Does It Matter if We Believe in Mental Illness?

Tim Desmond, LMFT
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It’s clear that different people relate to the idea of “mental illness” and labeling differently. Many people find the experience of being diagnosed with a mental illness stigmatizing and disempowering. However, there are others who find the idea of “having an illness” liberating. They say that it helps them to stop feeling overly identified with their symptoms. Believing that “I have an illness” helps them to stop thinking, “There is something wrong with me, deep down.”

As a therapist, I’ve worked with hundreds of people who have been diagnosed by someone else before coming to see me. The overwhelming majority of them had a negative reaction to being diagnosed and strongly prefer my non-labeling approach to therapy. However, I’ve worked with a few people who strongly identified with their diagnoses. From the first session they have been clear with me that they want me to understand their disorder is “real.”

When someone strongly identifies with their diagnosis, I never argue with them. Instead, I proceed to try to get to know them just like I would any other person seeking therapy. I want to know what’s important to them and what changes they’re hoping to make. In order to learn these things, we talk in terms of their unique experience and their suffering. I do my best to relate to and empathize with their symptoms as completely coherent responses to their suffering. After working in this way for some time, almost everyone I’ve worked with has become much less attached to their diagnoses.

While I believe the idea of “mental illness” comes from a deeply flawed logic (more on that in a later post), I’m not sure that it is always harmful. There might be cases in which it is not. However, I challenge all of us to reflect on how thinking in those terms changes how well we can connect with another person’s suffering.

An illness is something that some people have and others do not. It is, by definition, a qualitative break from the norm. It also carries with it the idea of something not functioning as it should. In my experience (and my reading of the research), what seems to help people most is another person’s willingness and ability to empathize with their experience of suffering. The kind of empathy I have experienced as the most healing is when one person is able to relate so deeply that they really see themselves in the experience of the other and see the beautiful humanity in their response to suffering.

While some people might be able to empathize deeply while viewing the other person as “having a mental illness,” it seems to me that such a way of thinking can only get in the way of connection.

The question then arises, “If I stop believing in mental illness, how will I communicate with my colleagues?” In my experience, a sentence or two describing the person’s symptoms and when they show up conveys much better information than a diagnostic category that could mean any number of symptom clusters. Ideally, we can communicate in terms of what the person’s hopes and goals are, so we also know what’s most important to them.

Through reflecting on the idea of “mental illness,” we might find a way of thinking that helps us to better connect with people who are suffering.

Tim Desmond, LMFT offers therapy and consultation through www.phonecounseling.net

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

23 COMMENTS

  1. I have lead courses in Mindfulness Based Relapse Prevention, working with people who come identifying themselves as addicts to everything from crystal meth to alcohol to pot. The chief joy to me about this kind of work is that, by the fourth or fifth session, the discussion about addiction (or at least the addiction in the ego-syntonic sense) falls away, and the conversations become pretty much like the kind that would take place in any mindfulness or meditation group anywhere in the world; discussions about how we manage the ongoing, evolving, emerging experience of being human and interacting with ourselves, the world and each other in a manageable, sustainable, fulfilling way.

    I’ve always looked forward to pointing out the shift in the conversation, which takes place without any comment on the perils and pitfalls of “diagnosis” or “identity.” Simply working at bringing attention to what is merely happening, with interest if not curiosity, and without judgment, is the process and the goal. It ain’t easy, but it’s the way to detangle fear from the experience, which is usually what makes the difference.

    • Kermit, Tim, thank you both for raising important points about diagnoses and the limitations of making something concrete that is in all actuality quite fluid. I think what is most true is that we all experience suffering, Whatever we call this suffering is not as relevant as our experience and perhaps we are better off qualifying any description of distress with “in this moment.”

  2. I just came across this reference, which is relevant here:

    Treatment-Specific Changes in Decentering Following Mindfulness-Based Cognitive Therapy Versus Antidepressant Medication or Placebo for Prevention of Depressive Relapse. J Consult Clin Psychol. 2012 Mar 12. [Epub ahead of print]

    Objective: To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT’s effectiveness. Method: This study, embedded within a randomized efficacy trial of MBCT, was the first to examine changes in mindfulness and decentering during 6-8 months of antidepressant treatment and then during an 18-month maintenance phase in which patients discontinued medication and received MBCT, continued on antidepressants, or were switched to a placebo. In total, 84 patients (mean age = 44 years, 58% female) were randomized to 1 of these 3 prevention conditions. In addition to symptom variables, changes in mindfulness, rumination, and decentering were assessed during the phases of the study. Results: Pharmacological treatment of acute depression was associated with reductions in scores for rumination and increased wider experiences. During the maintenance phase, only patients receiving MBCT showed significant increases in the ability to monitor and observe thoughts and feelings as measured by the Wider Experiences (p < .01) and Decentering (p < .01) subscales of the Experiences Questionnaire and by the Toronto Mindfulness Scale. In addition, changes in Wider Experiences (p < .05) and Curiosity (p < .01) predicted lower Hamilton Rating Scale for Depression scores at 6-month follow-up. Conclusions: An increased capacity for decentering and curiosity may be fostered during MBCT and may underlie its effectiveness. With practice, patients can learn to counter habitual avoidance tendencies and to regulate dysphoric affect in ways that support recovery.

  3. Just came across this as well, in Applied Psychophysiological Biofeedback. 2012 Mar 30.:

    “Psychology Moment by Moment: A Guide to Enhancing your Clinical Practice with Mindfulness and Meditation” was written by Labbe (Psychology moment by moment: A guide to enhancing your clinical practice with mindfulness and meditation. New Harbinger, CA, 2011) to review the literature supporting many mindfulness-based interventions and to highlight evidence-based practices. It is written for the mental health clinician who is interested in integrating mindfulness-based interventions into their practice. Chapters range from an initial description of the construct of mindfulness to later chapters that introduce treatment protocols for special populations (children, aging adults, couples) and specific illnesses (chronic illness, stress, anxiety, depression, eating disorders).

  4. Thanks for this balanced blog. I read it as a reminder that what ultimately matters about mental health is helping patients get better. Giving a diagnosis is useful if it helps the patient gets better, it is counter-productive if it causes the patient to get worse. When discussing theories, nosology about mental illness, the background question that should always be present is: are the patients getting better with that model. Any theory that says a mental illness is lifelong and chronic should be understand as: “our current model of mental illness is so limited and erroneous that we don’t help those patients”, such a prognosis is a diagnosis of the mental health model, not of the patient. But it is important to distinguish a time-limited diagnostic about the present state of the patient, and a prognosis about the evolution. Right now, I would not trust any provider doing prognosis (the evidence is flaky), although a diagnostic understood as a snapshot of currently observed behavior can be useful to help people think of what it would mean to get better.

  5. I am not a professional: all my insight into “mental illness” comes from personal experience and from reading mental health blogs on the Internet. I have the impression that there are two sorts of people: those who want to understand what happened to them during their psychotic break and what caused it. Those are the ones who refuse to see themselves as “mentally ill” and don’t want a diagnosis. Those who accept their diagnosis, or ask for one, usually don’t want to delve to deeply into themselves and they certainly don’t want to blame anyone for their predicament-others or themselves. It is oh so much easier to accept the diagnosis, sweep everything under the carpet, take the medication and hope for the best. That way nobody is to blame,neither the person herself nor other people. There is somewhere guilt involved into this: guilt and maybe shame

    • yes there is a differece: medical illness has a physical site, i.e., cancer , diabetes, pneumonia, (even) the common cold , etc. where does mental illness reside? Even if one can see “chemical imbalacec in the brain, taking a”trauma-based” view, the question, then, arises which came first the trauma or the”imbalance” My answer would be the trauma; therefore, work through the trauma not try and change the one’s “brain chemistry”.

      • Yes, I agree, however (and for the sake of conversation); if the trauma has adulterated the nervous system, are people not entitled to whatever might restore it back to a manageable range of function? If so, is there a medication that might be included in that? Is that what, perhaps, some medications that seem to “work” DO, if only for a short time, but their effects are mistaken for correcting a “disease”?

        • All of the so called “medications” to treat so called “mental illness” have been proven useless, but deadly to the point none can be justified. Sadly, western medicine is based on a bogus division of mind and body unlike eastern medicine, which has led to the corrupt, broken mainstream medical industrial complex that has made so called patients mere profit centers for toxic treatments to maintain lifetime toxic habits and unwellness.

          To use words like “mental illness” is a vile use of a bogus pretense that it has any relation to physcial illness that Dr. Thomas Szasz and many others have been exposed. With all due respect, I find the title of this article offensive and assume the author has never been literally destroyed by a bogus stigma of bipolar, ADHD, schizophrenia and others all proven to be based on fraud and junk science to push the latest lethal poison drugs on patent.

          Hans Seyle in his books on stress talked about ideal and toxic levels of stress in that a certain amount of stress is necessary to motivate us to achieve at our best level while excess stress is toxic and deadly, causing one’s total organism to break down. Such stress involves every part of the body including one’s brain and mind.

          So, it seems that what one falsely calls psychiatric symptoms due to the hijacking of every human behavior into the bogus DSM for profit and power, should be seen as various levels of stress caused by one’s environment, possible real medical illnesses (See Safe Harbor)and other factors which can run the gamut from too little stress, ideal peak levels of stress for maximum performance to lethal levels of stress leading to trauma and/or stress breakdown.

          I believe the term “mental illness” is very evil and lethal to dehumanize, discredit, ostracize, justify the current lethal treatments with robbery of all civil and human rights, disempower and destroy anyone so labelled with impunity since they are deemed subhuman by society and psychiatry.

          Also, some may get relief from a bogus psych stigma initially before they learn the truth of the fraud behind it and the destruction it causes to one’s life for being so stigmatized. This is because most if not all in the so called mental health system have been abused and traumatized in some way per Dr. Judith Herman, trauma expert. Thus, getting such a label may temporarily give the victim an illusion/delusion of a false sense of control when in reality it robs them of what little control they may have had and validates the abusers while invalidating the victim, the ultimate crime.

          I believe the term, mental illness, should be abolished since it is only a bogus, fraudulent way of calling people crazy to get away with it this crime against humanity with impunity.

    • The term “mental illness” in itself already is a paradox. Are we talking illness, as in medical illness, disease, or are we talking mental, as in mind, thoughts, emotions? — And while thoughts and emotions without doubt have a certain influence on the body, the brain included, on a physiological level, they themselves, since they are immaterial, cannot be diseased. — Some time ago. I read an article about some research that alternately used virtually all imaginable terms to refer to the phenomenon: mental illness, emotional distress, brain diseases, neurological disorders, etc. After finishing the not even especially long article I sat in complete confusion wondering what actually the authors were talking about. Well, of course, in their understanding the mind equals the brain, or rather the biochemical processes going on in the brain equal our thoughts and emotions. So they just tossed medical, scientific as well as philosophical concepts into the mixture, gave it a good shake, and sprinkled it over the article. A reductionist view of life like the authors’ of course is very comforting and reassuring for everybody who fears nothing more than… I was about to say “God”, but what I mean is not God in a religious understanding, but in an existential one, and I might as well say “life”. Anyway, there is something important missing in such a reductionist view: experience. And thus, since experience does indeed exist, the view doesn’t make much sense. Just like the term “mental illness” doesn’t make much sense, unless “illness” is understood metaphorically, as the term “sickness” in Kierkegaard’s “The Sickness Unto Death”.

      Body and mind are inextricably linked, with the body being a metaphor for the mind. But they are not one and the same. Disease only exists on the physiological level. And the mind is not a physiological entity.

  6. Although I personally find mental health diagnoses wrong and damaging some people really want them as explanations to what they are going through during psychosis for exemple. You only have to read some of the schizophrenia blogs to realise this.I suppose they are intitled to their opinion. Some take their meds quite willingly and say they couldn’t do without them. What is wrong though is to impose these diagnoses on people who see things differently, to forcibly drug them and label them against their will. My son was literally brain- washed into believing that he is mentally ill at a time when he was so drugged up by meds that he could not think clearly for himself nor stand up for himself and that is criminal

  7. The title is confusing voluntary and involuntary “mental illness”.
    Diagnosis can not be resisted. Learned helplessness occurs to the patient-victims. There is no escape from psychiatry, and psychiatric “help”.

    “Does It Matter if We Believe in Mental Illness?”
    Who is the “WE”?
    WE are on the same team?
    WE are both taking the same poisons?
    WE are both locked up? with hospital medicinal cement, not that jail kind of cement.

    Mental Illness matters to those who have the power to enforce the diagnosis. I was made my diagnosis by the passage of time and the poisons and experiences that physically changed my brain.

    If science finds brain abnormalities in the mentally ill, it is from their experiences, but idiots like to say the brain abnormality is the cause of the mental illness. Like a weight lifter has muscles from lifting weights.

    No one is born “mentally ill”, we are manufactured.

  8. Words form us. Words shape our mind and that shapes our behavior and that shapes our life and that shapes our communities and that shapes our states and that shapes our nations and that shapes our world.

    And it is written that god created the WORlD, by power of the WORD. god is the most powerful word in all the universe.

    And the truth is hidden in plain sight and the truth is WORDS – our language.

    There is only ONE mind and we are all THOUGHTS, embodied. We are THOUGHTS, in the flesh.

    A mind can be malformed, deformed (barely recognizable as a man) and severely degraded. Foul language and less than accurate TERMS for CONDITIONS is a fundaMENTAL cause of all the effects that we each experience and live with.

    Use the exact, correct, RIGHT WORDS (terms)… PROBLEMS SOLVED.

    Understanding is greater than knowledge. Peace of mind is understanding. Without understanding, one will never know PEACE.

    Please UNDERSTAND.

    YES YES YES ……….. words MATTER. Quite literally.

  9. Just to add to the conversation, I escaped an abusive home only to be thrown into a psychiatric hospital. I started out with an “emotional illness” which over time morphed into a ‘mental illness” and then in the past few years changed into a ‘behavioral illness.” And all I had was a human reaction to torture and rape by my caretakers. For the purposes of charging insurance there should only be the category “trauma injury.” I have an injury, not a disease.

    • Jeanne, great perceptive post!! I am so sorry about all that you Tim Fields in his great web site, BULLYONLINE, was the frist one I ran across who said that the PTSD one gets from abuse such as bullying or mobbing in the home, at work, at school and the world in general should be referred to as injuries whether emotional and/or physical PTSD or stress breakdown (the term used by another abuse/bully expert).

      Thanks for reminding me! Let’s try to use terms like abuse, life crisis or trauma related INJURIES rather than the toxic label, “mental illness” that I believe only a psychopath could invent, These intraspecies human predators all but ignored by psychiatry are well known for the inevitable harm they do and mind, body, soul (not to mention career and financial)INJURIES and losses they cause normal people who have the misfortune to cross their deadly path leaving much pain, suffering and trauma in their wake per Dr. Robert Hare, the world’s foremost authority on psychopaths, another name for evil people. Most psychopaths are not serial killers, but rather, are found as heads of many corporations that could be labelled psychopathic themselves per the book and DVD, THE CORPORATION. Dr. Hare and Dr. Paul Babiak wrote a book called SNAKES IN SUITS to describe their deadly tactics as did John Clarke with his book, WORKING WITH MONSTERS. Let’s not forget THE SOCIOPATH NEXT DOOR by Martha Stout (or the one in your own house as it seems in your case) or workplace or so called mental health place, another name for psychopath based on ones’s theory of causes. Dr. Tim Fields describes these conscienceless, remorseless human predators on his bullying web site as well.

      Anyone targeted by a psychopath or malignant narcissist is almost sure to have PTSD, many injuries and much loss caused by this lethal predatory encounter.

      You are a very wise, brave woman and I hope you are on the road to recovery based on your brilliant insights. I highly recommend Dr. Judith Herman’s TRAUMA and recovery and Dr. Matsakis’ I CAN’T GET OVER IT to help you on your path

      Thank you for your great post.

    • Jeanne, great perceptive post!! I am so sorry about all that you Tim Fields in his great web site, BULLYONLINE, was the frist one I ran across who said that the PTSD one gets from abuse such as bullying or mobbing in the home, at work, at school and the world in general should be referred to as injuries whether emotional and/or physical PTSD or stress breakdown (the term used by another abuse/bully expert).

      Thanks for reminding me! Let’s try to use terms like abuse, life crisis or trauma related INJURIES rather than the toxic label, “mental illness” that I believe only a psychopath could invent, These intraspecies human predators all but ignored by psychiatry are well known for the inevitable harm they do and mind, body, soul (not to mention career and financial)INJURIES and losses they cause normal people who have the misfortune to cross their deadly path leaving much pain, suffering and trauma in their wake per Dr. Robert Hare, the world’s foremost authority on psychopaths, another name for evil people. Most psychopaths are not serial killers, but rather, are found as heads of many corporations that could be labelled psychopathic themselves per the book and DVD, THE CORPORATION. Dr. Hare and Dr. Paul Babiak wrote a book called SNAKES IN SUITS to describe their deadly tactics as did John Clarke with his book, WORKING WITH MONSTERS. Let’s not forget THE SOCIOPATH NEXT DOOR by Martha Stout (or the one in your own house as it seems in your case) or workplace or so called mental health place, another name for psychopath based on ones’s theory of causes. Dr. Tim Fields describes these conscienceless, remorseless human predators on his bullying web site as well.

      Anyone targeted by a psychopath or malignant narcissist is almost sure to have PTSD, many injuries and much loss caused by this lethal predatory encounter.

      You are a very wise, brave woman and I hope you are on the road to recovery based on your brilliant insights. I highly recommend Dr. Judith Herman’s TRAUMA and recovery and Dr. Matsakis’ I CAN’T GET OVER IT to help you on your path

      Thank you for your great post.

    • Jeanne, great perceptive post!! I am so sorry about all that you Tim Fields in his great web site, BULLYONLINE, was the frist one I ran across who said that the PTSD one gets from abuse such as bullying or mobbing in the home, at work, at school and the world in general should be referred to as injuries whether emotional and/or physical PTSD or stress breakdown (the term used by another abuse/bully expert).

      Thanks for reminding me! Let’s try to use terms like abuse, life crisis or trauma related INJURIES rather than the toxic label, “mental illness” that I believe only a psychopath could invent, These intraspecies human predators all but ignored by psychiatry are well known for the inevitable harm they do and mind, body, soul (not to mention career and financial)INJURIES and losses they cause normal people who have the misfortune to cross their deadly path leaving much pain, suffering and trauma in their wake per Dr. Robert Hare, the world’s foremost authority on psychopaths, another name for evil people. Most psychopaths are not serial killers, but rather, are found as heads of many corporations that could be labelled psychopathic themselves per the book and DVD, THE CORPORATION. Dr. Hare and Dr. Paul Babiak wrote a book called SNAKES IN SUITS to describe their deadly tactics as did John Clarke with his book, WORKING WITH MONSTERS. Let’s not forget THE SOCIOPATH NEXT DOOR by Martha Stout (or the one in your own house as it seems in your case) or workplace or so called mental health place, another name for psychopath based on ones’s theory of causes. Dr. Tim Fields describes these conscienceless, remorseless human predators on his bullying web site as well.

      Anyone targeted by a psychopath or malignant narcissist is almost sure to have PTSD, many injuries and much loss caused by this lethal predatory encounter.

      You are a very wise, brave woman and I hope you are on the road to recovery based on your brilliant insights. I highly recommend Dr. Judith Herman’s TRAUMA and recovery and Dr. Matsakis’ I CAN’T GET OVER IT to help you on your path

      Thank you for your great post.

  10. Jeanne,

    ADDENDUM: I obviously had a problem typing my post, but I wanted to say I am so sorry about all the losses you suffered at the hands of your family and the massive betrayal and retraumatization by the so called mental health profession/psychiatry. Sadly, this is all too typical, but hopefully you have escaped this evil and can use your great hard won wisdom to focus on your recovery and ultimate peace and happiness. I wish you the very best. You deserve it and I appreciate the reminder that what the so called mental health profession is dealing with are INJURIES including the original ones and the worst ones psychiatry inflicts with their horrific gas lighting, invalidation and cruelty in the guise of treatment.

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