Tag Archives: Recovery

Proactive Neuroplasticity and Positive Behavioral Change

Dr. Robert F. Mullen
Director/ReChanneling

Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI—deliberate, repetitive, neural information. WeVoice

This is a general overview of Dr. Mullen’s 90-minute Academa.edu course titled Neuroscience and Happiness. Neuroplasticity and Positive Behavioral Change and a reprint of a guest post for a Canadian mental health website.

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

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

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Reactive neuroplasticity is our brain’s natural adaption to information. Information includes thought, behavior, experience, and sensation. Active neuroplasticity is achieved through cognitive pursuits such as engaging in social interaction, teaching, aerobics, and creating. Proactive neuroplasticity is the most effective means of learning and unlearning because the regimen of deliberate, repetitive neural input of information accelerates and consolidates the brain’s restructuring. 

Neurons, the core components of our brain and central nervous system, convey information through electrical activity. The input of information causes a receptor neuron to fire. Each firing stimulates a presynaptic or sensory neuron that, depending upon the integrity of the information, forwards it via an axon or connecting pathway to a synapse. The signal is picked up by the postsynaptic neuron’s hairlike dendrites that forward the information to the nucleus of the cell body. Continuous electrical energy impulses engage millions of participating neurons, causing a cellular chain reaction in multiple interconnected areas of our brain.  

A Brief History

The science of neuroplasticity was identified in the 1960s from research into the rejuvenation of brain functioning after a massive stroke. Before that, researchers believed that neurogenesis, or the creation of new neurons, ceased shortly after birth. Our brain’s physical structure was assumed to be permanent by early childhood. 

Today, we recognize that our neural pathways are not fixed but dynamic and malleable. The human brain retains the capacity to continually reorganize pathways and create new connections and neurons to expedite learning.

Neurons do not act by themselves but through neural circuits that strengthen or weaken their connections based on electrical activity. The deliberate, repetitious, input of information impels neurons to fire repeatedly, causing them to wire together. The more repetitions, the more robust the new connection. This is called Hebbian Learning.

Hebbian Learning

Synaptic connections consolidate when two or more neurons are activated contiguously. Neural circuits are like muscles, the more repetitions, the more durable the connection. Hebb’s rule of neuroplasticity states, neurons that fire together wire together. When multiple neurons wire together, they create more receptor and sensory neurons. Repeated firing strengthens and solidifies the pathways between neurons. The activity of the axon pathway is heightened, causing the synapses to accelerate neurotransmissions of pleasurable and motivating hormones.

We not only prompt our neural network to restructure by deliberately inputting information, but through repetition, we cause circuits to strengthen and realign, speeding up the process of learning and unlearning. 

What happens when multiple neurons wire together? Every input of information, intentional or otherwise, causes a receptor neuron to fire. Each time a neuron fires, it reshapes and strengthens the axon connection and the neural bond. The more repetitions, the more neurons are impacted, creating multiple connections between receptor, sensory, and relay neurons, attracting other neurons. An increase in learning efficacy arises from the sensory neuron’s repeated and persistent stimulation of the postsynaptic cell. Postsynaptic neurons multiply, amplifying the positive or negative energy of the information. Energy is the size, amount, or degree of that which passes from one atom to another in the course of their chain reaction. The activity of the axon pathway is heightened, prompting the synapses to increase and accelerate the release of hormones that generate the commitment, persistence, and perseverance useful to recovery or the pursuit of personal goals and objectives.

The consequence of DRNI over an extended period is obvious. Multiple firings substantially accelerate and consolidate learning. In addition, DRNI activates long-term potentiation, which increases the strength of the nerve impulses along the connecting pathways, generating more energy. Deliberate, repetitive, neural information generates higher levels of BDNF (brain-derived neurotrophic factors) proteins associated with improved cognitive functioning, mental health, and memory. 

We know how challenging it is to change, to remove ourselves from hostile environments, to break habits that interfere with our optimum functioning. We are physiologically hard-wired to resist anything that jeopardizes our status quo. Our brain’s inertia senses and repels changes, and our basal ganglia resist any modification in behavior patterns. DRNI empowers us to assume accountability for our emotional wellbeing and quality of life by proactively controlling the input of information.

Neural Reciprocity

Neural restructuring does not happen overnight. Recovery-remission is a year or more in recovery utilizing appropriate tools and techniques. Meeting personal goals and objectives takes persistence, perseverance, and patience. Substance abuse programs recommend nurturing a plant or tropical fish during the first year before contemplating a personal relationship. The successful pursuit of any ambition varies by individual and is subject to multiple factors. However, once we begin the process of DRNI, progress is exponential. Our brain reciprocates our efforts in abundance because every viable input of information engages millions of neurons with their own energy transmission. 

DRNI plays a crucial role in reciprocity. The chain reaction generated by a single neural receptor involves millions of neurons that amplify energy on a massive scale. The reciprocating energy from DRNI is vastly more abundant because of the repeated firing by the neuron receptor. Positive energy in, positive energy multiplied millions of times, positive energy reciprocated in abundance. 

Conversely, negative energy in, negative energy multiplied millions of times, negative energy is reciprocated in abundance. 

Proactive Neuroplasticity YouTube Series

Our brain does not think; it is an organic reciprocator that provides the means for us to think. Its function is the maintenance of our heartbeat, nervous system, and blood flow. It tells us when to breathe, stimulates thirst, and controls our weight and digestion.

Neurotransmissions

Because our brain does not distinguish healthy from toxic information, the natural neurotransmission of pleasurable and motivational hormones happens whether we feed it self-destructive or constructive information. That’s one of the reasons breaking a habit, keeping to a resolution, or recovering is challenging. The power of DRNI is that a regimen of positive, repetitive input can compensate for decades of irrational, self-destructive thoughts and behaviors, and provide the mental and emotional wherewithal to effectively pursue our personal goals and objectives. 

We receive neurotransmissions of GABA for relaxation, dopamine for pleasure and motivation, endorphins for euphoria, and serotonin for a sense of wellbeing. Acetylcholine supports our positivity, glutamate enhances our memory, and noradrenalin improves concentration. In addition, information impacts the fear and anxiety-provoking hormones, cortisol and adrenaline. When we input negative information, our brain naturally releases neurotransmitters that support that negativity. 

Conversely, every time we provide positive information, our brain releases hormones that make us feel viable and productive, subverting the negative energy channeled by the things that impede our potential. 

Definitions

Dysfunction and discomfort are conditions that can result in functional impairment and impact our quality of life. The difference is in severity. A dysfunction is a diagnosable condition that psychiatrists label a mental illness or disorder. Discomfort does not rise to the level of diagnosability but is holistically disruptive, nonetheless.

Personal goals and objectives are those things we want to change about ourselves: eliminating a bad habit or behavior, improving life satisfaction, and revitalizing self-esteem. The benefits of DRNI cannot be underestimated. The deliberate, repetitive, neural input of information significantly improves the probability of recovery. Likewise, it empowers us to pursue those personal goals and objectives that make our lives more viable and productive. 

Constructing the Information

Deliberate neural information is differentiated by context, content, and intention, which determine the integrity of the information and its correlation to durability and learning efficacy. The most effective information is calculated and specific to our intention. Are we challenging the negative thoughts and behaviors of our dysfunction? Are we reaffirming the character strengths and virtues that support recovery and transformation? Are we focused on a specific challenge? What is our end goal – the personal milestone we want to achieve? 

The process is theoretically simple but challenging, due to the commitment and endurance required for the long-term, repetitive process. We do not don tennis shorts and advance to Wimbledon without decades of practice with racket and balls; philharmonics cater to pianists who have spent years at the keyboard. DRNI requires a calculated regimen of deliberate, repetitive, neural information that is not only tedious but also fails to deliver immediate tangible results, causing us to readily concede defeat and abandon hope in this era of instant gratification.

Fortunately, the universal law of compensation anticipates this. The positive impact of proactive neuroplasticity is exponential due to the abundant reciprocation of positive energy and the neurotransmission of hormones that generate motivation, persistence, and perseverance. Proactive neuroplasticity utilizing DRNI dramatically mitigates symptoms of physiological dysfunction and discomfort and advances the pursuit of goals and objectives.

To quote Noble Prize-winning author, André Gide “There are many things that seem impossible only so long as one does not attempt them.”

WHY IS YOUR SUPPORT SO IMPORTANT?  ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.

Anatomy of an Online Recovery Workshop

Personal • Organization • Corporate
Seminars • Workshops • Groups

Dr. Mullen is doing impressive work helping the world. He is the
pioneer of proactive neuroplasticity utilizing DRNI—deliberate,
repetitive, neural information. — WeVoice

ReChanneling researches and develops methods to (1) alleviate symptoms of dysfunction (disorder) and discomfort (neurosis) that impact an individual’s emotional wellbeing and quality of life, (2) pursue personal goals and objectives—eliminating a bad habit, self-transformation—harnessing our intrinsic aptitude for extraordinary living. Its paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and historically, clinically practical methods including proactive neuroplasticity, cognitive-behavioral therapy, positive psychology, and techniques designed to compel the recovery and reinvigoration of self-esteem disrupted by the adolescent onset of dysfunction.  

CONTACT US

The suspension of on-site workshops due to pandemic restrictions compelled ReChanneling to focus on online recovery groups and workshops, broadening its outreach from local to national participation. Our social anxiety group, for example, includes persons from SF, Vancouver, NYC, Riverside, Taos, Tracy, Los Angeles, and Houston. Although we will be reinstituting on-site workshops next year, we will continue our online recovery work with persons nationally. 

ReChanneling’s focus on recovery from anxiety and depression has expanded to their comorbidities including PTSD, OCD, ADHD, and substance abuse. The Anxiety and Depression Association of America and other expert organizations report multiple dysfunctions related to social anxiety including major depression, panic disorder, alcohol abuse, PTSD, avoidant personality disorder, generalized anxiety disorder, substance abuse, eating disorders, schizophrenia, ADHD, and agoraphobia. Well over 60% of individuals with anxiety also have depression and both can lead to substance abuse. Anxiety-related comorbid disorders with similar emotional issues are treatable with the same paradigmatic approach that fosters self-reliance, determination, and perseverance. This overview focuses on social anxiety and, by design, its multiple comorbidities.

Cumulative evidence that a toxic childhood leads to psychological complications has been well-established, as has the recognition of early exploitation as a primary causal factor in lifetime emotional instability. It has been determined that the onset of dysfunction ostensibly occurs in adolescence or earlier due to childhood physical, emotional, or sexual disturbance. This disturbance can be real or imagined, intentional or accidental. This causes a disruption in natural human development, negatively impacting the natural development of self-esteem.

The Online Recovery Group

A group provides support and information. It is a safe and confidential space where participants can share experiences in a collegial and supportive environment.

The Online Recovery Workshop.

The ultimate objectives of a Recovery Workshop are:

  • To provide the tools and techniques to replace years of toxic thoughts and behaviors with rational, healthy ones, dramatically alleviating the self-destructive symptoms of anxiety, depression, and other dysfunctions
  • To compel the rediscovery and reinvigoration of the individual’s character strengths, virtues, and attributes.
  • To design a targeted behavioral modification process to help the individual re-engage their social comfort and status.
  • To provide the individual the means to control their dysfunction, rather than allowing it to control them.

Logistics. A targeted Recovery Workshop is most effective with a maximum of ten on-site participants, and eight participants for the current online workshops. 

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Proactive neuroplasticity is supported by DRNI – the deliberate, repetitive, neural input of information. What is that information? What goes into manufacturing that information? The objective is to ensure the information is of the highest quality in order to effect change. How do we expedite this? What are the best tools and techniques? There is no one right way to recover or achieve a personal goal or objective. 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. Individually, we are a conglomerate of personalities―distinct phenomena generated by everything and anything experienced in our lifetime. Every teaching, opinion, belief, and influence develops our personality. It is our current and immediate being and the expression of that being. It is formed by core beliefs and developed by social, cultural, and environmental experiences. It is constant and 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 believe we are destined to become.

The insularity of cognitive-behavioral modification, positive psychologies, and other approaches cannot comprehensively address the complexity of the personality. It requires an integration of multiple traditional and non-traditional approaches, developed through client trust, cultural assimilation, and therapeutic innovation. Environment, heritage, background, and associations reflect an individual’s wants, choices, and aspirations.

An integration of science and east-west psychologies captures the diversity of human thought and experience. Science gives us proactive neuroplasticity; cognitive-behavioral self-modification and positive psychology’s optimal functioning are western-oriented; eastern practices provide the therapeutic benefits of Abhidharma psychology and the overarching truths of ethical behavior. Included are targeted approaches utilized to help the individual rediscover and reinvigorate their self-esteem.

Each integrated approach collaborates with and supports the others.

I’ve lived with social anxiety for decades. I spent many years (and thousands of dollars) on conventional talk therapy, self-help books, and medication, without experiencing any real change or relief. ReChanneling’s Social Anxiety Workshop produced results within a few sessions, with continuing improvement throughout the workshop and beyond. I’m now much more at ease in situations that were major sources of anxiety and avoidance for me just a few months ago. The shared experience of working through social anxiety with other people who “get it” is powerful, and I’ve felt Dr. Mullen is truly committed to our growth and recovery. — Liz D. 

More Testimonials

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

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

Reactive neuroplasticity is our brain’s natural adaption to information. Information includes thought, behavior, experience, and sensation. Active neuroplasticity is cognitive pursuits such as engaging in social interaction, teaching, aerobics, and creating. Proactive neuroplasticity is the most effective means of learning and unlearning because the regimen of deliberate, repetitive neural input of information accelerates and consolidates restructuring. 

Cognitive-Behavioral Self-Modification (CBSM), is an adaptation of cognitive-behavioral therapy, one that reshapes the program, rather than subverts it by emphasizing the self-reliance and personal accountability demanded by proactive neuroplasticity.

Cognitive-behavioral self-modification supports our efforts to recognize and replace our automatic negative thoughts with healthy rational ones (ARTs). It is most effective when used in concert with other approaches. Like its elemental predecessor, CBSM is structured, goal-oriented, and focused on the present solution.

That focus on the individual’s current condition is important because proactive neuroplasticity is a here-and-now solution. This does not devalue psychodynamic or regression therapies, but they are not front and foremost in proactive neuroplasticity.

Roughly 90 percent of therapeutic approaches involve cognitive-behavioral treatments. However, critical studies dispute its efficacy, claiming it fares no better than non-CBT programs. They argue 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 behavior modification fostered by Beck in the 1960s is still useful in modifying our irrational thoughts and behaviors when used in concert with other approaches.

Positive psychology emphasizes our inherent and acquired character strengths, virtues, and attributes that help us achieve optimum functioning – in this case, recovery and transformation. PP’s mental health interventions have proved successful in mitigating the symptoms of depression, anxiety, and other self-destructive patterns, producing significant improvements in emotional wellbeing.

Positive psychology’s objective is to encourage us to shift our negative outlook to a more optimistic view to support the motivation, persistence, and perseverance important to recovery and the pursuit of our goals and objectives. 

Abhidharma psychology explores the essence of perception and experience, and the reasons and methods behind self-analyzation and awareness. It presents a clear system for understanding our psychological dispositions, processes, habits, and challenges. Its emphasis on probity over immorality is evident in the eightfold path of positive and constructive activity.

Western teachings tell us what to avoid—envy, gluttony, greed, lust, hubris, laziness, and rage. Buddhist psychology tells us what to embrace—a valuable life, good intentions, tolerance, wholesome and kind living, productive livelihood, positive attitude, self-awareness, and integrity – all things that facilitate the neural input of healthy and productive stimuli. 

Addressing self-esteem is an essential part of recovery and transformation. A fusion of clinically proven exercises helps us appreciate our value and potential – to realize that we are necessary to this life and of incomprehensible worth. Due to our disorder and our life experiences, we are subject to issues of self-esteem and motivation, assets vital for the positive restructuring of our neural network.

To comprehensively address the complexity of the personality, we must create individual-based solutions. Training in prosocial behavior and emotional literacy are useful supplements to typical approaches. Behavioral exercises and exposure consolidate our social skills. Positive affirmations have enormous subjective value. Data provide evidence for mindfulness and acceptance-based interventions. Motivational enhancement strategies help overcome resistance to new ideas and concepts.

Each approach provides an integral link to the quality and intention of our neural input of information via proactive neuroplasticity.

Proactive Neuroplasticity YouTube Series

Next: Video Series #7: Coping Skills (9/1/2022)

Workshop Components

The main components utilized in our Recovery Workshop include psycho-education, cognitive comprehension, roleplay, exposure, and homework.

Psycho-Education involves teaching individuals about the relationship between thoughts, emotions, and physiological reactions. Complementarity is the inherent cooperation of our human system components in maintaining physiological equilibrium. It is mind, body, spirit, and emotions working in concert. The sustainability of our dysfunction, as well as recovery, is supported by simultaneous mutual interaction.

Cognitive Comprehension involves correcting negative or inaccurate cognitions by identifying distorted thoughts and developing rational replies. It is based on the premise that dysfunction compels individuals to avoid the reality of their symptomatic negative self-image and beliefs, generating inaccurate, biased processing while in social situations.

Roleplay. Participants act out various social roles in dramatic situations that, through comprehension and repetition help us learn how to cope with stress and conflicts.

Exposure. By utilizing graded exposure, we start with Situations that are easier for us to manage, then work our way up to more challenging tasks. This allows us to build our confidence slowly and to practice learned skills to ease our situational anxiety. By doing this in a structured and repeated way, we reduce our fears and apprehensions. In vivo exposure allows us to confront feared stimuli in real-world conditions.

Homework consists of self-evaluating exercises that help us identify and address our distorted thoughts and irrational behaviors.

Recovery Workshop Strategies May Include:

Positive Personal Affirmations
Character Resume
Distractions/Diversions
Vertical Arrow Technique
Shame, Guilt, Blaming
Persona
Complementarity
Positive Autobiography

Deliberate conversations
Affirmative Visualization
Slow-talk, slow thinking
Cognitive Distortions
ANTs (automatic negative thoughts)
Moderating Exposure Situations
Coping skills

These are active, structured Recovery Workshops for people who are willing and motivated to address the symptoms of their dysfunction. This means we can only work with self-motivated and committed individuals. We cannot accept people or continue to support them unless they are willing to participate in the discussions and exercises. While progress is exponential, goals are not met overnight. Recovery is a lifelong work-in-progress.

The current workshops consist of ten online weekly sessions, meeting in the evening and lasting roughly 1-1/2 hours. There is minimal homework (approximately 1 hour weekly). At the conclusion of the ten weeks, we conference monthly for the following year, at no cost, to support the recovery process. 

The cost of the workshop is on a sliding scale:

  • $40 per session if income is $100,000+
  • $35 per session if income is $75,000 – $99,999
  • $30 per session if income is $50,000 – $74,999
  • $25 per session if income is less than $25,000 – $49,999
  • $20 per session if income is under $25,000.
  • Scholarships are available for those who have difficulty meeting these thresholds.

On-site workshops will resume post-pandemic. Individual recovery support is available to a select few. 

For further information or to request an interview, please fill out the following form.

WHY IS YOUR SUPPORT SO IMPORTANT?  ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.  

Dysfunction in the LGBTQ+ Community

Establishing a Wellness Model for LGBTQ+ Persons with Anxiety, Depression, and Comorbid Emotional Dysfunction

Robert F. Mullen, Ph.D.
Director/ReChanneling

Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond. 

65 million U.S. adults and 18.5 million adolescents have major depression and anxiety. Estimates show that 60% of those with anxiety also have depression symptoms, and both are comorbid with substance abuse. The LBGTQ+ community is 1.5-2.5 times more likely to have anxiety and depression than their straight or gender-conforming counterparts. Similar numbers hold for LGBTQ+ persons with other mental and emotional disorders. Anxiety and depression are the primary causes of the 56% increase in adolescent suicide over the last decade. High school LGBTQ+ students are almost five times as likely to attempt suicide than their heterosexual peers, and 40% of transgender adults have attempted suicide in their lifetime.

Wellness must become the central focus of mental health because the disease model has provided grossly unsatisfactory results. Rather than obsessing on disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance essential to recovery. Psychological science is there, but it needs positive implementation through program integration, positive evaluation, transparency, and information management. Empathy and communication must supersede etiology and misdiagnosis. 

Wellness impacts more than mental health; it is a paradigmatic perspective that seeks to promote a state of complete physical, mental, and social well-being. This paper will show how the wellness model’s sociological emphasis on character strengths and attributes not only positively impacts the self-beliefs and image of a mentally ill person but resonates in sexual and gender-based identities and portends well, the recovery-remission of an LGBTQ+ person with a mental illness.  

Introduction

To illustrate the wellness model’s potential impact, this paper focuses on LGBTQ+ persons with anxiety and depression disorders, which comprise 42% of diagnosable dysfunctions in the current Diagnostic and Statistical Manual of Mental Disorders (DSM). It posits what is learned can be applied to the remaining 58% of mental disorders that impact an LGBTQ+ person’s emotional wellbeing and quality of life. “There is an urgent need to develop and disseminate tailored evidence-based interventions that improve the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. (Wilkerson et al., 2016, p. 358). 

Depression and anxiety are the two most common forms of mental dysfunction impacting millions of U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. Johns Hopkins (2020) reports that around 25 million U.S. adults have a depressive illness, and 45 million have anxiety. Adolescent numbers fluctuate between 8 and 18 million (CDC, 2020; NIMH, 2017); the actual number is indeterminate. Statistics are even less reliable for the LGBTQ+ community because large-scale mental health studies rarely include sexual and gender identity (NAMI, 2020b). “Federally funded surveys only recently have begun to identify sexual minorities in their data collections” (Medley et al., 2020, p. 1). Experts estimate the infection rate in the LBGTQ+ community is 1.5 to 2.5 times higher “than that of their straight or gender-conforming counterparts” (Brenner, 2019, p. 1).

Depressive illnesses tend to co-occur with anxiety and substance abuse (Johns Hopkins, 2020). “Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety” (Salcedo, 2018, p. 1). Anxiety and depression are the primary causes of the 56% increase in adolescent suicide over the last decade (Curtin & Heron, 2019). “High school students who identify as lesbian, gay or bisexual are almost five times as likely to attempt suicide compared to their heterosexual peers,” and “40% of transgender adults have attempted suicide in their lifetime” (NAMI, 2020b, p. 1). 

Anxiety is the most common mental dysfunction, impacting the emotional wellbeing and quality of life of adults and children who find themselves caught up in a densely interconnected network of fear, worry, and apprehension. The psychological and sociological toll can be overwhelming. Physically, anxiety can cause sweating, trembling, fatigue, and rapid heartbeat, lower the immune system and increase the risk of heart disease risk. Persons with depression may experience a lack of interest and enjoyment of daily activities, significant weight fluctuation, insomnia or excessive sleeping, enervation, inability to concentrate, feelings of worthlessness, guilt, and recurrent thoughts of death or suicide. Anxious and depressed persons frequently generate images of themselves performing poorly in social situations (Hirsch & Clark, 2004; Hulme et al., 2012) for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. Symptoms can be repressive and intractable, imposing irrational thought and behavior (Richards, 2014; Zimmerman et al., 2010) that govern perspectives of personal attractiveness, intelligence, and competence (Ades & Dias, 2013). Over time, these self-beliefs become automatic negative thoughts (Amen, 1998) that determine initial reactions to situations or circumstances. 

Mental Health and LGBTQ+ Culture

Halloran and Kashima (2006) define culture as “an interrelated set of values, tools, and practices that are shared among a group of people who possess a common social identity” (p. 140). Culture determines how mental illness is perceived or diagnosed, how services are organized, and how they’re funded. It also affects how patients express their symptoms…and how they cope in the range of their community and family supports. (Daw, 2001, p. 1)

Studies and research indicate that mental health culture is underscored by the same interrelated attributions to mental health stigma: public opinion, media representation, family rejection, distancing, and the diagnosis itself. These attributions are also LGBTQ+ cultural influences along with heterosexualism and victimization. Both are impacted by history, while the disease model remains the primary contributor to mental health culture.   

LGBTQ+ culture is defined by its sexual and gender identity as distinct from the heterosexual and cisgender community (NAMI, 2020b). Subcultures within the community comprise “a diverse set of groups, including distinct groups based on sexual orientation and gender identity” (Lewis et al., 2017, p. 861), each struggling to develop their recognition. LGBTQ+’s social identity is shaped by oppression and its role in overcoming it. The community faces “numerous challenges and instances of heterosexism and homophobia in their daily lives” (UW-Madison, 2020, p. 1), including “discrimination, prejudice, denial of civil and human rights, harassment, and family rejection” (NAMI, 2020b, p. 1). The contrast in social culture is underscored by 26 countries with legalized same-sex marriage versus 73 countries where homosexual activity between consenting adults is illegal (Equaldex, 2020) and 8 countries where it is punishable by death (ILGA, 2019). LGBTQ+ people worldwide are confronted by “violence, arbitrary arrest, imprisonment, torture, and execution, according to Amnesty International” (WEF, 2018, p. 1). Because of this cultural disparity, this paper limits its focus to LGBTQ+ mental health issues in the United States. 

Transition

Working within a wellness model of mental health has become a central focus of international policy (Slade, 2010). As psychologist Kinderman (2014) writes, “we need wholesale and radical change, not only in how we understand mental health problems but also in how we design and commission mental health services” (p. 1). Decades of pathographic focus in psychological research and studies, negative diagnostic attributions, stereotyping and stigma, public and institution resistance, and a doctor-client power dominance factor in the need to transition to a wellness paradigm.

Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond. Rather than obsessing on disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance to recovery. Psychological science is there but needs implementation through program integration, positive evaluation, transparency, and information management. Empathy and communication must supersede etiology. This paper does not endorse a total dissolution of medical model approaches, but a review of their efficacy and the psychological effectiveness of their pathographic dominance is highly warranted. 

Redefining Mental Health

Government agencies define mental illness as a “diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria” that can “result in functional impairment which substantially interferes with or limits one or more major life activities” (Salzer et al., 2018, p. 3). This ‘defective’ emphasis has been the overriding psychiatric perspective for centuries. 

The pathographic or disease perspective of diagnosis and recovery focuses on the history of an individual’s suffering to facilitate diagnosis. Schioldann (2003, p. 303) defines pathography as a historical biography from a medical, psychological, and psychiatric viewpoint. It analyses a single individual’s biological heredity, development, personality, life history and mental and physical pathology, within the socio-cultural context of his/her time, in order to evaluate the impact of these factors upon his/her decision-making, performance, and achievements. (Kőváry, 2011, p. 742)

One only needs the American Psychological Association’s (APA, 2020) definition of neurosis to comprehend the mental health community’s pathographic focus. The 90-word overview contains the following words: distressing, irrational, obsessive, compulsive, dissociative, depressive, exaggerated, unconscious, conflicts, anxiety, disorders. DSM-3 abandoned the word ‘neurosis’ in 1980, but it remains the go-to term in the mental health community. Coined by a Scottish physician in 1776, neurosis defined itself as functional derangement of the nervous system. Pathography focuses “on a deficit, disease model of human behaviour,” whereas the wellness model focuses “on positive aspects of human functioning” (Mayer & May, 2019, p. 159). 

Studies and research portray the mental healthcare community drowning in pessimism (Henderson et al., 2014; Khesht-Masjedi et al., 2017; Pryor et al., 2009). “There is evidence to indicate the problem may be endemic in the medical health community” (Gray, 2002, p. 3), and universally systemic (Knaak et al., 2017). Noted psychologist Alison Gray (2002) argues that more disordered persons would seek treatment if psychiatric services were less stigmatized and stigmatizing. Patients commonly report instances where a staff member was inordinately rude or dismissive. They cite coercive measures, excessive wait times, paternalistic or demeaning attitudes, treatment programs revolving around drugs with undesirable side-effects, stigmatizing language, and general therapeutic pessimism (Henderson et al., 2014; Huggett et al., 2018). Clients with more severe complications or illnesses are often deemed “difficult, manipulative, and less deserving of care” (Knaak et al., 2017, p. 2). Nurses and clinicians cite a lack of collegial support, insufficient knowledge and training, and the fear of client self-harm (Henderson et al., 2014), leading them to over-diagnose and over-prescribe (Huggett et al., 2018).

Transitioning from the disease model’s pathographic language to the optimistic and encouraging language of wellness models is everyone’s responsibility in the mental health community―its institutions, associations, practitioners, researchers, media, and clients. In the growing opinion of clinical psychologists, empathy and communication must take precedence over etiology. 

We must move away from the disease model, which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognizes our essential and shared humanity. Our mental health is largely dependent on our understanding of the world and our thoughts about ourselves, other people, the future, and the world. (Kinderman, 2014, p. 3

Language and Perspective

Language generates and supports perspective, and linguists agree that the relationship between language and power is mutual (Ng & Deng, 2017). Language influences thought and action. Terms like incapacity, deceit, unempathetic, manipulative, and irresponsible describe DSM-5 traits for various disorders. The argument is not that these descriptions are invalid; they are overwhelmingly negative and perceptually hostile. Judging by public opinion, media representation, and mental health stereotypes and stigma, these words help frame the perception of a person with a mental disorder (DeMare, 2016; Pinfold et al., 2005; Pryor et al., 2009).

Realistically, we cannot eliminate the word ‘mental’ from the culture. The disease model’s guide for 70 years is called the Diagnostic and Statistical Manual of Mental Disorders. Unfortunately, the word ‘mental’ is a limited description of a disorder, and its negative implications support perceptions of incompetence, unworthiness, and undesirability. It is the dominant source of stigma, shame, and self-denigration. Psychologically, the word mental defines a person or their behavior as somehow extreme or illogical. Adolescents derisively assign the term to the unpopular, different, and socially inept. The urban dictionary defines mental as someone silly or stupid. 

Hostile and demeaning language is pervasive throughout mental healthcare promulgated by the disease or medical model’s pathographic undercurrent. This perspective influences public opinion, study and research, media representation, the doctor-patient power structure, community interrelationships, and client self-beliefs and image. Transitioning from the disease model to wellness models requires constructing a more reasonable mental health perspective by addressing misunderstanding, misinformation, and the overriding focus of the disease model on diagnosis, disorder, deficit, and denigration. 

Misinformation is generated by the psychological community’s difficulty finding agreement due to changing criteria, “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata et al., 2015, p. 724), and the intractability of the American Psychiatric Association. There are four common misconceptions about mental disorders. They are (1) abnormal and selective, (2) a consequence of behavior, (3) solely mental, and (4) psychotic. These are corrected by universality, age of onset, complementary, and the clear differentiation of psychosis from neurosis. 

Universality. A recent article in Scientific American speculates that “mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life” (Reuben & Schaefer, 2017, p. 1). It is a part of natural human development. One-in-four individuals have a diagnosable mental disorder. According to the World Health Organization, nearly two-thirds of people who believe they have a mental disorder reject or refuse to disclose their condition. Include those who dispute or chose to remain oblivious to their dysfunction, and we can conclude that mental disorders are common, undiscriminating, and universally impacting. 

Age of Onset. The onset of a disorder is a consequence of early psychophysiological disturbance, according to Mayoclinic (2019). Perhaps parental behaviors are overprotective or controlling or do not provide emotional validation (Cuncic, 2018). The receptive juvenile might be the product of bullying, abuse, or a broken home. “LGBT youths experience greater stressors from childhood into early adulthood, such as child abuse and unstable housing, that exacerbate mental health problems” (Mustanski et al., 2016, p. 527). LGBTQ+ youth experience disproportionately high rates of verbal and physical harassment and other types of peer victimization (Berlan et al., 2010; Reisner et al., 2015). “Gender minority youth had approximately four-fold higher odds of experiencing any bullying or harassment in the past year” (Reisner et al., 2015, pp. 35-36).

Childhood/adolescent exploitation or abuse are generic terms to describe a broad spectrum of experiences that interfere with a youth’s optimal physical, cognitive, emotional, and social development (Steele, 1995). Any number of situations or events can trigger the susceptibility to onset; it could be hereditary, environmental, or some traumatic experience (Mayoclinic, 2019; NIH, 2019). Statistically, the LGBTQ+ community is at “a higher risk than their heterosexual counterparts for traumatic life experiences such as childhood physical, psychological, and sexual abuse” (Bandermann, 2014, p. 3).

Despite the implication of intentionality in the words’ abuse’ and ‘exploitation,’ a toddler might sense abandonment and develop emotional issues when a parent is preoccupied (Lancer, 2019). The child/adolescent is not accountable for their dysfunction; there is the likelihood no one is intentionally responsible. Similarly, with the scientific affirmation that, while sexual and gender-based identities may have a genetic or biological basis, they are not chosen, and the LGBTQ+ person is not accountable; unlike mental illness, there is no implicit or explicit responsible party.

Undoubtedly, this sociological model conflicts with moral models that claim, “mental illness is onset controllable, and persons with mental illness are to blame for their symptoms” (Corrigan 2006, p. 53), and sexual and gender-based orientation is a choice.

Complementarity. In early civilizations, mental illness was the domain of supernatural forces and demonic possession. Hippocrates and diagnosticians of the 19th century looked at the relative proportions of bodily fluids. Lunar influence, sorcery, and witchcraft are timeless culprits. In the early 20th century, it was somatogenic. The biological approach argues that neuroses are related to the brain’s physical functioning (McLeod, 2018), while pharmacology promotes it as a chemical or hormonal imbalance. Carl Roger’s study of the cooperation of human system components to maintain physiological equilibrium produced the word ‘complementarity‘ to define simultaneous mutual interaction. All human system components must work in concert; they cannot function alone. The simultaneous mutual interaction of all human system components—mind, body, spirit, and emotions—is required to sustain and recover from a mental dysfunction. The same mutual interaction is evident in sexual and gender-based identities as it is in all persons.

Psychosis and Neurosis. There are two degrees of mental disorder: neuroses and psychoses. When someone sees, hears, or responds to things that are not actual, they are having a psychotic episode. While few persons experience psychosis, everyone has moderate-and-above levels of anxiety, stress, and depression. A neurosis is a condition that negatively impacts our emotional wellbeing and quality of life but does not necessarily impair or interfere with normal day-to-day functions. Since the overwhelming majority of mental disorders are neuroses, humans are all dysfunctional to some extent. 

“Language reveals power, reflects power, maintains existing dominance, unites and divides . . . and creates influence.” (Ng & Deng, 2017, p. 15). The similar impact of the wellness model on the mentally ill and the LGBTQ+ person is evident. Revising negative and hostile language to embrace a positive dialogue of encouragement and appreciation generates new perspectives that positively contribute to self-beliefs and image, leading to more disclosure, discussion, and, in the case of mental illness, recovery-remission. The self-denigrating aspects of shame should dissipate; stigma becomes less threatening. 

Accepting that mental illness and sexual and gender-based identities are ubiquitous and non-discriminating should make it easier to embrace the subject within the family structure. Realizing their proximity and general susceptibility should mitigate the desire to distance and isolate. Accepting their social pervasiveness should alleviate the prejudice, ignorance, and discrimination attached to mental illness (Khesht-Masjedi et al., 2017; Pescosolido, 2013; Pinfold et al., 2005; Wood & Irons, 2017), as well as sexual and gender-based identities (Adamczyk & Liao, 2018; Dodge et al., 2016; Lewis et al., 2017). Recognizing that neither the mentally ill nor the LGBTQ+ person is accountable disputes the belief that they are weak or amoral and their condition a reflection of behavior. (Condition is herein defined as the state of something with regard to its quality.)

Resistance to Recovery

The term stigma-avoidance defines those who fear that public disclosure could, potentially, stigmatize and discredit them. Statistics from the National Bureau of Economic Research “find that survey respondents under-report mental health conditions 36% of the time when asked about diagnosis” (Bharadwaj et al., 2017, p. 3). A recent study by Salzer et al. (2018) reveals that only one-third of disordered persons were in recovery-remission in 2017. The lower recovery-remission rates may be partly due to the inability to afford treatment due to anxiety-induced financial and employment instability (Gregory et al., 2018). More than 70% of social anxiety disorder patients, for example, are in the lowest economic group (Nardi, 2003).

The LGBTQ+ community’s resistance to disclosing a mental disorder, seeking treatment, or accepting diagnosis is due to the same attributions that underscore general reticence: stigmatization, victimization, public opinion, media representation, family rejection, and the diagnosis itself. 

Stigmatization 

Mental health stigma is the hostile expression of the abject undesirability of the afflicted. 90% of survey respondents with a mental disorder claim they have been impacted by mental health stigma (NAMI 2020a). Stigmatization is deliberate and proactive, distinguishable by pathographic overtones intended to shame and isolate (Pryor et al., 2009). Disclosure of a mental disorder jeopardizes livelihoods, relationships, social standing, housing, and quality of life (Huggett et al., 2018; Pinfold et al., 2005; Sowislo et al., 2016; Wood & Irons, 2017). “The deleterious effects of stigma and prejudice on the health of sexual minority individuals have been well-documented across both physiological and psychological domains” (Dodge et al., 2016, p. 1). 

For LGBTQ youth, the minority stress theory posits that their health is affected by the degree to which their social environment stigmatizes sexual and gender minorities and the extent to which LGBTQ+ youth in these environments are expected to hide their nonconformity. (Wilkerson et al., 2016, p. 359)

Mental health stigma is expressed within three categories:

  • Tribal stigma devalues.
  • Moral character stigma implies amorality and weakness.
  • Abominations of the body stigma refers to physical deformity or disease (Pryor et al., 2009).

Mental disorder occupies the last two categories. Ignorance equates a mental disorder with weakness or contributing behavior, while the medical model focuses on the disease and deformity aspect. LGBTQ+ persons share the added onus that their sexual and gender-based identity is socially and culturally tribal.

Victimization

“Community-based samples of LGBT youths have shown that as many as 30% may experience psychological distress at clinically significant levels” (Mustanski et al., 2016, p. 527). A study of the effects of cumulative victimization on LGBTQ+ youth’s mental health found that they “experience greater mental health problems, such as depression, anxiety, suicide attempts, and posttraumatic stress disorder (PTSD) . . . than do heterosexual and cisgender individuals” (Mustanski et al., 2016, p. 527). Contributors include internalized homophobia, stigma consciousness, identity concealment, and experiences of heterosexism and victimization. (Heterosexism is the sociological term for discrimination or prejudice against gay people by heterosexuals who assume heterosexuality is the normal sexual orientation). Sexual and gender-identity minorities are disproportionally subject to bullying, harassment, and other peer victimization (Berlan et al., 2010; Reisner et al., 2015). The LGBTQ+ community is “one of the most targeted communities by perpetrators of hate crimes in the country” (NAMI, 2020b, p. 1). 

Because of the greater risk of victimization in LGBT individuals compared with heterosexuals starting as early as adolescence, research is needed that examines how trajectories of sexual orientation-based victimization across development influence the risk for mental health problems for LGBT people. (Mustanski et al., 2016, p. 528)

Public Opinion 

Although recognition, attributions, and service use may reflect prejudice associated with mental illness, the heart of stigma lies in social acceptance” (Pescosolido, 2013, p. 8). The image of the dangerous, unpredictable, mentally ill person is still widely endorsed by the public (Corrigan & Watson, 2002; Pinfold et al., 2005). Stuart and Arboleda-Flórez (2012) analysis of two surveys (1990/2006) on public perception found, that “between 80-100 percent of respondents . . . favored involuntary hospitalization for that disorder when they thought that violence was an issue” (p. 7). 

Attitudes toward sexual and gender-based identity became substantially more accepting between the 1970s, the most significant shift among 18- to 29-year-olds (Adamczyk & Liao, 2018; Dodge et al., 2016). “It is clear that Americans have become more accepting of same-sex sexual behavior and relationships, but it is unclear how universal those changes are and whether they are due to age, time period, or cohort” (Twenge et al., 2016, p. 10).

Persons tend to be more supportive, in part, “because gay men and lesbians are then seen as less responsible for their orientation” (Adamczyk & Liao, 2018, p. 4). An overwhelming share (92%) of the U.S. LGBTQ+ community believe “society has become more accepting of them in the past decade and expect it to grow even more accepting in the decade ahead” (Pew, 2020, p 1). However, many rights and benefits afforded to LGBTQ+ individuals depend on region, race and ethnicity, political persuasion, educational attainment, economics, and religiosity (Adamczyk & Liao, 2018; Dodge et al., 2016; UW-Madison, 2020). Religion is strongly associated with negative beliefs about the justifiability of LGBTQ+ “sexual behavior and marriage” (Twenge et al., 2016, p. 8). The degree of intolerance is denominational and subject to the frequency of attendance. Jews and moderate-to-liberal protestants are more tolerant than Baptists, fundamentalists, and Catholics (Adamczyk & Liao, 2018; Schnabel, 2016). The Pew (2020) study shows that 29% of LGBTQ+ persons have felt unwelcome in a place of worship;

Heterosexual women consistently demonstrate more positive attitudes toward sexual and gender minority groups than heterosexual men who are “traditionally expected to more rigidly conform to gender explicitly heteronormative norms and stereotypes” (Dodge et al., 2016, p. 4). Attitudes toward lesbians and gay men are significantly more positive than attitudes toward transgender people (Adamcyzk & Liao, 2018; Lewis et al., 2017), whereas “bisexual individuals commonly report experiencing stigma, prejudice, and discrimination from both heterosexual and gay/lesbian individuals” (Dodge et al., 2016, p. 1).

Education and interpersonal contact mitigate prejudicial attitudes and behaviors towards both the mentally disordered and LGBTQ+ individuals. Contact-based education has emerged as the most influential factor in public attitude and behavior towards people with mental health problems (Pinfold et al., 2005; Corrigan, 2006). “Multiple studies have found that knowing someone who is LGBTQ+ is associated with more supportive attitudes” (Adamczyk & Liao, 2018, p. 10), and “may increase knowledge, reduce anxiety, and increase empathy” (Lewis et al., 2017, p. 862). This benefit has not crossed over to transgender people, likely, because “personal contact is relatively small” (Lewis et al., 2017 p. 871).

According to the Pew Research Center (Pew, 2020), 30% of the LGBTQ+ community reported they have been threatened or physically attacked, 21% treated unfairly by an employer, and 58% the target of slurs or jokes. Heterosexism inflicts itself on individual, familial, institutional, employment, political, and cultural levels, and openly occurs in educational, career, religious, and social settings (Bandermann, 2014; Lewis et al., 2017). 

While public opinion has drastically improved for the LGBTQ+ community, the perception of the dangerous and unpredictable mentally disordered person who should be isolated has not changed substantially in decades (Stuart & Arboleta-Flórez, 2012). A primary goal of wellness models is mitigating mental health stigma by changing the public perspective. 

Media Representation 

A 2011 study revealed that nearly half of U.S. media stories on mental illness mention or allude to violence (Pescosolido, 2013). News and social media, propelled by far-right politics, fundamentalism, and other fringe organizations, contribute to discrimination and prejudice. Analysis of film, television, and tabloid presentations identify three common misconceptions: people with mental illness are homicidal maniacs, they have childlike perceptions of the world that should be marveled at, or they are rebellious, free spirits (Corrigan, 2006). Portrayals of sexual and gender-based identity in the latter half of the 20th century were, generally, stereotypical exaggerations. “Beginning in the 1990s, some highly likable gay and lesbian television and media characters began to appear in the media” (Adamczyk & Liao, 2018, p. 10). Still, there is an abundance of gay-themed portrayals designed to arouse feelings of shock, betrayal, and titillation. Media coverage commonly promotes images that negatively impact the self-beliefs and image of LGBTQ+ and mentally ill persons. 

Family Rejection

Family stigmatization is the rejection of an LGBTQ+ or mentally dysfunctional child or sibling. A 2008 literature review found around 38% of family members “attempt to hide their relationship in order to avoid bringing shame to the family” (Stuart & Arboleda-Flórez, 2012, p. 8). Another study showed that 34% of LGBTQ+ persons reported rejection by family members, 49% reported unfair treatment, and “52% were subject to anti-gay remarks from family members” (Bandermann, 2014, p. 3). The implication of familial undesirability impacts a mentally disordered and LGBTQ+ person’s sense of positive self, a devaluation more potentially “life-limiting, and disabling than the illness itself” (Stuart & Arboleda-Flórez, 2012, p. 3). “The difficulties of living with psychiatric distress are magnified by the experience of rejection” (Gray, 2002), which can lead to psychological and physiological health issues, substance abuse, and addiction.

Etiology and Misdiagnoses 

Etiology and diagnosis drive the disease model. Which disorder do people find most repulsive, and which poses the most threat? What behaviors contribute to the disorder? How progressive is the disorder, and how effective are treatments? (Corrigan, 2006). It is essential to recognize how these attributions affect public perception, treatment options, and client self-beliefs and image. 

“Until the 1950s, most homosexual persons studied by psychologists and others were prisoners or mental patients, so it was easy to conclude that these were linked” (McFarland, 2018, p. 1). In 1973, the APA announced homosexuality was no longer an illness. DSM diagnostic criteria change dramatically from one edition to the next. Lynam and Vachon (2012) cite therapists’ concern that criteria are “added, removed, and rewritten, without evidence that the new approach is better than the prior one” (p. 483). The social fears described in the DSM-II in 1968 became social phobia in the DSM-III (1980), and social anxiety disorder in 1994’s DSM-IV, resulting in the nickname, the ‘neglected anxiety disorder.’

Revisions, substitutions, and contradictions between DSM’s are never universally accepted. Even under the best circumstance with a knowledgeable and caring clinician, it is difficult to obtain a proper mental disorder diagnosis. In addition to the nine types of depression, four anxieties, and eight obsessive-compulsive disorders, the current DSM lists five types of stress response and ten personality disorders, each sharing similar traits and symptomatology with varying degrees of impact. Bipolar personality disorder, for example, shares characteristics and symptoms with generalized anxiety disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder (Sagman & Tohen, 2009). The most common comorbidities associated with anxiety are major depression, panic disorder, posttraumatic stress disorder, and alcohol abuse/dependence. For example, social anxiety disorder is often comorbid with avoidant personality disorder, eating disorders, schizophrenia (Cuncic, 2018; Vrbova et al., 2017), ADHD, and agoraphobia (Koyuncu et al., 2019).

The Social Anxiety Institute (Richards, 2019) reports that an estimated 8.2% of patients had generalized anxiety, but just 0.5% were correctly diagnosed. A recent Canadian study by Chapdelaine et al. (2018) reported, of 289 participants in 67 clinics meeting DSM-4 criteria for social anxiety disorder, 76.4% were improperly diagnosed. 

Self-Esteem

Maslow’s (1943/1954) hierarchy of needs reveals how childhood disturbance can disrupt natural human development. Healthy growth requires satisfying fundamental physiological and psychological needs. The experience of detachment, exploitation, or neglect may disenable the subject from satisfying their physiological and safety needs and or the need to belong and experience love, which can impact the acquisition of self-esteem

If the child is criticized, overly controlled, or not given the opportunity to assert itself, it begins to feel insecure in its ability to survive, and may then become overly dependent on others, develop low self-esteem, and experience a sense of shame or doubt in its own abilities. (Vanderheiden & Mayer, 2017, p. 15)

Research on persons with depression and anxiety reveals how the disease model “diminishes hope, self-esteem, self-efficacy, empowerment, and quality of life.” (Garg and Raj, 2019, p. 124). LGBTQ+ youth rejected because of their identity have much lower self-esteem, are more isolated, and have less support than those accepted by their families (House, 2018). 

Self-esteem determines one’s relation to self, to others, and the world. Self-esteem is the umbrella for all the positive self-qualities that structure optimal functioning, e.g., self -respect -resilience, -efficacy, -reliance, -compassion, -value, -worth, and other intrinsic wholesome attributes. Self-esteem provides the recognition that one is consequential and worthy of love. A grassroots poll by Unite UK (2016) found that 62% of LGBTQ+ persons believe they have low self-esteem. Exposure to historical alienation, ambiguous public opinion, adolescent bullying, heterosexualism, and other harmful elements, in time, will have an impact on an LGBTQ+ person’s self-beliefs and image (Unite UK, 2016). 

Recovery

Recovery is an individual process. Humans have unique DNA and disparate sensibilities, memories, and abilities. One-size-fits-all approaches are inadequate to fully address the personality’s dynamic complexity and its owner’s uniqueness. Mental illness is ubiquitous and non-discriminating; dysfunction embraces every walk of life. Indeed, “the LGBTQ+ community encompasses a wide range of individuals with separate and overlapping challenges regarding their mental health” (NAMI, 2020b, p. 1). 

Recovery is “about seeing people beyond their problems – their abilities, possibilities, interests, and dreams – and recovering the social roles and relationships that give life value and meaning” (Slade, 2010, p. 2). Recovery programs must be fluid, integrating multiple traditional and non-traditional approaches developed through client trust, cultural assimilation, and therapeutic innovation. Any analysis must consider the subject’s environment, hermeneutics, history, and autobiography in conjunction with their wants, beliefs, and aspirations. Otherwise, the personality complexity is not valued, and the treatment is inadequate.

Positive Psychology and the Wellness Model

In 2004, the World Health Organization began promoting the advantages of the wellness perspective, declaring health “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Slade, 2010, p. 1). The World Psychiatric Association states, “the promotion of well-being is among the mental health system” (Schrank et al., 2014, p. 98). As psychologists point out, “psychological well-being is viewed as not only the absence of mental disorder but also the presence of positive psychological resources” (Sin & Lyubomirsky, 2009, p. 468). 

The wellness model’s chief facilitator is positive psychology (PP), which originated with Maslow’s (1943/1954) seminal texts on humanism; APA president Seligman legitimized it in 1998. Positive psychology and other optimistic approaches focus on the inherent ability, “not only to endure and survive but also to flourish” (Mayer & May 2019, p. 160). 

Positive psychology is a relatively new field (since 1998) that, ostensibly, complements rather than replaces traditional psychology. Defined as the science of optimal functioning, PP’s objective is “to study, identify and amplify the strengths and capacities that individuals, families, and society need to thrive” (Carruthers & Hood, 2004, p. 30). Cultural psychologist Levesque (2011) describes optimal functioning as the study of how individuals attempt to achieve their potential and become the best they can be. 

Studies support the utilization of positive psychological constructs, theories, and interventions for enhanced mental health understanding and improvement. PP interventions have “improved wellbeing and decreased psychological distress in mildly depressed individuals, in patients with mood and depressive disorders, [and] in patients with psychotic disorders” (Chakhssi et al., 2018, p. 16). As Carruthers and Hood (2004) point out, “The things that allow people to experience deep happiness, wisdom, and psychological, physical and social wellbeing are the same strengths that buffer against stress and physical and mental illness” (p. 30).

The academic discipline of positive psychology continues to develop evidence-based interventions that focus on eliciting positive feelings, cognitions, or behaviors (Schotanus-Dijkstra et al., 2018). Positive psychology offers promising interventions “to support recovery in people with common mental illness, and preliminary evidence suggests it can also be helpful for people with more severe mental illness” (Schrank et al., 2014, p. 99). 

Positive Psychology 2.0.  

One of the early challenges of positive psychology was its inattention to the negative aspects of character. Recognizing this, psychologists advocated a more holistic approach to embrace the dialectical opposition of human experience. As one psychologist put it, “people are not just pessimists or optimists. They have complex personality structures” (Miller, 2008, p. 598). Positive Psychology 2.0 (PP 2.0) evolved as a correction to the singular focus on optimism to embrace a more inclusive and balanced perspective (Rashid et al., 2014). 

The disease model of mental health bases recovery on the remission of symptoms or the suspension of substantial interference or limitation (ADAMHA, 2012; Salzer et al., 2018). The wellness model maintains that individuals with a mental disorder can live satisfying and fulfilling lives regardless of symptoms or impairments associated with the diagnosis (Slade, 2010). Schrank et al. (2014) describe recovery as people “(re-) engaging in their life on the basis of their own goals and strengths, and finding meaning and purpose through constructing and reclaiming a valued identity and valued social roles” (p. 98). By emphasizing wellness over dysfunction, the positive psychology movement aims to destigmatize mental illness by emphasizing “the positive while managing and transforming the negative to increase wellbeing” (Mayer & May, 2019, p. 163). Perkins and Repper (2003, p. 3) write: 

People with mental illness who are in recovery are those who are actively engaged in working away from Floundering (through hope-supporting relationships) and Languishing (by developing a positive identity), and towards Struggling (through Framing and self-managing the mental illness) and Flourishing (by developing valued social roles).  

Concluding Thoughts

Thomas Insel (2013), director of the National Institute of Mental Health, is “re-orienting its research away from DSM categories” (p. 2), declaring that traditional psychiatric diagnoses have outlived their usefulness (Kinderman, 2014). NIMH is transforming diagnosis based on emerging research data and a doctor-patient communication dynamic rather than on the current symptom-based categories. Kinderman (2014) suggests replacing traditional diagnoses with easily understandable descriptions of the issues.

A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and the design and planning of services. (1)

In mental health, recovery-remission is a realized, long-term mitigation of symptoms. Wellness impacts more than mental health; it is a paradigmatic perspective that seeks to promote a state of complete physical, mental, and social well-being. Its sociological emphasis on optimal human functioning, designed to counter the pathographic focus of other models, not only positively impacts the self-beliefs and image of a mentally ill person but resonates in sexual and gender-based identities and portends well, the recovery-remission of an LGBTQ+ person with a mental illness. 

There are many approaches to recovery. Psychology textbook author, Farreras (2020) cites 400 different schools of psychotherapy. Mayer and May (2019) characterize current positive psychology as “a balanced, interactive, meaning-centered and cross-cultural perspective” (p. 156) that considers equally “positive emotions and strengths and negative symptoms and disorders” (Rashid et al., 2014, p. 162). Positive psychology works best in conjunction with other programs (CBT, for example), and its mental health interventions have proved successful in mitigating symptoms of depression, anxiety, and other disorders. “Growing research suggests that a positive psychological outlook not only improves ‘life outcomes’ but enhances health directly” (Easterbrook, 2001, p. 23).

Training in prosocial behavior and emotional literacy might be useful supplements to specific interventions. Behavioral exercises enhance the execution of resilient and generous social skills. Positive personal affirmations have enormous subjective value as well. Data supports mindfulness and acceptance-based interventions to re-engage and regenerate positive thoughts, feelings, and memories. Castella et al. (2014) suggest motivational enhancement strategies to help clients overcome resistance. Ritter et al. (2013) tout the benefits of positive autobiography to counter destructive thoughts and behaviors. The importance of considering the nuanced and unique dynamics inherent in the relationships among emotional expression, intimacy, and overall relationship satisfaction for dysfunctional individuals and LGBTQ+ persons, should be thoroughly investigated (Montesi et al., 2013).

However, this paper balks at throwing out the baby with the bathwater, positing that the current diagnostic system should be utilized as a part of a more thorough analysis that embraces communication and emphasizes the character strengths that generate motivation, persistence, and perseverance towards recovery-remission. All “patients with mental disorders deserve better” (Insel, 2013, p. 2). 

WHY IS YOUR SUPPORT SO IMPORTANT?  ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.  

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It’s Not Your Fault!

What is shame? The painful feeling of humiliation or distress that comes from the sense of being or doing a dishonorable, ridiculous, or immodest thing; the feeling that we are less than, unbefitting, or undesirable. 

What causes shame of mental disorder and discomfort? History, education, culture, the disease model of mental healthcare, mental health stigma (MHS), and correlated self-image. 

Why we should not be ashamed. History is crude and inconsistent, culture is misinformed, the disease model is exploitive and archaic, and MHS is generated and sustained by prejudice, ignorance, and discrimination based on misinformation and disinformation.

What are disorders and discomforts? We all have them. They limit or interfere with our life activities and impact our emotional wellbeing and quality of life. They distance us from our optimum functioning – from being the best that we can be. The difference is in severity. A disorder is a diagnosable condition that the disease model of mental healthcare labels a mental illness or disorder. Discomfort does not rise to the level of diagnosability but is physiologically disruptive, nonetheless. How did we become disordered and discomforted? Childhood disturbance, heredity, the normal vicissitudes of life, and the universal drive towards meaning, purpose, and identity.

It’s a simple but salient maxim: we are not accountable for the cards we have been dealt; we are responsible for how we play the hand we have been given. We were infected in adolescence due to heredity or for some childhood disturbance(s). We did not make it happen; it happened to us. We are, however, responsible for doing something about it. We are the captains of our ship. Recovery programs can provide the tools and techniques, but the onus of recovery is on the individual.

Carl Goldberg described shame as”feeling ridiculous, embarrassed, humiliated, chagrined, mortified, shy, reticent, painfully self-conscious, inferior, and inadequate.” There are many aspects and degrees of shame; volumes have been written about the types of shame and its complexities. Shame is painful, incapacitating, and uncontrollable. Shame makes us feel powerless, inferior, acutely diminished, and worthless. 

Shame makes us want to escape, to become invisible. It elicits self-defensive reactions that can make us feel inadequate or become hostile and aggressive. Shame is unavoidable and impacts every aspect of the human experience.

Shame is not all bad; it alerts us to our irresponsible and irrational actions. Shame can be revealing, cathartic, and motivational, broadening self-awareness, and promoting emotional and spiritual growth.

We are all disordered to some extent; it is a natural part of human development. A disorder is evidence of our humanness. Our disorder is not selective, but a universal and undiscriminating condition, impacting every type of individual. Social anxiety disorder, for example, is not the consequence of childhood behavior but is driven by a combination of genetic and environmental factors. In either case, it is not our fault. While behavior over our lifetime can impact the severity, the origins of disorder happen in childhood. It is not a mental affliction but impacting and impacted by the simultaneous mutual interaction of mind, body, spirit, and emotions. Forget what we have been taught by the disease model of mental health and influenced by associated stigma. We are not our disorder; we are individuals with a disorder. We are not the sum of what’s wrong with us, but the aggregation of our character strengths, virtues, and attributes. 

So why do we feel shame? Because mental illness is historically denigrating and culturally feared and scorned – beliefs perpetuated by the disease model of mental health and reinforced by mental health stigma. These influence our self-image, generating feelings of inadequacy and undesirability.

The disease model of mental health focuses on what is wrong with us. It labels us by our diagnosis, and we cease to be an individual. We are lumped with others similarly diagnosed, labeled as schizophrenics, paranoids, depressive persons, or nervous wrecks. We are stereotyped by the most descriptive symptoms and characteristics of our disorder using terms utilized by the unreliable Diagnostic and Statistical Manual of Mental Disorders (e.g., incapable, deceitful, unempathetic, manipulative, irresponsible). Then we are branded as personifications of that stereotype.

Mental Health Stigma is the hostile expression of the abject undesirability of an individual impacted by a disorder. Studies show that aversion to mental illness is socially hard-wired. Society considers the disordered unpredictable, undesirable, and dangerous. The public wants to distance itself and isolate us because of its deep-rooted fear and realization of its own susceptibility. The stigma or branding does not need to be valid or accurate; it just has to be believable. Its purpose is to separate us from the rest of society.

What are the factors or attributes in MHS? Mental health stigma is formed and facilitated by ignorance (misinformation), prejudice (fear), and discrimination (false superiority). Stigma supports and is supported by public opinion, media misrepresentation, the mental healthcare industry, and the disease model of mental health. 

The media stereotypes anyone with a disorder as an unpredictable, hysterical, and dangerous schizophrenic. Half of the news stories on mental illness allude to violence. A person with a mental illness is either a homicidal maniac, autistic, or antisocial. 

Healthcare professionals are often undertrained and inflexible. We know how our disorder impacts our emotional wellbeing and quality of life far better than our doctors. Clinicians deal with 31 similar and comorbid disorders, over 400 schools of psychotherapy, multiple treatment programs, and an ever-increasing plethora of medications. Utilizing a one-size-fits-all approach to recovery is the normal course of action.

The mental healthcare community is drowning in pessimism. There is evidence to indicate the problem is endemic in the medical health community and universally systemic, which means that it impacts us personally, and the current disease model is the culprit. 

Clients report instances where staff members are rude or dismissive. Complaints include coercive measures, excessive wait times, paternalistic or demeaning attitudes, one-size-fits-all treatment programs, medications with undesirable side effects, and stigmatizing language. 

The ‘defective’ or disease emphasis has been the overriding psychiatric perspective for over a century. By the 1952 publication of the first DSM, the focus had drifted from pathology (the science of the causes and effects of disorder) to pathography (the breakdown of our psychological shortfalls, categorizing them to facilitate diagnosis). Pathography focuses on a deficit, disease model of human behavior. Which disorder poses the most threat? What behaviors contribute to the disorder? Are we contagious? What sort of person has a mental illness? It is these attributions that form public opinion, stigma, and our self-beliefs and image. 

The disease model and the DSM’s diagnostic system are under increasing scrutiny for their misdiagnoses, constant criteria revisions, symptom comorbidity, one-size-fits-all recovery programs, and general negativity. 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 our strengths and attributes. That is how we recover―with pride and self-reliance and determination―with the awareness of our capabilities. 

WHY IS YOUR SUPPORT SO IMPORTANT?  ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.  

Positive Psychology and the Wellness Model of Mental Health

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

Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI—deliberate, repetitive, neural information. WeVoice

Clinical psychologists posit the need for wholesale and radical change, not only in how we understand mental health problems but in how we communicate positivity and collaboration with the client. 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 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 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.

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

Health experts define mental illness as a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria that can produce functional impairment which substantially interferes with or limits one or more major life activities. 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. 

The pathographic or disease model of mental healthcare has been the modus operandi for centuries and it has been the overriding psychological perspective for over a century, with an insular focus on the biological and neurological origins of mental illness. In Scientific American, psychologist Kinderman argues, 

We must move 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.

Positive Psychology

The wellness model’s chief facilitator is positive psychology (PP), which originated with Maslow’s 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.” 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.” 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.” 

PP has been defined as the science of optimal functioning, its objective is to identify the inherent strengths, virtues, and attributes individuals and society need to live a productive life. Cultural psychologist Levesque describes optimal functioning as the study of how individuals attempt to achieve their potential 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.” Studies support the utilization of positive psychological constructs, theories, and interventions for enhanced understanding and improvement of ‘mental health. 

A range of approaches promoting wellbeing has 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.” Continuing research suggests that a positive psychological outlook not only improves life outcomes but enhances health directly. 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.“

The academic discipline of positive psychology continues to develop evidence-based interventions that focus on eliciting positive feelings, cognitions, or behaviors. 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.” 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.” 

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
  • A 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, incorporating both positive and negative aspects of the holistic individual. As one critical psychologist wrote, “people are not just pessimists or optimists. They have complex personality structures.” 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.” 

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. Positive psychology aims “to emphasize the positive while managing and transforming the negative to increase well-being.”

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.” 


WHY IS YOUR SUPPORT SO IMPORTANT?  ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.  

[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.