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Mental Illness or Mental Health Concern?

Welcome to From Insults to Respect. 

The two dominant manuals for “diagnosing mental disorders” are the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases. (ICD). Their overarching concept is mental disorders. Synonyms are psychopathology, and mental illness. To access mental health services, most people are required to accept being labelled as having a mental illness. Not everyone respects this requirement.

These manuals continue this pathologizing despite the long history of such terminology being cogently criticized. In contrast to this pathologizing concept, there exists a peer reviewed published article that advocates an alternative method for accessing services, one that replaces the “mental illness” overarching concept with “mental health concerns” that includes the idea that these concerning experiences often serve adaptive functions. It is argued that this approach is a significant improvement over the pathologizing concept.

Criticism of the Mental Illness Concept

Professor William James

William James (1902/1961) was an early critic of the concept of psychopathology, referring to it as “simple minded” (p. 29) and “superficial medical talk” (p. 324). In his 1896 Lowell Lectures on Exceptional Mental States (which were reconstructed by Eugene Taylor in 1984 from James’s notes), he 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” (p. 15). James went on from there to note that medical writers tend to,

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? (pp. 163-165)

In more recent time, Schroder, et al. (2023), carried out a relevant study. It presents data from a 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.

Additional recent criticism of the mental illness concept has been presented by the World Health Organization (WHO) and the United Nations (UN). In its jointly published report titled “Mental health, human rights, and legislation: guidance and practice” (2023), it states:

The biomedical model of mental health is based on the concept of mental health conditions being caused by neurobiological factors (1, 2). As a result, care often focuses on diagnosis, medication, and symptom reduction, rather than considering the full range of social and environmental factors that can impact mental health. This can lead to a narrow approach to care and support that may not address the root causes of distress and trauma (p. xiii).

The same report also states:

Every person should have the opportunity to define what recovery means for them, and which areas of their life they wish to focus on as part of their own recovery journey. Recovery considers the person and their context as a whole, and no longer adheres to the idea or goal of the person “being cured” or “no longer having symptoms” (p. xiv).

Is it possible to respectfully address these issues?

Dr. Jeffrey Rubin

I  have proposed an alternative classification system (Rubin 2018; Rubin in press) titled “Classification and Statistical Manual of Mental Health Concerns” (CSM). This approach does not simply exchange the mental illness concept with mental health concerns; rather, the mental health concerns concept is different in several important ways.

The CSM assumes each person seeking to access services as a unique individual. Rather than labeling anyone, it labels expressed concerns. Whereas the mental illness concept declares there is something wrong with the person, the CSM emphasizes, mental health concerns often turn out to be indispensable stages in acquiring valued fruits.

A mental health concern, as defined in the CSM, 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 well documented reliability and validity problems of the mental illness concept.

Once it has been established what the concerns are, a collaborative effort between the mental health service provider and service seeker, begin creating answers to a semi-structured psychological formulation that looks at:

  1. How distressing is each of the concerns that were mentioned on a scale of 1 to 7?
  2. When and in what situations is the concern most problematic?
  3. When and in what situations is the concern least problematic?
  4. What are personal strengths?
  5. Levels of functioning in the areas of sleep, eating, employment, education, relationships, on a 1 to 7 scale?
  6. What is a tentative theory of cause or causes, jointly created, that considers the full range of social and environmental factors.

Arguments for the Practicality of the CSM

In Some Settings Using Expressed Concerns Has Worked Fine

When I was doing my PhD practicum at the University of Minnesota’s Counseling Center, I worked there for a whole year and we had no need to use the “mental disorder” jargon of the DSM and ICD to communicate. When my advisor asked me to quickly tell him about my morning cases, I would reply with words like, “My 9:00 a.m. case is concerned about feeling depressed, my 10:00 case is concerned about his failing grades, my 11:00 case is concerned about how anxious she is in social situations.”

If my advisor wanted to know more about a case, we went into the psychological formulation type of information. This informal way to communicate among the professionals and graduate students at the counseling center flowed smoothly while we provided a wide range of mental health services.

The CSM Is Practical Because It Maintains the Concept of “Mental Health”

Currently, we have such enormous organizations as Mental Health America and its state and regional affiliates, the National Institute of Mental Health, university and college programs offering degrees in mental health counseling, and states offering certifications in this field. Psychologists, social workers, counselors, and psychiatrists regularly refer to themselves as providing services under the umbrella of “mental health service providers.” For these reasons, the CSM would maintain the concept of “mental health” so it can be comfortably and realistically accommodated into the many large organizations currently using it.

However, the CSM would use the term “mental health” in a way that is different from what is implied in the DSM and the ICD. The CSM would explicitly reject the idea that the opposite of mental health is mental illness. Rather, the word “health” in the CSM’s “mental health” would be phrased in a manner that indicates 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 the CSM’s list of related topics 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 providers under the proposed CSM system is 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. It is in this very specific sense that the mental health concern topics are viewed not merely as mental concerns but also mental health concerns. By being explicit about this change in conceptualizing mental health, we have good reason to believe that the CSM proposal holds promise for avoiding most of the negative baggage that comes with this type of terminology.

So, in brief, the CSM approach promises to reduce stigma, improve care, increase self-efficacy, and open new avenues of research. In going forward, I encourage people to begin the process of reconceptualizing what has been promoted as mental illnesses to a mental health concerns. Moreover, for those who have any influence with those in the world of psychology and psychiatry, please encourage them to adopt the CSM approach.

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.

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Psychiatry, Science or Business Model?

Welcome to From Insults to Respect.

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 and panic, emotional flattening, involuntary muscle movements, sexual impairment, 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.

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Mental Illness As Distress, Abnormality, and Dysfunction

Welcome to From Insults To Respect. 

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.

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Alternative to mental health treatment conflict resolution dealing with anxiety dealing with criticism

A Psychological Maturity Approach for Addressing Psychological Concerns

Welcome to From Insults to Respect.

Regular readers of this blog know that I have become disenchanted with the mental disorder/mental illness/medical model for addressing psychological concerns (see, for example, HERE). Today I describe how this came about, along with my reasons for preferring a psychological maturity approach.

My Disenchantment With The Mental Disorder Model

Let’s begin with my early education as a psychologist. At first, I was quick to adopt the medical model for dealing with the types of concerns that lead people to seek psychological services. This was because I was incredibly impressed with the medical model for dealing with physical illnesses.

You see, when I was very young, I had seen films of polio victims stuck in iron lungs. My generation was the first to benefit from the vaccine Dr. Jonas Salk came up with to prevent these awful infections, and he was hailed as a “miracle worker.” Later, I hurt my leg in a football game and to my extreme distress, I couldn’t walk on it. The doctor I went to took an x-ray and saw I had broken my fibula. He put a cast on my leg, and three months later, I was starring on my high school baseball team with absolutely no pain. Grateful for preventing polio infections and healing my leg, coupled with the respect others in my community had for medical doctors, I had become primed to think that the same model would be helpful for psychological concerns.

Then, in the early part of my undergraduate psychology courses at Brooklyn College, the various psychological concerns were all described as various mental illnesses, psychopathologies, and mental disorders. At first, this seemed to make sense. But then, in more advanced courses, doubts began to emerge.

In the courses that taught principles of science, I began to see that the definition of “mental disorder” and the various types of “mental disorders” are seriously flawed. Studies were coming out indicating that doctors looking at the same data about a case did not reliably come up with the same diagnosis. When reliability is low, so too must be validity according to well established principles of statistics. Meanwhile, the chemical imbalance theory that had been viewed as support for the notion that these concerns were illnesses just like physical illnesses proved to be unsupported by the evidence. In courses on the history of psychology, I learned that utilizing the medical model for psychological concerns led to lobotomies, shock treatment, and drug treatments that, from my scientific literature review, convinced me that they resulted in far more harm than good.

To be clear, I recognized millions of people that received drug treatments for their mental health concerns reported they found them helpful, but I also found that millions of others came to the opposite conclusion. I began to wonder if there was an approach that would be less likely to have people end up feeling they were harmed.

Meanwhile, I learned that many psychologists and counselors who provide mental health services also recognize the flaws in the medical model approach. Although they don’t prescribe drugs as a treatment approach, to their dismay, in order to have a viable professional practice, they are required to utilize the same invalid medical jargon as drug prescribing doctors because insurance companies require for reimbursement a mental disorder “diagnoses.”

Given this educational background, I began a search for an alternative model for providing psychological services.

Discovering a Developmental Psychological Maturity Model

In one of my classes I began to learn about Abraham Maslow, who had recently been elected president of the American Psychological Association. Rather than treating people as a bag of mental disorder symptoms, he focussed on identifying people who exhibited the most mature aspects of life, and he looked to see how these developed. He referred to those at this highest developmental level as self-actualized.

Maslow’s approach focussed on this highest level of maturity, but at about this same time period, I began to come upon other researchers who described various aspects of psychological development as a process of going through four or five stages. In these models, higher stage functioning is viewed as “better” than lower in the long run.

After graduating with a masters degree and getting a job in which I was to address various psychological concerns, having this developmental model in mind proved enormously helpful. The two most common concerns that I addressed were depression and anxiety. From Maslow’s model, a major impediment to reaching the highest level of maturity is not having one’s basic needs met. So, in addition to providing a safe place for my clients to get emotional support, which is one basic need, I also focussed on coming up with my clients plans that can better achieve their other basic needs. For example, when seeing someone who was dealing with poverty, and therefore was insecure about food and shelter issues, we would work on a career development plan.

At the same time, many clients had difficulties fulfilling their love and belonging needs. When I explored this issue with them, it became clear that the way they handled criticism was a major hinderance. They would describe nasty, attacking interactions which left a bad state of affairs for both parties. These began with either someone criticizing them, or they criticizing others. Further discussions led me to understand that when they made mistakes they utilized the same nasty, attacking criticism style directed at themselves.

With the developmental stages model in mind, I developed a five stage model for handling these criticism situations; the higher the stage, the more mature the approach (see HERE, HERE and HERE). To find out how people perceived the five stages, I made a lot of TV shows with a variety of actors, each one depicting a scenario in which someone responded to criticism.

When I showed these videos to students in conflict resolution classes that I had been teaching, they rated the actors who displayed responses to criticism in a style consistent with the higher levels as more likable, respected, and mature.

When I described these stages to my counseling clients in a way that did not claim they represented an absolute truth, but was a starting point to think about these issues, I found that there was something about the stages that seemed to them plausible. And then, after a few practice sessions in which we would rehearse using the highest level, the feedback that I got from clients was very rewarding. Long standing flareups with family members and others often completely disappeared, and criticism situations changed from being nasty to playful fun, and a valued learning experience. Clients also reported that this increased the amount of respect they received from others, as well as their own self respect. This led me to feel I was on to something that might be better than the medical model approach for dealing with psychological concerns.

I then went on to study for my PhD at the University of Minnesota.

Dr. Sprinthall

There, one of my professors, Norman A. Sprinthall, published a paper in the American Psychologist that further validated my new way of thinking. It reviewed the research evidence demonstrating the value of reaching higher levels of maturity. Thus, Dr. Sprinthall wrote:

“By providing detailed information on the content and structure of the multiple domains of psychological development, contemporary theorists are filling in the gaps and advancing more accurate successive approximations to critical definitions of developmental stages and sequences.”

He then discussed several studies that found life skills and success after the completion of formal education are more closely related to psychological maturity than to scholastic aptitude or grade point achievement. For example, a Ford Foundation study followed for over 16 years a group of “at risk students” who had scholastic aptitude scores about 150 points below average for college students. Estimates of their psychological maturity by counselors and principals when these students were in high school were a more effective predictor of success than their academic record, not only for college itself, but also in the following years.

Finally, Dr. Sprinthall summarized six studies that provide support for the contention that certain education programs can be designed to successfully promote psychological maturity. In all of them, those in the experimental maturity promoting programs improved their level of psychological maturity; those who were not in these programs did not.

To be successful, Dr. Sprinthall argued, these programs must include a constant interplay between opportunities to learn some basic principles of psychological maturity, opportunities to apply the principles to one’s own actual, real world experiences, followed by readings to help illuminate the possible meanings of such experiences. More recent research suggests that certain narratives such as found in novels in which readers can identify with characters dealing with the types of situations requiring higher levels of maturity can also promote this type of development.

This body of research sometimes falls under the three headings of “emotional intelligence,” “social intelligence,” and “positive psychology.” When all three are taken together they cover much of the same ground as the more general concept of “psychological maturity.”

Given these findings, I found myself in recent years taking to heart something psychologist George A. Miller promoted in a classic 1969 paper. There he urged psychologists to give psychology away. What he meant by this was that elder psychologist professionals should create a new psychology that could be given away to the public. These professionals, he advocated, should select principles and practices that the public could use in their own behalf. He wanted a psychology not for the profession, not for the Library of Congress, and not for graduate student’s eyes only, but a psychology that everyone could use, a practical psychology that would help each person manage his or her own life with greater effectiveness and competence.

This blog, From Insults to Respect, aims to do exactly that. It is completely free, and I have been drawing on what I have found to be the most helpful principles and practices that, once learned, can be used by the average Joe or Jill in any way they might choose. Early posts, which can be retrieved by beginning HERE, introduce some basic ideas, and I then describe the following tentative description of psychological maturity:

Psychological maturity is “better” in the long run, it considers more variables, and represents more comprehensive cognitive problem solving. Individuals who tend to act at higher levels of psychological maturity can think more critically, logically, and scientifically while acting civilly to people with whom they disagree; they can graciously admit they are wrong when information comes in supporting such a conclusion; they welcome receiving criticism, respond without getting defensive, though they know it can be emotionally concerning for them; they are hesitant to provide uninvited criticism, only doing so when they can formulate it in a way that promises to be specific enough to be helpful, and they do so without insulting tones of voice or name calling; they can role-play and empathize with the emotions of a wide variety of human beings and can process moral dilemmas according to standards of democratic justice and the golden rule; they understand that melancholy and anxiety, rather than symptoms of mental disorders, are part of the natural process of addressing concerns about losses and fears; and they have the ability to puzzle through the tough problems of living, to take a stand, and yet to remain open to possible revisions and new information—thus demonstrating a capacity to make successive approximations toward more efficient, effective, economical, and beautiful accomplishments.

Such a description of maturity, in a general sort of way, can be a valuable aid to challenge each of us to begin to consider what psychological maturity means. It is not claimed that it is absolutely true for everyone and every conceivable situation. The paragraph is my personal best effort to summarize what respected theorists have written, and there is some preliminary evidence that it describes a type of functioning that is predictive of life success, and interventions can help to promote higher levels of functioning.

When, in my posts, I offer suggestions for dealing with specific types of situations, I aim to stay consistent with the summary, while providing additional details for handling such situations. In many of them, I describe a little assignment that provides an opportunity for readers to apply what they have just read to some event in their own personal life. Moreover, to get a deeper sense of handling specific situations, readers are encouraged to access my three novels (see HERE).

So, in conclusion, I invite readers to give this free approach a try.

Assignment: If you will, reread the paragraph in italics that describes, in summary form, psychological maturity, and then write a paragraph or two about how the various phrases in the description relate to your own way of dealing with life.

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.