Tag Archives: Motivation

Positive Psychology and the Wellness Model

The Disease Model focuses on the problem; the Wellness Model emphasizes the solution.

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 (Medical) Model

  • Pathography/etiology
  • DSM intractability
  • Systemic pessimism
  • Disease, deficit and denigration
  • One-size-fits-all recovery programs
  • Doctor-client power relationship
  • Rampant Misdiagnosis

Wellness Model

  • Communication
  • Optimal functioning
  • Emerging research data
  • Positive language, perspective
  • Client strengths and abilities
  • Program integration
  • Individual dynamics

Positive Psychology

  • Optimal human functioning
  • Support and enhance traditional psychology
  • Emphasize character strengths & attributes
  • Evidence-based interventions
  • 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]

___________________


Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of psychological 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.

____________________

[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.

[ii] 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/ 

[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)

[iv] 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).

[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.

[vii] 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.

[viii] 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).

[ix] Ibid.

[x] Carruthers, C., & Hood, C. D. (2005).  The Power of Positive Psychology. Parks and Recreation.  .file:///C:/Users/rober/ OneDrive/ Pending/New%20Psychobiography/carruthers%20x.pdf 

[xi] Levesque, R. J. R. (2011). Optimal Functioning. In Levesque R. J. R. (eds) Encyclopedia of Adolescence. New York City: Springer. doi:https://doi.org/10.1007/978-1-4419-1695-2

[xii] 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.

[xiii] Carruthers, C., & Hood, C. D. (2005).  The Power of Positive Psychology. Parks and Recreation.  .file:///C:/Users/rober/ OneDrive/ Pending/New%20Psychobiography/carruthers%20x.pdf 

[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.

[xxiii]  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)

[xxiv] 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.

[xxv] Ibid.

Why We Should Avoid the Term ‘Mental.’

“Everyone will develop at least one diagnosable disorder in their lifetime.”

‘Mental’ Disorder

  • 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.

We are not accountable for the hand we have been dealt. We are responsible for how we play the cards.

___________________

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of psychological 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.

____________________

[i] Henderson, C., Noblett, J., Parke,  H., Clement, S., Caffrey, A., Gale-Grant,  O., Schulze,  B., Druss,  B., & Thornicroft, G. (2014).     Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry,  1(6), 467-482 (2014). doi:10.1016/S2215-0366(14)00023-6.

[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

[iv] Gray, A.J. (2002). Stigma in Psychiatry. Journal of the Royal Society of Medicine, 95(2): (2002). doi:10.1258/jrsm.95.2.72

[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

[vi] Mullen, R. F. (2018). Social Anxiety Disorder. (Online.). https://rechanneling.org/page-20.html

The Wellness Model versus the Disease Model of Recovery

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

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.

____________________

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of psychological 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.

____________________

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 are Psychological Dysfunctions and Discomforts?

Psychological dysfunction and discomfort are common elements of natural human development.

http://ReChanneling.org

What are psychological dysfunctions and discomforts and how do they differ? Both are conditions that can result in functional impairment which interferes with or limits one or more major life activities, both are neuroses that impact our emotional wellbeing, and both are correctible through the same basic processes. It’s really a matter of severity. A discomfort is a condition that impacts our quality of life, a dysfunction is a diagnosable condition that impacts our quality of life. The disease model of mental healthcare labels the latter a mental illness or disorder.

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 Disorders (DSM) was produced in 1952 to address the influx of veteran shell shock (PTSD). It 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 DSM-3 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. 

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). ‘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 behavior,” 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. 

The fact is that simultaneous mutual interaction of all our human system components is required for sustainability-of-life and sustainability of a psychological dysfunction, which is not ‘mental,’ biologic, hygienic, neurochemical, or psychogenic, but all of these things facilitated by all our human system components – mind, body, spirit, and emotions – 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 are all dysfunctional to some extent. Psychological dysfunction and discomfort are common elements of natural human development. Scientific American speculates psychological dysfunction is so common almost everyone will develop at least one diagnosable disorder at some point in their life. Dysfunction and discomfort are, simply, conditions that negatively impact our emotional wellbeing and quality of life and there is nothing abnormal or unusual about them. 

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.

Research shows that the onset of dysfunction 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?

____________________

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of psychological 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.

____________________

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.

Why One-Size-Fits-All Approaches Fail

Recovery programs must reflect individual over diagnosis.

Personal recovery from psychological dysfunction and discomfort 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. It is myopic of recovery programs to lump us into a single niche. Recovery programs must address the complexities of the individual personality. The insularity of cognitive-behavioral therapy, positive psychology, interpersonal therapy, and other approaches cannot address the dynamic complexities of our personality.

It is myopic of recovery programs to lump us into a single niche. Stereotyping is what people do in lieu of getting to know the individual. Judging by public opinion, a person with a psychological dysfunction is unpredictable, potentially violent, and undesirable individual―a claim supported by the stigma triad of ignorance, prejudice, and discrimination.

We are not toasters, mass-produced in a factory. We have individual personalities generated by everything and anything experienced in our lifetime. Every teaching, opinion, belief, and influence facilitates personality development. It is our current being and the expression of that being. It forms itself by core-beliefs and is developed by social, cultural, and environmental experiences. It is constant yet fluid, singular yet multiple. It is our inimitable way of thinking, feeling, and behaving. It is who we are, who we think we are, and who we are destined to become. Any evaluation and treatment program must comprehensively address the complexity of the individual personality.

In the disease model of mental healthcare, we are treated as the diagnosis rather than the individual with concerns and issues. Unfortunately, the traits, characteristics, and symptoms defined by diagnosis are subject to substantial deviations in definition, epidemiology, and treatment. Mental health experts maneuver among eight or 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 with varying degrees of impact. 

The disease model of mental health focuses on what is wrong with us. It is based on the history of our negative behavior. The Wellness Model of mental health focuses on our character strengths and virtues that generate the motivation, persistence, and perseverance to recover. A battle is not won by focusing on incompetence and weakness; it is won by knowing and utilizing inherent strengths and attributes. That is how we successfully recover―with pride and self-reliance and determination―with the awareness of what we are capable of. 

All treatment programs are flawed to some extent; integration into a platform of approaches can compensate for that ineffectiveness. Let us use the example of cognitive-behavioral therapy. Almost 90 percent of the approaches to recovery involve cognitive-behavioral treatments. Critical studies dispute CBT’s efficacy, claiming it fares no better than non-CBT programs. They claim its effectiveness has deteriorated since its introduction, concluding it is no more successful than mindfulness-based therapy for depression and anxiety.

Despite these criticisms, the program of thought and behavior modification pioneered by Beck in the 1960s is still useful in modifying the irrational thoughts and behaviors that sustain a disorder when used in concert with other approaches.

One such integration is utilizing positive psychology in the cognitive behavioral therapy model: CBT would modify automatic negative self-beliefs, thoughts, and behaviors, and positive psychology would emphasize positive replacement. The Wellness Model’s chief facilitator, positive psychology focuses on our virtues and strengths that help us transform and flourish, but the approach has its critics, too. They claim positive psychology is still in its formative stage and, despite recent scientific attention to the positive spectrum of human potential, has yet to be integrated into mainstream theory, assessment, and treatment options.

Until recently, the focus on optimal functioning’s positive aspects ignored the individual’s holism by neglecting their negative aspects. The emergence of PP2.0 rectified the lacuna. Positive psychology now emphasizes the positive while managing and processing the negative to increase wellbeing, but this is still innovative and not thoroughly tested. This is no t to disparage evidenced-based solutions but to show how an evolving customized platform is the better option. 

Focusing on the individual personality would compensate for the statistical failures of diagnosis based on the disease model’s reliance on DSM criteria. Even mainstream medical authorities have begun to recognize the unreliability of conventional psychiatric diagnosis. A recent Canadian study reported, of 289 participants in 67 clinics meeting DSM-IV criteria for social anxiety disorder, 76.4% were improperly diagnosed. The Anxiety Institute in Phoenix reports an estimated 8.2% of clients had generalized anxiety, but just 0.5% were correctly diagnosed. Experts cite the mental health community’s difficulty distinguishing different disorders or identifying specific etiological risk factors due to the fluidity and ambiguity of the Diagnostic and Statistical Manual of Mental Disorders. . 

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. What is lacking is communication and collaboration between subject and clinician. 

We are better served by the 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. Our environment, heritage, background, and associations reflect our wants, choices, and aspirations. If they are not given consideration, then we are not valued.

We must emphasize individual over diagnosis and create individual-based solutions. Training in prosocial behavior and emotional literacy might be useful supplements to typical interventions. Behavioral exercises can be used to practice the execution of considerate and generous social skills. Positive affirmations have enormous subjective value as well. Data provide evidence for mindfulness and acceptance-based interventions. Motivational enhancement strategies could help clients overcome their resistance to new ideas and concepts. Many therapists tout the benefits of positive autobiography to focus on our positive life experiences. Evidence-based solutions must address issues of self-esteem.

The best solution is to establish an integrated platform of approaches as a general solution , then further customize as determined by effectiveness. Diagnosis must be vigorously challenged by individual concerns and experiences, and treatment programs must reflect this dynamic.

____________________

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of psychological 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.