Some Thoughts on the Origins of Mental Illnesses

Hugh Middleton, MD
37
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One of the things debated and discussed in blogs such as this, and in a lot of other places, is the nature of “mental illness”. Is it biochemistry? Is it genes? Is it the result of stress? Does it exist at all? Is it a construction arising from oppressive political influences? Take your pick and follow the trail that leads from it.

This is all very interesting and entertaining for those of us who enjoy debate and discussion, but it can leave the distressed, anxious or confused person who is seeking help somewhat lost. Do I need medication? Have I got faulty genes? Should I seek a less stressful situation? Am I making all this up? Is it someone else’s fault? Perhaps it is just as well the British Journal of Psychiatry has recently published a special supplement which offers clarification.

Before you go rushing off to find this Holy Grail, let me explain. The January 2013 edition of the British Journal of Psychiatry includes a short supplement of some nine papers edited by Swaran Singh and Max Birchwood which is entitled “Youth mental health: appropriate service response to emerging evidence”. What is notable about this is not so much what each of these papers says, directly, but how what they say, collectively, can be interpreted as a meta-message of much wider application and interest.

It is significant that the authors are all established mental health research professionals with a recognised track record of publications in mainstream medical journals, grants-winning success and senior academic posts. Their research is respected and influences practice and practitioners, and as a result it is of interest to look closely at what they are saying. It might be different from what is expected, or even from what they intend.

In essence there are three messages which interweave. The first is led by Peter Jones, Professor of Psychiatry at the University of Cambridge, England. His first sentence reads: “Adult mental health disorders begin in adolescence.” 1 The substance of his paper, which follows this assertion, is careful and convincing evidence from clinical studies, clinical epidemiology, secondary analysis of birth cohort data and cross-sectional surveys which support it. If conventional definitions are accepted, that 50% population will experience a DSM-IV mental health disorder during their lifetime, then a staggering half of these disorders will have begun by the age of 14. This ranges from 11 as the age when half of all anxiety disorders might have begun to 30 for the same assessment of mood disorders. Jones’ paper is a clear and authoritative summary of empirical, positivist data.

They inescapably identify what we call mental illnesses, as difficulties which have their origins in adolescence. He chooses to associate these findings with what is known about human brain development through childhood, puberty and adolescence but there is no evidential or epistemological justification for privileging this causative connection over explanations based upon emotional wellbeing and appropriate parental nurture. Jones’ statement: “Adult mental health disorders begin in adolescence.” is firmly supported by data. It doesn’t point to earlier developmental stages, and by adolescence he means the period that extends into early adult life. It is not a re-statement of psychodynamic dogma. In fact there is something intuitively obvious about it.

A second message is that there is value in attempting to do something about this, proactively, and preventatively. Patrick McGorry illustrates some of the benefits from such approaches, bemoans the scale of challenges of doing so, champions “early intervention” as a more realistic institutional approach, but at the same time draws attention to the inescapably harmful labelling that comes with this2. In contrast Paul Stallard and Rhiannon Buck describe how it is quite realistic to include a resilience-promoting programme in the school curriculum and reduce the risk of “depression”3. It seems to work. In another paper Andrew Chanen and Louise McCutcheon discuss ways in which earlier intervention amongst younger, more vulnerable individuals might mitigate the development of distressing patterns of interaction which are conventionally known as Borderline Personality Disorder4.

The third message is that we don’t listen to these first two messages. The core theme of the supplement is that current Irish, UK and Australian services are poorly matched to what the editors describe as young people’s needs. In particular the clear evidence that most so-called mental health difficulties apart from dementia begin in adolescence or early adulthood is not matched by services that focus upon this period. Instead, conventional child and adolescent mental health services provide for young people to the age of eighteen. After this, professional input is provided by the same service and with the same approach and philosophy as that providing for older adults to the age of sixty five.

Several papers draw attention to the consequences of discontinuity, as young people receiving professional mental health input transfer from child and adolescent services to adult services at eighteen, right in the middle of the period of vulnerability Jones and others identify. Inevitably recommendations about how things might be done differently have to be constrained by reluctances to change, but also by the fact that in the UK, in Australia and in most other countries an individual’s legal status changes as they reach the age of eighteen. This is important.

It is important because growth and maturation are, by definition, progressive processes. Becoming an adult is not something that suddenly happens on a particular day. These papers are also important because they draw attention to the fact that a very large proportion of what is conventionally called “mental illness” begins during the time when children are changing into adults … during a time when their identities are forming and when they are still vulnerable to influences beyond closer family ties and, during adolescence, increasingly exposed to them.

Most of us navigate this period safely and successfully, though I guess few would look back on it as a trouble free time. What Jones reminds us is that the cost for those who don’t can be very high. From many points of view “mental illness” is a self-fulfilling prophecy; disabling medication, sick role, stigmatisation and reduced ambitions and expectations are all so easy to fall into, and very difficult to escape.

Locating the origin of many “mental health difficulties” in adolescence also forces a review of what they are. The prevailing “illness” model identifies them as something alien that has afflicted the individual from outside, rather like an infecting parasite, or as something that has assaulted them such as an injury or the development of a malignant growth. If most actually begin during a time of vulnerability, then rather than identifying the condition itself as the problem, it would seem more appropriate to focus upon the vulnerability. It isn’t a big step, then, from identifying vulnerable young people as tomorrow’s psychiatric patients, to recognising that much might be done by being available to and responding accordingly. I am not advocating widespread methylphenidate for ADHD, or any of the other misguided misapprehensions which contribute to the growing number of medicalised young people. They have already been damaged by diagnosis. For all of us who can recall anything of it … or indeed observe it amongst our own family and friends, what makes for a successful adolescence and what hinders it? Acceptance, rather than pathologising? Respect and encouragement rather than criticism? Consistency?

Adolescence might be uncomfortable to observe or to experience, but it isn’t an obscure mystery. I wonder if we are giving it the attention it deserves? Perhaps what we call mental health problems really are largely due to the fact that not everyone gets the love and support they need when they are growing up. It’s a no brainer but an awfully difficult one to really get hold of … even harder to correct or prevent, yet if this is where the facts point us, shouldn’t we follow?

  1. Jones, P.B. (2013) Adult mental health disorders and their age at onset. British Journal of Psychiatry 202, s5 – s10.
  2. McGorry, P. (2013) Prevention, innovation and implementation science in mental health: the next wave of reform. British Journal of Psychiatry 202, s3 – s4.
  3. Stallard, P. & Buck R. (2013) Preventing depression and promoting resilience: feasibility study of a school-based cognitive-behavioural intervention. British Journal of Psychiatry 202, s18 – s23.
  4. Chanen, A.M. & McCutcheon. L (2013) Prevention and early intervention for borderline personality disorder: current status and recent evidence. British Journal of Psychiatry 202, s24 – s29.

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37 COMMENTS

  1. I would take this research with a grain of salt.By highlighting a specific period as a causative point for Mental Health dysfunction this is creating a point of stigma. My psychotic episodes did not start until my late 40’s. They were associated with extreme stress and PSTD.Rather than spend time, money, and valuable resources on the seeds of Mental Illness why not pursue the venue that has been a continuous player throughout time – stress.When I was a staff person at a Residential Center for Adolescents none of the kids there were on medication. Many came from abusive and or neglectful environments. None were ever completely out of control.
    What has happened since then? Either there is a global epidemic or the quantities and multiple layers of stress has caused maladaptive behavioral issues and disordered thinking while concurrently medication has been used to treat rather then spend time and money on reducing stress in our lives of economic globalization and great economic disparity.There has also been a dearth of research on environmental concerns. How much of this is environmentally based ? Who knows? Asthma rates have skyrocketed as well as food allergies and Celiac disease. An educated person on the street would conclude that if these medical problems affect the body in those particular areas might they affect human thought processes as well?
    Either there is a vast epidemic going on or

  2. Great, so the message is don’t worry your little head about any of the issues being discussed by people who have experienced the same thing. Instead submit yourself like a child to the responsible adults who are psychiatrists. Listen to your psychiatrist for they are the font of all wisdom for they have read the right research and they know whats best for you.

    Suffering and distress is real and demands a response but submitting to the will of psychiatry only ever makes things worse. That’s the evidence.

    Give me an inspirational blog over the dismal scribble in the British Journal of Psychiatry any day. Reading the BJOP may be interesting and entertaining for those who enjoy puffing up their egos and fancying they can discern meta-messages.

    People need alternatives not more of the same from illness informed sickness services. The more widely spread this message is the more people will be able to defend themselves against mental health services if/when the time ever comes.

    • “Give me an inspirational blog over the dismal scribble in the British Journal of Psychiatry any day.”

      Oh, but those professionally employed, some of them, will ask if you’ve been reading on the internet and when you say you have, they’ll tell you “don’t do that”.

  3. Dr. Middleton refers to Peter Jones’s statement: “Adult mental health disorders begin in adolescence.” and comments “In fact there is something intuitively obvious about it.”

    Yes, it’s intuitively obvious because it’s a statement of the obvious. Of course an adult mental disorder (if such exists) would have to have its origin somewhere in the past. Where else would it start? It can’t start in the future, and no one supposes such conditions are instantaneous.

    How about adolescent mental disorders? Must have started in childhood? And childhood mental disorders? Must have started in infancy? Infant mental disorders? Must have started with in the womb.

    Such reverse engineering of cause amounts to a tautology. Suicides — of course they were depressed, who else would kill themselves? Murderers — must be mentally ill, why else would they kill?

    This is psychiatry playing dumb to have something to talk about.

  4. So because mental illness starts in adolescence the writer concludes that ” not everyone gets the love and support that they need when they are growing up”. He then refers to his brilliant conclusion as a “no brainer”. Blaming parents for mental illness is about as scientific as blaming evil spirits or aliens for taking over people’s brains.

    There is good research out there that shows that depression and psychosis are due to inflammation of the brain. The causes of brain inflammation are many and include vitamin defieciencies, allergies, parasite infestation (especially T gondii), bacterial infections, viral infections(herpes simplex), heavy metal poisoning,auto-immune disorders and many others. Although it is not yet clear why some of these factors cause mental illness in some people and not others, it is believed that there could be genetic factors and immunological factors. For a complete list of probable causes of mental illness see the website “Economy of an Epidemic”. Another good source of the latest research on the causes of mental illness is PubMed.

    If Dr. Middleton is concerned about preventing mental illness he should first look at causes. Inflammation of the brain is not caused by poor parenting.

  5. I believe that mental illness begins and ends with psychiatry. Backed up by a range of labels/diagnoses in the DSM/ICD. Life transitions, trauma, difficult circumstances, a combination of factors. Which are translated into lifelong mental illness, treatment with psychiatric drugs and extreme difficulty in leaving psychiatry behind and getting back on with your life.

    Blaming it on mothers and families is annoying and just not good enough. Social work ‘interventions’, removing children from parents, seem to be on the increase and can’t surely be the answer. In Fife, Scotland, where I live, the social work services have overspent and need another £4 million because they have removed more children than planned from parents with drug problems. And everybody thinks that’s OK and gives the social work more money to identify risk and separate families.

    Psychiatry does its best to separate families. I have a lifetime experience of this. They do it by blaming the mothers/parents/upbringing/genetics/bio this that and the other. And do their utmost to keep control of the individual by psychiatric drugging, labelling and disabling. A religious fervour that requires obedience to the regime. Medical notes record the labels, accurate or not, for they are written indelibly, even though psychiatric constructs. Such is the power of psychiatry to name and shame.

    We don’t have to believe it or adhere to it even when we have no choice but to engage with it. It’s a matter of resisting the pressure and extricating ourselves as soon as possible. I’ve never believed any of it, since 1970, although have had to engage with it, periodically ever since. For they do like to label families as well as individuals, if they can get away with it. As in “family history of …”. Very irritating. It’s nothing to do with science or medicine but everything to do with social control and giving a false sense of security.

    For if the mad people are locked up then we are all safe. Aren’t we? And to avoid being locked up psychiatrically then we have to take the psychiatric drugs given out by the gatekeepers/GPs/ordinary doctors in communities. Hence the rise in anti-depressant and benzodiazipine prescribing. The drugging of children, ADHD labelling, and now the drugging and labelling of pregnant women, perinatal psychiatry. Care in the community or coercion and control, as Prof Tom Szasz described it.

  6. Just because something has been written in a journal of psychiatry by some psychiatrists doesn’t mean that it is wrong. Some people automatically assume so. My personal breakdown occured during my adolescence and I blame it on all sorts of circumstance and yes, my family had something to do with it, as well as all the stupid rules and regulations of my school.It had also something to do with my oppositonal confrontational character and my desire to understand how the world worked and what life was all about. To add to this, I was shocked by the two-facedness of society and adults in particular.Last but not least, I started carrying on like a “proper porc chop”,burning my candle at both ends, thinking I was immortal, until I collapsed, started hearing voices in my head etc. What would have helped in my case? The open dialogue approach where people sit down and talk properly. May be a sleeping tablet now and then. Looking back I can see how I brought it all onto myself. Luckily my parents never asked for any psychiatric help. They sat me down and talked to me and assured me that they were there for me. It took me about six months to recover.

    • Alix,

      I am happy for you that you recovered in six months after your parents talked to you. Not everyone recovers that quickly.

      I am not saying that what the psychiatrists said was wrong. Society has known for thousands of years that mental illness usually begins in adolescence. What makes me angry is that they are wasting research dollars on studying facts that are already known.

      Just this week there was another case in Canada of a young woman who murdered her seven year old son. She and her family had been trying various medications for depression for two years. Her family was supportive and trying to help. She had been admitted twice to the hospital in the last year. Well meaning doctors and psychiatrists were unable to help yet another family who was in distress.

      What is needed is a commitment by our health care systems to check patients for all known causes of psychosis and provide proper treatment. All doctors should be required to read “Brain on Fire” by Susan Callahan. All emergency departments should be required to do blood tests, MRIs, CNS tests, etc. Patients should not be turned into guinea pigs for the drug companies. Many are sent home with one prescription after another without any proper tests to see what is causing their problems.

      • I know how lucky I was and I shudder when I think of what could have happened had I ended up in the mental health service. I agree that things need to be changed,that people need safe havens not forced treatement etc. All I am saying is that families are sometimes at fault, sometimes unwittingly, and psychiatrists are not always wrong: it depends on what they are saying.

      • Alix ~ I agree! There are way too many people being treated as guinea pigs and these drugs are handed out like candy. Drugs should not be used as a first line of treatment, instead alternatives should be offered along with medical testing to rule out any possible medical causes and people should be given all the information regarding any drugs they prescribe so people can make truly INFORMED choices. Part of the problem is that many people don’t take the time to do their own research and put too much faith in these so called “therapists/psychiatrists”. People need to take control of their own health and their own lives!

  7. Like everything else in this Universe, the nature of our evolving progress is circular, and it would seem that we are firmly heading back towards those “shaming & blaming” conclusions of early “emotional systems” theories of previous generations.

    Don’t blame us! Cried mother’s, father’s and families, in the 1940-60’s and of coarse we still do.

    Yet is our endless blaming and shaming stimulated by intelligent reasoning or an instinctual reaction? Of coarse in this particular community the blaming & shaming reactions towards psychiatry are well to the fore of our debate. Yet should we be asking ourselves if there is an unconscious motivation involved in our social politics? Please consider an abridged excerpt from my own struggles to write about the “unconscious” stimulation of my “seemingly,” bipolar constitution;

    “The Family, Attachment Affects & Mental Illness?

    February 2013: Exactly 33 years on from my very first episode of euphoric psychosis, and my headline here looks, at first glance, that I’m about to blame & shame my Mom & Dad?
    Your own “at first glance” impulse, will quiet possibly be to ignore, to skip this post. Stimulated by the power of “affect.” Or you may be “intrigued,” a cognizance, stimulated by an affect called “interest-excitement,” and a learned word. These are unconscious motivations we are barely aware of, and socially encouraged to deny.

    After 33 years and a decade of desiring to write about the experience of mental illness, from the inside-out. I really should begin at the beginning, my birth experience and the three day labor of my poor old mom. Birth trauma, not a mysterious brain disease, lies at the heart of my bipolar type 1 experience, of trying to overcome the unconscious motivation of negative “affect.” Harshly treated by a less than empathic nursing sister, my mother struggled to give me life. The pain and the psychic injury of continious distress, were further heightened by a rather brutal forceps delivery, and with no cradling or sight of her child for a week, a pain fueled void was stimulated between us, which persists to this very day. Fueled by the unconscious nature, and power of “affect.” As an experience of the nervous systems (See Affect theory: The word “affect,” as used in Tomkins theory, specifically refers to the “biological portion of emotion,” that is, to “hard-wired, preprogrammed, genetically transmitted mechanisms that exist in each of us” which, when triggered, precipitates a “known pattern of biological events,” although it is also acknowledged that, in adults, the affective experience is a result of both the innate mechanism and a “complex matrix of nested and interacting ideo-affective formations.”) My bipolar type 1 disorder is also known as an “affective disorder”, or disorder of “affect.”

    A traumatic experience during my birth and isolation and separation form the very source of mother nature’s natural healing powers, resulted in an “affective“ conditioning of my nervous systems. An unconscious injury of overwhelming negative affect, laid the neural foundations for my classic, early adult onset of mental illness. A three day experience of distress/anguish charging a high tolerance, and “unconscious” expectation of negative experience, within my brain-nervous systems. Hence, people like myself experience a self-defeating pattern of negative life-expectation/experience, motivated by the unconscious power of affect, the real “economy” of human motivation. Yet what exactly is an affect, and can it be described effectively by the mind numbing language of neuroscience? And what does “affect” have to do with mental illness and our human sense-of-self?

    Secure Attachment, Affect Regulation & Origins of The Self?

    “The defined mission of the Infant Mental Health Journal is to focus upon infant socialemotional development, caregiver–infant interactions, contextual and cultural influences on infant and family development, and all conditions that place infants and/or their families at risk for less than optimal development. In this work I want to suggest that although the unique importance of “optimal development” has long been addressed by the psychological sciences, due to the advances of “the decade of the brain,” developmental neuroscience is now in a position to offer more detailed and integrated psychoneurobiological models of normal and abnormal development. The incorporation of this information into developmental psychological models could forge closer links between optimal brain development and adaptive infant mental health, as well as altered brain development and maladaptive mental health.

    A theoretical concept that is shared by an array of basic and clinical sciences is the concept of regulation (Schore, 1994, 1996, 1998d, 1999c, 2000b), and because it integrates both the biological and psychological realms, it can also be used to further models of normal and abnormal structure – function development, and therefore, adaptive and maladaptive infant mental health. Interdisciplinary research and clinical data are affirming the concept that in infancy and beyond, the regulation of affect is a central organizing principle of human development and motivation. In the neuroscience literature Damasio asserts that emotions are the base of text highest order direct expression of bioregulation in complex organisms (1998), and that primordial representations of body states are the building blocks and scaffolding of development (1994).

    Brothers argues that emotion occurs “in the context of evolved systems for the mutual regulation of behavior, often involving bodily changes that act as signals” (1997, p. 123). Emotions and their regulation are thus essential to the adaptive function of the brain, which is described by Damasio:
    “The overall function of the brain is to be well informed about what goes on in the rest of the body, the body proper; about what goes on in itself; and about the environment surrounding the organism, so that suitable survivable accommodations can be achieved between the organism and the environment.” (1994, p. 90)”

    Excerpt from: EFFECTS OF A SECURE ATTACHMENT RELATIONSHIP ON RIGHT BRAIN DEVELOPMENT, AFFECT REGULATION, AND INFANT MENTAL HEALTH

    The Family & Generational Transmission of Affect-Motivation

    Let me tell you a story. The story of a family and its generational patterns of poor attachment, negative affect regulation, and our general human denial that such unconscious motivations, even exist.

    Firstly, there will be a “reaction” of indignation amongst members of my family, at my perceived betrayal of family secrets. Anger-rage will be unconsciously stimulated in a need to avoid the “sensation” of “shame-humiliation.” An angry reaction, unconsciously stimulated by innate “affect.” Similar angry reactions, in avoidance of shame sensation, are the unconscious root of the endless blaming and shaming games, in the social politics of our human experience. “The slings (anger) and arrows (shame) of outrageous fortune,” as William Shakespeare so eloquently puts it. Of coarse “reaction,” will take precedence over my efforts at explanation and reason, my family will need, not, to understand the reasons for my experience. “Your on your own,” the overwhelming need now of denial and distance in the regulation of affect. Will the family even want to understand, let alone try to? The answer, unfortunately, an emphatic, No! My fault, of coarse?

    We seem to be aware of being “affected,” by others in our rational accusations of “you did this and you did that,” while remaining unaware of the unconscious stimulation, of our own and other people’s behavior. Aware of what happens yet unaware of how it happens, beneath our rather shallow impressions, within the mind. Yet as the Einstein of neurobiology, Allan N Schore points out “the regulation of affect is a central organizing principle of human development and motivation,” while most of us have never heard of affect, let alone its regulation? We remain unaware because, as Silvan Tomkins points out, affect refers to the “biological portion of emotion,” that is, to “hard-wired, preprogrammed, genetically transmitted mechanisms that exist in each of us” which, when triggered, precipitates a “known pattern of biological events.” Hmm! “Genetically transmitted mechanisms that exist in each of us?” Sounds like Murray Bowen’s notion of the generational transmission of emotionality, and a principal reason for my current estrangement from my family. My 2006, “differentiation of self” assignment for a counseling degree, and a very public airing of shameful family secrets.

    Unconscious, defensive reactions to the transmission of affect?

    “I have three lovely handkerchiefs here, choose one.” Then Monica left the house and my mother never saw her mother again. My mother was just five years old when this rather brutal act of abandonment took place. Already the focal point of a family projection process, which sought to dump feelings of guilt and shame onto an unwanted “other,” my mother, no doubt, had already begun to form her hard-core defense against the transmission of “affect.” A tendency to distance and isolation which has had its ripple effects through the continuing generations of our family tree. As family therapists and neuroscientists like Allan N Schore increasingly understand, the emotional style of family members is learnt unconsciously, in an affect/emotion development phase of brain-nervous system experience, within the early years of life.

    In late 2006, my essay was written with the concepts of Bowen theory firmly in mind, a theory of emotional development which had further eroded my faith in the brain disease concept of bipolar disorder. I guess this post could be viewed as part two of that essay, updated with the latest insights, more recent neuroscience discoveries have provided us with. Knowledge that was not available in the 1940-50’s when Murray Bowen and others were laying the foundations of our current Family Therapies, from an emotional systems perspective. An emotional systems perspective, which has a remarkable 86% success rate in treating first episode psychosis, using the “Open Dialogue“ method in Finland. When the “double-bind” concept of schizophrenia, as the result of a dominant mother, weak father and a child enmeshed in an emotional system, was floated during this period, it led to the predictable “shame reaction” of “how dare you blame mothers – how dare you blame the families.”

    The eagerly embraced “brain disease” concept of schizophrenia alleviates the transmission of shame to other members of an emotional system, reducing a sense of guilt and blame, and restoring emotional equilibrium. Magic bullet, medication interventions can reduce the need for distance and “emotional cut-off,” in families where medication tolerance is good and the “identified patient” remains stable. Yet where medication tolerance is low, as in my case, the emotional systems notions of “emotional cut-off” and “identified patients” (scapegoats) are generally present within the emotional system we call the family.

    The family “affect” on society at large is obvious from an emotional systems perspective, the family being the nuclear cell of society, its building blocks, so to speak.

    For those wishing to explore more of this emerging new perspective on our “unconscious” motivations beneath our “reactive” social politics, I highly recommend a new book, with this short excerpt;

    “The spontaneous movement in all of us is toward connection, health, and aliveness.
    No matter how withdrawn and isolated we have become,
    or how serious the trauma we have experienced,
    on the deepest level, just as a plant spontaneously moves toward sunlight,
    there is in each of us an impulse moving toward connection and healing.

    It is the experience of being in connection that fulfills the longing we have to feel fully alive. An impaired capacity for connection to self and others and the ensuing diminished aliveness are the hidden dimensions that underlie most psychological and many physiological problems. Unfortunately, we are often unaware of the internal roadblocks that keep us from the experience of the connection and aliveness we yearn for. When individuals have had to cope with early threat and the resulting high arousal of unresolved anger and incompleted fight-flight responses, adaptive survival mechanisms develop that
    reflect the dysregulation of the nervous system and of all the systems of the body. These adaptive survival mechanisms disrupt the capacity for connection and social engagement and are the threads that link the many physical, emotional, behavioral, and cognitive symptoms that are the markers of developmental posttraumatic stress.”

    Excerpt from “Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship,” by Laurence Heller, PhD and Aline LaPierre, PsyD.

    Buy the book here: http://www.cellularbalance.com/book.html

    Best wishes to all,

    David Bates.

  8. I can easily trace the roots of what led to my Bipolar misdiagnosis back to my childhood and my teen years. Furthermore, I can trace many of the roots of my inner turmoil as a teenager and young adult back to my parents’ childhoods as well.

    In my view, “mental illness” is often the result of underlying generational pain and dysfunction, often combined with factors that emerge during teen years (including major hormonal changes, social factors, personal identity issues, self-esteem, etc.).

    This is not something I’ve pondered lightly. I’ve very closely and carefully examined my situation and the events surrounding my life that led to my psychotic breakdown at the age of 21, which was at the same time a very rich spiritual experience.

    I was diagnosed as “Bipolar” (first Type 1, then later reassessed as Type 2) and treated accordingly with antipsychotics, mood stabilizers and benzos, for over ten years.

    The only time I was ever non-compliant with my medications led to my second episode which earned me the label “Bipolar Type 1”. I was always compliant after that point, and never made any sudden drastic changes to my medications over the years.

    When I have carefully made changes, I’ve noticed side-effects emerging and subsiding that would have certainly been much more pronounced had I not been mindful of the withdrawal and transition processes. Those very side-effects are exactly what most psychiatrists would consider to be the symptoms of my supposed “mental illness”, and had I not been more mindful of those processes, I would almost certainly still be diagnosed as suffering from a Bipolar disorder.

    I know now based on my own experience and research that almost all of the complications to my health and my mental/emotional processes that I developed after treatment began- which I was told were symptoms of my Bipolar disorder- were in fact the symptoms of iatrogenic mental illness. Based on my experience alone, I’m not sure if there is actually any other kind. I’m highly skeptical.

    My bipolar diagnosis was recently removed, something that was endorsed by two separate psychiatrists, and I am currently at the tail end of my med withdrawal process.

    My mind and my life are being returned to me.

    I’m 32, and only now am I finally discovering my own identity and, well, becoming an adult. This is exactly what psychiatric treatment stopped me from doing- becoming my own person, becoming an adult.

    I’ve never been more mentally clear, emotionally grounded, or physically fit. None of this was possible while I was in the midst of my psychiatric treatment/abuse.

    I consider my own story to be a prime example of how all of these factors- emotional problems stemming from familial dysfunction and broader societal dysfunction, social alienation as a teenager, hormonal changes that accompany growing up- can lead to what is commonly misdiagnosed as mental illness.

    I believe what happened to me is a fine example of the psychiatric lie in action, and also how it can fall apart in the face of confident and mindful personal action.

    I have come to believe that the only real mental health epidemic we have on our hands is an iatrogenic mental illness epidemic, which has been engineered and implemented for the sake of profit and social control.

    • Julian thanks for sharing your story. It’s great to hear how you have taken control of your own mental health and recovered, got free from the system. It’s the only way, in my opinion. Like you, when non conformist/compliant, my label was changed but to schizoaffective disorder, back in 2002, my episodes were postnatal and menopausal, I’m now 60. I also managed to also take charge and recover completely in 2004, and have helped other family members do the same. Something like a resistance fighter.

      Like you say, it is psychiatric abuse and there is no excuse for it. Your experience is a powerful antidote to system control and I hope you get opportunities to share it with others so that they can also escape and live more full and productive lives.

      All the best, Chrys

      • Hi Chrys ~ I’m so happy you had the courage and strength to gain control over your health and your life! I lost my niece to suicide due to these drugs, and now her father(my brother) and ex- wife(which I largely blame their divorce on these drugs) and my remaining niece all are on these destructive drugs. I feel that they are almost brainwashed or in complete denial about what these drugs are doing to them and blame these “therapists/psychiatrists” for destroying not only their lives, but our entire family’s lives. I feel these psychiatrists are really the “SICK” or “Mentally Ill” ones!

    • Julian

      Amen to that… profit and social control. I spent 3 years in the mental health system… medication induced mania at 43… lead to my first major depression, bipolar diagnosis… then two years of psychotropics/multiple combinations of meds, rapid mood swings, elevations and depressions. Ultimately I knew they were all wrong, so I stopped taking everything. Luckily I knew a possible psychosis would come. It did. 2 weeks of talking to god/euphoria. That ended and unfortunately I went thru a final major depression. 8 months later I am now off meds and the side effects are almost gone. My mediation became the diagnosis, side effects were treated with more meds… common theme on this site.

      My daughter is now in the system. She is a troubled teen, mired in my own confusing episodes, along with being a first hand witness to a very ugly and difficult divorce, puberty, a newly diagnosed learning disability, teen angst… and conflictingly supportive parents (we did not talk for 2 years while I was being “treated”for my “condition”. I contend she is not mentally ill… my ex, in her frustration to understand her anger and at often times the violence… points to mental illness and the fact that professionals have confirmed the following diagnoses: Major Depressive Disorder, Oppositional Defiant Disorder, Bipolar Disorder, and most recently Disruptive Mood Dysregulation Disorder (this was given by her latest trip to a facility… weekend attending psych who talked to her for 30 seconds)

      Far too many therapists have confirmed at least one of these diagnoses, and while I agree that she fits some of them by definition… I am sure that her troubles are a direct result of external factors and her own ability to process/not understand them. I am told I am in denial… but I contend that I accept the responsibility for possibly causing some of her troubles, and I’m willing to do whatever it takes to help her thru it. I have fought medication the whole way… there is now a movement by her lawyer and a court official to remove me from blocking these treatments. Very scary. I have read many books now and understand so much more, but most of her treaters are in the system and it is truly an uphill battle.

  9. I was interrupted while writing so I have enjoyed the dialogue.I never want to leave the impression that I support the 1950’s blame the mother paradigm.In fact D. W. Winicott came up with the idea of the “good enough mother.”Perfect parenting does not make perfect children. There are interesting writings on the “dance” kind of a double helix spiral between a mother and new born infant for many many reasons that dance can be damaged through no fault of the child or mother.But I don’t think that would be the be all and end all of a strong causation for mental illness and adult onset psychosis.
    There is a lovely phrase that is not heard of often anymore
    nonlocus of control – meaning trauma that is no ones fault. Bad things happen and hurt happens because of life in a variety of ways.No one can function at their best no matter how much they want to when they are in strong duress. No one.

    I would strongly suggest folks look up the TED talk given by Juan Erniquez recently posted and presented on April of 2012 entitled Will Our Kids be Different Species. He talks very succciently on the epidemic theory of brain based issues.His views need to be heard here!!!

  10. So where on earth will our endless blaming & shaming of others cease? When will we give up our need to displace personal responsibility onto “them?”

    DOES THE PRIDE/SHAME AXIS OF SOCIAL POLITICS BEGIN IN THE FAMILY?
    More from my 33 year struggle with bipolar type 1 and managing it medication free by improving my awareness of me and the nature of this curious word “affect,” and how it stimulates human function & dysfunction.

    “The way a family has generationally learned to cope with life’s challenges, with subconscious affect/emotion reactions, revolves around an emotive axis of strength/weakness, psychologically understood as the pride/shame axis of our ego function. A pride/shame axis of ego function generated by the subconscious stimulation of our needs for both active and passive responses to survival. A pride/shame axis which I believe is an expression of the constant dominance-sub-dominance activity of the sympathetic and parasympathetic nervous systems. A constant subconscious activity we often call anxiety, which is both contained and managed by projecting (dumping, shedding) sensations of its negative affects, onto other members of the family group. Dumping unwanted sensation/feelings onto others, is the subconscious transmission of affect, which generally helps to spread the “affective” load of these subconscious stress reactions to life. Partially explaining why the loss of the “extended family“ has led to a galloping increase in anxiety disorders in the Western world. An affective load sharing perhaps most easily understood by viewing the humor we call sarcasm, from this emotional systems point of view. Indeed, as individuals, we generally cope with difficult occupations, by developing what we call a “dark” sense of humor, to manage our “affective” experience.

    Bowen’s concepts included the notion of fusion between an individuals emotional-intellectual functioning and an emotional fusion between members of any emotional system. His idea of fusion is most easily understood as the fusion experienced by the enchanted couple, whom we may observe as quiet definitely “in-love.” A certain chemistry of emotional fusion, which can be mildly embarrassing to some observing others, “get a room will ya!” I remember mine and another’s children exclaiming. In Bowen’s view, a well balanced individual has a high level of “differentiation” between their emotional and intellectual functioning. It was Bowen’s concept of a “differentiation of self” which informed my essay in 2006, and my exploration of the generational transmission of emotionality via the spouse couples of my family tree. Please consider Bowen Theory’s understanding of the nuclear family, also known as the family-of-origin, keeping in mind my previous comments about subconscious ego functioning.

    “People pick spouses who have the same level of differentiation. Most spouses can have the closest and most open relationships in their adult lives during courtship. The fusion of the two pseudo-self’s into a common self occurs at the time they commit to each other. It is common for living together relationships to be harmonious, and for fusion symptoms to develop when they finally get married. It is as if the fusion does not develop as long as they have an option to terminate.

    The lower the level of differentiation, the more intense the emotional fusion of marriage. One spouse becomes more the dominant decision maker for the common self, while the other adapts to the situation. This is one of the best examples of the borrowing and trading of self in a close relationship. One may assume the dominant role and force the other to be adaptive, or one may assume the adaptive role and force the other to be dominant. Both may try for the dominant role, which results in conflict; or both may try for the adaptive role, which results in decision paralysis. The dominant one gains self at the expense of the more adaptive one, who loses self.

    More differentiated spouses have lesser degrees of fusion, and fewer of the complications. The dominant and adaptive positions are “not” directly related to the sex of the spouse. They are determined by the position that each had in their families of origin. These characteristics played a major role in their original choice of each other as partners. The fusion results in anxiety for one or both of the spouses. There is a spectrum of ways spouses deal with fusion symptoms.

    The most universal mechanism is emotional distance from each other. It is present in all marriages to some degree, and in a high percentage of marriages to a major degree. Other than emotional distance, there are three major areas in which the amount of un-differentiation in the marriage comes to be manifested in symptoms. The three areas are marital conflict; sickness or dysfunction in one spouse; and projection of the problems onto children.

    It is as if there is a quantitative amount of un-differentiation to be absorbed in the nuclear family, which may be focused largely in one area, or distributed in varying amounts to all three areas. The various patterns for handling the un-differentiation comes from patterns in their families of origin, and the variable involved in the mix of the common self.

    Marital conflict.

    The basic pattern in conflictual marriages is one in which neither gives in to the other, or in which neither is capable of an adaptive role. Theses marriages are intense in the amount of emotional energy each invests in the other. The energy may be thinking or action energy, either positive or negative, but the self of each is focused mostly on the other. The relationship cycles through periods of intense closeness, conflict that provides a period of emotional distance, and making up, which starts another cycle of intense closeness.

    The intensity of the anger and negative feeling in the conflict is as intense as the positive feeling. They are thinking of each other even when they are distant. Marital conflict does not in itself harm children. There are marriages in which most of the un-differentiation goes into marital conflict. The spouses are so invested in each other that the children are largely outside the emotional process. When marital conflict and projection of the problem onto children are both present; it is the projection process that is hurtful to children. The quantitative amount of marital conflict that is present reduces the amount of undifferentiating which is focused elsewhere.

    Dysfunction in one spouse.

    This is the result when a significant amount of un-differentiation is absorbed in the adaptive posture of one spouse. The pseudo-self of the adaptive one merges into the pseudo-self of the dominant one, who assumes more and more responsibility for the twosome. The degree of adaptiveness in one spouse is determined from the long-term functioning posture of each to the other, rather from verbal reports. Each does some adapting to the other, and it is usual for each to believe that he or she gives in more than the other. The one who functions for long periods in the adaptive position gradually loses the ability to function and make decisions for self.

    At that point, it requires no more than a moderate increase in stress to trigger the adaptive one into dysfunction, which can be physical illness, emotional illness, or social illness, such as drinking, acting out, and irresponsible behavior. These illnesses tend to become chronic and they are hard to reverse.

    The pattern of the over-functioning spouse in relation to the under-functioning spouse exists in all degrees of intensity. It can exist as an episodic phenomenon in families who use a mixture of all three mechanisms. When used as the principle means of controlling un-differentiation, the illness can be chronic and most difficult to reverse. The sick or invalided one is to impaired to begin to regain function with an over-functioning spouse on whom he or she is dependant.

    This mechanism is amazingly effective in absorbing the un-differentiation. The only disadvantage is the dysfunction in one, which is compensated for by the other spouse. The children can be almost unaffected bt having one dysfunctional parent as long as there is someone else to function instead. The main problem in the children is inheriting a life pattern as caretaker of the sick parent, which will project into the future.

    These marriages are enduring. Chronic illness and invalidism, whether physical or emotional, can be the only manifestation of the intensity of the un-differentiation. The under-functioning one is grateful for the care and attention, and the over-functioning one does not complain. Divorce is almost impossible in these marriages unless the dysfunction is also mixed with marital conflict.

    There have been families in which the over-functioning one has died unexpectedly and the disabled one has miraculously regained functioning. If there is a subsequent marriage, it follows the pattern of the previous one.

    Impairment of one or more children.

    This is the pattern in which parents operate as a we-ness to project the un-differentiation to one or more children. This mechanism is so important in the total human problem it has been described as a separate concept, the family projection process. There are two main variables that govern the intensity of this process in the nuclear family. The first is the degree of the emotional isolation, or cut-off, from the extended family, or from others important in the relationship system.

    The second important variable has to do with the level of anxiety. Any of the symptoms in the nuclear family, whether they be marital conflict, dysfunction in a spouse, or symptoms in a child, are less intense when anxiety is low, and more intense when anxiety is high. Some of the most important family therapy efforts are directed at decreasing anxiety (flight/fight) and opening the relationship cut-off.” _Murray Bowen.

    * * *

    The Butterfly Effect & The Generational Nature of Affect-Regulation?
    So how does this notion of generational emotionality lead to a child who comes to suffer a major mental illnesses like bipolar disorder? In my opinion, the hidden factor in the generational process is internal “sensitivity,” a sensitivity of the organism’s complex feedback systems which cannot be observed. A constitutional sensitivity conditioned, in my case, by my genetic inheritance and my birth experience and circumstantial neglect. A sensitivity maintained by my subsequent experience of coping with the “transmission of affect,” in my family’s generational style of affect-regulation. Please consider the forward to Allan N Schore’s complex, yet brilliant book “Affect Regulation & The Origins of The Self.”

    “In his work on “shame” Dr. Schore brought to our attention the unusual importance of a particular stage of infancy, 10-12 to 16-18 months, the practicing sub-phases of separation and individuation, a period of heightened activation of the sympathetic aspects of the autonomic nervous system, and the need for the mother to attune properly to the infant’s excitement at that time. Failure to do so results in the premature activation of excessive shame to counterbalance the now-found-to-be-dangerous excitement of the early practicing period.

    Thus he postulated that in the early practicing sub-phase normal excitement evolves and has to be properly attuned. Then, in the later aspects of practicing, the parasympathetic system comes into play becoming a normal neurobehavioral “antagonist” to its predecessor so as to mediate and regulate its expression.

    The infant brings inherent, constitutional givens (genotype) to the birth situation, which continue to unfold for a considerable length of time past birth. These genetic endowments are partially open to environmental modification (phenotype) and are also partially closed. To the extent that they are open they are acted upon, modified, completed, and developed in a continuous dialectical interaction with primary caregivers.

    What psychoanalytic theory had speculated upon from its very beginnings now turns out to be truer than had been anticipated. As in chaos theory, which states that there occurs an unusual sensitivity to initial conditions, the role of the mothering person with her offspring, which had been all but neglected in the dawn of psychoanalysis. Nobody then anticipated how dependant the infant’s brain was on the mothers care giving.

    In developmental disorder one thinks of psychopathology, insecure attachments and their neuropsychological consequences, affect dysregulation, the onset of personality disorders, and vulnerability to somatization disorders. Developmental psychopathology, which is rapidly becoming a field unto itself, can certainly be understood in no small measure by the concept of the “failed appointment,” that is, failure, whether by chance, trauma, neglect, or inherent genetic programming, for the key neuronal connections to have been evoked at the proper time by the mother-as-appropriate-self object at the appropriate time.

    One certainly must now view such disorders on the anxiety spectrum, such as the disorders of anxiety, panic, phobia, hypochondria, and such trait-state disorders as borderline personality, the obsessive compulsive disorders, affect dysregulation (the manic-depressive-dysthymic spectrum disorders), schizophrenia, and many others as being deeply rooted in one or another form of a neuro-biologically induced disorder of regulation.

    Joseph Palombo, who works with the neuro-perceptual-cognitive aspects of developmental disorders of childhood, including borderline syndrome, calls attention to the presence in these impaired children of a discrepancy between their private, personal selves and their shared selves in terms of a lack of ease in communication. Put another way, these damaged children seem to sense that there is something neurodevelopmentally wrong with them, and they feel a deep sense of shame about themselves as a result.”

    “The concept of the “failed appointment,” that is, failure, whether by chance.” A concept of chance, otherwise known to chaos theory as “the butterfly effect.” Or as this forward to Schore’s book points out. “As in chaos theory, which states that there occurs an unusual sensitivity to initial conditions,” the post-natal maturing of our brain-nervous systems, is subject to the Universal law of chaos, as our complex biological systems develop orders of stability, dependant on enviromental conditions. Who would have thought that chaos theory could explain human personality and mental illness? Framed in these terms, would an understanding of this reality of affect/emotional development, soothe the subconscious reactions of shame avoidance in my own family-of-origin, just as much as the concept of a brain disease does? Or am I just blaming and shaming my Mom & Dad? And what is that curious term in my title “The Transmission of Affect.” Please consider;

    “In a time when the popularity of genetic explanations for social behavior is increasing, the transmission of affect is a conceptual oddity. If transmission takes place and has effects on behavior, it is not genes that determine social life; it is the socially induced affect that changes our biology. The transmission of affect is not understood or studied because of the distance between the concept of transmission and the reigning modes of biological explanation. No one really knows how it happens, which may explain the reluctance to acknowledge its existence. But this reluctance, historically is only recent. The transmission of affect was once common knowledge; the concept faded from the history of scientific explanation as the individual, especially the biologically determined individual, came to the fore.

    We think that the ideas or thoughts of a given subject has, are socially constructed, dependant on cultures, times, and social groups within them. Indeed, after Karl Marx, Karl Mannheim, Michel Foucault, and any social thinker worthy of the epithet “social,” it is difficult to think anything else. But if we accept that our thoughts are not entirely independent, we are peculiarly resistant to the idea that our emotions are not altogether our own. The taken-for-grantedness of the emotionally self-contained subject is a bastion of Eurocentrism in critical thinking, the belief in the superiority of one’s own worldview over that of other cultures. The idea that progress is a modernist and Western myth are nonetheless blind to the way that non-Western as well as premodern, preindustrial cultures assume that the person is not “affectively” contained.
    Notions of the transmission of affect are suspect as non-white and colonial cultures are suspect.

    But the denial is not reasonable. The denial of transmission leads to inconsistencies in theories and therapies of the subjective state. All reputable schools of psychological theory assume that the subject is energetically and affectively self-contained. At the same time, psychologists working in clinics experience affective transmission. There are many psychological clinicians ( especially the followers of Melanie Klein) who believe they experience the affects of their clients directly.

    Present definitions of the affects or emotions stem mainly from Darwin’s physiological account of the emotions. Descartes, inclines us towards the isolating motions that can be verified by another observer, and this is reinforced by modern psychology. Knowledge of bodily motion, even internal bodily motion, is no longer gleaned by the path of bodily sensation, but by visual and auditory observation. Taxonomies of the emotions and affects have descended from three branches. One is ancient; another is identified with Darwin; and a third stems from James and Lange.

    Because of their observational bias, the lists descended from Darwin do not reckon with more complex affective states, such as envy, guilt, jealousy and love. Such cognitive affects are termed desires by some. In the 20th century’s cognitive psychology, a distinction between affect as a present thing–and desire–as an imagined affect, holds significance to deal with the cognitive component in desires, which involve goals and thinking. Critical to the transmission of affect though, is the moment of “judgment,” when the “projection” or “introjection” of affect/emotion takes place. By “affect,” I mean the physiological shift accompanying a judgment. By judgment I mean “any evaluative (positive or negative) orientation towards an object.”

    The evaluative or judgmental aspects of affects, is critical in distinguishing between these physiological phenomena we call affects, and the phenomena we call feeling or discernment. In other words feelings are not the same thing as affects. At present, feelings are a subset of affects, along with moods, sentiments and emotions. This distinction between affects and feelings comes into its own once the focus is on “the transmission of affect.”

    There is no need to challenge an existing view that emotions are synonymous with affect, yet what needs to be borne in mind is that affects are material, physiological things. Affects have an “energetic” dimension, which is why they can enhance or deplete. They enhance when they are projected outward, when we are relieved of them; in popular parlance this is called “dumping.” Frequently, affects deplete when they are “introjected,” when we carry the “affective” burden of another, either by a straightforward transfer, or because the other’s anger becomes your depression. But other’s feeling can also enhance as affect, as when you become energized just being with loved ones or friends. Yet with some other’s you are bored or drained, tired or even depressed. All this means that we are not completely self-contained in terms of our affective energies. There is no secure distinction between the “individual” and the “environment.”

    The transmission of affect questions the individuality of persons, and how our individuality is achieved and maintained. We cannot grasp what is truly distinctive about individuality, without first coming to appreciate, that it is not to be taken for granted. What is not to be taken for granted, is the distinction between the individual and the environment at the level of physical and biological exchange. At this level, the “energetic” affects of others enter the individual, as are the individuals energetic affects transmitted into the environment. Here lies the key to why people in groups, crowds and gatherings can often be “of one mind.”

    Excerpts from “The Transmission of Affect” by Teresa Brennan, PhD.

    Best wishes to all,

    David Bates.

  11. I must make a quick remark. There is no such thing as mental illness. Problems in living labeled mental illnesses by various mental health professionals are not caused by inflammation of the brain.There are absolutely no blood or brain tests that differentiate psychiatrically labeled persons (eg “psychotics”) from “normals.” Thus there is no evidence of any brain pathology. David Oaks and MindFreedom forced the APA to admit that 6 years ago. THE APA ADMITS IT. That means that the following recommendation by MadinCanada is a terrible idea–although I’m sure it would be very popular among psychiatrists and NAMI members:” What is needed is a commitment by our health care systems to check patients for all known causes of psychosis and provide proper treatment.” This is a repressive agenda that will create millions of victims for psychiatrists to label and drug. It is against the principles advocated by most of the authors on this website Mad In America, including Bob Whitaker. I think the author of the article above ceded too much ground by agreeing adult problems originate in adolescence. But this is worse. What is needed is a commitment of “health care system” to leave people’s brains and minds alone.And to stop labeling people with “psychopthology.”
    “All emergency departments should be required to do blood tests, MRIs, CNS tests, etc.” As stated none of these tests provides evidence for mental illnesses– which do not exist.
    Furthermore: Child psychiatry is a form of child abuse and should be criminalized
    Seth Farber, Ph.D.
    wwww.sethHfarber.com

  12. Mcoma is absolutely right– the first time. The focus should be on the present. Present oriented interventions produce dramatic changes. There is no justification for using the demeaning term “mentally ill.” People here are using it and citing NAMI excuses. No one said parent is or is not responsible.I know plenty of NAMI mothers or fathers who preferred to keep their adult children on psychiatric drugs than see them become independent.
    I studied family therapy(post-doc) with Savador Minuchin and Jay Haley and others.I was then thrown out of the public “mental health” sector because I was encouraging kids to get off psych drugs. But I saw the power of present focused interventions within families–provided the parents are willing to dispose of mental illness label. THen I saw the same thing in psychiatric survivors movement: Those who rejected the psychiatric narrative became political activists. THey shed all signs of mental illness. That does not mean they did not have problems>
    The problem now is there is a massive psychiatric-pharmaceutical industrial complex that successfully markets metal illnesses and drugs. REad Anatomy of an Epidemic, Read David Healy. See Daniel Fischer’s alternatives.
    Support the movement against the DSM5, against psychiatric diagnosis. THAT is a MAJOR INTERVENTION.
    SF
    http://www.sethHfarber.com

  13. It seems we are indeed heading back towards those fearless observations made by Family Therapy’s founders? Why does the “Open Dialogue” approach to psychosis work by addressing “relationships” within the family?

    We really need to accept that despite the general rise in our standards of education, which produces a higher level of critical thinking within the population, we are still overwhelmingly motivated by sub-cortical emotive energies, rather than the generally assumed cognitive powers of the cortex. We lack the ability to rise above the subconscious motivations we become “immersed” in, confusing emotionally charged cognitive constructs with reality.

    As long as we take for granted, an “us & them” view of life and refuse to step back and see the subconscious projections involved, we will remain trapped in the same old cycle of “the more things change…….”

    This projection process begins in the family, not because its the family’s fault, its simply the way we subconsciously motivated human beings function. Psychiatry scapegoats us & we in turn scapegoat psychiatry, immersed in a subconscious emotional sea of “knee jerk” reactivity? Please consider;

    The societal projection process:
    The family projection process is as vigorous in society as it is in the family. The essential ingredients are anxiety and three people. Two people get together and enhance their functioning at the expense of a third, the “scapegoated” one. (identified patients) Social scientists use the word scapegoat , I prefer the term “projection process,” to indicate a reciprocal process in which the twosome can force the third into submission, or the process is more mutual, or the third can force the other two to treat him as inferior.

    The biggest group of societal scapegoats are the hundreds of thousands of mental patients in institutions. People can be held there against their wishes, or stay voluntarily, or they can force society to keep them there as objects of pity. All society gains something from the benevolent posture to this segment of people. A fair percentage of people are too impaired to ever exist outside the institution where they will remain for life as permanently impaired objects of the projection process.

    The conventional steps in the examination, diagnosis, hospitalization, and treatment of “mental patients” are so fixed as a part of medicine, psychiatry, and all interlocking medical, legal, and social systems that change is difficult. There are other projection processes. Society is creating more ‘patients” of people with dysfunctions whose dysfunctions are a product of the projection process. Alcoholism is a good example. At the very time alcoholism was being understood as the product of family relationships, the concept of ‘alcoholism as a disease” finally came into general acceptance.

    There might be some advantage to treating it as a disease rather than a social offense, but labeling with a diagnosis invokes the ills of the societal projection process, it helps fix the problem in the patient, and it absolves the family and society of their contribution. Other categories of functional dysfunctions are in the process of being called sickness. The total trend is seen as the product of a lower level of self in society. If, and when, society pulls up to a higher level of functioning such issues will be automatically modified to fit the new level of differentation. To debate such a specific issue in society, with the amount of intense emotion in the issue, would result in non-productive polarization and further fixation of current policy and procedures.

    The most vulnerable new groups for objects of the projection process are probably welfare recipients and the poor. These groups fit the best criteria for long term, anxiety relieving projection. They are vulnerable to become the pitiful objects of the benevolent, over sympathetic segment of society that improves its functioning at the expense of the pitiful. Just as the least adequate child in a family can become more impaired when he becomes an object of pity and over sympathetic help from the family, so can the lowest segment of society be chronically impaired by the very attention designed to help. No matter how good the principle behind such programs, it is essentially impossible to implement them without the built-in complications of the projection process.

    Best wishes to all,

    David Bates.

  14. David, You’re right I think about the benevolent posture often being just as harmful to the scapegoat. Let me say that I think the term scapegoat is better. When there is a choice between a term that most people will understand and a term that’s meaning derives from a theoretical context unfamiliar to most people I choose the former. Also “scapegoat” is better because it makes clear that one person IS the victim even if he participates in his victimization.
    Here in the US to understand social scapegoating–about whose existence David is absolutely right to point out as significant social phenomenon– one has to take into account economic and sociological factors that have nothing to do with psychology For example many poor black people end up in prison not because
    of psychological projecton but because there is a prison industrial complex. David writes of the poor, “They are vulnerable to become the pitiful objects of the benevolent, over sympathetic segment of society that improves its functioning at the expense of the pitiful” OK there is no sympathy hre–I’ll get to that. But there is scapegooating and there is improvement of functioning of one group. If we look at it in broad sociological terms we see that taking poor people who use illicit drug to alleviate the misery of their lives are seized upon by the police and entered into a system. Each one provides job for many people. I call this cannalbalization-in which certain group derive their income through destroying other groups. THose in prison become chronic criminals since if they are released they cannot find work. Those who become chronic metal patients are increasingly larger percentage of the population. They enable many people to make a living and the drug companies make billion of dollars. The scapegoated mental patient becomes increasingly dis–abled while a variety of professionals derive status and income by ministering to the patient. IN order for the system to function the patient must be defined as chronically mentally ill and he/she must internalize this image of herself.This is of course what happens. Does anyone really benefit. No master-slave relationship are dehumanizing and existentially unsatisfying Why then do we have these systems? This is the million dollar question. However with Foucault I would point out the pervasiveness of relations of domination as opposed to relationship of equality, of peers.Also we must refuse to define either the mental patient or the drug addict as intrinsically defective. She becomes defective in order to provide the resources needed to maintain the psychiatric-pharm industrial complex and prison industrial complex. Only macro social policy can put an end to these systems. For example legalizing marijuana and decriminalizing crack would immediately shrink the prison industrial complex and make possible a more productive use if resources, more creative possibilities for people.
    Seth Farber, Ph.D.

  15. Hi Seth:)) I guess we have to accept that the bottom line is self-preservation, even as we each play the “nice or civil” cognitive games by degrees of denial, that such a subconscious motivation even exists.

    As we head into the 21st century, is it possible that all the new emphasis on TRAUMA and its relationship to mental anguish/illness, mistakenly viewed as a brain disease because we lack insight into our own subconscious motivation, also applies to nation states as much as it does any individual or family?

    Are we in dire need of “healing developmental trauma,” both individually and nationally? Please consider this excerpt from one my favorite books addressing this new emphasis on traumatic experience and human development;

    “Healing Developmental Trauma:

    Chapter 1:

    The Need-Satisfaction Cycle

    A primary need emerges and is satisfied. It recedes into the background and another need emerges; and so the cycle continues. When, for a child, this need-satisfaction cycle is significantly interrupted, healthy development is disturbed, and the environmental failure triggers both tension and bracing in the musculature and activation and imbalances in the nervous system and biochemistry— all of which sets the stage for symptoms and disease. When basic needs are not met and the protest to get those needs met is unsuccessful, children come to feel that something is wrong with their needs; they cannot know that it is their environment that is not responding adequately. Therefore, they internalize caregiver failures, experiencing them as their own personal failures. Reacting to their caregivers’ failure to meet their needs, children come to feel various degrees of anger, shame, guilt, and physiological collapse. Tragically, to the degree that there is chronic lack of attunement to their core needs, children do not learn to attune to the needs within themselves. When basic needs are consistently left unsatisfied, the need-satisfaction cycle is interrupted, and nervous system dysregulation and identity distortions are set in motion that often have a lifelong negative impact.

    Adaptive Survival Styles

    Human beings are born with an essential adaptive ability: the capacity to disconnect from painful internal and external experience. We are able to disconnect from experiences of pain and anxiety that accompany the lack of fulfillment of our primary needs. To the degree that any core need is chronically unfulfilled, children are faced with a crucial choice: adapt or perish. Any core need that remains consistently unsatisfied threatens children’s physiological and psychological integrity and prevents them from fully moving to the next developmental stage. Developmental progression is disturbed or interrupted. In order to survive, children adapt to their compromised situation by developing what in NARM we call an adaptive survival style. Survival styles are the result of children’s adaptations to the chronic lack of fulfillment of one or more of their biologically based needs: connection, attunement, trust, autonomy, and love-sexuality.

    Identity and Identifications

    We survive by adapting to our environment. Initially, our survival strategies are life-saving responses and represent successful adaptations, not pathology. However, the adaptations and accommodations we make, although once protective, limit us as adults. Living life based on adaptations learned in childhood restricts our capacity to respond appropriately and creatively to the many challenges of adult life. The coping strategies that initially helped us survive as children over the years become rigid beliefs about who we are and what the world is like. Our beliefs about ourselves and the world, together with the physiological patterns associated with these beliefs, crystallize into a familiar sense of who we are. This is what we come to view as our identity. What we take to be our identity is better described as the shame- and pride-based identifications of our survival styles. As children, we learn to live within the limitations imposed by our environment. However, as adults these initially adaptive much limitations become self-imposed prisons. What in children was adaptive in adults becomes maladaptive. It is the persistence of survival styles appropriate to the past, continuing beyond when they are needed, that distorts present experience and creates symptoms. Survival styles, after having outlived their usefulness, function to maintain ongoing disconnection. Every identification we hold about ourselves disconnects us from the fluidity of our core nature. Our identifications— that is, all the fixed beliefs we take to be our true self— along with the associated patterns of nervous systems dysregulation separate us from ourselves and the experience of being present and engaged. As much as we may feel constrained by our survival styles, we are afraid to, or do not know how to, move beyond them.

    Survival Styles and the Body

    Our survival styles are reflected in our bodies in two ways: as areas of tension (hypertonicity) and as areas of weakness or disconnection (hypotonicity). Patterns of tension and weakness reveal the ways we have learned to compensate for the disconnection from our needs, core self, and life force. Muscular constriction, bracing, and collapse are the physical mechanisms of adaptive survival styles. Tracking in the body and paying attention to the felt sense gives us an important roadmap for working with the internal conflicts of each survival style.

    Looking Through the Lens of Developmental and Relational Trauma

    There are many ways that connection can be compromised in human development, including through inadequate parenting or misattunement, shock trauma, and developmental/ relational trauma such as abuse, neglect, or early loss. Understanding the process by which each adaptive survival style internalizes and perpetuates the environmental failure distinguishes the NARM approach from other psychodynamic therapies. NARM helps individuals become aware of how they organize their experience using survival styles that have outlived their usefulness. All of us are somewhere on the continuum of connection to disconnection from our core selves and our bodies.

    Looking at human development through the lens of developmental and relational trauma gives us an understanding of the five basic patterns of physiological dysregulation and their accompanying identity distortions. It is helpful to recognize these five basic physiological and identity patterns in order to make sense of what otherwise can seem to be a confusing broad spectrum of symptoms:
    • Connection: A survival style develops around the need for contact and the fear of it.
    • Attunement: A survival style develops around the conflict between having personal needs and the rejection of them.
    • Trust: A survival style develops around both the longing for and the fear of healthy trust and interdependence.
    • Autonomy: A survival style develops around both the desire for and the fear of setting limits and expressing independence.
    • Love-Sexuality: A survival style develops around wanting to love and be loved and the fear of vulnerability. It also develops around the splitting of love and sexuality. The symptoms and emotional suffering particular to each survival style indicate specific patterns of disconnection that are reflected in our bodies, our behavior, our personalities, our relationships, our work life, and even in the illnesses to which we are prone. At the onset, survival styles are life-saving adaptive strategies that we have all used. It is important never to lose touch with the suffering inherent in each survival style and to approach this suffering with compassion. Each of the five adaptive survival styles is complex and multifaceted.”

    Heller, Laurence Phd; Lapierre, Aline Psyd “Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship.”

    Best wishes to all,

    David Bates.