Welcome to From Insults to Respect. Today, we take a look at the question, Can psychologists come up with a kinder, more respectful, healthier approach for dealing with the types of concerns people seek mental health services?
The current approach, often referred to as the “medical model” or the “mental disorder model,” is promoted by the American Psychiatric Association (APA), the World Health Organization (WHO) and the pharmaceutical industry. Mental health service providers, to be reimbursed for their services by third party payers, are required to select from a variety of the “disorders” listed in the APA and WHO mental disorder manuals and then place its code on the service user’s third party form. To access mental health service in an affordable manner, most service users rely on a third party payer, such as a government universal health plan or a private health insurance program.
We begin to wrestle with this question about an alternative model with some concerns about the current medical model.
Concerns about the Medical Model
Here’s a quote from my favorite psychologist and philosopher, William James:
William James
“Individuality outruns all classification, yet we insist on classifying everyone we meet under some general head. As these heads usually suggest prejudicial associations to some hearer or other, the life of philosophy largely consists of resentments at the classing, and complaints of being misunderstood.”
The various “mental disorders,” falls under the head of “diseases” in the WHO’s International Classification of Diseases. Not everyone feels at home with this. Here is one service user expressing her discomfort:
“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.”
Note that she was looking for a framework that would give her complex life positive value. We shall return to this issue shortly. But first, I think it would be helpful if I share my own concerns about the medical model.
My Experience: My original exposure to the pathologizing medical model occurred when I took a course in Abnormal Psychology as an undergraduate at Brooklyn College. Shortly afterwards, I found that my classmates began to use the new terms that they learned in the course as insults whenever someone did something they didn’t like. One person was called a narcissist, another–a manic depressive, another–psychotic, and on and on.
This insulting behavior didn’t sit well with me. As an undergraduate I had, at various times, the typical troubling emotional experiences of teenagers that could easily be framed as various mental disorders. The stigmatizing mental disorder labels being used as insults could readily be applied to me.
Then, as a PhD graduate student, I was required to take a course titled, “Descriptive Psychopathology.” There I learned that because of a vote, mental health professionals had first declared that being what they termed “homosexuality” was a mental disorder, but recently they voted to no longer view it as a disorder. Although I’m not gay and happily married to a wonderful woman, I was glad to hear this, for I had since met some gay folks and felt the psychopathologizing of them didn’t seem right. I also thought that classifying people as having a disease based on a vote, rather than on some objective evidence of an infection, tumor, organ blockage, or tissue tear also wasn’t quite right.
Then I began to read books by William James. He had advocated that mental health service providers should not take their terminology too seriously, referring to it as superficial medical talk. This viewpoint of James began as early as 1896. In his Lowell Lectures on Exceptional Mental States (which were reconstructed by Eugene Taylor in 1984 from James’s notes), the good professor stated that experiences that are commonly viewed as unhealthy or morbid are really “an essential part of every character” and give life “a truer sense of values.” He went on from there to note that,
“medical writers represent the line of mental health as a very narrow crack, which one must tread with bated breath, between foul friends on the one side and gulfs of despair on the other…. There is no purely objective standard of sound health. Any peculiarity that is of use to a man is a point of soundness in him, and what makes a man sound for one function may make him unsound for another…. The trouble is that such writers use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with…. The only sort of being, in fact, who can remain as the typical normal man, after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity. Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all?
Upon graduating and serving in various roles as a psychologist, I learned about the various shortcomings of the pathologizing approach:
It is stigmatizing to mental health service users.
It privileges the clinician’s perspective over that of the mental health service user.
It has serious reliability and validity problems.
By focusing on what’s wrong with the individual it tends to miss their strengths, the complex relational context they find themselves in, and malfunctioning social structures.
By framing these concerns as mental disorders it misses the fact that the greatest advances of human being has been borne out of strife. There are numerous examples that suggest the possibility that these challenging experiences often serve an adaptive function. In framing these concerns as opportunities to expand possibilities, rather than suppress “symptoms,” we could increase self-efficacy and resilience.
By pathologizing psychological concerns, it promotes the use of psychiatric drugs that in many situations worsen outcomes.
Regarding this last shortcoming, I became aware that the pharmaceutical industry has had a huge financial interest in promoting the idea that psychological concerns are real “illnesses” that require drug treatments just like physical illnesses. Cosgrove, and her team of researchers have made a compelling case that this can be seen by how the industry has been exerting a great deal of influence on psychiatric research and practice, resulting in publications and news reports that exaggerate claims of its drug treatments’ effectiveness while minimizing harms. For example, the “Clinical Practice Guidelines (CPG)” for mental health services provides the “standard of care” for health care providers. The confidence in the benefits of these drug treatments, if it were free of industry influence, would be more convincing but Cosgrove’s team found,
“Ninety percent of the authors of 3 major guidelines in psychiatry had financial ties to companies that manufacture drugs which were explicitly or implicitly identified in the guidelines as recommended therapies for the respective mental illnesses. None of the financial associations of the authors were disclosed in the CPG”.
Now, I know millions of people like taking drugs, whether they be prescribed by doctors or not. So, any alternative to the medical model that interferes with this desire is going to meet with a tsunami of resistance. So, the medical model as an option to service users is likely to continue. The best we might hope for, is that third party payers that now require a mental disorder “diagnosis” also cover services under a more kinder, respectful framework.
A Proposed Alternative
For people who have come to believe the medical model is too stigmatizing, and drugging problems away is not for them, what might a more acceptable alternative look like? One idea comes from a recent study by Schroder, et al. (2023).
“We describe the historical development of popular messages about depression and draw from the fields of evolutionary psychiatry and social cognition to describe the alternative framework that depression is a “signal” that serves a purpose. We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a “disease like any other” with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition) …. The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression.”
As we have discussed above, the medical model conceptualization of the types of concerns that is classified under the disease heading often fails to motivate active coping beyond taking a pill. Moreover, it fails to honor the labeled person’s perspective. The above study suggests that framing these concerns as a potentially healthy functional signal can lead to less self-stigma, and perhaps greater self-efficacy in making healthy life-style improvements.
Dr. Jeff Rubin
Consistent with this suggestion, in several of my earlier posts, I provide numerous examples of people who found various experiences typically labeled as “mental disorders” as helpful. For example, Joshua Wolf Shenk in his biography of Abraham Lincoln, makes the case that his depression fueled his greatness. Similarly, the music legend, Joni Mitchell, upon discussing her frequent bouts of depression observed,
Joni Mitchell
“Depression can be the sand that makes the pearl. Most of my best work came out of it. If you get rid of the demons and the disturbing things, then the angels fly off, too. There is the possibility, in that mire, of an epiphany.”
In a paper I published in the Journal of Humanistic Psychology, I describe in detail one proposed alternative that is consistent with this way of thinking. This alternative involves creating a manual for a classification system that replaces the disease overarching concept of mental disorders with mental health concerns that potentially serve an adaptive function. Those seeking mental health services would be given a choice to have their concerns addressed utilizing the pathologizing approach or the mental health concern approach. Both types of services would be equally covered by third party payers. I argued that, in contrast to the pathologizing approach, this alternative would increase the self-efficacy of individuals struggling with these concerns. Additionally, it would be kinder, more respectful, improve outcomes, provide a new choice, stimulate fresh perspectives, and open new avenues of research.
The first chapter of the manual would explain that the mental health concern approach begins from the perspective of the person seeking services. It does not classify anyone. Instead, each person is viewed as a unique individual. What is classified is the concern expressed to a mental health service provider. Then, the manual would clearly define its main overarching 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, addictions, meaning of life, death, dying, managing chronic pain, work, relationships, education, eating, cognition, sleep, and challenging life situations.”
This is an observable event that occurs at a specific time and place, and therefore avoids the reliability and validity problems of the vague definitions provided in both the APA and WHO mental disorder manuals.
Two types of data sources would be utilized to identify the list of concerns that would appear in this alternative manual. The first would come from a large sample of mental health service providers that ask them to list the various concerns that they have been asked to address in their practice in the past year without couching them in psychopathological language and to stick as closely as possible to the language used by those seeking their services. The second source would come from another survey that 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 psychopathological terminology.
Some have argued that there is no need to have any classification system. According to this argument, a “psychological formula” approach consisting of a few paragraphs describing the case without pathological labels is sufficient to replace the medical model. But note that the vast majority of current third-party payer systems do use the mental disorder codes. The codes are used in the following manner. Third party payer systems utilize forms that must be filled out whenever someone seeks mental health services under their plan. These forms typically have a little box that reads, “Diagnosis.” In that box, mental health professionals must fill in a short code that corresponds to some specific “mental disorder.”
Utilizing just the psychological formulation approach, which involves the creation of several paragraphs as an alternative to these codes, would be far too cumbersome. The concern approach, like the medical model approach, provides a short descriptive phrase coupled with a code and is therefore far more workable.
With the concern proposal, all that third-party payer institutions would need to do differently to add value for their customers is to slightly change that little “Diagnosis” box. Instead of just reading “Diagnosis,” that box would add two simple words, so it would read, “Diagnosis or Concern.” Then, when mental health professionals fill in the box, they would be given the choice to either write in the letters “D” and the code number that corresponds to the so-called diagnosis, or they would write the letters “C” and the code number that corresponds to the specific concern. Mental health consumers would be given the choice to go to pathologizing mental health service providers or those using the concern approach. This is all the change that would be required to increase value for a significant number of mental health service users. The cost and effort for third party payers to make both the pathologizing and concern approaches available would be minimal.
Moreover, a short word or phrase that could replace terms like “major depressive disorder” or “attention deficit hyperactivity disorder” is necessary for other practical means of communication. For example, if I want to write a title for a research article, it would not be practical to insert several of the formulation paragraphs into the title. The psychological formulation approach would be far more widely used if it had some practical way of providing some standard short terms for conceptualizing an individual’s mental health concerns arranged in a valid scientific classification manual.
Some may argue that the mental health concern approach is not practical because 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 third-party payers’ costs would soar. Because third party payers made up of insurance companies and national health services only cover people with more serious conditions known as mental disorders, so the argument goes, this limits the number of people who can get to see a mental health professional. However, how do mental health service professionals honestly determine if a person has a serious enough condition to warrant “treatment?”
The process with the pathologizing approach is suppose to be as follows. When someone who expresses a concern (which is referred to as a “symptom”) to the mental health professional, the professional is to decide if the symptom arises to the vague level of “clinical significance.” Only if it does is the symptom considered serious enough to warrant a “mental disorder diagnosis.”
I have been a PhD level psychologist for over forty years. Not once have I heard of an occasion in which an individual who made an appointment for mental health services and then showed up for it, leave the appointment without a mental disorder diagnosis. This intuitively makes perfect sense because mental health professionals are in the business of increasing the number of their clients. Given that they have over 300 vaguely described “mental disorders” to choose from, and the only way they will get paid for their services is to declare that the person seeking services has a “clinically significant” disturbance, who can doubt that no one is turned away.
The professional status of the service provider leads the public to think something more serious has been established when a diagnosis is declared. Although it is true that some expressed concerns are more serious than others, a mental disorder diagnosis is not indicative of this.
So, the alternative “Mental Health Concern” approach more honestly describes what is actually going on in easy to understand language. It is one proposal for a more kinder, respectful, and healthier way for people to have their expressed concerns addressed by a mental health provider and covered by third party payers. Criticism of this approach and suggestions for some other alternatives are highly encouraged.
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.
Welcome to From Insults to Respect. Let’s start off this post with a brief tale that illustrates some of the strong feelings that come about when religion is discussed:
A rabbi and atheist are heatedly arguing over whether or not god truly exists. After a whole hour of this, finally the rabbi cries out in a rage, “How can you be so absolutely certain that there is no god!?”
“Hey,” cries the atheist, “a person has to believe in something!”
Neither of these two characters in this tale respects the position of the other. It illustrates my experience of regularly meeting people who insult others with whom they disagree on religious matters.
Isaac Bashevis Singer
At times, I sympathize with some of these expressed feelings. I remember reading a short story by Isaac Bashevis Singer titled “Yentl the Yeshiva Boy.” It tells us about a girl named Yentl who wants to enter a school to learn about a subject that greatly interests her, but according to the leaders of her Jewish community she is excluded solely because she is a woman. That seems unfair to me.
Then I learned about Malala Yousafzai and two other young female students who, on 9 October 2012, were shot by people who, based on their religious convictions, believed girls should not go to school. And more recently, in 2022, I read of a religiously motivated man stabbing novelist Salman Rushdie because Rushdie had written a story that included what some viewed as an irreverent depiction of Muhammad.
Salman Rushdie
When I learn about these types of stories, I do get an instant negative reaction about religion. But my mind quickly turns to the fact that the people I personally know do not condone violence against anyone because of their religious or non-religious convictions.
In thinking deeply about these issues, my mind always drifts to the ideas of William James, the esteemed Harvard professor of psychology and philosophy, and author of The Varieties of Religious Experience.
William James on Religion
James lived from 1842 to 1910, and throughout his lifetime faced some extremely challenging ideas about this topic. To begin with, his father, was a deeply religious person. Though James frequently expressed a great admiration for his dad, he, himself, had just the slightest connection to religious feelings. He expressed this connection in a letter to James Henry Leuba on April 17, 1904:
My personal position is simple. I have no living sense of commerce with a God. I envy those who have, for I know the addition of such a sense would help me immensely. The divine, for my active life, is limited to abstract concepts, which, as ideals, interest, and determine me, but do so faintly, in comparison, with what a feeling of God might affect, if I had one. It is largely a question of intensity, but differences of intensity may make one whole center of energy shift. Now, although I am so devoid of religious feelings in the director and stronger sense, yet there is something in me, which makes response when I hear utterances made from that lead by others. I recognize the deeper voice. Something tells me, “thither lies truth”– and I am sure it is not all theistic habits and prejudice of infancy. Those are Christian; and I have grown so out of Christianity that entanglement therewith on the part of a mystical utterance has to be abstracted from and overcome, before I can listen. Call this, if you like, my mystical germ. It is a very common germ. It creates the rank and file of believers. As it withstands in my case, so will withstand in most cases, all purely atheistic criticism, but interpretive criticism (not of the mere “hysteria” and “nerves” order) it can energetically combine with. Your criticism seems to amount to a pure non possumus [inability]: “Mystical deliverances must be infallible revelations in every particular, or nothing. Therefore, they are nothing, for anyone else their owner.” Why may they not be something, although not everything?
Your only consistent position, it strikes me, would be a dogmatic atheistic naturalism; and, without any mystical germs in us, that, I believe, is where we all should unhesitatingly be today.
Once allow the mystical germ to influence our beliefs, and I believe that we are in my position. Of course, the “subliminal” theory is an inessential hypothesis, and the question of pluralism or monism is equally inessential.
I am letting loose a deluge on you!… but I had to restate my position more clearly. Yours truly,
Wm. James
Meanwhile, many of the experts in his field believed those who were religious were suffering from a pathological condition. In his book, “The Varieties of Religious Experience: A Study In Human Nature,” he responded by calling this pathologizing “medical materialism” and critiquing its view as follows.
Medical materialism seems indeed a good appellation for the too simple-minded system of thought which we are considering. Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic. It snuffs out Saint Teresa as an hysteric, Saint Francis of Assisi as an hereditary degenerate. George Fox’s discontent with the shams of his age, and his pining for spiritual veracity, it treats as a symptom of a disordered colon. Carlyle’s organ-tones of misery it accounts for by a gastro-duodenal catarrh. All such mental overtensions, it says, are, when you come to the bottom of the matter, mere affairs of diathesis (auto-intoxications most probably), due to the perverted action of various glands which physiology will yet discover.
James goes on from here to point out that it is true, of course, that psychology has found that there are definite psycho-physical connections that “hold good”. Psychology, therefore, assumes as a convenient hypothesis that the dependence of mental states on bodily conditions must be thoroughgoing and complete. If we adopt the assumption, then of course what medical materialism insists on must be true in a general way, if not every detail…. But now, I ask you, how can such an existential account of facts of mental history decide in one way or another on their spiritual significance? According to the general postulate of psychology just referred to, there is not a single one of our states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditioned just as much as religious emotions are; and if we only knew the facts intimately enough, we should doubtless see “the liver” determining the dicta of the sturdy atheist as decisively as it does those of the Methodist under conviction anxious about his soul. When it alters one way the blood that percolates it, we get the Methodist, when in another way, we get the atheist form of mind. So of all our raptures and our drynesses, our longings and pantings, our questions and beliefs. They are equally organically founded, be they religious or of non-religious content.
James points out that in the natural sciences and industrial arts it never occurs to anyone to refute opinions by putting down their authors’ neurological constitutions. Value is determined by “judgments based on our own immediate feelings primarily; and secondarily on what we can ascertain of their experiential relations to our moral needs and to the rest of what we hold as true.” All states of mind are related in extremely complex ways to neural functions.The significance of each state of mind must be tested, not by its neurological origins, but by the value of its fruits. When the term “pathological” is applied to an experience, it wrongly implies a neutral science classification.
At another point in his career, James, wrote an an essay in response to philosopher Thomas Huxley and other great champions of the scientific method who were criticizing religious beliefs. James titled his essay, “The Will to Believe.” There he wrote that it was designed to be a “justification of faith, a defense of our right to adopt a believing attitude in religious matters, in spite of the fact that our merely logical intellect may not have been coerced.” It goes on to say,
Our nonintellectual nature does influence our convictions. Once we recognize this, we have a duty “to ask whether it be simply reprehensible and pathological, or whether, on the contrary, we must treat it as a normal element in making up our minds.
Discussion
Jeff Rubin, PhD
It is perfectly natural that folks vary in the degree that some aspect of life interests them, When I was growing up, I never once felt a call to become an accountant. Some people chose voluntarily to enter into that career, and love it. Some people have no motivation to learn to play a musical instrument. I was motivated to learn the piano and guitar, but just devoted myself to playing several times per week for 15 to 30 minutes. Others devote enough time to playing so they achieve a professional level. They go on from there to play in a band for two or more hours nightly and love it.
William James’s father valued his religious sentiment, invited similar interested folks to his home for long evenings of discussions about religious experiences. As we have seen, for Professor James, his religious feelings were of a far less intensity. “The divine, for my active life, is limited to abstract concepts, which, as ideals, interest, and determine me, but do so faintly, in comparison, with what a feeling of God might affect, if I had one.”
My own religious feelings are much more in line with Professor James’s than his father’s. Nevertheless, I don’t disrespect those folks who are more or less religious than I.
Some religious folks, I have found, are kind and pleasant, while others express their religious faith in ways that I feel is unfair or even horribly violent. Similarly, I have found that there are atheists who are kind and decent folks, while others do as awful actions as the very worst religious folks. In the end, like James, I judge a person not by their degree of religiosity, but by the fruit that comes from a person’s full range of beliefs.
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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.
When I got the phone call informing me that I was accepted into the University of Minnesota’s Psychology/Philosophy PhD program I experienced a happiness as grand as the Mighty Mississippi. With it came a charge of energy, and a hint of anxiety as my mind raced to think of what I needed to do to get ready for the move to the Twin Cities.
By the next day, the dramatic high I initially felt began to ease into some other, more complex emotions. I felt moments of sadness when I realized how far I would be from my family and friends back in Brooklyn. Anxiety came upon thoughts of the possibility of spending so much on this undertaking despite the possibility that I might flunk out?
Now, many people when they think of what happiness means, they simply say it is a pleasant experience. This definition is not wrong. However, a single word can have several different meanings. Today, in order to clear up some misunderstandings, I would like you to keep in mind one particular slightly more complex meaning for happiness.
This type of happiness has three features. First, it occurs upon the awareness that one of your challenging desires has turned from maybe likely to occur to one that is very likely to occur or indeed has occurred. I use the term “challenging desire” to distinguish it from others that are so easy to achieve that there is not much thought or emotion given to them. For example, you might wake up in the morning desiring to have breakfast. If you have a well practiced way to prepare it and you are fully confident that you can make this happen, then this would not be a challenging desire. When I had the desire to be admitted to Minnesota’s graduate program, I was not fully confident that the steps I took to achieve this would work and therefore it is an example of a challenging desire.
A pleasant feeling is the second feature of this type of happiness. The third feature is a shot of energy that functions to focus on achieving some important things in light of this new awareness.
So, in the example with which I began this post, 1. I learned that my challenging desire to be accepted into the Minnesota program was fulfilled, 2. felt a surge of happiness, which was then, 3. accompanied by a shot of energy helping me to increase my focus on what I needed to do as a result–arrange for moving, helping my wife to apply for a job, etc.. Here’s another example.
Jill has fallen in love with Bob and has the challenging desire that someday he will ask for her lovely hand in marriage. One evening he pops the question and although she knows that something could go wrong during the interim between being asked and the wedding day, just knowing Bob has asked her is a far more hopeful stage in her relationship. This recognition is accompanied by a feeling of happiness and a shot of energy. She uses this energy to begin to consider what kind of wedding she desires, where will they live, and numerous other details that must be tended to. As this process unfolds, the sense of happiness fades from time to time as other feelings arise to the surface.
Now, many people in our society have the belief that it just might be possible to find a way to always be happy. Moreover, if they are not as perpetually happy as they wish to be, they may begin to think that they have some mental illness such as depression, an idea that many in psychiatry and the pharmaceutical industry have an interest in promoting. Meanwhile, some people who hear about a person whose goal in life is to simply be happy, lose respect for that person, viewing them as shallow and having superficial desires.
Today, we are going to look at three highly respected people, long gone, that had disagreed with the goal of perpetual happiness, and then we will turn to a discussion about the importance of making the crucial distinction between happiness and well-being.
Three Respected Folks That Had Questioned The Goal Of Happiness
In a book titled, Living Philosophies: A Series of Intimate Credos, the first chapter is by Albert Einstein. There he states in part:
The ideals which have always shone before me and filled me with the joy of living are goodness, beauty, and truth. To make a goal of comfort or happiness has never appealed to me; a system of ethics built on this basis would be sufficient for a herd of cattle.
When I read the rest of Einstein’s chapter, I came away with the following image. He viewed happiness as one-half of an oscillation process, with sadness and happiness going back and forth, thrusting his ship forward, and where he chose to steer his ship was in the direction that led to goodness, beauty, and truth.
This is a deeper way to view the nature of happiness, and for those of us who want to be respected for being deep, in contrast to shallow, I think that there may be some value in meditating on this.
In September 1965 the humorist, Leo Rosten, published an essay titled “The Myths by Which We Live” in “The Rotarian” magazine. It reads in part,
“Finally there is the myth which gives me the greatest pain: the myth that the purpose of life is happiness, and that you ought to have fun, and that your children ought to have fun. Where was it written that life is so cheap? Where was it written that life is, or should be, or can ever be free of conflict and effort and deprivation and sacrifice?…the purpose of life is not to be happy at all. It is to be useful, to be honorable. It is to be compassionate. It is to matter, to have it make some difference that you lived.”
I’ve been told that the famous essayist, Ralph Waldo Emerson, had expressed a similar point of view.
Add to the above views on happiness the fact that many people perceive people who always act like they are happy and positive are annoying and are frequently insulted by being called a Pollyanna. Although it is true that some people enjoy being around someone who at least appears to be always happy and uplifting, there may be a point that even they find it annoying. With these complicating considerations in mind, let’s see what comes from making a distinction between happiness and well-being.
Distinguishing Happiness from Well-Being
Patrick Jones, in the June 2023 issues of Review of General Psychology provides us an article titled, “Mindfulness and Nondual Well-Being–What is the Evidence that We Can Stay Happy.” There we find that many researchers for many years tended to use terms such as well-being, life satisfaction, and happiness interchangeably. More recently, well-being has become the dominant term and is seen as a subjective experience that includes the role of affect, a broad range of cognitive processes utilized to evaluate external conditions and to deliver satisfaction with one’s life. Although positive and negative events can temporarily affect well-being, people typically maintain a relatively stable level of well-being.
“That is, satisfaction with one’s life is seen to be under homeostatic control within a set point that ensures that people usually return to a resourced and mostly positive view of their lives…. This can be made up of internal buffers such as optimism or reframing, and external buffers such as seeking social support to get us back on track.”
Typically, when people are asked how satisfied they are with their life, they generally answer about three-quarters satisfied and they vary just a few points from their average level, despite variations in the conditions they experience. As we can see, Mr. Jones is discussing something different than the experience I referred to as happiness, which occurs during certain points in one’s life, rather than a feeling about one’s life in a general kind of way.
Some people find that their homeostatic set point can be defeated under some trying conditions. How might a person find a way to return to their set point?
Patrick Jones presents evidence that mindfulness training may target psychological dimensions that could contribute to an experience of well-being that transcends the impact of life conditions. He reviews evidence that practicing mindfulness increased positive affect, emotional self-regulation, and self-compassion, strengthens interpersonal relationships, and selfless behavior, and may set the foundations of emotional stability. It was also found to decrease negative affect in response to negative stimuli and build greater resilience to trauma. Finally, in terms of its role in the maintenance of well-being, mindfulness increased attentional regulation, which in turn was found to build greater sensitivity and capacity to notice or interrupt negative thoughts and behavior that may threaten well-being.
From the above description of mindfulness, I think by now you can see there is a distinct difference between the swell of happiness connected to achieving challenging desires versus what recent research studies have been discussing under the term “well-being.” Referring to both as the same thing can be misleading as I hope to make clear in the next section.
The Importance of Making the Distinction
One reason for making the distinction is telling people that your goal in life is happiness when you actually mean, improve your well-being, has the potential of leading some to think you are a shallow person. It is also important to clarify with yourself what you personally mean by happiness because if you are really seeking to always feel like when you achieve a challenging desire, you are very likely setting yourself up for a lifetime of disappointment.
If, instead, you seek to improve your well-being, there is some research evidence that this can be accomplished. The regular practice of meditation, taking daily walks–especially in natural settings beside a body of water appear promising paths toward this goal.
In addition to research evidence, I can speak to my own experience. For me, when I was in my teens, most of my experiences were seen dualistically, that is either good or bad. Although I still experience a few things, such as Russia attacking Ukraine, as bad, most of my experiences that I used to see as bad I now view as the grand tapestry of life. I still grieve about certain things, but it has taken on a new feel. I experience the bodily sensation that comes with the awareness of what led to my grieving, allow myself to feel it deeply, savor the experience, and in time, thoughts come to me on how to move productively forward. Joni Mitchell, in her lovely song, “Hejira” well captures what I am trying to convey–“There’s comfort in melancholy where there is no need to explain, it’s as natural as the weather in this moody sky today.”
Okay then, that’s my post for today. I hope it provides a few nourishing ideas to reflect upon until next time. Have a great week, and may your well-being be all that you desire!
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 clickHERE.
We’re now into that early summery month of June. I think I’ll glance over here at my calendar.
Hmmm, Father’s Day–June 18th–is rapidly approaching. For Mother’s Day, I utilized aspects of Bob Dylan’s entertaining Theme Time Radio Hour episode on mothersto have some fun commemorating it. I think I’ll do likewise for Bob’s Father’s Day episode. Let’s go see if we can find some precious jewels there.
Bob’s Show On The Theme Of Fathers
Bob begins by telling us, “We’re here today to celebrate fathers.
Jimmie Rodgers
“We’re going to start things off with the singing brakeman, the yodeling cowboy, the father of country music–Jimmie Rodgers.”
Bob then plays us Jimmie’s “Daddy’s Home.” Here’s a few of its lyrics:
I am dreaming, tonight, of an old southern town And the best friend that I ever had For I’ve grown so weary of roaming around And I’m going home to my dad
Your hair has turned to silver and I know you’re failing too Daddy, dear, oh, Daddy, I’m coming back to you You made my childhood happy but still I longed to roam I’ve had my way, but now I’ll say, I long for you and for home
Dear daddy, you shared all my sorrows and joys You tried hard to bring me up right I know you’ll still be one of the boys I’m starting back home tonight
The song kinda gets to me ’cause I sure wish I could go visit my dad. He passed away when I was barely 13-years old. I was talking to my sister just the other day about our memories of him, and both of us had moments when tears came to our eyes.
In the “Daddy’s Home” song we get a sense of what the song writer respected about his dad–being the best friend that he ever had, making his childhood happy, sharing his sorrows and joys, and trying hard to bring him up right. Those sure are fine qualities.
Julie London
As Bob’s show continues, he introduces a humorous song called “Daddy” by the smokey and sultry Julie London that is filled with revelations and bits of stimulation. Let’s check out some of the lyrics:
Ooh Daddy, I want a diamond ring and bracelets, everything Daddy, you oughta gather this for me
Ooh, Daddy gee, won’t I look swell in sables? Clothes with Paris labels? Daddy, you oughta gather this for me.
Here’s amazing revelation with a bit of stimulation I’d be a great sensation, I’d be your inspiration Daddy, I want a brand new car and champagne, caviar Daddy, you oughta gather this for me
Dress me up in silks and satins Put good booze in my Manhattans Tap me with expensive presents Feed me oysters and broiled pheasants
The humor of the song comes from the singer pleading with her dad to give her all of these materialistic things. I think that for most people there is a sense of extreme, over the top, shallowness being displayed here.
To me, appreciating the noncommercial aspect of being a dad, such as sharing love, sorrows, and joys, along with providing for those things that children truly need is somehow a deeper quality when it comes to being a great dad.
In the middle of the show, Bob tells us:
Charlie Sheen
“Ran into Charlie Sheen again…. I asked him about his dad, Marty Sheen, a free radical, an atomic molecule of an actor. He loves his father, and he had this to say about him.”
At this point we hear Charlie saying:
“I think it was when I was in elementary school. I had a real hard time with separation anxiety. My dad, for a while would have to stay in the class with me and I started to see the reaction to him by the staff, by the teachers. I started to get the sense that what he did was a lot different from what the other dads were doing.
Marty Sheen
“The most important lessons he taught me involves the truth and honesty, not just in my work, but as the person and the value and the importance of the truth because he told me early on that the truth doesn’t change.
Happy Father’s Day, I love you and thanks for being my dad and being one of the best guys a son can hope to know.”
Now, there’s a guy who really appreciates his dad. Interestingly for me is that when Charlie told about his father teaching him about the value of truth and honesty, I found myself experiencing a bit of angst for it led me to recall times when I just might have stretched the truth on one or two occasions. I have two sons, now grown men, and I wonder if they have forgiven me for times they feel I had misled them, or do they still hold some rough feelings about me for this. I think this might be worth discussing with them before too long.
The next song is by The Sons of the Pioneers and recounts the great times the singer had with his father before he sadly passed away.
And then Bob introduces the song “Color Him Father.”
“Gonna color him father, color him love, this is a big top ten hit about a father tired and beat, sitting at the table to eat, never a frown, always a smile–‘Color Him Father,’ The Winstons.”
It’s one of those rare songs that pays a heart warming tribute to a stepdad that came to be a real father to his family:
There’s a man at my house, he’s so big and strong He goes to work each day, and he stays all day long
He comes home each night looking tired and beat He sits down at the dinner table and has a bite to eat
Never a frown always a smile
When he says to me how’s my child I said that I’ve been studying hard all day in school Tryin’ very hard to understand the golden rule
I think I’ll color this man father I think I’ll color him love
Said I’m gonna color him father I think I’ll color the man love, yes I will
He says education is the thing if you want to compete Because without it son, life ain’t very sweet I love this man and I don’t know why Except I’ll need his strength until the day that I die
My mother loves him and I can tell By the way she looks at him when he holds my little sister Nell I heard her say just the other day That if it hadn’t of been for him she couldn’t have found her way
I think I’ll color him father I’m gonna color him love I’ve got to color him father I think I’ll color this man love
Our real old man he got killed in the war And she knows she and seven kids couldn’t of gotten very far She said she thought that she could never love again And then there he stood with that big wide grin He married my mother and he took us in And now we belong to the man with that big wide grin
I’ve got to color this man father I’m gonna color him love I’ve got to color him father I believe I’ll color this man love
He’s just been so good to me I know I’ve got to color him love
The song brings up some strong feelings for me because like its narrator, my biological father died when I was young, and when my mother remarried I was raised by a stepdad. Unfortunately for me, as a teenager my stepdad’s authoritarian efforts led me to rebel. I sure wish I could have come up with some less heated ways to respond.
As Bob begins to close this episode, he plays us a little audio from the old “Leave It To Beaver TV show.” The show’s father figure happens to come upon a school assignment of his young son whose nickname is “The Beaver.” The assignment was, “Write something about your most interesting character.” As The Beaver’s father reads it, you can tell he is pretty touched by the words.
The most interesting character I have ever known is my father, Mr. Ward Cleaver. He does not have an interesting job. He just works hard and takes care of all of us. He never shot things in Africa or not saved anybody that was drowning. He might not be interesting to you, or someone else because he’s not your father, just mine.
There’s something kinda touching about these words.
What was Bob like as a father? According to his son, Jakob, the leader of the band The Wallflowers, in an interview with the New York Times, “He was affectionate. When I was a kid, he was a god to me for all the right reasons. Other people have put that tag on him in some otherworldly sense. I say it as any kid who admired his dad and had a great relationship with him. He never missed a single Little League game I had. He’s collected every home-run ball I ever hit. And he’s still affectionate to me.”
Well, there you have it, my Bob Dylan salute to all of you dads out there.
My Best
Jeff
———————
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.
Welcome to From Insults to Respect. I hope you all are all having a splendid week, especially you mothers out there for my calendar indicates Mother’s Day is just around the corner.
Regular readers of this blog well know that from time to time I like to utilize aspects of Bob Dylan’s entertaining show, Theme Time Radio Hour, to highlight some important issues regarding the nature of respect (see for examples, HERE, HERE, HERE, and HEAR). Well, it just so happens one of the episodes of his show is on mothers, so let’s see if there are any gold nuggets we can mine.
Bob’s Show On The Theme Of Mothers
You can access Bob’s show for free HERE. He begins by telling us,
Bob getting a kiss from his mom
Today we are going to pay a tribute to that bountiful breast we all sprang from, mother dearest…. A mother is the only person on Earth who can divide her love amongst ten children and each child still has all her love.
The first song Bob plays is “Momma Don’t Allow It” by Julia Lee. Here are a few of its lyrics:
Now our Momma don’t allow no trumpet playin’ ’round here Our momma don’t allow no trumpet playin’ ’round here Papa don’t care what mama don’t allow, He plays his trumpet any how Momma don’t allow no trumpet playing in here.
Then we hear some rollicking trumpet playing, followed by another similar verse:
Now my Momma don’t allow no eighty-eight playin’ ’round here My momma don’t allow no eight-eight playin’ ’round here I don’t care what momma don’t allow We’re gonna beat those eighty-eights anyhow Momma don’t allow no eighty-eight playin’ ’round here.
The song goes on from here to tell us of other instruments momma don’t allow, but different family members just refuse to listen. The last verse tells us,
Momma don’t allow no good time music here Momma don’t allow no good time music here Oh, we don’t care what momma don’t allow We’re gonna have ourselves a good time anyhow Momma don’t allow no, one more time, here we go….
This lively, upbeat song doesn’t seem very respectful to the wishes of Julia Lee’s mom. Nevertheless, it did bring up for me this idea that most of us sure can recall a few incidents that occurred during our upbringing when our mother told us not to do something, we disagreed, and we went right ahead and did it anyway. In most situations we still loved and generally respected her, but just couldn’t accept that everything she felt was wrong was wrong.
Here’s one such example from my own life.
My Example
When I was about nine years old, I was playing in the street with a black buddy of mine, Leroy, and after awhile I became thirsty, so I cried out, “Hey, let’s go up to my apartment to get us some drinks.” This was a common thing to do when I was with a friend, but it was the first time I had invited Leroy.
My Mom when I was 9-years old
My Mom greeted us in her usual warm manner, and gave us each a nice glass of milk and some cookies. We scarfed them down, and then hustled back down into the street for more fun. Later, when I returned home for supper, my mom sat me down, and told me, “Leroy is a fine boy, and I have nothing against him, but you shouldn’t bring a colored person into our apartment. What will the neighbors think?”
I had no idea what my mother was talking about because there were black kids in my Brooklyn school, along with Puerto Ricans, Jews, and a variety of others, and we played together, and at least to me, this seemed as natural as an ocean breeze. So I said to my mom, “Leroy, he’s a good guy.” Mom sighed, and said, “The neighbors might not like this.”
I usually obeyed Mom’s request, and I loved and respected her dearly. However, for this request, I ignored it and brought Leroy to our apartment whenever I felt like it. Mom, as she did the first time, always treated Leroy in a friendly manner. Still, I continued to be confused about why she was concerned that the neighbors might not like this.
But then, a few months later, I saw a movie titled, “To Kill a Mockingbird.” It depicted a story of a small town white lawyer, played masterfully by Gregory Peck, who was asked to defend a young black man against a charge of raping a white woman. When he accepts the case, he and his family take a great deal of heat from several white community members. I don’t want to reveal too much of the plot for those who hope to see it one day, but it led me to come to understand why Mom had become concerned. She was just trying, in her own way, to protect her family. Fortunately, my neighbors never gave any indication that they had become upset with what I continued to do.
Back to Bob’s Show
Although sometimes our moms didn’t always give us the most sound advice, sometimes they were right on, as Bob points out by playing us “Mama Didn’t Lie” by Jan Bradley. Here are a few of the lyrics:
Mama didn’t lie, she didn’t lie Mama didn’t lie, she didn’t lie
Here comes that boy and his friends Making eyes at me again Do they all think that I’m a toy? To be played with by every boy? Well, they’re wrong to think I Will be caught by the wink of an eye
My mama didn’t lie (Mama didn’t lie) She didn’t lie Mama didn’t lie She didn’t lie
The greatest pastime in this man’s world Is playin’ tricks on every young girl To have one is how they get their kicks But not me, because I know their tricks And they’re wrong to think I Will be caught by the wink of an eye.
After a few more songs about mothers, Bob tells us that he, “caught up with Penn Jillette of Penn and Teller [the popular magic performers] the other day, and he told me what it’s like to be a momma’s boy.” Here’s what Penn had to say:
There are two ways momma boys turn out. The one way is kinda the accepted nansy pansy way, the whimpsey way. But there is another kinda momma’s boy who had such complete unconditional love from his mother and father that he had the feeling that he was twelve feet tall and bullet proof and that’s what my mom did for me.
My favorite story about my mom about unconditional love is when Penn and Teller opened on Off Broadway. There was this opening tradition in theater that you wait up all night at a party until the New York Times comes out at three or four a.m., and the review is read aloud and that decided whether your show was successful or not. So we waited up and my mother and father was at the party and they were sitting with our producer and they read the review from the New York Times aloud and it was really an unbelievable money review. And, uh, the next day, I had breakfast with my mom and dad, and my mom said, “When they read that review from the New York Times and your producer turned to me and said, “Doesn’t that make you proud?” it made me so sad and uncomfortable because I don’t need the New York Times to tell me to be proud of my son. I was proud of you the instant you were born.”
Man! I just love that story!
Bob’s mom as a young woman
As this show’s episode comes to a close, Bob tells us, “That’s all the time we have today on Theme Time Radio Hour. We’ll see you again next week. In the meantime, go call your mothers.” Sound advice if your mother is still alive. Sadly, my mom passed away several years ago. I sure miss her.
As I thought about Bob’s show, it occurred to me that he didn’t just devote a whole show to mothers, at least two of his great songs featured a mother as a central character. “Stuck Inside of Mobile with the Memphis Blues Again” repeatedly includes the following lines:
Oh, Mama
Can this really be the end?
To be stuck inside of Mobile
With the Memphis blues again
Throughout the song we hear of a great deal of dissatisfaction with life in Mobile, and Bob cries out to his mom for solace.
Bob with his mom
In “It’s Alright, Ma (I’m Only Bleeding),” Bob tells his ma about a number of disquieting aspects of life but in each of the choruses he seeks to reassure her he will somehow get through this. So, for example, there’s this one:
So don’t fear if you hear
A foreign sound to your ear
It’s alright, Ma, I’m only sighing
And then there is this one:
And though the rules of the road have been lodged
It’s only people’s games that you got to dodge And it’s alright, Ma, I can make it
And then there is this one:
But though the masters make the rules
For the wise men and the fools
I got nothing, Ma, to live up to
And then there is this one:
But I mean no harm, nor put fault
On anyone that lives in a vault But it’s alright, Ma, if I can’t please him
And finally, there is this one:
And if my thought-dreams could be seen
They’d probably put my head in a guillotine
But it’s alright, Ma, it’s life, and life only
With Bob’s great poetic art, as is true with much of great art, there are no straight forward solutions offered, and yet the imagery provided is pregnant and is accompanied with angst, deep concern, and a process that we go through that at least offers the possibility of the birth of something beautiful.
Perhaps some of you who have joined us here today have begun to notice that many in the media have begun to replace using the words “mentally ill,” “mental disorder,” or “psychopathology,” with words like, “a person with a mental health concern,” “mental health issue,” “mental health challenge,” or “mental health problem.” This change is viewed by some as more respectful, while others insist that this realm of existence is an illness like any other illness, and we should therefore stick to the original psychiatric terminology.
Why would anyone care what words are used to refer to a group of people? Isn’t one name just as good as another? Try convincing a black person that the n-word is as good as any other name to refer to him or her, and you might begin to see that some people do have strong emotional reasons for their word preferences.
A concept like “mental illness” is used to serve mainly a pragmatic purpose, though in time it may begin to pick up some negative emotional associations that pack a pretty nasty punch in the gut. So, with this in mind, let’s take a few minutes to examine the pros and cons of using these mental illness-type concepts. But first, a brief tour of the health care system will set the stage for our pros and cons discussion.
Brief Background History
For centuries people who were financially well off went to doctors that specialize in treating physical ailments. For those who had money merely for food and housing, home remedies substituted for professional care. Some of these poor folks saw themselves getting worse and worse and ended up desperately crying out for help at hospital emergency rooms.
This presented a moral dilemma for physicians. On the one hand, treating these poor souls for free would save lives. On the other hand, their hospital would be unable to economically survive because it’s expensive to provide treatments for free.
Advocates for moral physicians, the poor, and hospital administrators struggled with this for years. Eventually, the idea came about in most developed countries that the government could create an insurance program that would have all tax payers pay an affordable increase in taxes and this would fund health care at no extra cost for all of its citizens whenever any of them become sick.
Despite most developed countries upon actually trying this approach and discovering it is a workable solution, the United States decision makers set up an alternative that had private insurance companies offer policies to people who could afford its premiums. This expanded to some degree the number of people who were able to access healthcare.
Poorer people, however, could not afford these premiums, and continued to show up at emergency rooms. When hospital administrators pressed for payment, an enormous amount of people ended up bankrupt, while hospitals found the legal bureaucratic process of bankrupt proceedings taxing and financially problematic.
In time, advocates of some doctors, hospital administrators, and the poor increased the availability of healthcare through political action that led to the passage of some aspects of the Medicaid and Medicare programs. With the passage of the Affordable Care Act, even more people can now afford insurance premiums.
So, there you have it, the essential background information needed to consider the pros and cons of the pathologizing and psychiatrizing mental illness concept. In our next section, the concept’s perceived benefits shall be presented. As you read it, please remain mindful that not everyone agrees that each of these perceived pros are indeed pros, especially when long term consequences are taken into account. That being said, bear with me as I temporarily skip over these richly complicating issues until we reach the subsequent “Cons” section.
Pros
The two main pros to the mental illness concept are, 1. connecting the concept to the notion of illness helps to increase access to needed services and 2. it reduces stigma, blame, and guilt.
Increasing Access to Support Services
While all of the health care changes I discussed above were going on, there were individuals who were experiencing concerns regarding their level of distress, dysfunction, abnormal feelings, or behavior. Some went to their clergy for guidance, and this continues to this day. Others who could afford it, went to their medical doctor. Typically, when nothing physically wrong could be found to explain their patients’ concerns, doctors had little to offer other than unsupported theories such as pathological glands, toxic substances in their blood, chemical imbalances, or brain neurology. Often, placebo pills or sedatives were prescribed along with a few kind words of encouragement. However, some doctors took a special interest in just these types of concerns, and began to specialize in treating these patients, calling themselves psychiatrists.
Initially these psychiatrists claimed that because these concerns were due to real illnesses they were the only ones who should be permitted to legally diagnose and treat these types of patients. To bolster their argument, they referred to their patients with medical sounding terminology. Their treatments at first consisted largely with what they called psychotherapy, which was a specialized conversation. Later, lobotomies, new pills, and electroconvulsive treatments were added.
In the last few decades, other professionals, such as psychologists, counselors, life coaches, and social workers began to compete with psychiatrists in providing conversation-type services to this group of people at significantly lower hourly rates. Psychiatrists, realizing they were the only professionals that could legally prescribe drugs, began to focus on the pill prescribing side of treatment. The pharmaceutical industry, for their part, came up with some pills that were marketed as “antidepressants,” “anti-anxiety medications,” and “antipsychotics.”
To expand their client base, psychiatrists along with the powerful pharmaceutical lobby, made the case that since these mental illnesses were illnesses the insurance industry and government agencies should offer health insurance plans that covered mental illness treatments. When this succeeded, two other mental health services providers–licensed psychologists and mental health counselors–provided research findings indicating their psychotherapy approaches offered relief to those viewed as having a mental illness. Decision makers became convinced, and in recent years, more and more health insurance plans are including coverage for a limited number of psychotherapy sessions.
This increased access to treatment to a wider number of folks, and in the United States, advocates were able, through the Social Security Administration, to provide additional types of support for people it refers to as having a “serious mental illness.” Its Social Security Disability Insurance and Supplemental Security Income programs provide funds and help with housing.
So, one of the major perceived pros of the mental illness concept is that by tying psychological concerns to the concept of illness, it probably made it easier to convince decision makers to expand access to services for those struggling with these challenges. Additionally, for psychiatrists, other mental health service providers, and the pharmaceutical industry, their businesses have flourished.
Reducing Guilt and Blame
The mental illness concept, it has been argued, reduces for many parents feelings of guilt when their offspring begins to develop mental health concerns. Interestingly, many in psychiatry initially were the ones who actually increased parental guilt despite utilizing the mental illness concept. They had argued that schizophrenia is caused by bad parents, and especially by bad mothers (see HEREfor a scholarly review of these theories).
In brief, mothers of patients were presumed to have provided a lack of authentic love of their child. Schizophrenia, and depression, according to other psychiatrists blamed some of women’s psychological concerns on their fathers molesting them. And so parent advocacy groups such as the National Alliance On Mental Illness (NAMI) jumped on the notion that mental illnesses were blamelessly due to an illness like any other illness such as diabetes or cancer. Most current psychiatrists are supporting NAMI’s position.
Despite the biological approach having failed over decades to find a relevant brain lesion or source of infection, or to nail down the hereditary nature of conditions referred to as mental illnesses, the “brain disease” idea still manages to alleviate parental guilt. It also alleviates the guilt of many patients who are told by people close to them that they should just snap out of whatever is concerning them. “You can’t just snap out of cancer, can you?” these patients argue. “My doctor says I have a real illness like any other illness, and I am acting responsibly because I went to a doctor, got diagnosed, and I’m taking my prescriptions.”
So, there you have it, the main perceived pros of the mental illness concept. By incorporating the word “illness” in naming this concept, which had already successfully helped to increase access for physical illness services, it appears to have eased the way to convince decision makers to provide access to services to address psychological concerns. Moreover, parents of the mentally ill labelled patients, along with the patients themselves, found that believing these concerns were illnesses like any other illnesses reduced their sense of guilt.
Cons
In seeking to weigh the pros of the mental illness concept with its cons, let’s break this task into four parts–1. insurance and government services issues, 2. illogic of trying to equate mental illness with physical illness, 3. psychiatric treatments causing more harm than good, and 4. confusing guilt with responsibility.
Insurance and Government Services Issues:
As mentioned above, one can theorize that the mental illness concept made it easier for insurance executives and government decision makers to agree to support providing services to people dealing with psychological concerns. In thinking about this, let’s first consider what really happens in the insurance industry when these types of decisions are made.
Long before mental illness policies were added to health policies, insurance companies had been offering policies that required no required illness connection. Examples of this are car insurance, theft insurance, flood insurance, etc.
In deciding to offer a policy to customers, insurance companies simply use actuary data to decide how much to charge people so the premiums would provide a profit. This is what they actually have done when deciding how much to charge for a policy that provides coverage for those who receive a “mental disorder diagnosis.” So, logically, there is no actual need for insurance companies to see mental health concerns as illnesses.
Some may argue that insurance executives, when considering whether or not to offer policies to people who are declared as having a mental illness probably first considered the following. By limiting services to just folks whose concerns are serious enough to warrant a mental disorder diagnosis, this would keep the number of people accessing services to a more manageable level. Thus, the system would avoid becoming overloaded with clients, and insurance premiums would remain manageable.
However, here is the counter argument. Mental health service providers now using the current “diagnosis” approach are not turning anyone away who has mental health insurance coverage. Professionals are in the business of increasing their clients. The current “diagnosis” system is so vague that anyone currently seeking services are easily provided with some “diagnosis” regardless of their expressed psychological concern.
So, with regards to the question, Was it easier for insurance executives to decide to offer policies that provide mental health support services because of the mental illness concept, there is really little logical support for this. How about for government decision makers? Again, we find example after example that the government provides support for reasons other than illness. The Federal Emergence Management Agency (FEMA) funds are used when an earthquake or flood devastates a community. Local, state, and federal funds are used to provide extra services to school age students who fall academically significantly below average. No illness connection is required to convince anyone that these kinds of services are in the best interest for our communities.
So, in conclusion, when insurance executives or government officials decide whether funds are to be used to provide assistance to people, employing a concept that includes the idea of an illness is simply not a necessity.
The Illogic of Equating Mental Illness
With Physical Illness
A diagnosis of a physical illness requires the doctor observing the presence of a physical pathology. A diagnosis of a mental illness occurs when the doctor does not find any evidence of the presence of a physical pathology such as a virus infecting the body, an MRI identifying an internal lesion, etc. There is no actual diagnosis when a psychiatrist says he or she has made a mental illness diagnosis. The doctor simply has a conversation with the patient and assigns what is referred to as a diagnosis despite research studies indicating this type of classification system lacks reliability and validity.
Rather than using an “illness” metaphor to convince insurance companies and government decision makers to provide support services for the concerns now being addressed by them, it would be more logical to refer to these concerns as “mental health” concerns and develop a classification around this concept. The word “health” in such a classification system would be used to provide the logical argument that professionals dealing with mental health concerns are part of the allied health professions. The reason for thinking of these professionals as health providers follows:
Many of the concerns that would fall under this type of classification system (behavior, emotion, mood, addictions, meaning of life, death, dying, managing chronic pain, work, relationships, education, eating, cognition, sleep, and challenging life situations) have been identified in scientific studies as “physical health risk” factors. For example, people who express a concern about being addicted to alcohol are at increased risk of developing sclerosis of the liver (O’Shea, Dasarathy, & McCullough, 2010). Those who express concerns about eating more than average may be at greater risk of diabetes and heart disease (Mokdad et al., 2003). Quality of interpersonal relations, lack of sleep, depression with thoughts of suicide, and various other concerns or clusters of concerns can be studied for the degree of physical health risk that they pose.
A major goal of mental health concern providers under this type of system would be to turn “physical health risk” factors into “physical health protective” factors. The degree to which this is successful can be studied using currently available methodologies and has the potential to save enormous sums of money in the long run.
The Mental Illness Concept Encourages Medical-type Treatments For Mental Health Concerns, Which has Led to More Harm than Good
According to the scientific evidence, the types of services that have come about as a result of medicalizing these types of concerns with “mental illnesses” terminology, has been far more harmful than health promoting. Medical doctors, which include psychiatrists, think of treatments chiefly in terms of surgery and medicines. Early in the psychiatric profession the surgical operation that it came up with was referred to as lobotomies.
First introduced in the 1930s, this highly traumatic brain procedure was once seen as a miracle cure for mental illness. But it soon became apparent that many patients lost their ability to feel emotions and became apathetic, unengaged, and unable to concentrate. Some became catatonic, and a few even died. After a few years it became clear it resulted in far more cons than pros, and has since been discarded.
The medical profession of psychiatry has now turned to the treatment option of prescribing “antidepressant, “anti-anxiety,” and “antipsychotic” pills. As it turns out, when the long term effects of consuming these pills is considered, overwhelming evidence indicates far more harm than good (see HERE). In brief, data indicate rising disability rates since these drugs became the standard treatment. Standard mortality rates for schizophrenia and bipolar patients have worsened as well. Long-term studies tell of higher recovery rates for schizophrenia patients off medication. There is evidence that tells of how depression has been transformed from an episodic disorder into a chronic condition in the “antidepressant” era.
Why, then, do so many people who have received this type of treatment report that they are being helped by them? It has to do with how most psychoactive drugs create the illusion that they are helpful (see HERE, and HERE). The best way to understand how this illusion is created, is to consider how people come to believe smoking cigarettes help them to deal with their stress. Thus, in a study published in the American Psychologist, researchers found the following:
Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.
This same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and the drugs that psychiatrists prescribe. They all create the illusion that the pills improve their functioning initially through a placebo effect. Then, once their bodies adapt to the drug, each time they haven’t taken the drug for a few hours, they begin to experience a withdrawal effect that they attribute to their mental health concern returning. When they take their next pill, their relief from the withdrawal effect abating is experienced as pleasant, and with that, the illusion has been accomplished. For many people, it is only by gradually withdrawing from these addicted substances can one safely recover from this type of addiction (see HERE for support to safely withdraw from these drugs).
Confusing Guilt With Responsibility
As for the belief that framing mental health concerns as an illness like any other illness reduces blame and feelings of guilt, this too is an illusion. Despite this belief, many people continue to blame parents for their offspring acting in certain socially unacceptable ways and they continue to blame the patients as well (see HERE). By the way, many also feel guilty when they get certain physical illnesses. For example, tobacco related illnesses often are met with a regretful twinge.
Rather than trying to convince oneself that a mental illness diagnosis somehow significantly reduces stigma, we would be better off considering the difference between blame and responsibility. Guilt and blame are associated with the attitude that the guilty party deserves to be insulted and punished, something I don’t at all support. In contrast, responsibility indicates that when working through troubling experiences, you recognize you have an important job to do. This job involves allowing yourself to fully experience the physical sensations that come, not as something awful, but as something useful and containing even some aspects of great beauty. It is like sitting beside a sparkling blue ocean listening in a caring way to a good friend who is going through an anxiety or grief experience, and empathizing on a physical level with what he or she is experiencing. This experiencing leads as naturally as life itself to seeking ways to address the concerns that bring about anxiety and grief.
Even if no immediate promising ideas come from a particular episode of spending time in this way, taking responsibility involves keeping hope alive. This means that you recognize that with particularly challenging situations, it takes an extended time to fully address such concerns. In the coming days, new, fresh ideas may yet come your way, or the situations that brought about the concerns may change in unexpected ways to your advantage. In contrast to acting responsibly, experiencing guilt when feeling anxious or grief becomes an aversive experience. The mental illness label pathologizes the concern, but there is a potential of improving one’s life with the experiences that get these illness conceptualizations.
Taking responsibility for one’s concerns, in my opinion, involves welcoming these experiences, kind of like you might a friend, for these experiences enrich our lives if handled responsibly. If you have something more pressing to take care of for a short period of time, it can make sense to gently delay your interaction with whatever anxiety and grief you have to deal with until a more convenient time. However, the responsible thing to do is to soon invite these experiences back so you can spend some time to work through these types of concerns. Daily meditation, quiet walks in natural environments, and journal writing, are free and ideal ways to do this.
Wow, this post has gotten quite a bit longer than I intended. I think I’ll give it a rest at this point. With that, I bid you a warm adieu.
Last week, I presented a post titled, “Mental Illness as Distress, Abnormality, and Dysfunction.” There, I explained that it is actually normal in our society to have periods during which we become concerned that we are too distressed, or too dissatisfied with our level of functioning. The pharmaceutical companies, I noted, promote that these concerns are mental disorders and can be safely addressed by going to a psychiatrist.
Psychiatrists, using the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), label expressed concerns as mental disorders, and then write prescriptions for drugs they call medications. This is financially rewarding for psychiatrists and makes billions for the drug companies. Unfortunately, this model is promoted as a sound science supported enterprise, although science paints a dramatically more complicated picture.
The question of whether psychiatry is even properly viewed as a science was taken up in an article titled, “Is Psychiatry Scientific? A Letter to a 21st Century Psychiatry Resident.” Published in 2013 by the National Library of Medicine, its conclusion section states in part, “The DSM-5 is a dead end, and even the NIMH scientists acknowledge that DSM-5 does not describe valid entities supported by valid scientific research.” Nevertheless, on the basis of this approach, the average psychiatrist makes $220,000 per year.
Here’s a narrative illustrating what they do to earn this.
Good afternoon, Mrs. Doe. I hope your trip here went smoothly.
Yes. I’ve come for an appointment, Dr. Smith, because I’ve been very depressed. I’ve been seeing on TV commercials that there are some pills that can help.
Yes, Mrs. Doe, there are. But first, please tell me how long these depressed feelings have been going on.
Well, my husband and I have begun the process of having a divorce, and, well even before that, we were having marital problems, and, well, maybe for a few months now its been pretty bad.
Has it been affecting your sleep?
Oh, yes. I often have trouble falling to sleep for hours.
How about eating?
Sometimes I end up drinking too much, and I have a bad stomach reaction….
After this type of conversation goes on for about an hour, the doctor prescribes a pill, informing the patient of what kinds of side effects to watch out for.
Psychiatrists, like other medical doctors, seek to validate their treatment with studies that are carried out using acceptable scientific methodologies. Let’s take a critical look at the outcomes of these studies.
The Science
Short term studies indicate the use of “antidepressants” can cause irritability, anxiety andpanic,emotionalflattening, involuntary muscle movements, sexualimpairment, suicidality, weight gain and aggression. Additionally, serious withdrawal effects are well-documented and can last for months, and can be mistaken for a return of depressive symptoms.
In these short term studies, some subjects taking these drugs do report some improvement after a few weeks, but so too do those who take a placebo, or begin a physical exercise program, or begin seeing a counselor or psychotherapist, or begin to meditate. The difference between the improvement experienced between the active drug and placebo groups tends to be slight.
Even this slight improvement has been questioned because of serious flaws in the research design. These flaws have to do with the drug studies being funded by pharmaceutical companies and because most of the subjects in the studies were taking a different “antidepressant” prior to the study.
Why would taking a different “antidepressant” prior to taking the new drug in these studies lead to making the new drug look more effective than a placebo? To qualify to be in the study, those who had been taking a different “antidepressant” had to agree to stop taking it for a couple of weeks prior to taking the new “antidepressant.” It often takes more than two weeks to wean off of these types of drugs. Therefore, many of these subjects in the placebo group were experiencing withdrawal reactions from no longer taking any “antidepressant.” This then creates the illusion that the new drug is more effective than a placebo because those taking the placebo mistake their withdrawal reaction that is continuing after they begin to take the placebo to a worsening of depression. Meanwhile, those in these studies who were taking the actual new drug are less likely to experience withdrawal reactions because new “antidepressants” are similar to the older ones.
As for the long term effects of these drugs, there are some studies that looked at this and found that those who took “antidepressants” had worse outcomes than those who did not receive the drug despite having the same symptoms.
I focus above on the science regarding depression because it is the most common reason people go to a psychiatrist, but all of the drugs psychiatrists tend to prescribe are unhealthy. The so called “antianxiety” drugs, colloquially called “benzos,” are addictive, and side effects include drowsiness, dizziness, and decreased alertness and concentration. Lack of coordination may result in falls and injuries. Another result is impairment of driving skills and increased likelihood of traffic accidents. Decreased libido and erection problems are also common side effects. Depression and disinhibition may emerge.
The so called “antipsychotic” drugs are even more dangerous. Here’s a list of them, and I provided a link for each one so people can learn more about what they are.
Some estimates suggest the “antipsychotics” shorten a person’s life by around 10 to 20 years. That’s a lot of damage to cause.
My Conclusions
Dr. Jeff Rubin
For several years, I moderated a series of debates on this topic. The panel members included several leading psychiatrists who supported what they did in their practice. I came away fairly convinced that they genuinely believed they were providing an enormously helpful set of treatments. They also struck me as intelligent, caring individuals, and I respected them for their willingness to debate the issues.
Their efforts at rationalizing what they do consists of describing their experience with their patients in glowing terms, minimizing the negative side effects while exaggerating the benefits of the drugs they prescribe, and admitting that much of the scientific support for their treatments are indeed flawed but set this quickly aside with comments like, “Hey, all research studies have flaws.” Even in the face of other debate panel members that included one psychiatrist, a noted scientist, and patients who disagreed with them, they steadfastly remained convinced that their approach was consistent with the best science available.
These debates also included patients who fervently believed the psychiatric/mental disorder way of looking at their concerns has been enormously helpful. Their two chief arguments were,
1. Mental illnesses are real illnesses, and therefore, this eliminates blame for what they were going through,
2. The psychiatric drugs have “saved their lives,” or significantly improved their lives.
To this, I want to make it clear that neither I, nor most of the people I know, blame patients/clients for experiencing psychological concerns regardless of their views on this issue. At the same time, I have met people who do blame people for any and all behaviors they don’t like about them regardless of their views on mental illness. Since the notion of mental illness as real illness has been the dominant position by psychiatrists, stigma has not been eliminated. Moreover, I know smart, intelligent people who choose to take psychiatric drugs that I genially like and respect. With those words of clarification, I nevertheless have, after hearing both sides of these issues, concluded psychiatry causes far more harm than good, while being a heck of a financially rewarding business model.
It’s hard to come to this conclusion because making a good living is a fine thing to be doing. I don’t want to be seeming to be putting down the value of this, and I fear that people might think I have unkind feelings toward psychiatrists in general. I recognize and accept good people see these issues so very differently than do I.
Well, enough for now on this so very challenging topic. Let’s depart with a shift to something more pleasant.
Spring has arrived, along with its beautiful, colorful flowers fluttering in fragrant breezes. And so, may we all find some time to get outside, breath deeply, and find within us a wonderful appreciation of the many fine aspects of being alive.
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.
In our society, many assume psychiatrist can accurately diagnose mental illness, also referred to as mental disorder or psychopathology. Why do they?
Sometimes we respect what a group of people do because of their association with something we highly value. Thus, in a commercial, we might see people purchasing a particular brand of car with a highly respected athlete, such as Derek Jeter, sitting in the driver’s seat.
Similarly, in our society many people respect the ability of psychiatrists to make a diagnosis of mental illness because psychiatrists have highly valued medical degrees. Those with this degree often save lives, a pretty amazing accomplishment certainly worthy of respect. However, the association between saving lives in situations that involve broken bones, tissue tears, heart disease, and cancer, might be irrelevant when it comes to their involvement in offering, for a fee, help for people who present with psychological concerns. In fact many view the psychiatrists’ approach to diagnosing and treating psychological concerns with drugs as causing far more harm than good (see, for example, HERE). Moreover, the type of “diagnoses” psychiatrists make is stigmatizing while lacking reliability and validity (see HERE).
Most publications on this topic present the relevant research. This leads many untrained folks to feel this type of information is way over their head, so they leave the necessary mental processing that can lead to a more thorough rational understanding of the issues to the experts. But when people cut short their reasoning in this way, it leaves them at the mercy of people who have an enormous financial interest in misleading patients and themselves. Consider the chemical imbalance theory that didn’t pan out, and yet I still hear it being promoted. Therefore, today I want to try my hand at providing readers a more accessible, common sense understanding of the type of labels psychiatrists use when describing the various concerns people present to them.
Mental Illness and Common Sense
To begin to understand, in a common sense manner, this notion of mental illness, we first have to come to understand that it is chiefly made up of three ideas–distress, abnormality, and dysfunction. By looking at these three ideas seperately we arrive at a place where our common sense can better understand why a psychiatrist’s “diagnosis” makes no sense for patients while being enormously valuable to the profession and the pharmaceutical industry.
Distress
The latest version of what is viewed by psychiatrists as the most authoritative American text on mental illness is the DSM-5. It tells us that mental disorders “are usually associated with significant distress in social, occupational, or other important activities.” Internationally, the most authoritative text according to psychiatrists is the International Classification of Diseases (ICD). It tells us that mental disorder “is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress…”
The phrase “significant distress,” as you can see, appears in both definitions. But notice that although this distress component in the definition is “usually” associated with mental disorder, it is not really a requirement.
In case this vague definition does not provide enough wiggle room for clinicians to label all people seeking their services as having a mental disorder and to prescribe a drug for it, the ICD tells the clinician, “When the requirements are only partially fulfilled, it is nevertheless useful to record a diagnosis for most purposes.” This type of double talk is one of the reasons why many people view the mental illness construct as super useful for a financially rewarding business model, but too vague and misleading for scientific purposes.
Let’s consider a patient who comes to a psychiatrist and asks for help because each day he becomes a mass of quivering fear. This patient sure sounds like he is experiencing distress. But so too do many woman who are giving birth, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.
When writers receive rejections from publishers, or a loved one dies, distress often accompanies these experiences. Yet, we do not typically describe them with pathological terms, but if you went to a psychiatrist expressing any such concerns there’s a pretty good chance you will leave the office labelled as having a mental disorder and a prescription for pills.
As mentioned, not all psychological concerns need to have the “symptom” of distress to be labeled a mental disorder by psychiatrists, e.g., attention deficit/hyperactivity disorder, conduct disorder, intellectual disability, and schizophrenia. Thus, by using the psychiatrists’ classification system, we find that people who are experiencing distress may or may not be classified as having a mental disorder, and people who are not experiencing distress may or may not be classified as having a mental disorder.
Meanwhile, according to a variety of wisdom traditions, distress is viewed as useful. According to many Christian philosophers, distress is something to make us think. It is a tool to get our attention and to accomplish a valued purpose in a way that would never occur without the trial. In Judaism, the Talmud teaches that the righteous suffer in this world in order to increase their reward in the Eternal World. Rabbi Eliezer, in the Talmud, welcomed his suffering, calling his emotional distresses ”my friends.”
Add to all of this the problems one encounters when one tries to decide objectively how much distress, beyond the “normal” amount that one experiences during life’s parade of disappointments, is required for a diagnosis, and the reader begins to get a sense of how problematic it is to decide from the descriptor distress if a disorder is or is not present. But, in less than an hour, often as little as fifteen minutes, a doctor can transform your distress experience into a mental illness diagnosis, prescribe drugs with many significant side effects, and consequently have a financially rewarding relationship with you for years.
Abnormality
Now, sometimes people come to believe that it is not merely distress that leads to a mental illness diagnosis; it has to be an abnormal amount of distress for that to occur. Abnormal means deviating from average. So, let’s think about this.
According to Buddhist philosophy, the first Noble Truth is that suffering is a normal part of life. The average soldier in Ukraine is currently experiencing significant distress. Are all of these soldiers mentally ill? At what point does it become abnormal. Is someone with a medical degree who has a financial interest in diagnosing as many people as he or she can get away with best suited to make this decision?
Perhaps you are thinking that under conditions of war it is normal to be distressed, and therefore these soldiers are not mentally ill. But people find themselves in various situations that they experience as significantly distressful. Deciding on what situations are legitimately worthy to experience significant distress is really a value judgment and psychiatric terminology is masquerading as a scientific decision.
Dysfunction
Having indicated some of the problems of unambiguously applying the descriptors of distress and abnormality to the concept of mental disorder, we now turn our attention to the descriptor, dysfunction.
There are reliable, valid assessments for determining a person’s level of functioning. If instead of a classification system that labels people as having mental disorders, we had one that classifies a person’s expressed concerns regarding their areas of functioning this would be clearer and easier to understand than the vague notion of mental illness (see HERE). Various domains of functioning are sleep, eating, exercise, interpersonal relationships, work/school, and household responsibilities.
Although functioning is mentioned as part of the diagnosis process used by psychiatrists, the mental disorder label fails to clearly indicate what specific function has fallen below average. The psychiatrists’ determination of a mental disorder seldom use any of the reliable and valid ways to assess a person’s level of functioning. Moreover, there is an assumption in the mental disorder classification system that a person having a below average level of functioning is bad.
William James
What do I I mean by this? Consider the case of William James, the eminent psychologist and philosopher. He described his experience of dropping out of medical school as a symptom of a mental disorder. I suppose if we believe that one function of the body is to learn and be educated, James’s medical school interruption might be viewed as a dysfunction. Yet, from another perspective, this interruption might be viewed as part of the normal search for understanding.
When an individual’s functioning diminishes in one domain, functioning in another domain oftentimes increases. By going to Europe, James, instead of continuing on with his studies, had more time during this period for contemplation and was exposed to fresh new experiences that he later used productively. This may seem a pathological waste of time to some, but to others it is greatly valued.
Aldous Huxley
Philosopher Aldous Huxley, for example, stated that “there is no form of contemplation, even the most quietistic, which is without its ethical values.” Those who practice it, Huxley goes on to say, “may bring back enlightening reports of another, a transcendent country of the mind.” And sometimes “they will become conduits through which some beneficent influence can flow out of that other country into a world of darkened selves, chronically dying for lack of it.”
Thus, from one perspective, it is possible to view James’s interruption of his medical education as one criterion for diagnosing a mental disorder, and from another perspective, to view it as a potentially beneficial response to some difficult problems that had chronically darkened his soul. Can a person, simply because he has a medical degree, be trusted to have the wisdom to make this determination? Does the fact that such medical professionals have a great financial interest in saying people who come to them have an abnormal, pathological amount of dysfunction be relevant when thinking about this?
Professor William James
A few years after James dropped out of medical school, he returned to his studies, graduated, and became a Harvard professor. During his tenure there, he came to view the mental disorder language of doctors as “superficial medical talk,” and he wrote,
The trouble is that such writers . . . use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with. . . . The only sort of being, in fact, who can remain as the typical normal man after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity . . . Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all? A certain tolerance, a certain sympathy, a certain respect, and above all a certain lack of fear, seem to be the best attitude we can carry in our dealing with these regions of human nature.
Regular readers of this blog know that from time to time I discussed some famous person’s experience with periods of severe distress. In each example, they found it clearly interfered with their functioning. Each one of them would likely have been “diagnosed” as having a mental illness if they went to a psychiatrist. The experiences of Abraham Lincoln (see HERE), Joni Mitchell (see HERE), U.S. Grant (see HERE), and Leo Tolstoy (see HERE) are some examples. All of them, despite their mighty struggles, still managed to earn the respect of millions.
As Joni Mitchell beautifully expresses this,
Depression can be the sand that makes the pearl…. Most of my best work came out of it. If you get rid of the demons and the disturbing things, then the angels fly off, too. There is the possibility, in the mire, of an epiphany.
Alternatives for Getting Professional Help During Distressful Periods
Today, the pharmaceutical companies have an impressive well funded program of convincing people that they have to go to a psychiatrist for treatment. Psychiatrists have a financial interest in supporting this promotional business model. That said, I don’t mean to suggest that all psychiatrists are purely in their profession for the money. I have moderated several debates on this subject and on the panel were several leading psychiatrists. I came away fairly convinced each of them genuinely convinced themselves their approach leads to more help than harm.
What alternative to the psychiatric pathologizing pill prescribing approach exists for people dealing with deeply challenging concerns? If someone can not find sufficient support from a family member or friend, counseling is often helpful. However, some counselors are just as pathologizing as psychiatrists, and encourage their clients confer with a psychiatrist in addition to receiving counseling services.
One example of a non-pathologizing, non stigmatizing way of providing counseling is the humanistic Power Threat Meaning Framework (PTMF). Dr Lucy Johnstone, one of its lead authors explains:
The Power Threat Meaning Framework can be used as a way of helping people to create more hopeful narratives or stories about their lives and the difficulties they have faced or are still facing, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’.
It highlights and clarifies the links between wider social factors such as poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress or troubled behaviour, whether it is confusion, fear, despair or troubled or troubling behaviour.
It also shows why those of us who do not have an obvious history of trauma or adversity can still struggle to find a sense of self-worth, meaning and identity.
Threat responses are not called “symptoms.” Instead, it looks at how we make sense of these experiences. It recognizes messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt.
At the top of each of my posts is a heading that says, “Counseling Services.” By clicking on it, you might find some help identifying humanistic, non-pathologizing counseling through Zoom. I get no kickback if you choose to work with them.
Okay, then, those are some thoughts to ponder for this week. Thanks for stopping by, and I hope you’ll soon join us again right back here at From Insults to Respect.
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 and social intelligence. To begin at the very first post you can click HERE.
Today, I came upon a NewYorkTimes article titled “Residents’ Rights to Be Rude Upheld by Massachusetts Supreme Court.” The ruling settled a conflict between the town of Southborough’s “civility code” for public comment at meetings and Ms Louise Barron who had said to a town board member, “Look, you need to stop being a Hitler. You’re a Hitler. I can say what I want.”
Ms Louise Barron
The Southborough’s civility code required “respectful and courteous” discourse “free of rude, personal or slanderous remarks.” Leading up to the high point of the conflict, Ms Barron had accused the town board members of “…spending like drunken sailors,” and breaking the law by limiting her speech. A board member expressed that she was starting to “slander” the town officials and indicated that if she continued with such words he would move to end the open comment section of the meeting. It was at this point that Ms Barron made the Hitler comments, and then the committee members agreed to end this part of the meeting.
It’s awfully expensive settling these issues in court. Therefore, it might be worthwhile for us to take a few minutes to look at the court’s reasoning, and then consider what preventative path we might wish to wisely choose to avoid getting embroiled in such conflicts.
The Court’s Reasoning
According to the New York Times:
John and Samuel Adams
Decorum, the new decision concluded, was not a top priority for the cousins John and Samuel Adams when they drafted Article 19 in the Massachusetts Constitution, ratified in 1780. By laying out the right to request “redress of the wrongs done them, and of the grievances they suffer,” the justices noted, they aimed to protect the colonists’ freedom to rail against King George III, disparaged at the time as “the Royal Brute,” in a profane and ungracious manner.
The Southborough Town House, where the town’s board of selectmen meets. Credit…Sophie Park for The New York Times
“There was nothing respectful or courteous about the public assemblies of the revolutionary period,” the court wrote in its opinion. “There was also much that was rude and personal, especially when it was directed at the representatives of the king and the king himself.”
“…..The court found that her reference to Hitler was “certainly rude and insulting,” but was protected speech nonetheless. The town’s insistence on civility “appears to cross the line into viewpoint discrimination: allowing lavish praise but disallowing harsh criticism of government officials,” the ruling said.
“Although civility can and should be encouraged in political discourse,” the justices wrote, “it cannot be required.”
As I read the court’s decision, I found myself frustrated that it relies so much on the reasoning of people who thought about this issue over two hundred years ago. At the same time, I do have a great deal of respect for the principle of freedom speech. I also realize that if enough people object to this court ruling, there is a democratic process that allows for changing the constitution. Making such a change would be a lengthy process. In the meantime, how might those who lead periods of public open comments prepare for the likelihood of being insulted?
Suggestions For Dealing With Insults
Given this ruling, a license for disrespectful language is now on the books. Public figures, therefore, are going to have to figure out ways to skillfully handle this. The Times article offered a suggestion on how to go about doing so.
To encourage civil behavior, “treat people civilly in the first place, and in a way that they perceive to be fair.” For example, imagine the difference if a board member, instead of getting defensive, said, “This person is not feeling heard,” and then said, “Tell us more.” This suggestion is a good start for thinking about how to wisely move forward in a positive manner, but in my opinion needs elaboration.
Although the justices wrote that “civility can and should be encouraged in political discourse,” the Times article is not as clear as I would like. How precisely this might be done without violating their ruling that this cannot be required? Here’s my suggestion.
Immediately prior to each meeting’s public comment period, the chairperson would make the following statement–“We now invite public comments. We would greatly appreciate it if all of your comments are phrased civilly and respectfully.” Although not all will comply, I think encouraging this is worth the effort.
The Times article seems to suggest a specific type of response from a board member to an insult–“The person is not feeling heard. Tell us more.” From my experience, just making this type of suggestion to board members, sound as it is, may work to some degree, but to really increase the likelihood of this occurring when board members are in the midst of a heated personal attack, I recommend three practice sessions lasting half an hour each. Each session would begin with someone reading Rudyard Kipling’s poem, “If.”
Rudyard Kipling
If you can keep your head when all about you
Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
If you can wait and not be tired by waiting,
Or being lied about, don’t deal in lies,
Or being hated, don’t give way to hating,
And yet don’t look too good, nor talk too wise,
….
Yours is the Earth and everything that’s in it,
And—which is more—you’ll be a Man, my son!
Then I would provide this little story about Abe Lincoln:
On one occasion, Secretary Stanton was particularly angry with one of the generals.
“I would like to tell him what I think of him!” he stormed.
“Why don’t you?” Mr. Lincoln agreed. “Write it all down – do.”
Mr. Stanton wrote his letter. When it was finished he took it to the President. The President listened to it all.
Secretary Stanton
“All right. Capital!’ Lincoln nodded. “And now, Stanton, what are you going to do with it?”
“Do with it? Why, send it, of course!”
“I wouldn’t,” said the President. “Throw it in the waste-paper basket.”
“But it took me two days to write —”
“Yes, yes, and it did you ever so much good. You feel better now. That is all that is necessary. Just throw it in the basket.”
After a little more expostulation, into the basket it went.
After these two readings at each of the three practice sessions a board member, while being video recorded, would pretend to insult another board member, and the person receiving the insult would try to respond civilly and fairly. Then the whole board would critique the response. By going through this process a few times at each of the three sessions, it would enormously increase the likelihood of each board member skillfully handling these challenging situations.
Today, while listening to some songs, Bob Dylan’s emotional pleas as he sang “Chimes of Freedom” cried out to my conscience. Its first stanza…
We ducked inside the doorway, thunder crashing As majestic bells of bolts Struck shadows in the sound Seeming to be the chimes of freedom flashing Flashing for the warriors whose strength is not to fight Flashing for the refugees on the unarmed road of flight An’ for each an’ every underdog soldier in the night An’ we gazed upon the chimes of freedom flashing
Bob’s song, it occurred to me, suggested that people vary in the following three ways. You have the type of person who appears to care only for him or her self, and when making connections with others, it is only for self benefits. Moving from that end of the spectrum to someone who we will call Jill, her family and close friends are dear to her, but beyond that, her feelings toward others can be summed up as an emphatic cry of, “Hey, I got my own problems to deal with!” At the other end of the spectrum, we find feelings expressed in words such as those inscribed on a plaque and placed on the pedestal of the Statue of Liberty–
Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me, I lift my lamp beside the golden door!
In thinking of all of this, it came to me that Dylan’s “Chimes of Freedom” is the musical version of the Statue of Liberty. As Dylan cries out in the song, we hear his pleas for…
empathy toward the luckless, the abandoned and forsaked, for the outcast, burning constantly at stake, for the kind, for the guardians and protectors of the mind, and the poet and the painter far behind his rightful time, for the disrobed faceless forms of no position, for the tongues with no place to bring their thoughts, for the deaf and blind, for the mute, for the mistreated, mateless mother, the mistitled prostitute, for the misdemeanor outlaw, chased and cheated by pursuit, for the ones condemned to drift or else be kept from drifting, for the searching ones, on their speechless, seeking trail, for the lonesome-hearted lovers with too personal a tale, for each unharmful, gentle soul misplaced inside a jail, for the aching whose wounds cannot be nursed, for the countless confused, accused, misused, strung-out ones an’ worse, and for every hung-up person in the whole wide universe.
Such outpouring of empathy for such a wide range of folks.
When Bob wrote this song, he lived in New York’s Greenwich Village. It is in just that part of the city where heading west down a few side streets you end up facing the grand New York Harbor, with its awe inspiring view of the Statue of Liberty standing guard against a diminishment of what many, but not all, Americans admire.
After jotting down the above ideas and then showing them to my wife and son, they encouraged me to see if I could deepen my thoughts on this theme. I thereby found myself envisioning a circle around each of the three general types of people who have various bands of empathy.
For those persons who have just self-empathy, I envisioned having a circle just around themselves. For those who have empathy for themselves, as well as close family members and friends, I envisioned having a wider circle that encompasses not only themselves, but also all of these other folks. And those whose empathy extends even beyond not only themselves, close family members and friends, but also all of those other folks we hear about in Dylan’s song, I found myself envisioning each of them wrapped around an even larger circle of people.
With this image in mind, I asked myself whether or not I find myself having an increasing amount of respect for people whose circle encompasses more people, compared to those whose circle encompasses fewer people. It turns out that if the type of person who has empathy just for him or herself has done some awful acts this would significantly lower my level of respect. But what about a person who despite having this very narrow encompassing empathy circle who has not harmed anyone? Now the question about my degree of respect becomes harder for me. Similarly, for those who just have empathy for themselves and close relatives and friends, but don’t hurt others, I find myself having some difficulty answering the level of respect question. Curiously, I do seem to have some additional respect for people who have empathy for all people who don’t go around harming anyone. How about each of you who are reading today’s post?
Now, let’s consider a related question. Regardless of how much respect you feel for each of these three general types of people, when you interact with them, do you think it wise to treat them all with equal respect?
As I personally thought about this, I imagined working in the prison. In such prisons, the convicts are typically informed that to the degree that they treat all the other convicts and prison staff members respectfully, and follow the various other prison rules, they will receive additional privileges, and for those who someday will be released, this will increase their chances of an early release. Convicts having the lowest level of privileges might be provided only a single type of very bland food, have the worse work assignments, and just one hour each day to socialize with other prison convicts. At the next level, convicts might be given a modest choice at meal times, a limited choice of work assignments, etc.
Under these conditions, is it wise for us to treat respectfully even those who have committed the most horrendous crime by avoiding mean, insulting name calling, expressions of disgust, asking, rather than demanding, and saying please and thank you at appropriate times? It seems to me that by doing so, you decrease the chances of resentments that can blow up into violence, while also increase the probability of making life in prison a more healthy, supportive place for all. Moreover, by creating a more consistent environment in which respectful behavior is practiced, those who are released after serving their time might end up having picked up the habit of treating people respectfully. In fact, it might even, as some psychological theories suggest, increase the likelihood that respect for others will become internalized for ex-cons thereby leading them to expanding their circle of empathy for others.
As a general rule, treating everyone respectfully, in a prison, or out, serves to model this type of behavior, and research suggests this can increase the chances that others will follow suit. And, finally, I think the golden rule applies well when thinking about these types of issues. If you want others to treat you respectfully, treat others respectfully.
So, there you have it, some thoughts that all spilled out of me after listening to Dylan’s “Chimes of Freedom.” I hope you find value in them, and until next time, may you find ways to be kind to yourself and to others.
Can psychologists come up with a kinder, more respectful, healthier approach for dealing with the types of concerns people seek mental health services?
My Experience: My original exposure to the pathologizing medical model occurred when I took a course in Abnormal Psychology as an undergraduate at Brooklyn College. Shortly afterwards, I found that my classmates began to use the new terms that they learned in the course as insults whenever someone did something they didn’t like. One person was called a narcissist, another–a manic depressive, another–psychotic, and on and on.
Then, as a PhD graduate student, I was required to take a course titled, “Descriptive Psychopathology.” There I learned that because of a vote, mental health professionals had first declared that being what they termed “homosexuality” was a mental disorder, but recently they voted to no longer view it as a disorder. Although I’m not gay and happily married to a wonderful woman, I was glad to hear this, for I had since met some gay folks and felt the psychopathologizing of them didn’t seem right. I also thought that classifying people as having a disease based on a vote, rather than on some objective evidence of an infection, tumor, organ blockage, or tissue tear also wasn’t quite right.
Then I began to read books by William James. He had advocated that mental health service providers should not take their terminology too seriously, referring to it as superficial medical talk. This viewpoint of James began as early as 1896. In his Lowell Lectures on Exceptional Mental States (which were reconstructed by Eugene Taylor in 1984 from James’s notes), the good professor stated that experiences that are commonly viewed as unhealthy or morbid are really “an essential part of every character” and give life “a truer sense of values.” He went on from there to note that,“medical writers represent the line of mental health as a very narrow crack, which one must tread with bated breath, between foul friends on the one side and gulfs of despair on the other…. There is no purely objective standard of sound health. Any peculiarity that is of use to a man is a point of soundness in him, and what makes a man sound for one function may make him unsound for another…. The trouble is that such writers use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with…. The only sort of being, in fact, who can remain as the typical normal man, after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity. Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all?
Upon graduating and serving in various roles as a psychologist, I learned about the various shortcomings of the pathologizing approach:
Regarding this last shortcoming, I became aware that the pharmaceutical industry has had a huge financial interest in promoting the idea that psychological concerns are real “illnesses” that require drug treatments just like physical illnesses. Cosgrove, and her team of researchers have made a compelling case that this can be seen by how the industry has been exerting a great deal of influence on psychiatric research and practice, resulting in publications and news reports that exaggerate claims of its drug treatments’ effectiveness while minimizing harms. For example, the “Clinical Practice Guidelines (CPG)” for mental health services provides the “standard of care” for health care providers. The confidence in the benefits of these drug treatments, if it were free of industry influence, would be more convincing but Cosgrove’s team found,“Ninety percent of the authors of 3 major guidelines in psychiatry had financial ties to companies that manufacture drugs which were explicitly or implicitly identified in the guidelines as recommended therapies for the respective mental illnesses. None of the financial associations of the authors were disclosed in the CPG”.
For people who have come to believe the medical model is too stigmatizing, and drugging problems away is not for them, what might a more acceptable alternative look like? One idea comes from a recent study by Schroder, et al. (2023).We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a “disease like any other” with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition) …. The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression.”
I argued that, in contrast to the pathologizing approach, this alternative would increase the self-efficacy of individuals struggling with these concerns. Additionally, it would be kinder, more respectful, improve outcomes, provide a new choice, stimulate fresh perspectives, and open new avenues of research.
Two types of data sources would be utilized to identify the list of concerns that would appear in this alternative manual. The first would come from a large sample of mental health service providers that ask them to list the various concerns that they have been asked to address in their practice in the past year without couching them in psychopathological language and to stick as closely as possible to the language used by those seeking their services. The second source would come from another survey that 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 psychopathological terminology.
Some have argued that there is no need to have any classification system. According to this argument, a “psychological formula” approach consisting of a few paragraphs describing the case without pathological labels is sufficient to replace the medical model. But note that the vast majority of current third-party payer systems do use the mental disorder codes. The codes are used in the following manner. Third party payer systems utilize forms that must be filled out whenever someone seeks mental health services under their plan. These forms typically have a little box that reads, “Diagnosis.” In that box, mental health professionals must fill in a short code that corresponds to some specific “mental disorder.”
Utilizing just the psychological formulation approach, which involves the creation of several paragraphs as an alternative to these codes, would be far too cumbersome. The concern approach, like the medical model approach, provides a short descriptive phrase coupled with a code and is therefore far more workable.
Mental health consumers would be given the choice to go to pathologizing mental health service providers or those using the concern approach. This is all the change that would be required to increase value for a significant number of mental health service users. The cost and effort for third party payers to make both the pathologizing and concern approaches available would be minimal.
In thinking deeply about these issues, my mind always drifts to the ideas of William James, the esteemed Harvard professor of psychology and philosophy, and author of The Varieties of Religious Experience.
By the next day, the dramatic high I initially felt began to ease into some other, more complex emotions. I felt moments of sadness when I realized how far I would be from my family and friends back in Brooklyn. Anxiety came upon thoughts of the possibility of spending so much on this undertaking despite the possibility that I might flunk out?
This same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and the drugs that psychiatrists prescribe. They all create the illusion that the pills improve their functioning initially through a placebo effect. Then, once their bodies adapt to the drug, each time they haven’t taken the drug for a few hours, they begin to experience a withdrawal effect that they attribute to their mental health concern returning. When they take their next pill, their relief from the withdrawal effect abating is experienced as pleasant, and with that, the illusion has been accomplished. For many people, it is only by gradually withdrawing from these addicted substances can one safely recover from this type of addiction (see 
Even if no immediate promising ideas come from a particular episode of spending time in this way, taking responsibility involves keeping hope alive. This means that you recognize that with particularly challenging situations, it takes an extended time to fully address such concerns. In the coming days, new, fresh ideas may yet come your way, or the situations that brought about the concerns may change in unexpected ways to your advantage. In contrast to acting responsibly, experiencing guilt when feeling anxious or grief becomes an aversive experience. The mental illness label pathologizes the concern, but there is a potential of improving one’s life with the experiences that get these illness conceptualizations.
n case this vague definition does not provide enough wiggle room for clinicians to label all people seeking their services as having a mental disorder and to prescribe a drug for it, the ICD tells the clinician, “When the requirements are only partially fulfilled, it is nevertheless useful to record a diagnosis for most purposes.” This type of double talk is one of the reasons why many people view the mental illness construct as super useful for a financially rewarding business model, but too vague and misleading for scientific purposes.
The experiences of Abraham Lincoln (see 
