Category: Name calling

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conflict resolution insults Name calling Obesity over weight

On Being Viewed As “Fat”

Welcome to From Insults to Respect. Recently, I’ve been reading about the trials and tribulations of being viewed as fat. For example, in a Psychology Today article titled “Is Your Child Being Teased About His Weight?” the author, Edward Abramson, Ph.D., tells us that,

“Although the medical consequences of childhood obesity may not emerge until adulthood, the psychological effects are immediately present. Studies have shown that discrimination against overweight kids begins in kindergarten or earlier. One study of five year-olds found that they described an overweight child as ‘lazy, dirty, stupid, and ugly.’ A new study found that 4 – 8 year old children were less likely to help overweight peers with everyday tasks like picking up toys. Another study reported that virtually all overweight teenage girls had been verbally abused. College students when asked to rate the desirability of a potential spouse rated cocaine users, embezzlers, and shoplifters as better marriage partners than an obese person.”

In another article, this one titled, “Being Called FAT. It Hurts. And You Don’t Forget,” Cassey Ho, a fitness instructor, tells us about a teenager who described her experience as follows:

“I was at a family birthday party, we were all eating together at this long table with all sorts of wonderful foods laid out. I was thoroughly enjoying my plate along with my mom and sister. Then this little girl who was probably a year or two younger than me looks at me and says ‘Why are you so fat?’

“I stopped chewing. My eyes welled up with tears. The edges of my lips curled and I fought the quivering frown overcoming my face. I dropped my fork. Ran into another room. Cried. The kind of crying where you can’t stop and you can’t breathe.”

When we meet someone we care about who is dealing with this kind of challenging experience, is there anything that we can do that can be helpful? To address this question, I’m going to present a little scenario that kinda describes what I have done over the years when I found myself providing counseling to someone dealing with this issue. In saying the scenario “kinda” describes what I have done I mean to indicate that it really is, by necessity, a shortened description of what actually occurs in my actual counseling sessions. More specifically, in real life sessions I spend distinctly more intervals of time listening in a caring way than we will see in the scenario. I ask more questions to clarify what specifically occurred in any event being described. I am more likely to slightly rephrase what the person had said so they see that I understand what I have been listening to, thus reassuring them I’m really deeply listening. A full rendition of such a counseling session would be a fifty-minute read, way too long for our purposes.

In presenting the scenario, I hasten to mention that it is not my intention to declare that it presents the ideal approach to being helpful. It is merely offered as a useful way to set up a model that can be critiqued. I encourage readers to freely suggest any improvements, and to point out where, in their estimation, I went astray.

The Counseling Scenario

Heather, a 17 year-old high school student, arrived for her weekly counseling session.

“How are you doing?” I ask as she sits down.

Heather folds her arms as if she’s holding herself. Her mouth curves downward. There’s a slight twitching at its corners. Her eyes begin to water.

“You’re looking mighty sad,” I say. “Did something happen?”

“While my mom was driving me here, I took out a candy bar, and she told me I shouldn’t eat it because I was getting fat. Do you think I’m getting fat?”

“Heather, I like you just the way you are.”

“How can you like me? Look at how fat I am!”

“Oh, it’s very possible for me to like and respect people who weigh more than the average person. One of my favorite actresses is Hattie McDaniel who surely weighed more than you. She played parts in numerous movies such as ‘Gone with the Wind’ and ‘Show Boat.’ It wasn’t just me who delighted in her character portrayals, many producers must have liked her too because they selected her to play in over 300 movies, and her peers selected her to win an Academy Award. She wasn’t just a movie actress, she also was a singer and song writer as well. The United States honored her with a U.S. postage stamp for her contributions to the arts.

President Taft

“William Howard Taft weighed far more than you, well over 300 pounds. Despite that, the American people selected him to be our 27th president. After that, he was selected to be Chief Justice of the United States Supreme Court, certainly one of the most respected positions in the country. So, people can surely like and respect people who weigh more than average.”

“You, and others might like and respect some people heavier than average,” Heather hastens to say, “but I bet you didn’t ask them out on dates.”

“Well, when I first started to date, I did have in mind asking out only women who matched the ideal Hollywood romantic lead image, and they did tend to have narrow waistlines. They also had faces that can lead one to drift into a dream. As it turned out, there were not a whole lot of such women around my neighborhood, and yet I did start to date. On some scales, those that I dated did not match the perfect Hollywood type here or there but I found I was still attracted to them. In time I got to know things about them that transcended mere looks. When I met my wife, she was wearing braces on her teeth, hardly a classic Hollywood look.

“And judging from my observations, most women that I knew during my dating days were willing to go out with guys who didn’t look exactly like Cary Grant or Robert Redford. After a while they found someone that had looks that fell short of what some might think of as perfect in every way, and nevertheless, they fell in love and got married.

“So, that’s my take on these questions you’ve been posing to me. Perhaps more important is how you have been feeling and thinking about these issues. Would it be okay if we switched to focus on this?”

“I guess.”

“Good. So, tell me a little more about how you felt when your mother said you were getting fat.”

“It felt awful.”

“You don’t like the idea that you might be becoming heavier than you would like?”

“I hate it!”

“Do you think you are becoming fat?”

Here, Heather pauses, and her face starts to turn a bit purple. After a few seconds, she says, “Lately, when I see myself in a mirror, I view myself as being fat.”

“I see.” I pause here for a few seconds, just experiencing within me strong empathy for what Heather has been going through, and also seeking a way toward some peace with it.

Then I say, “I think it would be helpful if we tried a little mindfulness exercise here. It’s quite simple. I’d like you to close your eyes for one minute and just focus on the physical sensations that you experience when recalling how you felt when your mom said you were getting fat, and how you have been feeling when you look in the mirror. I’ll also close my eyes for that minute and focus on my own physical sensations when I recall someone saying something to me that I found stressful and how I’ve been feeling when I look in a mirror. Would you be okay if we tried this little exercise?”

“Okay, I guess. What good would that do?”

“The exercise comes from several ancient wisdom traditions. It is part of what has been called ‘mindfulness.’ There is a theory that it deepens our stressful experiences in a way that perhaps leads us to take some positive actions to deal better with them.”

“Well, I guess if it will only take a minute.”

“Good. So, let’s close our eyes and focus on the stressful experiences we have just been talking about, focussing more on the physical sensations in a non-judgmental manner. I’ll keep track of the time. If you desire, at any time, to open your eyes, feel free to do so. You don’t have to keep them closed, but it is more relaxing and less distracting if you have them closed most of the time.”

“Okay.”

When the minute is up, I let Heather know that it was time to open our eyes. Then I ask her to describe what she had experienced.

“As I thought about what my mom said, I felt a tightness in my stomach and I noticed my hands squeezed very tightly into fists. When I thought about looking into the mirror, I felt like crying.”

“Anything else that you noticed on a physical level?”

“No. That’s about it. How about you, Dr. Rubin? What happened on a physical level with you.”

“I recalled when I was young I had the opposite problem than you, because people called me, in a nasty way, a ‘Skinny Marrink.’ I found, on a physical level I felt a kinda twisting sensation in the center and upper chest, and a tightness in the back of my neck. And when I thought about how I’ve been feeling when I look in the mirror, I felt a grieving sensation about my hair thinning and how much older I look, and I found on a physical level that I let out a long sigh, and then my lips tightened, and I sighed once again.”

At this, Heather smiles, and then she catches herself doing it, and she says, “I didn’t mean to smile at your distress, it’s just, well I guess I felt a little comforted hearing that even you can be stressed out about your looks.”

“Even me?”

“Well, that you’re a doctor and all.”

“I see. I suppose that’s understandable.”

Then Heather says, “When I was focussing on my physical sensations, I did think that if I don’t like how fat I’m getting, I oughta do something about it. It is healthier to not be overweight. Can you help me to come up with a plan?”

“If you like, we could work on that together. I think we would want to include not only eating less, but also eating healthy foods and getting sufficient exercise.”

“That makes sense to me, Dr. Rubin.”

Conclusion

So, there you have it, a scenario of one counselor’s effort to be helpful when someone was dealing with being viewed as fat. I hope that it was apparent in the scenario that I sought to listen in a caring manner, and remain supportive, respectful, and accepting.

Did I ask the right questions? Did I say something that you feel is wrong? Do you have any suggestions for improving the session? I encourage you all to speak up and express your views in the comment section. No one is going to bite you on this blog, I can assure you of that.

In any case, may you all find someone who will show you kindness as you meet up with all of your challenging experiences.

Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

Categories
anger Bullied bullying conflict resolution emotional maturity insults interpersonal conflicts Name calling providing negative criticism social skills sports coaching

Abusive Criticism In Big Time Sports

bryce1It’s the bottom of the eighth inning. The talented star, Bryce Harper, front runner for the National League Most Valuable Player Award, hits a pop fly to left field that a professional outfielder is very likely to catch. However, there are times when such fielders do lose the ball in the sun or the stadium lights, and the ball ends up being dropped, allowing the batter to safely reach base if he had bothered to run. It is for this reason that Mr. Harper is supposed to hustle down to first base even if he has a pretty good reason to think that the ball he hit is, in all likelihood, going to be caught. Instead of sprinting down to first, Mr. Harper slowly steps out of the batter’s box and then heads to the dugout where he runs into a very angry teammate, Jonathan Papelbon.

Papelbon-chokeAccording to several sports reporters, Mr. Papelbon, an incredibly talented pitcher, began to criticize Mr. Harper about his lack of hustle, and after a very brief exchange, he charged into Mr. Harper, putting his hands on his throat and shoving him into the back wall of the Washington dugout. Fortunately, Mr. Harper was still wearing his batting helmet because his head smacked hard into the wall, and his helmet came flying off. Several Nationals players and coaches responded immediately and physically separated the two.

How Mature was Mr. Papelbon’s Style of Providing Negative Criticism in this Situation?

Regular readers of this blog know that when it comes to providing negative criticism, we are encouraged to consider a tentative model that describes five levels of maturity. Level one is viewed as the most immature, and each higher level is viewed as a little more mature. Let’s take a quick look at these levels, and as we do so, let’s see if we can figure out which of the five levels best describes Mr. Papelbon’s approach.

PROVIDING NEGATIVE CRITICISM:  FIVE LEVELS OF MATURITY

1. The criticizer displays one or more of the following behaviors:

  • Cries without stating what the crying is about
  • Physically attacks the person being criticized
  • Damages property

 

 

 

 

 

    2.  Those who are at this level display one or both of the following behaviors:

  • The criticizer does not explain what the offending behavior is, but instead expresses displeasure with glares, insults, shouting, silence, or threats that do not involve bodily harm. (For example, someone might be making too much noise and the criticizer might turn to the noise maker and glare, or cry out, “Jerk!”)
  • Threatens bodily harm regardless of what else is said.

      

 

3. Those who are at this level clearly state the criticism with enough detail so the criticized person, if he or she wills, can improve the behavior, idea, or appearance, but couple it with glares, insults, shouts, or threats that are not about bodily harm.

         

 

 

 

 

 

 

 

4.  Those who are at this level state the criticism without bodily attacks, damaging property, glares, insults, threats, or shouts, and with enough details so that the criticized person, if he or she wills, can improve the behavior, idea, or appearance.  If the person receiving the criticism becomes defensive or angry, these criticizers empathize without returning glares, insults, threats, or shouts.

         

       

 

 

5.  Those who are at this level provide criticism in a manner very similar to a level four style of criticism but beforehand, they consider the person who is the target of the criticism, and the situation that he or she is in.  As a result of such considerations, they may decide to alter the criticism. 

 

 

 

 

According to the Above Model, What Level of Maturity Best Describes Mr. Papelbon’s Form of Negative Criticism?

While criticizing Mr. Harper’s lack of hustle to first base, Mr. Papelbon physically attacked him. Of the five levels described in the above model, level one, the most immature level, best describes what he had done.

Why is such a style considered immature? Well, one reason is that when people respond at the more mature levels, it demonstrates that they can consider the consequences of their actions before they choose what actions to take. In this case, the consequences for Mr. Papelbon has been a suspension for the rest of the season, a fine of thousands of dollars, and he has been displayed on national news in a negative light, thus tarnishing his reputation. A little forethought would have led to avoiding these clearly negative consequences.

sprintNow, it is important to note that the specific negative criticism that Mr. Papelbon wanted to deliver to Mr. Hudson, was, according to my own value system, correct. Mr. Hudson does owe it to his teammates to hustle down to first base in these situations. However, I disagree with how Mr. Papelbon provided the criticism.

Mr. Papelbon, center, after lunging at Mr. Harper.
Mr. Papelbon, center, after lunging at Mr. Harper.

What would have been a more mature response? A little forethought would have led to realizing that Mr. Harper was very frustrated with his own pop out in the game. Thus, to wait until the next day would give both parties time to calm down.

Moreover, providing negative criticism to someone in front of lots of other people is often a huge mistake. Face-saving actions tend to increase defensiveness for both parties. Asking to discuss such matters in private is often a kinder, wiser approach.

Finally, Mr. Papelbon would have been wise to first consider if he was the best person to present the criticism. Usually managers of a team are the ones who are considered to have the legitimate authority to bring these types of issues up to a player. If Mr. Papelbon felt he had a particularly close relationship with Mr. Harper, or an established mentor relationship, there could be some exceptions to this general rule. Otherwise, Mr. Papelbon might have been wise to privately discuss his displeasure about his teammate’s lack of hustle with his manager and urge him to take firm action.

Sports Illustrated Article on “Abusive Coaches”

In big time sports, Mr. Papelbon is in no way the only one who provides negative criticism in a manner that matches the most immature levels of our model. In a special report of the September 28, 2015 issue of Sports Illustrated, Alexander Wolff (with reporting by Lauren Shute) writes:,

Coaches yelling“Why do college coaches continue to yell, demean and demoralize? That’s yesterday’s tactic. Today’s athletes can’t-and won’t-take it. What’s more, it doesn’t work: Study after study shows the benefits of a more positive approach.” (p. 51)

What are the negative consequences of providing negative criticism in these low maturity level styles? The Sports Illustrated writer tells us about excellent players leaving their teams, and in rare cases, committing suicide.

Many coaches have lost their jobs after an athletic director’s investigation. Over the past 28 months at least seven Division I schools have had an investigation, and then parted ways with coaches following player complaints of mistreatment.

Moreover, some colleges end up getting sued. In one case, seven former players have filed a $10 million civil suit that charges the school and coaches were fostering a racially hostile environment.

There is some relatively good news in the Sports Illustrated article. Apparently, most players are not being treated in a demeaning manner judging from one recent NCAA survey. Of Division I players, 31% of men’s basketball players and 22% of football players reported that a coach “puts me down in front of others.” Although this indicates that there is still plenty of room for improvement, it can nevertheless be viewed as a hopeful sign that most coaches are finding more positive ways to bring out quality performances in their players.

Why Do Many Coaches Continue to Use Abusive Tactics?

As reported in the Sports Illustrated article, according to Ramogi Huma, executive director to the National College Players Association, which often hears from abused athletes:

“I believe this is a cultural problem. A lot of coaches, they were hollered at and abused when they were players.” (p. 52)

coach yelling 2There is also undoubtedly a great deal of pressure on the coaches. If they don’t win, they are very likely to be replaced.

But perhaps the major reason is that coaches are not provided enough inspiring stories about how successful coaches find ways to win by fostering bonding, loyalty, and commitment to a team in a positive manner. Dramatic enthusiasm when explaining to players what specifically they can do to improve, rather than belittling them about what they did wrong, is one such positive approach. Celebrating each step toward improvement is another.

Conclusion

Thinking about what happens when immature styles of criticism occur in the world of big time sports can provide us an important lesson with regards to how we provide criticism to others in non-athletic situations. The five levels of maturity provides guidance not only to big time athletic teammates and their coaches, but also to the rest of us.

Real change from lower levels of maturity to higher levels rarely occurs from reading a single article. More typically, it requires bringing examples of people utilizing the higher level skills before one’s consciousness at least weekly for several months, and, on each of these occasions, an effort must be put forth to consider how these skills can be specifically applied to one’s own life. Following this blog is a no cost way to help make this happen.

I hope you join us again real soon.

My Best, Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.

Categories
conflict resolution Donald Trump insults intergroup conflicts interpersonal conflicts intrapersonal conflicts Name calling politicians

The Insults of Donald Trump

Republican presidential candidate Donald Trump gestures and declares "You're fired!" at a rally in Manchester, New Hampshire, June 17, 2015. REUTERS/Dominick Reuter TPX IMAGES OF THE DAY - RTX1GZCO

When it comes to insulting people, Mr. Donald Trump is New Jersey Governor Chris Christie on steroids.

The Paradox

trump2Among Mr. Trump’s insults are calling some people “fat pigs” and “disgusting animals.” During his first presidential campaign, I observed him on national TV calling Senator Lindsey Graham “a stiff,” Governor Rick Perry “stupid,” and numerous other political opponents, “idiots.” He has denigrated federal judges who ruled against his efforts that sought to suspend refugee flows.

Chris ChristieIn an earlier post about Gov. Chris Christie’s use of insults, I described the following apparent paradox. On the one hand, there is a considerable amount of evidence that people who are very insulting tend to be less liked and respected. On the other hand, Former Gov. Chris Christie is well known to be very insulting, and despite this, he was twice elected governor of New Jersey, and at one point he was viewed as a front runner for the next U.S. presidential election. Here is a man that many people came to admire.

Now we see that Gov. Chris Christie has fallen in the respect others had had for him, while Mr. Trump has taken his place as a big time insulter who, despite his insulting ways, has gained respect from some and in 2016 received enough votes to get him elected US president. As I did when Gov. Christie was the king of insults, in today’s post I want to take this opportunity to explain this apparent paradox.

Explaining the Paradox

interpersonalintrapersonalFirst of all, the negative effects of being insulting is strongest in interpersonal and intrapersonal relationships.  As I define these terms, your interpersonal relationships are your interactions with people with whom you have direct, face to face interactions on an ongoing basis; your intrapersonal relationships involve interactions that you have with yourself.

intergroupThe relationship that politicians have with voters is best viewed as an intergroup relationship, rather than either an interpersonal or intrapersonal relationship. The intergroup relationship I’m discussing today regarding politicians involves the group of people who might potentially vote for them, the group of people who have a vested interest in getting the politician elected, and the groups of people who are working to get someone else elected.  Although insulting people is relevant to intergroup relationships, other issues often become more important.
interpersonal-conflict-violenceIn an interpersonal relationship, if you attempt to insult the person with whom you are personally interacting, that person might insult you back and the interaction can escalate into violence. In fact, the most common reason people turn to violence is because they felt someone treated them disrespectfully.

When we see politicians seeking to insult someone, they are modeling for others this type of violence producing behavior. But what makes this type of behavior very different for politicians is that they almost always have a group of supporters standing behind them and a team of armed security personnel well trained to intervene if an insulted party makes any moves at all that can be viewed as violent.  Under this set of circumstances, it is far safer to play the part of a tough guy who doesn’t take any crap. Meanwhile, as politicians like Mr. Trump model this behavior for people without the protections afforded to politicians, it can potentially increase levels of violence for non-politicians.

interpersonal conflict comicHere’s another difference between what typically happens during your interpersonal relationships and the intergroup interactions that involve politicians.  When someone directly seeks to insult you, unless you are well trained in handling this in a peaceful manner, you are likely to take the insult personally. The emotions that arise in this situation are more likely to be stronger than typically experienced when groups of people see on TV or in a large arena a politician throwing insults at someone they don’t personally know.

election-vote-ballot-boxPoliticians, moreover, are not seeking to develop a sound interpersonal relationship with you. They are, instead, seeking your vote. They know very well that not everyone is going to vote for them. If they anger the voters who aren’t likely to vote for them anyway, and end up getting 51 percent of the vote, this, to them, is success.

interpersonal conflict zNow, when it comes to interpersonal relationships, if you act in a manner that leads to even a minority not liking you, this can lead to far more direct problems for you than if a minority of people don’t vote for some politician. If those who personally know you don’t like you, they can begin to say things behind your back to people who actually personally interact with you. Some of what gets said can be untrue and very unfair, but you may never hear about this. This behind your back treatment may result in people that you like no longer inviting you to parties.  When you used to be invited to go bowling, now someone else is getting invited. In a work setting, you may be passed up for promotion. These types of consequences can have direct effects on your personal life. For Mr. Trump, the personal effects that may occur if he angers a minority of people who would have been unlikely to vote for him, would be far less important to him than getting elected.

issuesAlso, note that when people decide on who to vote for, they consider many issues, not just whether or not the candidate insults anyone.  When Mr. Trump insults someone, many voters are apt to say to themselves, he isn’t doing anything much different than all the other politicians. These voters then choose a candidate based on other issues.  If some voters recognize that Mr. Trump insults others a bit more than other candidates, they may feel that his stand on immigration is a far more important issue for them.

Others will actually like the insulting because the insults are aimed not at them, but at people whom they have come to dislike. If you have become angry because you like to use the “N-word” and people have criticized you about it, you may have become angry about what strpolitical correctikes you as political correctness. When Carl Tomanelli, a 68-year old retired New York City police officer was asked by a New York Times reporter why he is supporting Mr. Trump, he answered, “People are starting to see, I believe, that all this political correctness is garbage. I think he’s echoing what a lot of people feel and say.”

problemsOther voters are very angry at the lack of progress being made by current career politicians on solving immigration, economic, and other problems. Many of these voters’ own personal style for dealing with this anger is to throw insults at these politicians. When Mr. Trump does the same thing, these voters see him as one of them. These same individuals are apparently unable to see that if he was throwing the same types of insults at them, they would not like this. To them, it’s perfectly okay to insult people they have come to not like. If someone insults them, however, their blood would boil. It seems to me that because it is wrong for people to insult them when someone disagrees with them, it is equally wrong for them to insult others when they disagree with others.

Many like to characterize Mr. Trump’s use of insults as his way of being a tough no-nonsense kind of guy. But in my view a person can surely be a tough no-nonsense kind of guy without seeking to insult people.

dailynewstrumpWhen asked why he uses insults, Mr. Trump at times says that those whom he insults, insulted him first. It is true that he does often get insulted. Recently I’ve seen him called a “feckless blowhard,” a “jackass,” “reprehensible,” “vile,” “absurd,” “pathological lier,” a narcissist, and “shameful.” But those who insult him often say they do it because he insulted either them, or someone they personally know. And so many who are either leaders of our nation, or hope to be so, are choosing to engage in this “You Started it First” name-calling game.

It is simply not true that if someone throws an insult at you the only intelligent way to respond is to seek to insult them back. In my view, within the political arena, one way to respond in a manner that I would respect is to state firmly, “I’m not here to get into this name-calling game. I’m here to let the public know what my positions are on the problems of this nation, and how I, if elected, plan to go about fixing them.”

Yes, initially politicians can get a great deal of attention for being extra insulting. This increases name recognition, and a subgroup of people will initially admire the politician for it. But is it a lasting valuable asset? Trump yAlthough Mr. Trump won the most electoral votes in 2016, polls regularly indicated he was the most disliked candidate in history. Moreover, Mr. Trump had millions of dollars of contracts cancelled when he made a comment that many immigrants found offensive. And he lost the following election. So, perhaps his insulting behavior is not such a winning tactic as some may think.

I hope this post will help you to think twice if you think that the type of insulting behavior Mr. Trump uses is effective in your own interpersonal and intrapersonal relationships.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE

Categories
conflict resolution DSM mental disorders Mental Illness Name calling psychiatrists psychiatry psychologists The Diagnostic and Statistical Manual of Mental Disorders

Psychiatric Name Calling: What Do People Say About It?

Mental-Illness_1In recent weeks, I have been providing a series of blog posts on psychiatric name calling (see here, here, here, and here).  In these posts, I have expressed some negative opinions about the Diagnostic and Statistical Manual of Mental Disorders (DSM).

DSMThe DSM provides the names for the various mental health concerns that mental health service providers are often required to use if they want to be paid for their services or if they want to have their research published in professional journals.The language of the DSM places its terminology under the umbrella concepts of “mental illness,” “mental disorder,” and “psychopathology.”  In my blog series, I have argued that the pathologizing of human experiences in this way does far more harm than good.

A2EFXY Person behind a frosted window. Image shot 01/2007. Exact date unknown.

As part of my discussions on this topic, I quoted the opinions of some who agreed, and some who disagreed, with my opinions.  The quotes that I used were selected from my own personal readings. Therefore, they may not have been characteristic of how a wider range of different people may think and feel about the DSM approach to labeling the various mental health concerns.

Mental-Illness_4A few years ago, two teams of researchers have sought to obtain a broader range of views on this topic by carrying out surveys. Jonathan D. Raskin and Michael C. Gayle surveyed psychologists who regularly use the DSM, and published their findings in the Journal of Humanistic Psychology (DSM-5: Do Psychologists Really Want an Alternative? 2015, pages 1-18). Lois Holzman and her team surveyed people in some New York City communities, and published her findings on the DxSummit.org website (A Report on Community Outreach: Lay Opinions on Emotional Distress and Diagnosis, http://dxsummit.org/archives/2249). Let’s take a look at their findings.

What the Psychologists Had to Say

Here’s a summary of the survey data by Jonathan D. Raskin and Michael C. Gayle:

psychiatry5Only two published studies, both from the early 1980s, have specifically examined psychologist attitudes toward the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current article rectifies this by presenting the results of a recent survey of attitudes toward the DSM-IV-TR and DSM-5. Though the DSM has changed over the years, psychologist attitudes toward it have remained remarkably consistent. Although more than 90% of psychologists report using the DSM, they are dissatisfied with numerous aspects of it and support developing alternatives to it—something that psychologists over 30 years ago supported, as well. The finding that almost all psychologists use the DSM despite serious concerns about it raises ethical issues because professionals are ethically bound to only use instruments in which they are scientifically confident.

psych labelsIn the above summary, the number 5 after the letters DSM, refers to the fact that the DSM has undergone five major revisions. Since the 1980s, there have been three such revisions.  Ideally, users of the DSM would see clear improvement for each revision.

When a survey was done in the early 1980s, psychologists were clearly skeptical of the DSM-2.  As described by Raskin and Gayle,

More than 40% felt it (a) distorted clinician perceptions of clients, (b) applied medical labels to psychosocial problems, (c) was not reliable and valid, (d) emphasized diagnosis over treatment, (e) obscured individual differences, and (f) overemphasized pathology. Almost 60% were dissatisfied or somewhat dissatisfied with the DSM-2 with only 17% satisfied or somewhat satisfied.

Mental-Illness_5When the DSM-3 came out in 1983, Smith and Kraft carried out an updated survey on this revision of the DSM-2. The findings indicated that psychologists at that time (a) preferred social–interpersonal diagnosis, nondiagnosis, and behavioral analysis over DSM-3—in that order; (b) felt that most conditions in DSM-3 were best seen as nonmedical problems in living; (c) believed too little had been done to develop scientific alternatives to the DSM; and (d) thought that client welfare and integrity would be better served by abandoning the medical model. Eighty-five percent disagreed that mental disorders are a subset of medical disorders.

In the latest survey that was carried out by Raskin and Gayle, 128 anonymous psychologists participated.  Among the questions that were asked was, “How satisfied are you with the changes being proposed for DSM-5?” Their answers indicated that they were significantly more negative about it than neutral. The general attitude about the latest version of the DSM were very similar to what was found three decades ago, namely, that a significant number of psychologists are unhappy with the DSM.

What Community Folks Had to Say

Mental-Illness_6In the community outreach survey of lay opinions on emotional distress and diagnosis carried out by Lois Holzman and her colleagues, people were asked questions at two annual NYC street fairs attended by millions of people. Conversations lasted from five to over ten minutes each. In all, 143 people participated in the survey in the first of these two surveys, which occurred in 2013. The second one had 149 people who participated, which occurred in 2014.

In the 2013 survey, the focus was on how psychiatric diagnosis affected kids. Forty percent felt that psychiatric diagnosis was not valuable.  For the 60% that felt that psychiatric diagnoses can be valuable, 90% of them had reservations.  That is, they said that it was only sometimes helpful, there was a danger of misdiagnosis, there was racism involved in diagnosis, and it leads to stigma and over-medication.

Ten percent were completely against diagnosis under any circumstance, some sharing their experiences pertaining to children. Examples of comments from this group follow:

Mental-Illness_8“Medication makes you act out. My grandson was hyperactive, not ADHD and they wanted to put him on Ritalin – I told them no. Drugs at an early age can lead to hard core drugs later in life.”

“I worked with kids who had wrong diagnosis, and this is prevalent.”

“Kids get told in 1st grade they’re crazy—then it becomes a self-fulfilling prophecy.”

In the 2014 survey, the researchers:

“tried to go a little deeper and see if we could help people explore the apparent conflict around diagnosis, i.e., its value and its dangers. We also wanted to learn what they thought about the necessity and mandate of diagnosis.

  1. Mental-Illness_9We all know people who have gotten very depressed when they’ve lost a loved one, or children who cannot sit still in school, lots of folks who are angry and demoralized about not finding a job. Do you think any of these people need to get a diagnosis in order to get help with their emotional pain?

(IF THEY SAY YES, ASK THE NEXT 2 QUESTIONS):

  • Do we need to relate to them as having brain disorders? Or chemical imbalances?
  • Right now, in most settings, if you want to get help with ANY kind of emotional pain from a mental health professional, they are required to give you a diagnosis. Do you agree with that?
  1. Mental-Illness_10Are there other ways to support people emotionally? What do you think could help them?
  2. Like me, you probably know people in your family, church, or at work who have serious emotional problems, who may have been diagnosed with major depression, bipolar or schizophrenia. Obviously people deserve and need top quality mental health care including access to medication. Do you think that even in these situations a diagnosis can limit the person, label them, and stigmatize them? If so, how?
  3. From our past surveys we have found that people are conflicted about diagnosis and labels. They find it relieving to get a diagnosis and at the same time feel like the diagnosis can stigmatize or label them. Why do you think that so many of us are conflicted about this, feel it can be both helpful and harmful?

Here’s a brief summary of the finding, as described by Dr. Holzman:

  1. Diagnosis Needed: 60% of respondents said no, people did not need a diagnosis to get help with their emotional pain. The majority of the 40% who said diagnosis was needed told us that that was the only way to get to talk to someone.

Only those who said yes, diagnosis was needed (40%), were asked the next two questions.

Mental-Illness_71a. Biological Basis: 89% of those who said diagnosis was needed said we shouldn’t consider such people as having a brain disorder or chemical imbalance.

1b. Diagnosis Required: 75% of those who said diagnosis was needed did not agree that it should be required.

  1. Other Ways to Support (alternative types of treatment):

Everyone offered an alternative, with most people suggesting more than one. The most frequent responses involved talking to people—therapy, counseling, group therapy being the most common (including, “A center they can go to without getting diagnosed”), followed by family, friends, self-help and support groups.

A social eventA wide variety of social activities and life style changes were recommended—volunteering, hobbies, music, dance, writing, meditation, exercise, yoga, diet, prayer and creating community (“Have events that bring people out, like this fair”).

  1. & 4. Concerns about Diagnosis: 90% (including those who thought it was needed) expressed concerns about the stigma of diagnosis, the dangers of misdiagnosis, and/or the over-medication that too often accompanies a diagnosis.

Once you have that label it doesn’t stay at the clinic. You carry it with you for a long time.

People start calling you crazy. It can be a shame for the family.

I had to fight to get counseling for my kid. They just wanted to give him drugs.

Getting a diagnosis limits life experience, you’re treated differently, you feel like an outcast.

It’s helpful to the clinic but not in everyday life.

It’s good to know what’s wrong, but it might make them feel worse about themselves and put them in a box.

a meditatorIt pigeon-holes people and the diagnosis becomes all that I am.

It stagnates them. It keeps them on one path with only one destination.

They think something’s wrong with them.

There is too much use of medication. It is a quick fix to avoid a real understanding.

Against it – children are still growing. Against medication.

So there you have it, some views other than mine about psychiatric name calling. In interpreting these findings, I think it’s important to bear in mind that the views of the people surveyed developed in the context of a multibillion dollar advertisement campaign by the pharmaceutical companies over many years that is designed to convince them that emotional concerns are diagnosable illnesses requiring medication treatment. How might the views of those surveyed been different without this high finance selling of the illness model?

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.

Categories
Bob Dylan conflict resolution fools insults Listening skills Name calling

Bob Dylan On Fools

Bob Dylan

Bob Dylan2Bob Dylan begins his Theme Time Radio Hour show about fools, with a beautiful instrumental version of “Why Do Fools Fall In Love.” After a few bars of this tune, it continues in the background as Bob begins to speak:

James Thurber
James Thurber

James Thurber once said, “You can fool too many of the people too much of the time,” and for the next hour we’re going to try to do just that. Welcome back to Theme Time Radio Hour. Today we’re going to talk about patsies, stooges, marks, jesters, jokers, buffoons, clowns, tricksters, harlequins, and the village idiots, because in honor of April first, it’s our fools’ program. Everybody plays the fool sometimes, and for the next hour we’re going to play the greatest records about our favorite halfwits, the fools.

Recently, I provided a post on this blog titled, “Bob Dylan on Madness,” as an entertaining way to practice some of the basic principles I regularly discuss. That post was so popular that I thought, Why not do a similar post utilizing Bob’s show on fools? After all, in addition to people at times seeking to insult themselves and others by saying such things as “You’re mad” or “You’re crazy,” they do likewise by saying such things as “You’re a fool” or “You’re a buffoon.” Are there more respectful, helpful ways to deal with situations that give rise to such name calling?  I think so.  Let’s see if we can have some fun thinking about this issue as we review Bob’s show on fools.

Chain of Fools

ArethaAfter Bob’s brief introduction, he dives right into Aretha Franklin’s emotionally charged song, “Chain of Fools.”

For five long years
I thought you were my man
But I found out
I’m just a link in your chain

You got me where you want me
I ain’t nothin’ but your fool
Ya treated me mean
Oh you treated me cruel

Chain, chain, chain
(Chain, chain, chain)
Chain of fools

Every chain, has got a weak link
I might be weak yeah
But I’ll give you strength

Oh, hey
Chain, chain, chain
(Chain, chain, chain)
Chain of fools

Here we find a woman calling herself a fool because she sees herself attached to a man who treats her cruel. I wonder how I would react to a woman telling me a similar story.  I guess I would not rush into giving her any advice, but rather, give her some time to be with her emotional experience while I listened in a caring, empathic manner.

listeningAs we discussed in an earlier post titled “To Listen, Or To Criticize,” we often jump too quickly into providing advice. If you would like your listening skills to be respected, it helps to summarize, every few minutes, what is being said in a caring manner, thus reassuring the person talking to you that you are indeed listening and accurately hearing what is going on.

After perhaps fifteen minutes or so of listening and summarizing, I would continue to listen, but I might begin to start asking, as gently as possible, a few clarifying questions.  digI often use the DIG Conflict Model to come up with my questions. The letters of the word “DIG” would remind me to ask about what she “desires” in this situation, what is “interfering” with her desire, and if she feels she is “guilty” of doing something wrong. I would gently encourage her to be as specific as she could be.  A statement like, I’m guilty of being a fool” is way too vague to be helpful in coming up with any practical plan. “I’m guilty of not going out to social events on Friday evenings so I can find a loving relationship with a man who would treat me with respect,” fits better with my image of being specific.

Aretha Franklin’s song continues with these words:

One of these mornings
The chain is gonna break
But up until the day
I’m gonna take all I can take, oh hey

Chain, chain, chain
(Chain, chain, chain)
Chain of fools

We see a glimmer of hope in these words. That weak link in the chain is not completely unbreakable. I think that at some point in my relationship with a woman dealing with this type of concern, I might ask what she thinks she might do if the chain would indeed break.  My overall goal at this point in the relationship would be to focus not so much on what is wrong with what is happening in her life, but what she could specifically do to improve her situation.

Further On In the Show

A little later in Bob’s show, he introduces another song:

Hank Snow
Hank Snow

Everyone plays the fool sometime. Hank Snow knew that. We talk about Hank an awful lot [on my show], and he was one of the biggest voices in country music from 1951 and 1955. He had a remarkable number of top ten hits. This is from the tail end of that streak, in 1955–“Now And Then There Is A Fool Such As I.”

Here are some of the lyrics:

Pardon me, if I’m sentimental
When we say goodbye.
Don’t be angry with me should I cry.
When you’re gone, yet I’ll dream
A little dream as years go by.

Now and then there’s a fool such as I.

…

And now you say that we are through.
I’m a fool, but I’ll love you dear
Until the day I die.
Now and then there’s a fool such as I.

Like the Aretha Franklin song, this Hank Snow song is about someone in love who is feeling like a fool. As it turns out, almost all of the songs Bob plays over the course of his hour show is about love and someone feeling like a fool. But they differ nevertheless. In the first two songs we find out about two people who are calling themselves fools, but the first one is about a woman who feels she’s a fool for staying connected with a man even though he treats her bad. The second song is about a man who feels foolish for continuing to love a woman even after she said they are through.

In other songs that Dylan plays during his show, a singer is trying to convince her parents that she’s no fool for loving a man that they think is less than ideal. Then there’s one about a man who is trying to convince a woman that she’s a fool for not loving him despite all that he has to offer.

One of the highlights of Bob’s show is a little audio clip of Humphrey Bogart, as Sam Spade, confronting Mary Astor as the femme fatale, Brigid, in the classic film noir, The Maltese Falcon.

Maltese FalconBrigid, desperately: You’ve been playing with me, just pretending to trap me like this. You didn’t care at all. You don’t love me.

Spade: I won’t play the sap for you.

Brigid: You know it’s not like that! You can’t say that!

Spade: You haven’t played straight with me for half hour at a stretch since I’ve known you.

Brigid: You know down deep in your heart that in spite of everything I’ve done, I love you.

Spade: I don’t care who loves who, I won’t play the sap for you. You killed Miles and you’re going over for it.

As you can see, even when used in the context of love difficulties, the word, “fool,” or its related terms, are used to refer to quite a variety of different circumstances.  

Frankie LymonAs we leave the love arena, we see that the term is used in even a wider set of circumstances. Thus, Bob tells us about the enormously talented singer, Frankie Lymon, who died way too early with a heroin syringe by his side. As another example, he tells us about a couple of football games:

Every field has its fools, and the biggest mistakes are made on the football field. For example, Roy Unsway Regales played for the University of California, and in the 1929 Rose Bowl Game, he got turned around and ran 65 yards in the wrong direction.

Jim, upon realizing his mistake.
Jim, upon realizing his mistake.

That’s nothing compared to Jim Marshal who played for the Minnesota Vikings. On October 25, 1964 the Vikings were playing against the San Francisco 49ers. Marshal recovered a fumble and ran 66 yards in the wrong direction into his own end zone. He was so excited he threw down the ball in celebration. The ball landed out of bounds, resulting in a safety for the 49ers. Fortunately for him, the Vikings won the game anyway, 27 to 22, and I was there that day. Strange but true.

We All Sometimes Play the Fool

Throughout the show, Bob reminds us repeatedly that everyone plays the fool sometime.  He does it in a variety of ways. Thus, before playing the song, “Three Times a Fool,” Bob tells us “It wouldn’t be bad if you were just a fool once a year, but all of us are fools on more than one occasion.”

A  little later, he says:

We’re talking about fools of all stripes here on Theme Time Radio Hour. As Jean Brown once said, “Foolproof systems don’t take into account the ingenuity of fools.”

And still a little later, Bob gives us some quotes from Shakespeare and Twain on the subject of fools.

Shakespeare looking a little foolish in his outfit.
Shakespeare looking a little foolish in his outfit.

Shakespeare spoke quite often about fools. For example, in A Midsummers Night Dream he said, Lord, what fools these mortals be? Twelfth Night gave us the following line, Foolery, Sir, does walk about the orb like the sun. It shines everywhere. And From As You Like it, The more pity that fools may not speak wisely what wise men do foolishly.

Shakespeare, hell of a cat.

…

TwainAs Mark Twain says,”The first of April is the day we remember who we are the other 364 days of the year.

And so when people call us a fool, perhaps we may find that the sting of the comment is lessened if we keep in mind that no doubt these name callers have had their share of playing the fool on plenty of occasions.  And when, out of old habits, we find ourselves calling either ourselves, or someone else a fool, perhaps a little sympathy with the human condition is in order.

———————
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

 

 

 

 

Categories
Bob Dylan conflict resolution crazy criticism DSM insults madness meditation mental disorders Mental Illness Name calling negative criticism psychiatry psychopathology The Diagnostic and Statistical Manual of Mental Disorders

Bob Dylan on Madness

Bob Dylan

Bob Dylan2As some of you may know, Bob Dylan has a show called “Theme Time Radio Hour.” As the title suggests, each episode is centered on a theme. He begins his episode on madness as follows:

“Let me ask you a few questions, friends. Are you disinterested in work or family life? Do you suffer from sleep disruption? Have you had significant changes in appetite? Have you had paranoid thoughts? Thoughts of grandeur or invincibility? Any feelings of persistent anxiety or perhaps panic attacks? Are you hearing voices or seeing people who are not there? Do you have thoughts of dying? Do you exhibit strong or violent anger? Do you have the inability to pursue a normal life, normal activities or normal relationships? Well, I’m no doctor, but perhaps you’re mad as a hatter; crazy as a loon. Have you lost your morals? Are your bats in the belfry? Maybe you’re nutty as a fruitcake? Crazy as a coot? Taxed in the head? Bunkers? Bananas? Deranged? Are you crackers or daffy? Unhinged or loco? Not all there or all around the bend? Maybe you’re cuckoo or buggy or simply non compos mentis? Do you talk to yourself? Do you ever binge out on food? Do you swing suddenly from one mood to another? Do vague acquaintances treat you as though they know you far better than you would expect?

Allan Ginsberg
Allan Ginsberg

“Allan Ginsberg once said that he had seen the best minds of his generation destroyed by madness. Now for the next hour we’ll be providing the sound track. We’re going to look at madness, insanity, and craziness.”

Introducing his theme in this way may seem like quite a mouthful for Bob, but he manages to carry it off rather well.  There is deep, dungeon-like music in the background, and he varies his voice in a manner that is full of concern and dramatic interest.  Besides, if you think Bob’s description of his theme is lengthy, take a gander at the latest American Psychiatric Association’s description of a related topic.  In its book titled Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, over 900 pages are consumed describing various “mental disorders.”

name callingThe theme of “madness” is relevant to this blog’s theme because when people seek to insult others, we commonly hear words like, “You’re mad,” “You’re crazy,” “You have a mental disorder,” and “You’re mentally ill.” Negative consequences often flow from such name calling. Individuals flinging these efforts to insult often become less respected by those who are their targets. Those who are their targets sometimes end up having less respect for themselves. From here, conflicts can escalate, leading to losing friends, problems at work, and even violence.

Dylan’s First Madness Song

Bob introduces the first song for his show on madness as follows:

“If craziness was a country, this would be the national anthem. Here’s Patsy Cline in a little number written by Willie Nelson–“Crazy.”

Patsy Cline
Patsy Cline

Patsy’s beautiful voice, accompanied by gentle piano riffs, drifts into its melancholy words–“I’m crazy, I’m crazy, for being so lonely. I’m crazy, I’m crazy for being so blue.”

The song goes on from here to weave the sad story of a woman calling herself crazy for loving a man whom she knows will soon be leaving her. She feels she’s crazy for worrying when he’ll leave, and crazy for trying, and crazy for crying, and crazy for loving this man.

Here we learn of just one type of experience that falls under the enormous umbrella of madness.

Connecting Madness With Genius

As the song phases out, Bob begins to tell us that according to Aristotle, “No excellent mind is without a tincture of madness,” a position with which Bob heartily agrees.  He declares that “There is a thin line between genius and madness.” Defending this, he introduces us to several individuals who had been declared mad by some, and yet achieved at impressive levels in many valued fields.  Thus, he tells us about the brilliant writer, Ernest Hemingway:

Earnest Hemingway
Earnest Hemingway

“Ernest Hemingway, for example, was convinced that people were out to assassinate him. His wife, Mary, tricked him into a mental hospital by telling him it was to treat his high blood pressure.  He got shock therapy and maybe a dozen other treatments. It didn’t help. It left him more paranoid, delusional and depressed. He was afraid that his wife would put him away again, which many people believe is what led him to take his own life with a shotgun in July of ’61.” 

Bob then tells us about the great jazz musician, Charlie Mingus:

Charlie Mingus
Charlie Mingus

“Charlie Mingus spent some time away, although he later claimed he only had gone in to get papers declaring he was incompetent to get out of a contract with the gangster, Joey Gallo. Whatever the reason, he spent some time in Bellevue and was diagnosed as a paranoid schizophrenic.”

After this, Bob tells us the story of two more jazz greats–Bud Powell and Charlie Parker. Both at times were troubled by demons.

Then there was a comic writer:

Mad MagazineOne man that was no stranger to madness was Bill Gates. He was the editor of E. C. Comics. He had a series of horror comics in the ’50s, but then he was targeted by the government who said that his comics were ruining the morals of America’s young people. He was supposed to water down all of his books.  He had one humor comic he called “Mad.” He changed it to a magazine so it wouldn’t be subjected to the comics’ code of authority. It became a huge hit and generations of kids got their first lessons on comedy from the usual gang of idiots that he assembled.  He never sold advertising in the magazine while he was alive and there were no sacred cows.  Bill Gates, madman of free speech.” 

Bob soon moves on to the story of a hell of a fine baseball player:

Jimmy Piersall“One guy that was accused of cracking up was Jimmy Piersall. He became a professional baseball player at 18, signing with the Boston Red Sox in ’48.  On May 24, 1952, just before the game against the New York Yankees, he got into a fist fight with Yankee infielder, Billy Martin. After that, he scuffled with his teammate, Mickey McDermott. The final straw came when Jimmy Piersall spanked the four-year old son of his teammate, Burnt Stevens during a game in the Red Sox clubhouse. The four-year old had tried to tweek his nose and poured lemonade down his shirt. You can see Jimmy’s position–Boy, you need a spanking. There were a number of incidences like this and he was sent down to the minor leagues.  He got into a lot of trouble down in the minor leagues, and spent some time in the West Borough State Hospital. He was diagnosed with manic depression, but he still returned to baseball by the opening of the ’53 season. And get this, he finished ninth in the voting for the MVP award, and the next year he was the Sox’s regular center fielder.”

Feeling That We Are Crazy Is A Common Experience

crazy sayingIn addition to describing these individuals who were thought to be mad by some and yet achieved greatness in various valued arenas, Bob provides diverse examples of regular Joes and Jills who displayed behaviors that were viewed as crazy by either themselves or others. These examples touch a chord in the listener because they illustrate experiences that are pretty close to what we have all experienced at different points in our lives.

Thus, the show’s take away lesson, as I see it, is that if you catch yourself calling yourself names such as “crazy” note that many of the most talented people have had similar experiences.  Note, as well, that such criticism is too vague to be helpful. Learn to become more aware of these thoughts, to stand back and simply observe them passing through your mind–“Oh, there I go again calling myself mad.’  In time, you will come to a point at which you will formulate some more specific approach to make improvements in your life. jack_meditatingThe practice of meditation can help you to learn this skill.

If you are tempted to call someone else these types of names, remember that such names are way too vague, encompassing thousands of unusual and usual experiences.  For criticism to be truly helpful, it is usually best to craft a statement that avoids name calling and statements about what someone did wrong, and instead provides specific suggestions for what the target of the criticism can do to improve.  If you can not come up with such a statement right away, perhaps it would be best to delay the criticism until you have some time for your creative impulses to come up with something better than “You’re a crazy, mentally ill fool!”

Although these are my take away lessons for today’s post, let’s end with how the more poetic Bob Dylan ends his madness show:

Charles Bukowski“Time flies when you’re talking crazy, and we gotta get out of here.  But before we do I want to leave you with the words of the man who is the voice of the barroom, poet of the gutter, and Shakespeare of the alleyway. Here’s a poem by Charles Bukowski called “Some People.”

some people never go crazy.
me, sometimes I’ll lie down behind the couch
for 3 or 4 days.
they’ll find me there.
it’s Cherub, they’ll say, and
they pour wine down my throat
rub my chest
sprinkle me with oils.
then, I’ll rise with a roar,
rant, rage –
curse them and the universe
as I send them scattering over the
lawn.
I’ll feel much better,
sit down to toast and eggs,
hum a little tune,
suddenly become as lovable as a
pink
overfed whale.
some people never go crazy.
what truly horrible lives
they must lead.”

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.

    

 

 

Categories
conflict resolution DSM Emotional pain empathy insults mental disorders Mental Illness Name calling psychiatrists psychiatry psychopathology The Diagnostic and Statistical Manual of Mental Disorders William James

From Psychiatric Name Calling to Plain, Humane English

mental Health ImageMany mental health service providers well know that there are serious problems with the jargon that is used in their profession.  In a recent post titled “Psychiatric Name Calling: Is It Time To Put A Stop To It?” I outline some of the most glaring ones.  In a subsequent post titled “Psychiatric Name Calling: Is There An Alternative?” I describe a plan for professionals who have an interest in eliminating the problems inherent in the current psychiatric pathologizing approach.  This plan would allow professionals to replace the old model with one that would be practical, more consistent with principles of science, and far less stigmatizing.

gearsAs I have been seeking ways to promote these ideas, it has become more and more apparent that the gears of the mental health service provider professional organizations grind slowly. Until the necessary changes occur, what can the average English speaking person do when faced with terms like mental illness, major depressive disorder, psychosis, schizophrenia, etc.?

Three Principles That Can Be Used When Psychiatric Pathology Terms Are Employed by Others So That The Negative Effects Associated With Their Usage Can Be Reduced 

grinding gearsEven people who are not mental health service providers will regularly use psychiatric jargon. Thus, a French writer once wrote:

My sadness was without limit, and having got possession of me, it filled my life from the most indifferent external acts to the most secret thoughts, and corrupted at their source my feelings, my judgment, and my happiness. It was then that I saw that to expect to put a stop to this disorder by my reason and by my will, which were themselves diseased, would be to act like a blind man who should pretend to correct one of his eyes by the aid of the other equally blind one.

In this quote, the French writer, to describe some concerns he had about his sad mood and how it was affecting his feelings, judgments, and happiness, uses the words “disorder” and “disease.”  This is the type of language most mental health service providers throw around. What is the writer attempting to convey by their use?

meaning 2Sometimes when these words will be employed, their context will make it clear what meaning the author intends. In this example, the author does provide some context.  He clearly indicates he was much sadder than he wished to be, and he believed he was unable to do anything about it.  He also expressed a concern about his feelings, judgments, and happiness, but he was less clear about what he meant by this.

meaning 1When someone begins to use pathologizing language and we simply don’t know what is intended, we might end up with misleading, simplistic associations. And so, here are three principles that can be used when psychiatric pathology terms are employed so that we can avoid unnecessary confusion.

Each Time Someone Uses A Psychopathologizing Term, Ask The User Of The Term For A More Specific Description Of What Is Meant By It

clearIn the example that I provided above, there was some lack of clarity about what the French writer meant about his judgments. We know that he felt that it was disordered and diseased. That really tells us nothing more than he was dissatisfied with his judgments. To clarify, we could ask for some specific examples of when his judgment proved to him unsatisfactory.

mental illnessAs another example, suppose you hear Alice saying that John Doe is “mentally ill.” If you want to use this first principle, you would ask Alice what, specifically, does “mentally ill” mean to her and what has John done specifically that led to her calling John this name. These questions typically lead to further constructive discussions and ends up clarifying the nature of many fascinating experiences.

When Psychopathologizing Terms Are Employed, Express A Concern That This Terminology Simplistically Devalues An Experience

Terms like “mental disorders,” “mental illness” and “psychosis,” even when used by professionals, implies that there is something wrong with the person being described. However, as I described in my post “Are Mental Illnesses Really Potentially Helpful Tools?” there are numerous examples of the types of experiences that tend to be labelled mental disorders that end up being enormously helpful.  Moreover, in cultures that recognize this possibility the outcomes for those people undergoing these challenging experiences are distinctly better.

rethinkAnd so, as you begin to use the first principle, asking for the user of pathologizing terminology for more specifics, if he or she seems to be suggesting that the experience is bad, you might wish to point out this well documented observation.  At such times, I often say, “Many people with artistic temperaments have these types of experiences.  Such people have given the world some of its most valued achievements.”

Instead Of Using The Concept of “Disease” And “Illness” To Encourage Humane Responding Toward Individuals Undergoing Challenging Experiences, Emphasize Rights, Kindness, And Practical Reasons

In seeking to encourage people who are using pathologizing terminology to be more specific, it is not uncommon to find that one reason they use these terms is that they hope it will encourage people to be more humane toward those who have certain challenging experiences.  They usually mean well by this, but this approach has been used for centuries and history documents that despite such efforts, people who are being given these labels have often ended up in some of the most horrible, degrading treatment facilities.

rightsInstead of using the concept of “disease” to encourage humane responding toward individuals undergoing the experiences that get labelled with pathological terms, an alternative is to emphasize human rights, kindness, and practical reasons.

Note that when people in a town are hit with a hurricane, we don’t have to resort to calling them ill to encourage some help. Instead, we have set up laws that entitle people to certain rights from the government when emergencies occur. Moreover, as word gets out about what is occurring to those who are suffering, out of kindness, people make donations or join their hands to provide direct assistance in a variety of ways. And lest we forget, there are practical reasons to lend a hand.  By doing so, we model for people just what kindness is all about.

kindness 1Any of us can find ourselves in an emergency situation.  The more we promote acts of kindness, the more likely we may find that others will treat us with kindness if we are ever to find ourselves in a very unfortunate set of circumstances.

Using the Three Principles

William James, in his grand book, The Varieties of Religious Experience, tells us of some people who have mystical experiences that tend to be called “mental disorders.” James begins to use the three principles when he seeks out descriptions of the various mystical experiences that go well beyond the simplistic psychopathological descriptions.  He then states that these mystical states have the right to be absolutely authoritative over the individuals to whom they come.

mysticalIt is vain for rationalism to grumble about this. If the mystical truth that comes to a man proves to be a force that he can live by, what mandate have we of the majority to order him to live in another way? We can throw him into a prison or a madhouse, but we cannot change his mind-we commonly attach it only the more stubbornly to its beliefs.

It mocks our utmost efforts, as a matter of fact, and in point of logic it absolutely escapes our jurisdiction. Our own more “rational” beliefs are based on evidence exactly similar in nature to that which mystics quote for theirs. Our senses, namely, have assured us of certain states of fact; but mystical experiences are as direct perceptions of fact for those who have them as any sensations ever were for us…. The mystic is, in short, invulnerable, and must be left, whether we relish it or not, in undisturbed enjoyment of his creed. 

kindness 2In this quote, we find no plea from James that we should treat mystics humanely because they have a mental disease. Instead, James puts forth “rights” and “pragmatic” considerations. He argues that just like we in the majority would not like to be ordered to live in a particular way, these mystics have the right to live their way. And pragmatically, if we do use heavy-handed approaches to try to change them, such as throwing them in a madhouse, they will become more stubborn in their beliefs.

James proceeds from here to state that mystics have no right to claim that “we ought to accept the deliverance of their peculiar experiences, if we are ourselves outsiders, and feel no private call thereto.”  His theme is tolerance for both the majority toward the minority and vice versa.

Returning to pragmatic arguments, James tells us in his chapter on mysticism that some have found that their mystical experiences have led to wonderful fruits that they highly valued. Some, for example, suffered for a great period of time and after their mystical experience felt wondrously free from their pain and found in its place increased energy and happiness.

kindness 3James well realizes that the fruits from mystical experiences are not always positive, but he asks us, at the very least, to realize that they have the potential to “be indispensable stages in our approach to the final fullness of the truth.” Thus, we see that “rights” and “pragmatic arguments” can be used instead of a disease concept to promote humane, kind responses toward those who have the types of experiences that tend to be called mental disorders.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.

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conflict resolution DSM Name calling psychiatrists psychiatry psychopathology The Diagnostic and Statistical Manual of Mental Disorders

Psychiatric Name Calling: Is There An Alternative?

monopolyThe publishers of The Diagnostic and Statistical Manual of Mental Disorders (DSM) currently hold a monopoly for classifying the concerns that lead people to seek mental health services. Recently on this blog, in a series of articles, I have been pointing out numerous faults of the DSM.  To check out some examples of these, see my posts titled Name Calling by Psychiatrists: Is it Time to Put a Stop to it? and Are “Mental Illnesses” Really Potentially Helpful Tools?

alternativeIn these critical posts, I have touched upon what I believe would be a distinctly better alternative to the DSM and argued that its creation, in breaking up this monopoly, would stimulate through creative competition, improved mental health services. Today, let’s take a closer look at this.

The Classification and Statistical Manual of Mental Health Concerns (CSM)

concerns 1I called this proposed alternative manual, the CSM, and you can find a much fuller description of it in a peer reviewed journal HERE.  In brief, its first chapter would begin by stating that the developed 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.

concerns 3The CSM begins from the perspective of the person seeking services. Because the expression of a mental health concern is a clearly observable event, by making it the event being classified in the CSM it solves the reliability problems that have been plaguing the DSM’s far more abstract concept of “mental disorders.”

After this statement, the CSM would clearly define its main construct:

A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of these topics: behavior, emotion, mood, meaning of life, managing chronic pain, work, relationships, education, eating, cognition, sleep and challenging life situations.

MentalHealth 2Each of these topics would have separate major sections in the second chapter, and under each section would be a list of more specific concerns.

mental healthThis second chapter would be devoted to listing all of the concerns that professionals tend to hear from those seeking their services.  Each concern would be given a code that would be used for various administrative purposes such as insurance forms and computer filing systems. And then there would be, for each concern, a list of related search terms that can be used to assist people who want to utilize a search engine to find all the relevant literature regarding that particular concern.

Survey 2The list of concerns would be identified by two types of surveys.  First, a large sample of mental health service providers would be asked to list the various concerns that they are asked to address in their practice without couching them in pathological language and to stick as closely as possible to the language used by those seeking their services. So, a concern about feeling blue might simply be classified “feeling blue,” rather than the DSM’s “Major Depressive Disorder;” a concern about a child’s above average activity level might simply be classified as “above average activity level” rather than the DSM’s “Attention Deficit Hyperactivity Disorder.”   The second type of survey that would be used to generate the list of concerns that would appear in the CSM,  would ask the membership of mental health service user organizations to list the various concerns that led them to seek mental health services.  They, too, would be asked to avoid pathological terminology. For a number of practical reasons, a maximum of four words would be used for classifying each expressed concern in this chapter.

FormulationThe final chapter of the CSM would be devoted to describing good practice guidelines for the use of psychological formulation, which is an assessment approach that is consistent with the CSM’s philosophy of not pathologizing individuals.  Psychological formulation provides an approach that expands on the brief expressed concerns of individuals by developing a narrative of several paragraphs. It can be defined as the process involving a mental health service user and a mental health service provider co-constructing a hypothesis or ‘best guess’ about the origins of the mental health service user’s concerns in the context of his or her relationships, social circumstances, life events, and the sense that he or she has made of them. Once it has been established what the concerns are, the immediate next question is, ‘How do we jointly understand these experiences, why they arose, and how we might be able to address them?’

Unlike diagnosis, this type of psychological formulation is not about making an expert judgement, but about working closely with the individual to develop a shared understanding which will evolve over time. And, unlike diagnosis, it draws attention to the service user’s resources and strengths in surviving what are nearly always very challenging life situations.

Defending the CSM Approach

classifyNow, some believe that the psychological formulation is all that is needed as an alternative to the DSM and that there is no need to join it with any classification manual such as the CSM.  But keep in mind that currently the DSM is used by insurance companies and other third party payers such as Medicaid, Medicare, and Social Security. Insurance companies and these other third party payers have a form that must be filled out whenever someone seeks mental health services under their plan. This form has a little box that currently says, “Diagnosis.” In that box, mental health professionals must fill in the DSM code that corresponds to their so-called diagnosis of the person seeking services.

insurance formWith the CSM proposal, all that we would be asking insurance companies to do differently in order to add value for their customers, is to slightly change that little box. Instead of just saying “Diagnosis” as it currently says, that box would add two little words, so it would end up saying “Diagnosis or Concern.” Then, when mental health professionals fill in the box, they would be given the choice to either write in the letters “DSM” and its code number that corresponds to its so-called diagnosis, or they would write the letters CSM and its code number that corresponds to the expressed concern. Mental health consumers would be given the choice to go to pathologizing mental health service providers or those using the CSM approach.

That’s all the change that would be required in order to increase value for insurance customers as well as other third party payers. And a major goal that all third party payers have is to increase value for their customers. The cost and effort for these payers would be minimum and we would have numerous testimonials from customers that documents that this change would be viewed as a significant improvement.

bureaucracy 2A psychological formulation approach, which requires several paragraphs to be completed, would be far too cumbersome for these payers to incorporate into their bureaucratic system.  Moreover, a short word or phrase that could replace terms like “Major Depressive Disorder” or “Attention Deficit Hyperactivity Disorder” is necessary for other practical forms of communication. For example, if I want to write a title for a research article, it would not be practical to insert into it several paragraphs.  The psychological formulation approach would become far more widely used if it has some practical way of providing some short terms that are consistent with its non-pathologizing approach to conceptualizing an individual’s mental health concerns.

bureaucracySome may argue that if everyone could go to a mental health professional merely to have their concerns addressed, then the system would soon be overloaded with clients and insurance policy costs would soar.  Since insurance companies only cover people with more serious conditions known as “mental disorders,” so the argument goes, this limits the amount of people who can get to see a mental health professional.

Insurance and other third party payer executives are not stupid. They would readily understand, with a little explaining, that mental health service providers now using the current DSM do not turn anyone with a mental health insurance policy away who comes to their office expressing what I refer to as a mental health concern.  Professionals are in the business of increasing their clients.  Let’s be honest here; there are “close enough” matches throughout the DSM for anyone with mental health insurance coverage who currently wants mental health services to get it.

scienceHere’s another reason why the CSM would improve the psychological formulation approach. In pretty much any of the advanced countries in the world, there is a rather large segment of the population that believes science has been an enormous help advancing our knowledge. The CSM, as already mentioned, is even more consistent with principles of science than the DSM because it solves the problem of reliability that has been a mess with the DSM. And for science minded people, each branch of science must have a system of classification that helps to organize concepts, to retrieve relevant research, and to be useful in formulating programs of research. In my view, the pairing of psychological formulation with the CSM’s list of brief descriptors of mental health concerns will fit well with this worldview.

concerns 2And so, these are some of my arguments for uniting in the CSM proposal a classification system and the psychological formulation proposal. Together, both can clearly improve value for consumers of mental health services by providing a new choice, but only if consumers of mental health services role up their sleeves, organize, and effectively advocate for this type of change.

In summary then, the CSM is more consistent with principles of science. It is close enough to the worldview and administrative requirements of all of the stakeholders in the mental health field, thus reducing resistance that often comes with proposed changes. And the creation of the CSM would break up the DSM monopoly, thereby spurring creative approaches for understanding the nature of anguish, sadness and tears.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

 

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Albert Einstein anger conflict resolution criticism Name calling negative criticism providing criticism wisdom

Einstein and Stupidity

“Two things are infinite, the universe and human stupidity, and I am not yet completely sure about the universe.”–Albert Einstein

Einstein as a young man
Einstein as a young man

In the spring of 1914, Albert Einstein left his home in Switzerland to take a job at the University of Berlin in Germany’s capital. He was then, 35.

He took the job with much misgivings.  When he was a young boy living in Germany, Einstein had been deeply repelled by the authoritarians, militarism, and bigotry he found all around him. And as a young man, he was appalled by the prejudices, injustices and reactionary ideas found in the heart of many Germans in those days. Nevertheless, working in Berlin provided an opportunity to pursue his research without teaching and administrative obligations and to have ready access to many brilliant fellow scientists and mathematicians.

Einstein’s Name-Calling During World War I

world war 1Months after Einstein moved to Berlin, in August 1914, the first world war broke loose, creating wholesale death, misery, and hunger.  And then, many people with whom he was working signed a manifesto denying that Germany had any responsibility for the war. Instead, the blame fell entirely on Germany’s enemies.  The concluding paragraph states:

We cannot wrest from our enemies’ hand the venomous weapon of the lie [that Germany is responsible for the war].  We can only cry out to the whole world that they bear false witness against us.  To you who know us, who have hitherto stood with us in safeguarding mankind’s most precious heritage–to you we cry out: Have faith in us when we say that we shall wage this fight to the very end as a civilized nation, a nation that holds the legacy of Goethe, Beethoven and Kant no less sacred than hearth and home.

This type of document along with all that was happening in the world was pretty rough on Einstein. In a letter to Paul Ehrenfest, a physicist and one of his closest friends, he wrote:

Paul Ehrenfest
Paul Ehrenfest

The international catastrophe has imposed a heavy burden upon me as an internationalist. In living through this “great epoch,” it is difficult to reconcile oneself to the fact that one belongs to that stupid, rotten species which boasts of its freedom of will.  How I wish that somewhere there existed an island for those who are wise and of good will!  In such a place even I should be an ardent patriot. (From Einstein on Peace, p. 2)

We see in this quote that Einstein, in his anger, chose to refer to the human race as stupid.  And yet, some of the people that were supporting the war were among the smartest people of their day, at least in terms of their academic accomplishments.

Of course, Einstein is not the only one to use the word stupid upon becoming angry:

peanuts and criticism

Apparently, for Einstein, the word stupid was meant to mean something different than an inability to master challenging subject matter. What then did he mean?

Such terms are often used broadly, meaning the same thing as other words and phrases thrown at someone in anger, such as “crazy,” “mentally ill,” “jerk,” “piece of trash,” “rotten,” etc. When used like this, they all mean nothing more than the angry party strongly doesn’t like what the other party did. They serve as a type of exclamation point.

For Einstein, I think stupid might have had an added meaning; something like not being able to see something that seems so plainly reasonable to him.  War is a terrible thing, Einstein believed, and the justification that Germany used to enter into it clashed with his sense of what was so plainly reasonable.

Einstein’s Approach to Providing Negative Criticism After World War I

Einstein in his later years
Einstein in his later years

Soon after the end of the first world war, Germany saw the rise of Hitler and Einstein fled to America, taking a position at Princeton University.  As World War II got underway, Einstein did support military intervention.  As he explained it when declining an invitation to prepare a presentation of the pacifist point of view,

I am not what you might call a religious pacifist. Besides, I consider it preferable for men to fight rather than allow themselves to be butchered without lifting a finger. That was just about the alternative in the case of Hitler’s Germany. (Einstein on Peace, p. 553)

Korean_War_bombing_WonsanBut when America became involved in the Korean War, Einstein again experienced anger about a military intervention. Korea had not attacked any country, let alone the United States. Korea was engaged in an internal fight about what type of government it chose to have. US military intervention, Einstein believed, would serve to dramatically increase the loss of life. How did Einstein express his disagreement in his adopted country where most were fierce supporters of the war?

When writing to a trusted friend he would allow himself to let out his raw emotions about what was going on in the world. This occasionally included utilizing words like stupid, idiot, and rotten. But at least in the many public statements that I’ve read of his, it was extremely rare to see him utilizing anything that strikes me as name calling. Typical is a 1953 quote taken from Einstein’s review of a book on Gandhi. The author was Gene Sharp, a 25-year old graduate of Ohio State University who had just received a two-year sentence for defying the draft law during the Korean War.  Einstein wrote:

Gene Sharp
Gene Sharp


How is it possible that a young man was able to create such a mature piece of work? The author’s preface tells us how it was possible. He feels the profound obligation to serve, with all his energies and with unlimited readiness for sacrifice, a purpose which is clearly personified in Gandhi’s unique example: to overcome through an awakening of moral strength the danger of self-destruction which confronts mankind as a result of explosive technological developments.  The collapse which threatens mankind is characterized in the volume by the words depersonalization, regimentation, total war, while its salvation is characterized by the words personal responsibility, in conjunction with nonviolence and service to human beings in Gandhi’s sense.

I believe the author is completely right in asserting that every human being is compelled to come to a clear decision with regard to this important matter: there is no middle ground.

In the Nuremberg trials the following principle was laid down: Personal moral responsibility cannot be set aside by national laws. Let us hope that we may soon come to the point where the Nuremberg principle will not only be enforced upon citizens of vanquished nations! (Einstein on Peace, p. 544)

Gandhi
Gandhi

Here, Einstein, rather than calling those who support war insulting names, he instead expresses admiration for two people who had acted to resist participation in military activities–Sharp and Gandhi. He then places their activities in the context of a moral principle that was articulated by the judges at the post World War II Nuremberg trials. These judges convicted Nazi leaders who presented a defense that they were just following orders.

I like this approach of letting people know, by use of a narrative, what actions you do respect. It goes beyond just saying what you don’t like.  It adds specificity, and I think people learn ideas better through narrative rather than principles alone. It is this very approach that I tried to create in my three novels.

Okay, there’s my post for this week.  Until next time, here’s hoping we all find some helpful ways to bring about a more peaceful world.

Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.

 

Categories
conflict management conflict resolution DSM Name calling psychiatrists psychiatry The Diagnostic and Statistical Manual of Mental Disorders

Psychiatric Name Calling: Is it Helpful?

psychiatry3Today I offer a follow-up to my earlier post titled “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” Among the points that I had tried to make is that psychiatrists falsely claim that the names they use to describe patients are “diagnoses.”  In actuality, all that they do is convert someone’s expressed concerns into medical jargon.

I received a great deal of positive and negative comments about the post from readers, but my focus today is on the negative ones. Most of them argue that in contrast to my position, they had personally found their psychiatric diagnosis very helpful.

Those who Found the Psychiatric Pathologizing Helpful

straight talkingI just finished an excellent book on this topic by Lucy Johnstone titled, A Straight Talking Introduction to Psychiatric Diagnosis. There we find several quotes from people who received a so-called diagnosis from psychiatrists and spoke of its positive personal impact.  For example, some felt that it provided relief at knowing “what was wrong.”

I had something that I could firmly grasp, and, you know, I could find out more and try to resolve it…[I] felt relief that this whole jungle was going to be sorted out.

Another person wrote,

It gave me the comfort of explanation…. When I was told I was depressed it gave me a framework of understanding and a first grip on what was happening. 

Some felt that it gave them hope for treatment and support.

Illness meant treatment and the possibility of cure.

disorders

Acceptance of my illness was a turning point…. By accepting treatment I could actively seek the right medication, access support, and turn my life around.

I think I prefer my illness having a name because it makes me feel less lonely, and I know that there are other people experiencing my kind of misery.

Then there were those who felt it provided them freedom from blame and guilt.

Diagnosis implied that this was an illness and not my fault—important for someone whose depression has always been riddled with guilt.

Commentary

Although there are many, many people who feel this way, Ms. Johnstone points out that the relief that these people experience is based on their assumption that the diagnosis itself is valid. If it isn’t, they are simply being offered a circular explanation—“Why are my moods so up and down?” “Because you have bipolar disorder.” “How do you know I have bipolar disorder?” “Because your moods are so up and down.”

Keep in mind, as well, that these people came to view their so-called diagnosis as helpful without ever having an opportunity to compare the pathologizing approach to any alternative approaches. For example, what would be the reactions of these same people whom I have just quoted if they were provided an option that avoided simplistic, misleading terminology, while professional mental health providers and peer support groups assisted the person to find their own stories and provided a choice of treatment options?

motivationMoreover, finding freedom from blame and guilt by playing the blaming-the-brain game may not be anywhere as helpful as the pharmaceutical companies would have us believe. Many of us have learned that we all, from time to time, do things that violate our image of our ideal self and spend some time suffering the consequences.  We come to realize that we not only violated the image of the ideal self in the past, but we’ll no doubt do so again and again in the future.  The experience of suffering over these lapses is the spur that, after a period of difficult reflection, eventually gets us off our butts, learn new skills and seek out the type of support that moves us to make improvements.  It can take time for this to happen. It can take more time than we in our modern pressure pot world may feel we have any right to take, and our loved ones may lose their patience. However, in the long run, drugging these feelings away have always produced more harm than good.

Those who Found the Psychiatric Pathologizing Unhelpful

In contrast to those who tell of some positive reactions to psychiatric name calling, there are other people who tell a dramatically different story.

despair 2

For a number of years, I accepted the medical model as a framework of understanding…. But I gradually came to appreciate drawbacks to the framework. My reading suggested the model might not stand up scientifically…. By the time I was entering my second decade of service use, the medical model, which I had initially found reassuring, seemed increasingly unsatisfactory, without the capacity to encompass the complexity of my interior or exterior life and give it positive value. As a result, I began to actively explore frameworks that better met my needs.

despair 3I already knew something was wrong with me. Now I knew I was mad…. The diagnosis becomes a burden… you are an outcast in society…. It took me years to feel OK about myself again.  

My diagnosis label promoted despair and threatened to become a self-fulfilling prophecy.

I have been diagnosed with dysthymic disorder since I was thirteen.  One kind of harm I suffered from receiving a diagnosis, in and of itself, was that it seemed so final and despairing to receive as a teenager.  For me, having a diagnosis seemed so final.  Like it wasn’t just a tempory issue that I was having, adjustment or adolescence or something, but this disorder that I was going to have for the rest of my life no matter what I did.

But the worse part of this, which I have only been able to shake within the last year…is the defectiveness I felt.  Just kind of in some core way.  Like I’m totally different.

I was so offended. I was really offended.  I thought well, ‘F*** you! You’re attacking my personality; you’re attacking me.  You’re attacking the very soul of me, you know; who I am, and what I am, that’s a disorder.

I no longer identify with my previous role as a severely ill psychiatric patient but a human being that is experiencing and surviving life in my own unique way… just like every other human being on this planet.

Commentary

In her book, Ms. Johnstone summarizes what she has learned from these quotes:

Lucy Johnstone
Lucy Johnstone

It is understandable that service users, reaching desperately for an escape from anguish, confusion, guilt and blame, might see diagnosis (at least initially) as ‘salvation’.  However, these benefits may be bought at the high price of taking on profoundly destructive messages of defect, dangerousness, damage and despair. 

In my view, we can come up with a much better approach to the psychiatric pathologizing of people, an approach that doesn’t label anyone, but rather, classifies mental health concerns. For those who found the pathologizing approach helpful, this alternative approach would provide the professional and peer support that they value without misleading name calling. Psychiatric terms confuse questions of fact with questions of value, and superficially declare that a person’s experience is bad when it may have some pluses and minuses.

Undoubtedly, there are kind and decent folk who have a very different position than I on this subject. In no way do I mean to suggest that those who hold a different opinion are stupid, for I have met many who are as bright as a cloudless summer day. If they want to continue to use the DSM approach, it will continue to be available. All that I seek, all that I hope for, is that those who are uncomfortable with the DSM approach, can still assess mental health services using an alternative. All that I seek is that we all take some time to think more deeply about the nature of melancholy, sadness and tears.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.