The Wellness Model of Mental Health in the 21st Century
The disease or medical model has been the approach towards mental health since the dawning of civilization. It is called the pathographic perspective. Pathography is the history of our suffering. The Wellness Model focuses, not on our disease and deficits, but on our character strengths, virtues, and achievements. A disorder, condition, or dysfunction is what used to be called a neurosis. A neurosis is a common part of natural human development. It is, simply, a condition that negatively impacts our emotional wellbeing and quality of life.
The disease or medical model of ‘mental’ health focuses “on a deficit, disease model of human behavior.” The wellness model focuses “on positive aspects of human functioning.”[i] This disease model ‘defective’ emphasis has been the overriding psychiatric perspective for well over a century.
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.[ii]
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.”[iii] The World Psychiatric Association agrees, stating, “the promotion of well-being is among the goals of the mental health system.”[iv] As positive psychologists point out, “psychological wellbeing is viewed as not only the absence of mental disorder but also the presence of positive psychological resources.”[v]
The wellness model’s chief facilitator is positive psychology (PP), which originated with Maslow’s[vi] seminal texts on humanism, and was legitimated by Seligman as American Psychological Association president in 1998. The focus of positive psychology and other optimistic approaches, is on virtues and strengths “not only to endure and survive, but also to flourish.”[vii] PP 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.”[viii]
Positive psychology is a relatively new field (since 1998) that ostensibly complements and supports rather than replaces traditional psychology. “Positive psychology serves as an umbrella term to accommodate research investigating positive emotions and other positive aspects such as creativity, optimism, resilience, empathy, compassion, humor, and life satisfaction.”[ix]
PP has been defined as the science of optimal functioning, its objective “to study, identify and amplify the strengths and capacities that individuals, families and society need to thrive.”[x] Cultural psychologist Levesque[xi] describes optimal functioning as the study of how individuals attempt to achieve their personal potentials and become the best that they can be.
Research has shown that positive psychology interventions “improved well-being and decreased psychological distress in mildly depressed individuals, in patients with mood and depressive disorders, [and] in patients with psychotic disorders.”[xii] Studies supports the utilization of positive psychological constructs, theories, and interventions for enhanced understanding and improvement of ‘mental’ health. “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.”[xiii]
A range of approaches promoting wellbeing have been tested in intervention research. A recent study found positive psychology interventions showed “significant improvements in mental well-being (from non-flourishing to flourishing mental health) while also decreasing both anxiety and depressive symptom severity.”[xiv] Continuing research suggests that a positive psychological outlook not only improves life outcomes but enhances health directly.[xv] A meta-analysis of 51 studies with 4,266 individuals utilizing therapies focusing on mindfulness, autobiography, positive writing, gratitude, forgiveness, or kindness, found PPIs “significantly enhance well-being . . . and decrease depressive symptoms.“[xvi]
The academic discipline of positive psychology continues to develop evidence-based interventions that focus on eliciting positive feelings, cognitions or behaviors.[xvii] Independent research shows PPIs “decreased psychological distress [in individuals] with mood and depressive disorders [and] patients with psychotic disorders . . . improving quality of life and well-being.”[xviii] 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.”[xix]
Disease, deficit and denigration
One-size-fits-all recovery programs
Doctor-client power relationship
Emerging research data
Positive language, attitude, perspective
Client strengths and abilities
Optimal human functioning
Support and enhance traditional psychology
Emphasize character strengths & attributes
Balanced, holistic perspective
Positive Psychology 2.0. One of the early challenges of positive psychology was its inattention to the negative aspects of the individual. Recognizing this imbalance, psychologists advocated a more holistic approach to embrace the dialectical opposition of human experience. Positive Psychology 2.0 (PP 2.0) evolved as a correction to this singular focus on optimism so that it could “move forward in a more inclusive and balanced matter,[xx] incorporating both positive and negative aspects of the holistic individual. As one psychologist put it, “people are not just pessimists or optimists. They have complex personality structures.”[xxi] PP 2.0 recognizes the individual achieves optimal human functioning by living a meaningful life that comes through full engagement. PP 2.0 is a balanced approach, one that “equally considers positive emotions and strengths and negative symptoms and disorders.”[xxii]
The positive psychology perspective maintains that individuals with a ‘mental’ disorder can live satisfying and fulfilling lives regardless of symptoms or impairments associated with the diagnosis.[xxiii] Positive psychology aims “to emphasize the positive while managing and transforming the negative to increase well-being.”[xxiv]
Positive psychology focuses on enhancing wellbeing and optimal functioning rather than ameliorating symptoms. By emphasizing wellness rather than dysfunction, the positive-psychology movement aims to destigmatize ‘mental’ illness. Positive psychologists believe “the constructive use of positive psychology perspective is generally needed in contemporary research to complement the long tradition of pathogen orientation.”[xxv]
[i] 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.
[iii] 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)
[v] Sin, N. L., & Lyubomirsky, S. (2009). Enhancing Well-Being and Alleviating Depressive Symptoms with Positive Psychology Interventions: A Practice-Friendly Meta-Analysis. Journal of Clinical Psychology: In Session, 65(5), 467–487 (2009). doi:10.1002/jclp.20593
[vi] Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50(4): 370-396 (1943). doi.org/10.1037/h0054346; Maslow, A. (1954). Motivations and Personality. New York City: Harper & Brothers; Early edition.
[xiv] Schotanus-Dijkstra, M., Drossaert, C. H. C., Pieterse, M. E., Walburg, J. A., Bohlmeijer, E. T., & Smit, F. (2018). Towards sustainable mental health promotion: trial-based health-economic evaluation of a positive psychology intervention versus usual care. BMC Psychiatry 18:265, pp. 1-11 (2018). https://doi.org/10.1186/s12888-018-1825-5
[xv] Easterbrook, G. (2001). Psychology discovers happiness. I’m OK, You’re OK. The New Republic, Article 27, 6
[xvi] Sin, N. L., & Lyubomirsky, S. (2009). Enhancing Well-Being and Alleviating Depressive Symptoms with Positive Psychology Interventions: A Practice-Friendly Meta-Analysis. Journal of Clinical Psychology: In Session, 65(5), 467–487 (2009). doi:10.1002/jclp.20593
[xvii] Schotanus-Dijkstra, M., Drossaert, C. H. C., Pieterse, M. E., Walburg, J. A., Bohlmeijer, E. T., & Smit, F. (2018). Towards sustainable mental health promotion: trial-based health-economic evaluation of a positive psychology intervention versus usual care. BMC Psychiatry 18:265, pp. 1-11 (2018). https://doi.org/10.1186/s12888-018-1825-5
[xviii] Chakhssi, F., Kraiss, J. T., Sommers-Spijkerman, M., & Bohlmeijer, E.T. (2018). The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and metaanalysis. BMC Psychiatry 18:211, 1-17 (2018). https://doi.org/10.1186/s12888-018-1739-2.
[xix] 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).
[xx] Wong, P. T. P., & Roy, S. (2017). Critique of positive psychology and positive interventions. In N. J. L. Brown, T. Lomas, & F. J. Eiroa-Orosa (eds.), The Routledge International Handbook of Critical Positive Psychology, pp 142-160. London, UK: Routledge.
[xxi] Miller, A. (2008). A Critique of Positive Psychology— or ‘The New Science of Happiness.’ Journal of Philosophy of Education, 42(3-4), 591-608 (2008).
[xxii] Rashid, T., Anjum, A., Chu, R., Stevanovski, S., Zanjani, A., & Lennox, C. (2014). Strength based resilience: Integrating risk and resources towards holistic well-being. In G. A. Fava & C. Ruini (eds.), Increasing psychological well-being in clinical and educational settings (Vol. 8, pp. 153–176). Dordrecht, Netherlands: Springer.
Condition that negatively impacts your emotional wellbeing and quality of life.
Called a neurosis by DSM prior to 1980.
Facilitated by mind, body, spirit, and emotions working in concert.
Source of shame, stigma, and self-denigration.
Correctible inability to function in a ‘normal’ or satisfactory manner.
A normal facet of human development.
Language generates and supports perspective. Language influences thought and action. Not only is the word ‘mental’ inaccurate in describing a disorder, but 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 word ‘mental’ from models of healthcare. Still, we should utilize it sparingly, and only to differentiate a disorder from a physical injury or ailment.
The first descriptions that come to mind when one utilizes the word ‘mental’ are crazy and insane.A person with a disorder is not crazy or insane. She or he is someone who has a common malfunction that negatively impacts their emotional wellbeing and quality of life. Scientific American speculates that ‘mental’ disorders are so common that almost everyone will develop at least one diagnosable disorder at some point in their life.[i] A disorder is a normal facet of human development that infects at adolescence or earlier. A person cannot be held accountable for their disorder. They did not make it happen; it happened to them.
In political correctness, the word ‘mental’ defines a person or their behavior as extreme or illogical somehow. During our schooldays, anyone unpopular or different was derisively called ‘mental’ or ‘mental’ retard. The urban dictionary defines mental as someone silly or stupid. The word was used for attention, involving nonsensical references and actions, usually involving violent or divisive behavior, resulting in the general amusement and hilarity of onlookers. Add the words illness or disorder onto the adjective, ‘mental,’ and we have the public stereotype of dangerous and unpredictable, deranged persons who cannot fend for themselves, necessitating isolation in an institution.
Dictionary definitions of the adjective ‘mental’ are: (1) of or relating to the mind or (2) of, relating to, or affected by a disorder of the mind. A disorder is not mental. It is administered and facilitated by the mind, body, spirit, and emotions working in concert.
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 and sorcery and witchcraft are timeless culprits. In the early 20th century, it was somatogenic.[ii][iii] The biological approach argues that mental disorders are related to the brain’s physical structure and functioning.[iv] The pharmacological approach promotes it as an imbalance in brain chemistry. The first Diagnostic and Statistical Manual of Mental Disorders,[v] created to address the influx of veteran shell shock (PTSD), leaned heavily on environmental and biological causes.
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. 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. We know that emotions are reactive to the mind and body and vice versa. Spirit is not ethereal or otherworldly, but 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 boy.[vi]
In deference to a wellness paradigm, focusing on the word disorder (a correctable inability to function healthily or satisfactorily) and avoiding the mental description will help alleviate the healthcare system’s negativity. Changing negative and hostile language to embrace a positive dialogue of encouragement and appreciation will open the floodgates to new perspectives and positively affect the disordered person’s self-beliefs and image, leading to more disclosure, discussion, and recovery-remission. The self-denigrating aspects of shame will dissipate; mental health stigma become less threatening. The concentration on character strengths and virtues, propagated by humanism, PP2.0, and other wellness-focused alliances, will encourage client accountability and foster self-reliance, leading to a confident and energized social identity.
Transitioning from the disease model’s pathographic language to the optimistic and encouraging perspective of wellness models is everyone’s responsibility in the mental health community―its institutions, associations, practitioners, researchers, media, and clients. When ‘mental’ is essential for focus or differentiation, we recommend utilizing quotation marks (‘mental’) to diffuse its negative and harmful perspectives.
[ii] Khesht-Masjedi, M.F., Shokrgozar, S., Abdollahi, E., Golshahi, M., & Sharif-Ghaziani, Z. (2017). Exploring Social Factors of Mental Illness Stigmatization in Adolescents with Mental Disorders. Journal of Clinical and Diagnostic Research, 11(11) (2017). doi: 10.7860/JCDR/2017/27906.1083.
[iii] Pryor, J.B., Reeder, G.D., Monroe, A.E., & Patel, A. (2009). Stigmas and Prosocial Behavior Are People Reluctant to Help Stigmatized Persons in S. Stürner, M. Snyder (Eds.) The Psychology of Prosocial Behavior, (pp.59-80). New York City: John Wiley and Sons. doi:10.1002/9781444307948.ch3
[v] Knaak, S., Mantler, E., Szeto, A. (2017). Mental illness-related stigma in healthcare. Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111-116 (2017). doi:10.1177/0840470416679413
I am always in your corner throughout the process of recovery, from your program’s inception through your core-work, your neural network restructuring, the imple-mentation, and onto your recovery for as long as it takes. Your disorder has impacted your life in varying degrees since adolescence; recovery is a long-term commitment. I am your guide, your teacher, and your companion. I am with you every step of the way.
What is a mental ‘disorder’ in the wellness model of recovery? A mental disorder is any of the many neuroses that negatively impacts your emotional wellbeing and quality of life. It is defined as the inability to function healthily or satisfactorily and it is correctible. There are nine types of depression, several anxiety disorders, nine obsessive-compulsive disorders, five types of stress response, and ten personality disorders sharing similar traits and symptomatology. Every personality, experience, and cause of onset is unique. Every individual is affected differently, in varying degrees of intensity and impact. Rather than focusing on what is wrong with you, however, the wellness model emphasizes your character strengths and abilities that facilitate your recovery. You have always had the power to change; you need to embrace it and make it work for you. In the words of Nelson Mandela, you are the master of your fate and the captain of your destiny.
There are five steps to an effective platform of recovery. The first is customizing a program that addresses your individual needs and personality. Next is the core-work of learning the techniques and mechanisms that will lead you towards recovery. Simultaneously, we will go through the process of restructuring your neural network. The fourth step is going out, together, into the community, to implement what you are learning through positive exposure. Finally, it is achieving remission or one-year recovery. But my support does not have to stop there, because recovery is a journey, not a final destination. Replacing your negative thoughts, behaviors, and self-image with positivity and empowerment holds the key to your future wellbeing and happiness and I am with you every step of the way.
One-size-fits-all approaches are inadequate to address the complexity of the individual personality. The insularity of cognitive-behavioral therapy, positive psychology, and other methods cannot comprehensively address the personality’s dynamic complexity. Recovery programs must be fluid. Addressing the complexity of the individual personality demands integrating multiple traditional and non-traditional approaches, developed through client trust, cultural assimilation, and therapeutic innovation.
Any recovery program must consider your environment, hermeneutics, history, and autobiography in conjunction with your wants, needs, and aspirations. Absent that your complexity is not valued, and the treatment inadequate. A working platform showing encouraging results for most disorders is an integration of positive psychology’s optimum human functioning with CBT’s behavior modification, neuroscience’s network restructuring, and other personalized supported and non-traditional approaches. You are not your disorder. You are an individual who is impacted by a disorder―a person unique and special, unlike any other. Your recovery must reflect that individuality.
Over the past decade, I have facilitated groups and practicums for persons with depression, anxiety, and other disorders. I have created programs to facilitate recovery. 40 countries have accessed my work, and my latest article on social anxiety disorder is due for release by Springer. As an individual who battled severe social anxiety for 30 years, I understand the value and necessity of creating a platform of recovery entirely focused on your individual needs and personality.
Currently, the COVID19 crisis makes it impossible for us to go into the community and implement all the hard work we do together, but that should not discourage your recovery efforts. We will prioritize the core-learning and neural network restructuring in preparation for the implementation phase post COVID19. You will be even better prepared and more confident.
Every challenge presents opportunity, and the platform for recovery we prepare together will be even more durable. I urge you to resist the temptation to procrastinate your recovery during this crisis. The comprehensive, personalized level of commitment I provide to my clients severely limits the number of persons I can help. If your condition is affecting your emotional wellbeing and quality of life, now is the best opportunity to do something about it. Get in touch with me as soon as possible, so we can create your individualized program and begin your recovery process. You deserve the best life possible, and nothing should hold you back. For all sad words of tongue and pen, the saddest are these, “It might have been.”
Healthy philautia is an essential element of self-esteem. It embraces the positive aspects of self-love and facilitates our positive self-qualities (i.e., self -compassion, -love, -regard, -respect, -value, -worth, and other intrinsic wholesome attributes). Aristotle argued in the Nichomachean Ethics that healthy philautia was the precondition for all other forms of love.[i]
In psychological terms, healthy philautia adjuncts to other modification programs engineered to overcome or replace maladaptive self-beliefs and behaviors that have supplanted positive self-qualities due to a disruption in our natural human development. Healthy philautia serves as a more focused revitalization tool in CBT’s self-esteem reinforcement and or positive psychology’s optimal functioning. Healthy philautia’s primary psychological application is to regenerate the self-esteem that supports us and our intrinsic goodness.
What causes a deficit of self-esteem?
Maslow’s hierarchy of needs reveals how childhood/adolescent exploitation can disrupt their human development.[ii] Healthy evolution requires satisfying fundamental physiological and psychological needs. The child/adolescent experiencing detachment, exploitation, or neglect, may be disenabled from satisfying her or his physiological and safety needs and the need to belong and experience love, which can impact their acquisition of self-esteem. Self-esteem is the recognition of our value; value is the accumulation of positive self-qualities that generate character strength and virtue.
The deprivation of any fundamental need can detrimentally impact our wellbeing. Wellness models’ psychological positivity addresses this lacuna by emphasizing our character strengths that facilitate motivation and persistence/perseverance.
To Aristotle, healthy philautia is vigorous in its orientation to self and others in its potential goodness. By contrast, its darker variant portends disastrous consequences due to its narcissism, arrogance, and egotism. Healthy philautia encourages the development of our intrinsic positive self-qualities. Positive self-qualities determine our relation to self, to others, and the world. They provide the recognition that we are of value, consequential, and worthy of love. Healthy philautia is vital in every sphere of life and can be considered a basic human need.” [iii] To the Greeks, healthy philautia “is the root of the heart of all the other loves.” [iv] Gadamer writes of healthy philautia: “Thus it is; in self-love, one becomes aware of the true ground and the condition for all possible bonds with others and commitment to oneself.” [v] Healthy philautia is the love that is within oneself. It is not, explains Jericho, “the desire for self and the root of selfishness.” [vi]
Philautia is a binary category of classical Greek love, which embraces both its healthy and unhealthy aspects. Unhealthy philautia is akin to clinical narcissism―a mental condition in which people function with an “inflated sense of their own importance [and a] deep need for excessive attention and admiration,” behind which “lies a fragile self-esteem that’s vulnerable to the slightest criticism.” [vii] Citizens of Athens could be accused of unhealthy philautia if they placed themselves above the greater good. Today, hubris has come to mean “an inflated sense of one’s status, abilities, or accomplishments, especially when accompanied by haughtiness or arrogance.” [viii]
The Greeks believed that the narcissism of unhealthy philautia could not exist without its complementary opposition of healthy philautia. Positive psychology 2.0 recognized this by emphasizing the need to focus on both our negative and positive qualities. Just like we would not recognize light without darkness, or heat without cold―to know goodness is to understand evil.
Healthy philautia is essential for a good life; it is easy to recognize how the continuous infusion of healthy philautia and its reacquisition of positive self-qualities supports self-respect, reliance, and appreciation of our potential. “One sees in self-love the defining marks of friendship, which one then extends to a man’s friendships with others.” [ix] Recognition of our inherent value generates the realization that we are “a good person who deserves to be treated with respect.” [x] A good person is spiritually, one that is loved. “To feel joy and fulfillment at being you is the experience of philautia.” [xi] It is through recognition of our positive self-qualities and their contribution to the general welfare that we rediscover our intrinsic capacity for love.
[i] Lomas, T. (2017). The flavours of love: A cross‐cultural lexical analysis. Journal for the Theory of Social Behaviour, 48(1): 134-152 (2017). doi:10.1111/jtsb.12158.
[ii] Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50(4): 370-396 (1943). doi.org/10.1037/h0054346.
[iii] Sharma, A. (2014). Self-Esteem Is the Sense of Personal Worth and Competence That Persona Associate with Their Self – Concepts. IOSR Journal of Nursing and Health Science, 3(6), Ver.4: 16-20.
[iv] Jericho, L. (2015). Inner spring: Eros, Agape, and the Six Forms of Loving. Lilipoh, 20 (79): 38-39.
[v] Gadamer, H-G. (2009). Friendship and Solidarity. Research in Phenomenology, 39: 3-12. (2009). doi:10.1163/156916408X389604
[vi] Jericho, L. (2015). Inner spring: Eros, Agape, and the Six Forms of Loving. Lilipoh, 20 (79): 38-39.
Social anxiety disorder (SAD) is one of the most common mental disorders affecting the emotional and mental wellbeing of over 15 million U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. SAD is the second most diagnosed form of anxiety in the United States.[i] The National Institute of Mental Health[iii] report 31.1% of U.S. adults experience some anxiety disorder at some time in their lives. Statistics are imperfect for the LGBTQ community; the Anxiety and Depression Association of America estimates their rate is 1.5-2.5 times higher “than that of their straight or gender-conforming counterparts.”[iv]
SAD is the most common psychiatric disorder in the U.S. after major depression and alcohol abuse.[v] It is also arguably the most underrated and misunderstood. A “debilitating and chronic” affliction, SAD “wreaks havoc on those who suffer from it.”[vi] SAD attacks all fronts, negatively affecting the entire body complex, delivering mental confusion, emotional instability, physical dysfunction, and spiritual malaise. Emotionally, persons experiencing SAD feel depressed and lonely. In social situations, they are physically subject to unwarranted sweating and trembling, hyperventilation, nausea, cramps, dizziness, and muscle spasms. Mentally, thoughts are discordant and irrational. Spiritually, they define themselves as inadequate and insignificant. Approximately, only 5% of SAD persons commit to early recovery, reflective of symptoms that manifest maladaptive self-beliefs of worthlessness and futility. SAD has lower recovery-remission rates because many are unable to afford treatment due to SAD induced “impairments in financial and employment stability.”[vii] Over 70% of SAD persons “are in the lowest economic group.”[viii]
Feeling anxious or apprehensive in certain situations is normal; most individuals are nervous speaking in front of a group and anxious when pulled over on the freeway. The typical individual recognizes the ordinariness of a situation and accords it appropriate attention. The SAD person anticipates it, takes it personally, dramatizes it, and obsesses on its negative implications. Social anxiety disorder is a pathological form of everyday anxiety. The clinical term “disorder” identifies extreme or excessive impairment that negatively affects functionality.
The superficial overview of SAD is intense apprehension—the fear of being judged, negatively evaluated and ridiculed. There is persistent anxiety or fear of social situations such as dating, interviewing for a position, answering a question in class, or dealing with authority. Often, mere functionality in perfunctory situations―eating in front of others, riding a bus, using a public restroom—can be unduly stressful. The overriding fear of being found wanting manifests in perspectives of inadequacy and unattractiveness. SAD persons are unduly concerned they will say something that will reveal their ignorance, real or otherwise. They walk on eggshells, supremely conscious of their awkwardness, surrendering to the GAZE―the anxious state of mind that comes with the maladaptive self-belief they are the center of attention. Their movements can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing, and every situation is reactive to negative self-evaluation. They are apprehensive of potential “negative evaluation by others,” concerned about “the visibility of anxiety, and preoccupation with performance or arousal.”[ix] SAD persons frequently generate images of themselves performing poorly in feared social situations, and their anticipation of repudiation motivates them to dismiss overtures to offset any possibility of rejection. SAD is repressive and intractable, imposing irrational thought and behavior. It establishes its authority through its subjects’ defeatist measures produced by distorted and unsound interpretations of actuality that govern perspectives of personal attractiveness, intelligence, competence, and other errant beliefs.
SAD persons crave others’ company but shun social situations for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. People with social anxiety disorder are prone to low self-esteem and high self-criticism.
Anxiety and other personality disorders are branches of the same tree. There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression and substance-abuse.
For over 50 years, cognitive-behavioral therapy has been the go-to treatment for SAD. Only recently have experts determined that CBT is ineffective unless combined with a broader approach to account for the disorder’s complexity and the individual personality. A SAD subject subsisting on paranoia sustained by negative self-evaluation is better served by multiple non-traditional and supported approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation with CBT, positive psychology, and neural restructuring serving as the foundational platform for integration.
[vii] Gregory. B., Wong, Q. J. J., Craig, D., Marker, C. D., & Peters, L. (2018). Maladaptive Self-Beliefs During Cognitive Behavioural Therapy for social anxiety disorder: A Test of Temporal Precedence. Cognitive Therapy and Research, 42(3): 261–272 (2018). doi.org/10.1007/s10608-017-9882-5
[viii] Nardi, A. E. (2003). The social and economic burden of social anxiety disorder. BMJ, 327 (2003).doi:10.1136/bmj.327.7414.515
[ix] Tsitsas, G. D., & Paschali, A. A. (2014). A Cognitive-Behavior Therapy Applied to a Social Anxiety Disorder and a Specific Phobia, Case Study. Health Psychology Research, 2(3): 1603 (2014). doi:10.4081/hpr.2014.1603.
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 delineation of a person’s psychological disorders, 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?
[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
[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.
[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 Psychiatry; 62(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.
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.
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.
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 diksorder 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.