSHA. (2017).  2017 National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration.  (Rockville, MD: SAMHSA. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#:~:text=Serious%20 mental%20illness%20(SMI)%20is,or%20more%20major%20life%20activities.

[v] Mayer, C.-H., & May, M. (2019). The Positive Psychology Movement. PP1.0 and PP2.0. In C-H Mayer and Z. Kőváry (Eds.), New Trends in Psychobiography (pp. 155-172). Springer Nature Switzerland. https://doi.org/10.1007/978-3-030-916953-4_9.

[vi] Mullen, R.F. (2018). ‘Mental’ Disorders. ReChanneling.org. http://www.rechanneling.org/page-12.html 

[vii] Baron, M., Gruen, R., Asnis, l., Kane, J. (1983). Age-of-onset in schizophrenia and schizotypal disorders.Clinical and genetic implications. Neuropsychobiology,10(4):199-204 (1983). doi:10.1159/000118011; Kessler, R. C., Berglund, P., Demler, O., Jin,  R., Merikangas,  K. R., & Walters, E. E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry62(6):593–602 (2005). doi:10.1001/archpsyc.62.6.593; Jones, P. (2013). Adult mental health disorders and their age at onset. British Journal of Psychiatry, 202(S54), S5-S10. doi:10.1192/bjp.bp.112.119164

[viii] Steele, B.F. (1995). The Psychology of Child Abuse. Family Advocate, 17 (3). Washington, DC: American Bar Association.

[ix] Mayoclinic. (2019). Mental Illness. (Online.) Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968; NIH. (2019).Child and Adolescent Mental Health. (Online.) National Institute of Health. https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

[x] Lancer, D. (2019). What is Self-Esteem? (Online.) PsychCentral. https://psychcentral.com/lib/what-is-self-esteem/  Accessed 19 November 2019.

[xi] Corrigan, P. (2006). Mental Health Stigma as Social Attribution: Implications for Research Methods and Attitude Change. Clinical Psychology Science and Practice, 7(1), 48-67 (2006). Doi:10.1093/clipsy.7.1.48.

How Our Disorder Impacts Our Quality of Life.

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

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

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

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

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

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

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

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

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

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

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

Why One-Size-Fits-All Approaches Fail

Recovery programs must reflect our unique and individual personalities.

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

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


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

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

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

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

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

How Did It Happen?

Healthy human development requires satisfying fundamental human needs.

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The cumulative evidence that childhood and adolescent exploitation is a primary causal factor in lifetime emotional instability has been well-established. This is likely the cause of our disorder. Detachment, exploitation, and abandonment in our formative years can manifest in chronic depression, and feelings of helplessness, hopelessness, and unworthiness. We may be prone to repetitive patterns of shallow relationships. We may have difficulty trusting others;  we may be afraid of intimacy and commitment.  Add to these, debilitating anxiety, codependence, feelings of insecurity, isolation, and the loss of control over life.

In Maslow’s hierarchy theory, the orderly flow of social and emotional development requires satisfying specific fundamental human needs. The adolescent experiencing detachment, exploitation, or neglect, is disenabled from fulfilling his or her physiological and safety needs and the need to belong and experience love.

Maslow’s hierarchy illustrates how childhood abuse can impact natural human development

Child psychologist B.F. Steele maintains “abuse” includes events that interfere with the optimal physical, cognitive, emotional, and social development of the child. The term is subdivided into physical, sexual, and emotional abuse and various forms of neglect, all of which can occur alone or in combination. Maslow’s hierarchy is not a purely linear exercise, and it is not absolute that one level of needs must be satisfied to get to the next level. The list of individuals who have been deprived of fundamental needs yet achieved greatness is long and inspirational. But disruptions in our natural human development makes it more difficult. We did not make it happen; it happened to us as a child/adolescent. It is not our fault, but it is our responsibility to do something about it. 

Overcoming Our Resistance

Resistance is the deliberate or unconscious attempt to prevent something from happening.

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Our resistance is the first hurdle to recovery, and it is a formidable one. Resistance comes in many forms, and it has multiple attributions. We are usually unaware of it or refuse to admit it. There are seven legitimate causes of our resistance that need to be recognized and overcome. 

CHANGE. We are hard-wired to dislike change. Our bodies and brains are structured to resist anything that disrupts our equilibrium. Our body monitors our metabolism, temperature, weight, and other survival functions to balance and perform properly. A new diet or exercise regimen, for example, produces physiological changes in our heart rate, metabolism, and respiration, which impact these functions. Inertia senses these changes and resists them by making it difficult for us to maintain them. Our brain’s basal ganglia resists any change in our patterns of behavior. Therefore, habits like smoking or gambling are hard to break, and new undertakings challenging to maintain.

PERSONAL BAGGAGE: The various disorders affect us differently, and our personalities are unique; while there are similarities, no two situations are identical. A person with anxiety may be uncomfortable contributing to the classroom, while those with issues of self-esteem have difficulty establishing healthy relationships. Many of us make self-destructive decisions like substance abuse or emotional blackmail to feel viable or to numb us to the pain of our inadequacy. We may feel angry, incompetent, resentful, or worthless. This personal baggage makes commitment difficult; we have beaten ourselves so often we resist anything new, especially something of personal benefit. 

PUBLIC OPINION. Public aversion to mental illness is hard-wired. What is perceived as repugnant or weak in mind or body has suffered since the dawning of man. Having a disorder is not a sign of weakness or strength. It is an intrinsic part of nature. Much of society views it differently because they see our disorder in themselves, and it frightens them. That fear is reinforced by prejudice, ignorance, and discrimination. One would hope that negative public opinion would evolve, but studies indicate it has fluctuated since World War II but remains steadfast. 

MEDIA REPRESENTATION. TV, books, and films exaggerate dysfunction, stereotyping us as annoying, dramatic, and peculiar. More extreme portrayals suggest we 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. Half of the disordered surveyed by Mind, a London organization, focused on improving mental healthcare standards, said media coverage had a negative effect on their mental health. The media is powerful. Studies show homicide rates go up after televised heavyweight fights, and suicide rates increase after on-screen portrayals. Television content leads to an inflated estimate of adultery and crime rates and negative self-appraisal. 

VISIBILITY is the public display of behaviors associated with disorders. Not only is the public uneasy or repulsed by such behaviors, but we also are conscious of being watched, whether it is real or imagined, and often surrender to the GAZE―what psychoanalyst Lacan defines as the anxious state of mind that comes with scrutiny and unwanted attention.

UNDESIRABILITY.  Distancing is the public’s psychological expression of aversion and contempt for the behaviors associated with our disorder. Social distance varies by diagnosis. In a 2000 study, 38–47% of respondents supported a desire for social distancing from individuals with depression. The range was most significant for those with drug abuse disorders, followed by alcohol abuse, and depression. 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 loosely corresponds to the level of discriminatory behavior. E

DIAGNOSIS. Diagnosis drives mental health stereotypes. Which disorder is the most repulsive, and which poses the most threat? People are concerned about the severity of our disorder, whether it is contagious, or whether our behaviors caused the disorder. Will the symptoms worsen? Is our disorder punishment for our sins, implying the more dangerous the symptoms, the worse the offense. Do not believe everything you read on the internet, chose your friends wisely, and take what your relatives have to say with a grain of salt.

Resistance v. Repression

RESISTANCE is our 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 our conscious mind refuses to accept from entering it. It is more of that stuff that clogs our brain and impacts our thoughts and behaviors, but we cannot address it because we don’t know it’s there. We have compartmentalized it and misplaced the key.