Positive Explanations for Psychological Problems

Kjetil Mellingen
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I am a clinical psychologist working in an anxiety and OCD Clinic at the University of Oslo, Norway. In this clinic we do almost all the treatment without starting drugs, and for many patients we help them taper the drugs. One of the reasons for this is that taking drugs for psychological problems often may be seen as avoidance behavior, and this is exactly what maintains the anxiety, or in many cases makes it worse.

If a person starts taking a benzodiazepine every time he feels anxious, he will never discover that it passes by itself and is not dangerous. When doctors give strong drugs to “combat” anxiety symptoms, they may actually be signaling to patients that anxiety is dangerous.

The most effective treatment for anxiety disorders of all kinds, is exposure, and that is exactly the opposite of running away through drugs. Actually stepping down on drugs very slowly (less than 1% per day) may be very good exposure training.

I often tell my patients: it is great if the stepping down gives you a bit more symptoms. Then you get the possibility to learn that anxiety is not dangerous and that it is by going into it instead of avoiding that you get better.

Many people who have anxiety actually think the worst part of anxiety is the self-loathing. They hate themselves for being so weak, not daring enough, always worried etc.

The opposite should be the case. The ability to be afraid has enabled humans to survive. Those who were of the worrying kind were the best survivors in hard stone age times. They would worry about food supplies for the winter, living conditions, cleanliness, safety for themselves and their offspring.

Many of the best survivors of hard times could be diagnosed with generalized anxiety disorder, phobias, OCD and even social anxiety. In stone age tribes it could be very dangerous to talk to strangers. People with very low social anxiety could be a risk for themselves and their tribe.

Fear of heights, snakes, spiders, open spaces etc. have a distinct survival advantage for humans. It is just in the last centuries that conditions have changed so that some of these fears are problematic.

Even psychotic symptoms may have given a survival advantage in earlier times. We all have several thousand verbal thoughts every day, and often we don’t really pay attention to them. The internal dialog just keeps on chattering.

How can  the brain signal to us that a thought is more important than others, e.g. “you are in danger, run to the cave”? The logical thing would be to give more sound to it than normal thoughts, in other words a thought that sounds like it is spoken by somebody. This would today be called an auditive hallucination. We often see that hallucinations come in response to extremely stressful situations.

Trauma victims may develop internal audible voices in order to make sure the internal dialogue around possibly dangerous situations is very clear.

Depression may be a very useful reaction to overwork, in order to slow the person down and avoid exhaustion. It may also function to slow people down so that they have time to think about things they may have done wrong, so that they will be able to change their ways.

Bipolar behavior and ADHD may have its function in getting projects started, and bringing up many new ideas, even if most of them have no merit. The energy that is pathologized by these two diagnoses is probably the reason why we are not still in the stone age and why we have works of art. Inventors, artists and entrepreneurs are often seen by others as overly energetic and unrealistic. But they are needed in order to get development.

So what is characteristic with people who get psychological problems and what some may want to call mental illness?

I see this very clearly after 25 years as a therapist. People who get anxiety and depression have three positive traits in common:

  1. They are sensitive in a positive sense. They are very aware of others feelings and actions, and they may react strongly to things that happen in their surroundings, both positive and negative.
  2. They are analytical and thorough thinkers. They think of all possibilities of what may go wrong, often like chess players planning for all possible future problems. “What if” thinking is very useful in hard times, but may be annoying when conditions are very safe.
  3. They have good imagination. They are able to imagine possible things that may happen so vividly that they react strongly to them and take action, or avoid possibly dangerous action in the case of depression.

All psychological problems are on a continuum from not problematic to very disturbing. It is impossible to put a clear cutoff point, and what is dysfunctional in one setting may be very desirable in another. That is why the concept of mental illness is useless.

We may talk of patterns of behavior thoughts and feeling that are more or less functional in different situations, but it is usually not difficult to see that the behaviors thoughts and feelings may be appropriate in other contexts. The most classical may be over active children who would learn mush in natural environments but who get diagnosed for their active exploration in classroom settings.

In conclusion: Anxiety is a very natural feeling, happening in totally normal brains, to normal people who have more sensitivity, analytic capacity, empathy and imagination than most.

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This blog also appears on Kjetil Mellingen’s personal webpage,
Pschology – Hope and Research

47 COMMENTS

  1. I. LOVE. IT. you have put so eloquently into words what i have always believed. when i tell people i certainly believe in peace of mind and feelings of settlement and problems and struggles but that i do not believe in “mental illness” they never quite seem to understand what i am saying. from now on i’ll have to refer them to your article.

    thank you for sharing. please keep on speaking the truth. one day the world just might be ready to hear it.

    be well

    erin

  2. As I have suffered from OCD for the last 14 yrs, I laughed at this article. Unless the person has suffered this problem for 24/7 then they will really understand. He has mentioned traits which thousands of people who do not have anxiety /OCD and other mental problems. Now saying it is not an illness when it disables people to such an extent that they cannot work. These people want to have a life they actually want a life in which they have control of their own mind and life. As for what he recommends didn’t work for me. I worked in highly stressful jobs and had to interact with people. My anxiety levels didn’t change they stayed the same. I am not in favor of using drugs, but sometimes they are needed, even to help people get on an even kell to help deal with their problems. I don’t have OCD anymore. Now I am left grieving for the loss of 14 years of my life to something disabling when I could have been doing something else with my life. I wasn’t given the choice and the only loser is me…

        • Well I also find CBT unhelpful (or rather insulting my intelligence) but if it helps some people… at least it does not cause type II diabetes etc. There are also many forms of psychotherapy.
          I think the most important is to find out the reason for the problem and then to eliminate that reason. If someone “has” anxiety, OCD or panic disorder because of the situation they are in (abusive relationship, stressful work environment, poverty, what not) no amount of psychotherapy or drugs will help in the long run. It’s the biggest problem with psychiatric paradigm in general – they see a problem as medical and restricted to an individual when it’s rarely so.

          • I don’t agree with that … there are other people who have stressful work environments, have a low standard of living abusive relationships and don’t have OCD and or other disorders… It certainly doesn’t help, but its not the cause..
            Its is a medical problem and it does at times need medication(Not long term).. To help…

          • @julesy
            There are two aspects of what you’re saying:

            1) there may be underlying physical problems behind OCD behaviour which we still don’t understand at least in some cases (like it is for some cases of psychosis caused by viral infection in untreated AIDS or depressed mood in iron deficiency) and these should be identified and dealt with by real doctors

            2) the fact that people react differently to stresses does not mean that the stress is not causative and that these responses are somehow a medical pathology. In fact if you accept this argument then the person with highest degree of mental health would be a highly functioning psychopath – they tend not to get depressed about things nor do they suffer anxiety and are mostly stress resistant. People are affected by stress to various degree based on their genetics, developmental history, previous trauma and current circumstances and the responses are also different – some react with depression, others with panic attacks, psychosis or OCD. One of the main problems with psychiatry is that it does not try to remove the source of a problem or help people find ways to deal with them in their daily life but it pathologises these responses as some irrational behaviours and drugs people to suppress the response.

            I am not even necessarily against drugs (with informed consent) in a short term to help against extreme distress but I don’t think they should be the first line of treatment (except in rare cases) or the “first and last” as it usually is.
            Stress is causative to almost all mental illness and that is becoming more and more clear from the studies where practically no significant genetic markers were found and the ones which happen to be mildly associated are related to … stress signalling pathway. So the real way to deal with “mental illness” is to deal with the stress and trauma not to medicate someone.

  3. Thanks Kjetil, for the great post and for explaining everything in such a clear way.

    I think that if a person runs into difficulty because their anxiety skills aren’t effective – they can learn better skills, its not pathological. I don’t believe in medical diagnoses like ‘Schizophrenia or Bipolar’ (most of the time) either, because psychology can work here as well.

    I like what you say as well about careful drug tapering.

  4. Wow, if everyone could read such positivity and realize most emotions are ” normal” even though individuals respond in varied ways.

    In this increasing difficult world we live in, we need to be reminded how “normal” it is to feel many different emotions.

    Thank you for writing such an such an uplifting, timely piece.

  5. “All psychological problems are on a continuum from not problematic to very disturbing. It is impossible to put a clear cutoff point, and what is dysfunctional in one setting may be very desirable in another. That is why the concept of mental illness is useless.”

    I love this Kjetil, but that ‘rubber ruler’ of mental illness is making an awful lot of money for some people. So I posit that while the concept of mental illness is dysfunctional in a healing setting, it is very desirable in a profit making setting lol.

    Look forward to reading more of your work.

  6. As someone who has struggled and overcome many of the problems you describe, without meds, I must thank you for writing this brilliant article…Meds do not allow us to get through things…While they may be a temporary tool, the side effects are often worse than the original problems…thank you

    • I’d not forget about the fact that drugs can cause/exacerbate symptoms. I had bad mental (in addition to physical) reactions to pretty much every drug they threw at me but in terms of anxiety Prozac and Zyprexa (the latter in withdrawal) were absolutely awful. Many people also report aggression and suicidality on these drugs.

  7. Thank you for your community service in articulately describing anxiety; it is the natural, normal neurobiology of distressful experiences.

    Please consider the elementary neuroscience that supports your premise; it is published online at NaturalPsychology.org.

    I am excited to check out your website.

    Regards, Steve

  8. You are a true radical.

    “When doctors give strong drugs to “combat” anxiety symptoms, they may actually be signaling to patients that anxiety is dangerous.

    The most effective treatment for anxiety disorders of all kinds, is exposure, and that is exactly the opposite of running away through drugs.”

    The psychiatric establishment won’t like you.

    Keep it up. We need more like this.

    I had minor OC(D) (it an’t a disorder, it’s a natural response to difficult circumstances. Worrying that you are a potential danger to others or yourself is a way of warding off the rage that comes from being on the wrong end of an abuse of power).

    I cured it by repeating my worst fears, as recommended in some book I found in a library, going to a self help group where everyone said, “It sounds like OCD to me,” and seeing a therapist who said, “I have no evidence that you are…..(a danger to yourself or others).”

    So basically that is sit with the fear until it subsides, reassurance from people you trust, and maybe dig around and discover where it all came from.

    • When I say I had minor OC(D) I mean I used to worry I was a potential sexual danger to children. I’m not. I am, or was, a worrier. Sexually I’m a complete homosexual slapper. It wasn’t a bit worry, but it was there. However I started a job in a school just as I was starting an assessment for therapy so I mentioned it. They misunderstood me, panicked and made me leave my job. My OC(D) went through the roof. So I complained and got nowhere. I also started dealing with the worries by getting a book out of the library and going to a self help group.

      Eventually I got a referral to a competent psychotherapy unit that deals with sexual problems where I got an assessment that said no, they had no evidence I was any kind of pedophile, I was just a bit of a worrier – only in more technical, pseudo medical diagnostic terms that big shot psychotherapists like to use.

      I got a letter that went on my medical records and tried to take legal action but not joy with that one and got on with my life.

      It is fairly easy to decide if someone is a worrier or pedophile. You ask them what their sexual fantasies are and how they feel about them. Mine are all about men, adult me. Thoughts about sex with children disgusts me. But then that is what OC(D) is, repeated thoughts that that in some way one is a danger to oneself or more usually to others.

      Another case of psychiatric incompetence then. Though in this case it was state funded psychotherapy panicking and covering itself in case I really was a danger.

      Hey ho – not that I’ll ever get an apology for that then!

  9. As others have said, I find this piece brilliant! I have my own anecdote on this particular line,

    “It is impossible to put a clear cutoff point, and what is dysfunctional in one setting may be very desirable in another. That is why the concept of mental illness is useless.”

    I have told my story many times of having been involuntarilty committed in Europe to be put on so called “treatment” of OCD by my ex-family since my ex wife was unable to have me see a psychiatrist in the US (it’s my first comment in my comment history).

    What is funny, is that this lower tolerance for OCD-ish behaviors showed up in the psychotheray notes:

    – My casual dressing was dscribed in Europe as proof that I was in a path to “need treatment”. The same clothing was described as “neatly groomed” by my American psychiatrist. It was my ex-wife who noticed this :).

    – After comming from Europe to the US, my American psychiatrist gave me a https://en.wikipedia.org/wiki/Global_Assessment_of_Functioning score of 75-80, which means,

    ” 81 – 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.

    71 – 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). ”

    And yet, the laws of the European country where I was born in considered my fear of germs so extreme as to warranting involutary so called “treatment”.

    One of the reasons I opposed Obamacare is because of “medical tyranny”, what Thomas Szasz called “the therapeutic state”, is the biggest threat for individual freedom we currently have in the Western world.

    Western Europe is already ahead of the US in its usage of “public health” as a way to limit individual freedom. As explained here https://www.ncbi.nlm.nih.gov/pubmed/19199121 , Norway’s rates of involuntary commitment are among the highest in Europe. Other countries are not very far behind. Obamacare, with its national databases, takes us a step closer to the type of tyranny that is common place in Western Europe.

  10. Thank you for that excellent piece.
    I’d just add that sometimes the “symptoms” are not even really “inappropriate” in the modern world – they are just pathologised because the person is endangering the status quo or somebody’s reputation. It’s well known that psychiatry has been used to silence political dissent or cover up criminal activities by labelling and locking up whistleblowers and victims.
    “It is no measure of health to be well adjusted to a profoundly sick society.” – Jiddu Krishnamurti
    “Insanity – a perfectly rational adjustment to an insane world.” – R. D. Lang