Welcome to From Insults to Respect.
This week I happened to watch on TV the play Next to Normal. It dramatically and musically brought forth a wealth of thoughtful and emotional reactions. I can’t, in a single post, express all of these, so here, I’m going to focus on just one–the issue of blaming those given a mental disorder label and their parents for how they are acting and experiencing.
The Play’s Main Plot
A woman who had a baby that died in infancy continued to grieve after four months. A psychiatrist, therefore, has classified her as having a mental disorder and has been prescribing psychiatric drugs for depression. Because his patient also imagines that the baby is still alive, and on birthdays she sees him growing up, and she regularly has conversations with him, the doctor has been prescribing an additional cocktail of drugs. As we enter the play, we see the drugs have certainly not relieved the woman from her or her family of the anguish that has come about. The imagined baby has grown to be a teenager. 
Her family, made up of her husband and teenaged daughter, are deeply concerned and support the psychiatrist’s treatment recommendations. Treatment during the play changes from drugs, followed by an hypnosis approach, and finally Electroconvulsive Therapy (ECT), none of which lead to satisfactory results.
My Reaction To The Play
In my training as a psychologist, I learned to avoid blaming people who act in ways that lead to a mental disorder classification or their parents. Blame implies thinking someone is guilty of doing something wrong.
If I perceive that someone has done something wrong and I become frustrated and angry at the person and I begin to seek to punish the person, I view that person as guilty.
For example, if I make a wrong turn to go to my friend’s house and when I discover my error if I have a strong emotion of frustration that springs up in me and I cry out, “What an idiot I am for making that mistake,” I am feeling guilty that I made the mistake, and the reason I am calling myself an idiot is because it is my angry effort to punish myself.
I use that specific type of definition for “guilty” to distinguish it from how I define responsibility, which I view as a more mature response. When people act responsibly, they recognize that they did something wrong, experience a strong feeling of frustration, recognize at the same time that as long they are a human being they are going to make mistakes. They recognize that the strong feeling of frustration is a good thing because it leads them to focus on what they did wrong, and the emotionality helps spur a process that increases the possibility of fixing the error in the long term, decreasing the chance that they will make the same mistake. Part of this frustration reaction leads me to focus on what I can specifically do next time to prevent the mistake. This is a wonderful process, and I welcome the experience as I would a helpful friend. When I see guilt springing up in me, I have been getting more and more skillful at transforming it into my helpful friend.
It seems to me beneficial to keep the idea of angrily desiring punishment when someone does something wrong separate from the idea of learning from the experience of making a mistake by experiencing frustration in a friendly, non-punishing manner. If you see that your five-year old son has made a mistake when trying to add 7 plus 3 and he came up with 9, you may see that he has done something wrong, but you might experience this as somewhat different from when you feel someone is “guilty” of doing something wrong. You may think that your son almost got the right answer, and he’s trying, and this is part of a useful learning process. You might not feel angry at him, nor think he deserves to be punished for his efforts. Perhaps you might gently correct him and give him a warm smile.
Although I am pretty good at avoiding the blaming game, from time to time I slip up and become angry at what I’m perceiving is happening with people dealing with mental health concerns. This play, so well done, has helped me to better reconnect with the habit of making the distinction between guilting and taking responsibility as I conceptualize them.
The music, singing, and dialogue blend together to avoid simplistic interpretations of events and filled me with empathy for the complexity of dealing with such challenging circumstances. I was left thinking that people embroiled in the types of situations that the play depict would do well to learn for themselves the difference between blame and responsibility. Moreover, it seems to me that it takes more than just noting the difference; it takes practice to turn this understanding into a useful habit. One useful practice is to identify five times when you found yourself employing guilting, and then see if you can write out a way to turn them into a response that better matches a responsibility response.
My Best,
Jeff
This same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and the drugs that psychiatrists prescribe. They all create the illusion that the pills improve their functioning initially through a placebo effect. Then, once their bodies adapt to the drug, each time they haven’t taken the drug for a few hours, they begin to experience a withdrawal effect that they attribute to their mental health concern returning. When they take their next pill, their relief from the withdrawal effect abating is experienced as pleasant, and with that, the illusion has been accomplished. For many people, it is only by gradually withdrawing from these addicted substances can one safely recover from this type of addiction (see 
Even if no immediate promising ideas come from a particular episode of spending time in this way, taking responsibility involves keeping hope alive. This means that you recognize that with particularly challenging situations, it takes an extended time to fully address such concerns. In the coming days, new, fresh ideas may yet come your way, or the situations that brought about the concerns may change in unexpected ways to your advantage. In contrast to acting responsibly, experiencing guilt when feeling anxious or grief becomes an aversive experience. The mental illness label pathologizes the concern, but there is a potential of improving one’s life with the experiences that get these illness conceptualizations.
n case this vague definition does not provide enough wiggle room for clinicians to label all people seeking their services as having a mental disorder and to prescribe a drug for it, the ICD tells the clinician, “When the requirements are only partially fulfilled, it is nevertheless useful to record a diagnosis for most purposes.” This type of double talk is one of the reasons why many people view the mental illness construct as super useful for a financially rewarding business model, but too vague and misleading for scientific purposes.
The experiences of Abraham Lincoln (see 
Welcome to From Insults to Respect. Today we take a close look at one reason some folks have a low level of respect for people who are viewed as having a mental illness–the belief that such people are avoiding responsibilities.
One has to do with the fact that some people at a gut level look down upon anyone who acts a little different than the norm. The other is the belief that people labelled mentally ill are prone to be violent. In actuality, the vast number of these people are not any more violent than the average Joe or Jill (see 
Many years have gone by since James wrote that letter, and yet I have found it just as relevant in our own time. In recent years I have become acquainted with many who become angry at any suggestion regarding the value of seeking within, and to be open from others, for suggestions on how they may actively deal with these types of concerns. Rather, they choose to passively respond to what they view as a mental illness, while insisting that something like the “Powers of the Universe” is the only thing that could secure them. Although “The Powers of the Universe” sometimes is viewed by them as some religious figure, more and more in today’s world, filling this role are often psychiatrists prescribing drugs.
Approximately 2 million individuals classified as having a mental illness manage to receive Social Security Disability Insurance (SSDI). Some find this infuriating. I have personally heard many folks make remarks such as, “These recipients should go to work like the rest of us, damn it!”
The only reasonable proposal that I have heard to address this type of attack on responsibility is “Universal Basic Income” (see 
People who feel guilty typically seek to punish themselves by either throwing insults at themselves, or actually physically hurting themselves. In contrast, taking responsibility for one’s anxiety and grief, in my opinion, involves welcoming these two experiences, kind of like you might a friend, for these experiences enrich our lives if handled responsibly. If you have something more pressing to take care of for a short period of time, it can make sense to gently delay your interaction with whatever anxiety and grief you have to deal with until a more convenient time. However, the responsible thing to do is to soon invite these experiences back so you can spend some time to work through these types of concerns. Daily meditation, quiet walks, and journal writing, are ideal ways to do this.
Even if no immediate promising ideas come from a particular episode of spending time in this way, taking responsibility involves keeping hope alive. This means that you recognize that with particularly challenging situations, it takes an extended time to fully address such concerns. In the coming days, new, fresh ideas may yet come your way, or the situations that brought about the concerns may change in unexpected ways to your advantage. In contrast to acting responsibly, experiencing guilt when feeling anxious or grief becomes an aversive experience, and one way to avoid such negative experiences is by finding or creating distractions.
These distractions, when used too often are far from ideal. It is analogous to sleep. When people try to distract themselves from their sleepiness for too long, say by watching exciting TV shows, their sleepiness becomes stronger and stronger and more and more intense. If they continue to press on, avoiding getting enough sleep with various distractions, their functioning becomes compromised. A similar process happens when we keep avoiding providing sufficient time to work through our anxiety and grief concerns.
Thus, mania may, in some cases, be a way to avoid responding responsibly to anxiety and grief because of the guilt that occurs over misunderstanding the nature of these useful experiences. This misunderstanding, along with not knowing how to respond responsibly when these experiences occur, may lead to reaching a point at which the person becomes overwhelmed by unprocessed concerns. It is at this point that creating grandiose ideas manage to further distract these folks from the distressing thoughts spinning out of control. It has been estimated that 47 per cent of people who experience what mental health professionals often refer to as psychotic delusions during their manic phase claim they have grandiose abilities. This often leads to friends, family, and community members, concluding such folks are behaving irresponsibly.
Now, having surveyed these main reasons, some may therefore jump to the conclusion that people labelled as mentally ill should be blamed for not acting responsibly. Blame, in my estimation, is typically counterproductive. Too often, it will provoke horror, total rejection of the blamer, and a hardening of whatever position the person who is being blamed holds.
For a more in-depth story of this kind, I recommend my novel, Fights In The Streets, Tears In The Sand (see 
Your insurance company requires that I must place a diagnosis on your health insurance form for you to access that service. I hear, so far, that you are concerned about….”
“Well, I wish we didn’t have to get into this labelling issue. Personally, I think it’s best to treat each person that I provide counseling to as an individual. It is understandable that many people don’t want to be placed in a diagnosis box, especially one known to be stigmatizing. But the insurance companies do require a diagnosis.”
In my journal article, I go on to propose a practical, more scientific alternative to the DSM. I call this alternative, the Classification and Statistical Manual of Mental Health Concerns (CSM). The first words in the CSM would be: “The developers of the CSM fully recognize that individuality outruns any classification system. It is for this reason that the CSM does not seek to classify anyone. Instead, it classifies the expressed concerns of individuals seeking to have their concerns addressed by a mental health service provider.”
On the other hand, some resisted the CSM approach. As I began to question them, seeking to figure out where exactly the disconnect was, I discovered that for some, it had to do with their belief that the DSM is a classification system based on solid principles of science and nothing could possibly be better. As I questioned them further, I discovered that their understanding of what a scientific classification system is designed to do was a bit incomplete. So, in today’s post, I explain in an easy to understand manner the nature of scientific classification systems, beginning with a description of a classification system with which we are all so very familiar–birds. This will enable us to see clearly why the bird classification system is useful as a scientific instrument. We will then look at the DSM classification system in light of what we learned about the bird system, and this will reveal the DSM‘s serious scientific shortcomings. Finally, we will compare and contrast the DSM system with the proposed CSM system in a manner that can make the superior scientific merits of the latter crystal clear.
As it turns out, there are some people very interested in birds.
Once scientists carefully define their general topic of interest, they describe different types of what they are interested in. So in our bird example, the scientist interested in them came up with a taxonomy that lists bluejays, pigeon, sparrow, and so forth as subtypes of the general category of birds, describing each subtype in a precise manner that can reliably distinguish each from the others on their list. Why bother to do this?
The main reason is that when they discuss their findings with others, they want to make sure they are using words that mean the same thing, and it is a great time saver. For example, let’s say John is a bird scientist and he says to Judy, another scientist, “I saw a bird the other day and I didn’t know what type it was; can you help me figure out what it is?” Notice that since both of these scientists know the meaning of a bird, it saves John quite a few words. Just imagine if instead every time John uses the word bird he had to say, “I saw something that had an endothermic vertebrae, characterized by feathers, toothless beaked jaws, the laying of hard-shelled eggs, a high metabolic rate, a four-chambered heart, and a strong yet lightweight skeleton.” That’s quite a mouthful to have to say each and every time you refer to a bird. In this example, just saying bird saves a scientist about 30 words each time the word bird is used.
And let’s say John, the scientist, wants to find in a library some information about a particular type of bird. He would have to waste time looking at every single book in his library until he found one that seemed to be talking about what he was interested in.
This would result in John having to unnecessarily wade through numerous books on flying insects, of which there are hundreds of thousands of types, bats, and some fish that sort of can fly. With the current bird classification system, anyone can go to a library and quickly find the specific section that houses information on just birds. Similarly, placing the word “bird” in a search engine enables John to more quickly retrieve relevant information than would a less explicit definition.
“In the DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significant increase risk of suffering death, pain, disability, or an important loss of freedom.”
The latest edition of the DSM (DSM-5) is just as vague. It begins, “Although no definition can capture all aspects of all disorders in the range contained in the DSM-5, the following elements are required.” Although it says the following elements are required, it then makes it clear that the elements that it lists are not required. As I provide the rest of the definition, notice the use of the word “or” and “usually.”
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognitive, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expected or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.” 
This is about as vague a descriptor as one can possibly conjure up. How about the descriptor “dysfunction?” This, too, is left to the subjective opinion of mental health providers who often have financial interests in declaring that someone has a mental disorder.
I, for one, am interested in a phenomenon that I, and others, call mental health concerns. Obviously there is wide interest in this. After all, there are numerous educational institutions that provide training to people so they can become credentialed to address mental health concerns. Numerous people actually voluntarily go to these educational institutions, devoting considerable time and expense. Once completing the credentialing requirements, they apply to their state credentialing board, pay a fee, and then after the board checks to see if all of its requirements have been fulfilled, it grants a license permitting the person to legally provide mental health services. That person then sets up a practice that offers mental health services. People wishing to access these services first devote some time to decide where to go. They then make an appointment, show up for the appointment, and then express their mental health concern to the mental health service provider. Aspects of all of this occur each and everyday and involves tens of thousands of people working in a coordinated fashion to have mental health concerns addressed in a professional manner.
This definition of a mental health concern requires all of the following items for a mental health concern to exist:
Also notice that no one doubts that each of the 4 listed items that, taken together, make up the mental health concern concept exists. Everyone agrees that there are people who seek mental health services in our society. Everyone agrees there are people licensed to provide mental health services. If you go further down the list, there is no question whatsoever, that these other conditions also exist. So the definition, I contend, meets the scientific standard that it describes the something of interest (mental health concern) in a clear and detailed manner, leaving no room for confusion or doubt. Once the CSM classification system comes to be fully developed, people would be able to use the term “mental health concern” as a short way to indicate a phenomenon that contains all four of its defining characteristics.
With regards to the various types of concerns that mental health service providers are asked to address by those seeking their services, two major types would be, 1. concerns expressed about oneself, and 2. concerns expressed about someone else. Under the headings of each of these two major types would be concerns regarding behavior, emotion, mood, meaning of life, death, dying, managing chronic pain, addiction, work, relationships, education, eating, cognition, sleep, hearing voices others don’t hear, and challenging life situations. This, of course, is just a preliminary list of types, and through survey data that ask psychologists and mental health advocacy groups about the various mental health concerns that they are asked to address, the list would become more fully developed.
The above explanation was designed to clarify just one of the reasons why the proposed CSM’s mental health concern concept provides a far more solid scientific foundation on which to build a classification system than the DSM‘s mental disorder concept. Despite the fact that many people have become convinced that the DSM‘s classification system is a sound scientific instrument, its definition is far more vague than how I propose defining a mental health concern.
Regular readers know that I have, from time to time, been dealing with a conflict regarding psychiatric diagnosis. Said briefly, there are many people who immediately lose respect for anyone who questions the validity of the mental illness/mental disorder theoretical construct. On the other hand, many people have lost respect for the psychiatric profession because of its pathologizing approach of addressing concerns related to thinking, mood, behavior, or challenging life situations. Amidst this conflict, I have been trying to put forth on this blog, and in a number of other publishing outlets, an alternative approach with which the disputing parties can live in relative peace. 
Last year, I presented a paper on this topic at the American Psychological Association convention in Denver (see 
Albert Einstein created a revolution in the branch of science known as physics. Prior to the 20th century, physicists explained the propagation of light with the use of a theoretical construct known as the ether. There were experts in the ether who described ways to define it, along with its various characteristics. It was thought, for example, that the ether didn’t move in any direction, but it could vibrate. There was much discussion about an ether wind. And then Einstein came along and described the nature of light without resorting at all to the ether.
Criticism of the mental disorder construct began at the very beginning of American psychology when William James declared that it was nothing more than superficial medical talk. Criticism continued throughout the 20th century, and when the latest version of the DSM came out, there was a ton of media and professional articles that once again pointed out its numerous scientific shortcomings. Many throughout general psychology expressed deep concerns that psychologists utilizing the DSM approach had sold out to psychiatry and the pharmaceutical industry. Moreover, they bitterly complained that a paradigm that utilizes the mental disorder construct brings down respect for psychology as a legitimate branch of science. What can be done about this?
Well, in thinking about this I hasten to mention that Thomas Kuhn’s (1972) classic book, The Structure of Scientific Revolutions, rightly points out, for real change to occur in a branch of science, it is not enough to point out the weaknesses of a paradigm, there needs, as well, a new approach that is a distinct improvement over the old paradigm. So, is it possible to really come up with a distinct improvement over the current DSM approach? I think our APA can do this easily if it set its mind to it, and it can do so within a year.
Let’s say Mary Doe comes to a licensed practicing psychologist and says she has been feeling a great deal of sadness much of her days. The psychologist, for verification purposes can say, “I hear you saying that you are concerned about how sad you have been feeling much of your days, and you would like us to work together to address this concern, is that correct?” If the service seeker says yes, this would verify that a mental health concern has been expressed, and what the concern is.
Well, there you have it. I only have seven minutes to present the paper, so many of the essential points that I would love to make have to be left out. There will be some time for questions and discussion, so some additional information could be shared then. And, for those who are interested, as I point out in my paper, they can now readily retrieve a far more complete presentation of my proposal by assessing the journal article I wrote that was just published last month.
Perhaps he has come to believe that many of his most ardent supporters actually believe him when he lies, and it is the media who are telling the lies. Trump may also believe that others of his supporters don’t care that he lies because they believe business folks always exaggerate as they promote their goals, and that Trump is just promoting causes that match their values. Many Americans may therefore see his behavior not as a sign of mental illness, but simply that he is a shrewd businessman.
“I should note that nothing I am saying should besmirch the reputations of men like President Abraham Lincoln or Sir Winston Churchill, both of whom are said to have fought the ravages of major depression or bipolar disorder. One was instrumental in ridding America of slavery. The other was instrumental in saving the world from tyranny. Mahatma Gandhi, by the way, also reportedly suffered from depression. Psychiatric illness does not, a priori, disqualify a person from rendering extraordinary service to mankind.”
In the February 14, 2017 edition of the New York Times, there appears a 
At 39-years of age, Ron had been a respected employee in a department store for nearly ten years. If he had made it to ten full years, he would have qualified for some extra benefits. Upper management chose to replace him with someone new a week before the ten years were up. Discovering that landing a new job was leading to one rejection after another, Ron fell into an anguishing depression.
“You’ve been paying for mental health coverage on your health policy for over fifteen years. You might as well take advantage of it and see if a professional can help you through this.”
At his first appointment with Dr. Sigmund, a cigar smoking psychologist, Ron discovered that to access mental health services with his health policy, he would have to be labeled as a person with a mental disorder. “I don’t want that kind of nonsense in my medical record,” he told Dr. Sigmund. “I’m not mentally ill! I’m just going through some tough times right now and I can use some professional help getting through this.”
“Listen, Doctor, I’ve been paying for this mental health coverage for years and no one ever told me I had to be given a stigmatizing label to access services. That’s not fair.”
In fact we have recently learned that these disorders are properly viewed as genetic diseases. The evidence is pretty plain. We have learned that these types of conditions run in families, and genetic research has even identified the actual genes that are involved.”
First, Dr. Sigmund declares that “Without a mental disorder diagnosis, which I must place on the insurance form, I can’t see you.” This is pretty often true. In the United States, if you want to take advantage of your mental health insurance coverage, insurers require a mental disorder diagnosis [see 
In my opinion, it is not sound science that came up with these types of labels, but rather, a business model that serves the pharmaceutical industry and psychiatry. Psychologists have gone along with the plan for practical reasons. Additionally, some actually are convinced that the labeling system is indeed based on principles of science. For a full critique of their position, see 
In the parable, Dr. Sigmund declares that “these disorders are properly viewed as genetic diseases.” Is this a fair statement? The simple answer is no. To reasonably arrive at this answer, we’ll have to spend some time going step by step through some basic ideas.
Even identical twins won’t always have the same set of these types of characteristics despite the fact that a pair of identical twins have the same set of genes.
To understand why the answer is no, we have to first understand that all species have a great number of characteristics, and each of their characteristics vary to some extent between different members of their species. For example, human beings have a typical height, they can run at a typical speed, etc. The average height of male humans is about 5 feet, 9 inches. Some, men are, however, somewhat taller, others are somewhat shorter, and some are quite a bit taller or quite a bit shorter. Similarly, some men can run at the average speed for men, while others can run at various rates that are different from average.
If someone is above average in height, this does not mean he or she will be above average in running speed. Each of our numerous characteristics can be either within the average range, above average, or below, and because someone is below average in some set of characteristics does not mean that he or she will not have some characteristics that are average or even above average. And these differences are a great boom to the human race. If everyone was brilliant in academics and also had a strong genetic desire to be a professor at Ivy League universities, who would build the roads, drive our trucks, grow our crops, serve in law enforcement, cut our hair, tend to the sick, serve as fire fighters, staff stores, serve us in restaurants, etc.? People with different interests and talents enhance our own lives.
If you do end up shorter than average this does not mean you have a genetic disease, even if we can demonstrate that taller people tend to have some advantages over people who are shorter. Saying that people who are shorter than average have a dysfunction would be stigmatizing while clouding the fact that we cannot determine a person’s overall functioning based on just one set of characteristics. Being shorter, when combined with the rest of a person’s characteristics, can lead to him or her being more useful in a variety of ways.
Let’s move on now from discussing a person’s height to a more complex set of characteristics–athletic performance. There is some evidence that athletic performance might be a set of characteristics that, to some degree, 
Rather than pathologizing below average athletic skills, I’ve seen physical education teachers who encourage such children to participate in some after school programs that develop skills in sports that can be practiced non-competitively, such as running, bicycling, and golf. Some of these children take to such programs willingly and end up staying in fine physical shape the rest of their lives. If they don’t, they suffer the consequences and all of us end up paying higher health premiums because they are at an increased risk of getting sick. At the same time, their other sets of characteristics, when combined with their couch potato ways, may offer them and the rest of us some valued fruits.
I know that some psychologists say, it is only the sets of characteristics that can be linked in some way to a “dysfunction” that are properly labeled as a disease. But the dysfunctional descriptor is so vague that it can be applied to the vast majority of people, and, perhaps, everyone.
How about becoming a psychiatrist? This may run in the family. If we find that becoming a psychiatrist increases the likelihood of committing suicide, which some data suggests, are all of them to be viewed as having a genetic disease, or would it be clearer, and more scientific, to say their set of characteristics is a “risk factor” for some negative outcome? I believe the latter is more scientific.
Instead, psychologists have a conversation with the person seeking mental health services.
As I read the research on this issue, it became plain to see that genes can be likened to the buds of a beautiful flower. If they meet up with the right soil, sunlight, water, and care, they typically blossom into something beautiful. But even with a great deal of wonderful nourishment, sometimes they get tangled up with some surrounding weeds. Stigmatizing labels don’t help in such situations. Instead, some wise gardening can make a beautiful difference.