Welcome to From Insults to Respect. Today, let’s see if we can tie together some of the loose threads of my last post, which chronicled Joni Mitchell’s experience of depression. There we found that she explicitly rejected the idea that her experience indicated that she was mentally ill. Instead, she came to believe that, “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.”

We also discussed that in contrast to Joni’s position is the medical model, which views people who experience depression as having an illness that requires, as the first line of treatment, taking pills that are called “antidepressants.” Many who hold this view have absolutely no respect for people who hold the view expressed by Joni.

Upon publishing my post about Joni, one person that has impressed me over a period of time as being highly intelligent expressed a concern that attitudes like Joni’s will lead people to view depression as perfectly normal. The consequences of so doing, he feared, will lead to all of the efforts to increase access to mental health services getting flushed down the toilet. If depression is normal, why wouldn’t the majority of people decide to ignore this group of sufferers and their needs?

Well, in my opinion, this is a legitimate concern, and before this post draws to a conclusion I intend to address it. But first, let’s take a look at another example of someone who, like Joni Mitchell, came to believe that the experience of depression can be of enormous value.

Leo Tolstoy’s Experience

In his painfully personal book, My Confession, the great Russian writer Leo Tolstoy tells us about his two-year period of despair. At about the age of 50, his life had become “flat, more than flat: dead.”

“I felt that something had broken within me on which my life had always rested, that I had nothing left to hold on to, and that morally my life had stopped. An invincible force impelled me to get rid of my existence, in one way or another…. Behold me then … hiding the rope in order not to hang myself from the rafters of the room where every night I went to sleep alone; behold me no longer going shooting, lest I should yield to the too easy temptation of putting an end to myself with my gun.”

All of this took place at a time when Tolstoy’s outer circumstances seemed excellent.

“I had a good wife who loved me and whom I loved; good children and a large property which was increasing with no pains taken on my part. I was more respected by my kinsfolk and acquaintances than I had ever been; I was loaded with praise by strangers; and without exaggeration I could believe my name already famous.”

Tolstoy goes on to explain how his melancholy stimulated a gnawing questioning that eventually led to one insight after another. His trouble had not been with life in general, not with the common life of common men, but with the life of the upper, intellectual, artistic classes, the life that he had personally always led, the cerebral life, the life of conventionality, artificiality, and personal ambition. He had lived wrongly and had to change.

Then, one day in early spring, while he was alone in the forest listening to its mysterious noises, he was filled with a sense of deeper meaning. “After that,” he wrote, “things cleared up within me and about me better than ever, and the light has never wholly died away.” According to Tolstoy, his suicidal feelings disappeared, and he went on to live a productive life until he passed away at the age of 82 of natural causes.

Some Thoughts on Tolstoy’s Experience

The great psychologist and philosopher William James was someone who viewed the pathologizing of human experience as simple minded and nothing more than superficial medical talk. Rather than resorting to mentally ill jargon, the good professor explained in his monumental book, Varieties of Religious Experience, his view of Tolstoy’s experience:

It was logically called for by the clash between his inner character and
his outer activities and aims. Although a literary artist, Tolstoy was
one of those primitive oaks of men to whom the superfluities and insincerities, the cupidities, complications, and cruelties of our polite civilization are profoundly unsatisfying, and for whom the eternal veracities lie with more natural and animal things. His crisis was the getting of his soul in order, the discovery of its genuine habitat and vocation, the escape from falsehoods into what for him were ways of truth. It was a case of heterogeneous personality tardily and slowly finding its unity and level.

Tolstoy’s anguishing experience appeared at first to come on him as if out of the blue. Later, Tolstoy came to understand it as having been due to living wrongly. Only by questioning deeply and repeatedly the meaning of his despair did he come to this understanding.

Now, with all of this as background information, let’s return to the concern that came up at the beginning of this post–if we don’t accept the medical model, might it provide a perfect justification for not funding mental health services?

In my view, the medical model actually gets in the way of adequately funding services.

Viewing someone in the midst of an anguishing experience as someone with an illness that is no different than any other illness leads many prescribing doctors to most often send the client home with some pills. That is viewed as sufficient. The patient is left with a host of negative side effects, and maybe in time, the patient will begin to feel better and attribute the improvement to the pills. If not, they go back to the doctor who will try adjusting the dose, trying a different pill, or adding other pills.

It is my view that even when people learn to value, even treasure, depression experiences, they don’t say that’s all there is to life. These experiences lead them to more deeply delve into their personal concerns thereby potentially leading them to seek more effective, efficient, economical, and beautiful ways to address their concerns.

Although Tolstoy did manage to successfully work out his most pressing concerns without professional help, keep in mind that he was an extraordinarily gifted person with a great deal of supportive people around him, and he was financially comfortable. Even with all of that, a well trained mental health service provider who avoided pathologizing his experience may have been of enormous help.

In my previous post, we saw that Joni Mitchell was not only experiencing the physical sensations of depression. Fully part of her experiences was to delve deeply into several concerns– “How am I going to get back in the saddle? And what about the audience? Would you still love me if you knew what I was really like?” She sought help from a psychotherapist.

As someone who provided mental health services for many years, let me present an example of what I am trying to get at.

Phil, not his real name, came to my office troubled about how depressed he had been feeling. After some time listening in a caring way to his concerns, I discussed this notion that depression can be viewed as a valued experience. He was pleased to learn this. At the same time, he didn’t in the slightest bit come to the conclusion that with this interpretation of the nature of depression there was no more need to continue to see me. However, I do think that framing depression as often a very valuable experience that many of our most gifted people put to good use was far more hopeful than framing it as due to defective genes.

Over the course of a year I found that the concerns Phil was most troubled about was his drinking, and that he had trouble developing close relationships. Both of these concerns are genuine health risk factors. My job was to help Phil to transform these risk factors to “health protective factors.” By doing so, this could prevent far more serious health issues down the line.

So we explored what was interfering with his developing close friends. It soon became apparent that he was very critical of people he met, and his style of criticizing was very nasty. For example, he would call people he disagreed with stupid in a very nasty way. And it also became apparent that he would criticize himself in the same disturbing manner.

I explored with Phil options that have been helpful to others. He selected learning to meditate, and to get more exercise in order to work off his anger in a positive, healthy manner. He learned the value of saying more supportive things to people he met, and to himself as well. He came to realize the value of minimizing the negative criticism that he provided, and when he did criticize, to do so in a far more charming manner. In the end, he made a new group of friends, joined AA, and was in a far more healthy state when my services came to an end.

So, as this example illustrates, rather than a mental illness model, in which pills are often viewed as sufficient, we can utilize a mental health concern model to advocate additional support for mental health services. With a mental health concern model, counselors and psychotherapists can be viewed as valued members of the allied health profession because they help to transform health risk factors into health protective factors.

The need for these types of mental health services, therefore, need not be reduced by framing depression as a valued experience. Rather, it allows us to move on from this understanding to advocate that our services fully address real mental health concerns.

——————————-

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.

“Good morning, Barbara,” I say, as my first counseling case walks into my office. I notice she looks a little angry. Upon sitting down, she declares, “I’m terribly frustrated. I’ve been depressed now for over two weeks, and I just can’t shake it!”

It’s easy for me to empathize because I regularly have bouts of what I refer to as melancholy. A deep anguish comes over me, and during this period I often begin to think about how I went through my father’s death when I was twelve, how I’m getting older and can no longer do the many athletic things that thrilled me when I was younger, and on and on. Sometimes these dark melancholy experiences come about because something clearly happened that upset me, and sometimes they seem to come out of the blue.

Beyond Listening in a Caring Manner

After listening in a caring way to Barbara for a few minutes, I ask her if something specifically happened that led her into her current emotional experience. Then I explore with her a question about how often she has these experiences and if she feels she has them more frequently than most people, about as often as most, or less than most. Then, I ask her about how she has been functioning in other areas of her life–sleep, eating, exercise, interpersonal relationships, work/school, household responsibilities.

You see, as people experience depression, or other concerns that often lead to a classification of having a mental disorder, some people go about their lives functioning as they typically were doing before the concern arose, while some find that in some areas they begin to function below the levels that are typical for them, while some find that their functioning increases in one or more areas. For example, some sleep about the same amount, some less, and some more. I have met people who, when they are depressed, start cleaning every inch of their home, while others find it difficult to get out of bed.

Also of interest when exploring a person’s expressed concern is to look at how the person had been functioning before the onset of the presenting concern. If some important relationships had begun to function below average, or if the person had been sleeping less than average to keep up with work demands, these facts can be insightful when seeking ways to address the presenting concern.

Now, once I found out what Barbara was concerned about, what might have precipitated the concern, and how she had been functioning in various areas of her life, I had a pretty good idea as to how to proceed in addressing her concern. I had no need to decide whether or not she had a mental disorder. However, many mental health practitioners are required to declare that the person seeking mental health services has a mental disorder if they want to get paid. Is this mental illness labeling really necessary?

Mental Illness Labeling Versus an Addressing Concern Approach

There are those who embrace this mental illness/disorder labeling. One reason is the pharmaceutical industry’s promotion of this idea to sell people on the idea that they need certain drugs to live a more normal, healthier life.

Beyond that, another major reason for this is that these individuals have a group of people in their lives that blame them for the way that they have been feeling or acting. When a doctor has declared, for example, that John Smith has a mental disorder, he may feel vindicated. “You see, there really is something wrong with me!” he may cry out in his defense.

In actuality, those who are doing the blaming may continue their blaming despite the doctor’s opinion. Moreover, many of us don’t blame people whenever they find some concern has arisen in their lives even if they are going through a non-illness experience. I know I’m not blaming myself when I experience melancholy, and I was not at all blaming Barbara for what she was going through.

Those who are uncomfortable about the use of “mental illness” terminology point out they are stigmatizing because they are used as put downs in our society. Moreover, the media associates the most heinous crimes with those referred to as the mentally ill even though the vast majority of those classified in this manner are not violent.

Among the most articulate individuals to voice objections to the mental disorder labeling was Harvard psychologist and philosopher William James. Over one hundred years ago he wrote a book titled, The Varieties of Religious Experience (1902). At that time many medical doctors argued that people who were religious were all mentally ill. In response, Professor James wrote:

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.

Girl (6-8) praying, profile, close-up

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. (p. 29)

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” (p. 30). 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. (p. 30)

James points out that in the natural sciences and the arts it never occurs to anyone to refute opinions, beliefs and experiences by putting down their author’s neurological constitution. 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” (p. 33).

James was additionally concerned that medical materialism greatly overgeneralizes its knowledge of the connections between physiological variables and mind states. In James’s day, the pathology writers would take the few psychophysical correlations that they obtained under highly specialized conditions and then vaguely generalize their findings to discredit, to their satisfaction, all of the states of mind that they disliked.

The Modern Day View

Now, modern day psychiatrists sometimes respond,

“Well, certainly in James’s day we indeed knew almost nothing about such matters, but today our knowledge has vastly increased! Thus, James’s position is no longer valid because we can now make sound statements about the connections between physiological states and mind states.”

To this, I respond that in point of fact there is currently a renewed respect for the extraordinary complexity
that exists during the integration process between mind, physiology, behavior, and environmental variables. Whereas it is true that there have been large gains in our knowledge, these gains are best likened to moving from a few drops of knowledge to a glass almost full; yet, to really understand the integration process, we would need oceans and oceans of knowledge. Trillions and trillions of interactions are involved.

It is for these reasons that the mental illness/disorder terminology is misleading. As Dr. Thomas Insel, the former director of the National Institute of Mental Health, recently said about the psychiatric labeling process known as the DSM.

The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century as we have understood that symptoms alone rarely indicate the best choice of treatment.

To hear and view other leading scientists further make this point, I highly recommend the following free video:

“This Video Dispels Every “Nature VS Nurture” Myth You’ve Ever Heard. The Implications are Profound.”

Conclusion

When individuals express a concern, exploring how they are functioning in the main areas of their life can be enormously helpful. Someone who reports a concern about experiencing depression, whom, by some gentle questioning, we find out has been functioning below average in the areas of sleep, interpersonal relationships, and exercise may benefit enormously if we work together on getting these areas of functioning in a more optimal range. This is true for those who report other types of concerns such as experiencing anxiety, hearing voices, below average range of attention, obsessive thoughts, and on and on. With a model that includes addressing concerns and exploring ways to improve functioning, labeling someone as having a mental disorder becomes unnecessary and may actually interfere with the aims of a counseling/psychotheraputic relationship.

For those who desire, for whatever reason, to be labeled as having a mental disorder, I am not proposing that we interfere with this. But for those who desire to have their concerns addressed by well trained mental health professionals without being referred to as having a mental illness or disorder, I do propose that we do provide a reasonable option for them to access mental health services. In my view, mental health professionals, once we hear our clients’ concerns and how they are functioning in the various areas of their lives, we have the basics to formulate, in full cooperation with our clients, a plan for addressing these concerns. I hope you give this some thought.

For those of you who would like to learn more about how an addressing concern approach would work and be consistent with science if adopted by mental health providers, you can access my peer reviewed article for free by clicking HERE.

Until next week, may you find some kindness out there in this fascinating world of ours.

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.