What exactly are “mental health problems”?
In the mainstream, psychological difficulties are seen as “symptoms” of an “illness” or “mental disorder” and based on this the focus is put on suppressing them, either by using drugs, or shock, or by psychological interventions that also aim to “eliminate the problem.”
Unfortunately, this mainstream approach often works poorly, and too often its main effect is to aggravate the problem, or to cause “collateral damage” as critically important parts of the person are suppressed along with the supposed “symptoms.”
But if we want to replace the mainstream approach, we need a coherent alternative view, which realistically frames both the difficulties people experience and suggests better approaches to resolving those problems.
One avenue to this needed reconceptualization was expressed by Jacqui Dillon, who wrote, “When you understand your own ‘symptoms’ as meaningful and essential survival strategies, a more respectful and loving acceptance of yourself begins to emerge.”
I like a lot about that perspective and the shift in attitude it suggests. It helps explain why the traditional approach does so poorly – it’s difficult to heal if we are thinking of essential parts of ourselves as an illness!
There is one possible complication with this perspective though: if we think of disturbing patterns of experience or behavior as being “essential” then we might also feel stuck with them just as they are, with no alternative but just learning to accept and respect them no matter how much trouble they are causing.
One way out of that bind is to think of “symptoms” as meaningful strategies that do fit and are indeed essential in some kinds of situations, but which also are often put into action unconsciously or without much thinking or in mistaken ways. That is, at times they may be truly necessary for our survival, at other times they only seem necessary to some part of our psyche that activates them, while in reality they may be “going too far” and backfiring with destructive effects.
Defining them this way allows for more ambiguity, and suggests that each strategy etc. must be looked at in context, to sort out what really is essential or at least helpful in a given situation from what is well intended but misguided, and may be currently destructive. From that perspective, what we need is not wholesale suppression of what disturbs us, or complete acceptance, but rather an increase in discernment about what strategies are working or not, in particular situations. A strategy that truly was lifesaving during a traumatic situation, for example, may be extremely damaging when carried on into everyday life: but if we can appreciate the way it saved us at one time, we may also be better able to “let it go” in a present that no longer requires it.
To clarify this reconceptualization, what I would like to do now is to outline some of the major categories of psychiatric “symptoms” and describe how they can be reframed as possibly helpful, though often harmful, strategies:
Anxiety and Worry: Most of us can identify times we didn’t worry enough about something, or when we ignored our anxious feelings, went ahead and did something, and then experienced some kind of disaster as a result. So it’s not too hard to see how feeling anxious and getting worried is an evolved strategy that helps us deal with various sorts of threats. These kinds of feelings disturb our calm, but they often do so when we need to be disturbed so we will change our direction in order to face some kind of problem.
Of course, it’s also possible to go way overboard with anxiety etc. But instead of attempting to suppress it in a wholesale manner, we can learn to listen in a discerning way, making judgment calls about how much time to spend worrying and how seriously to take anxious feelings. We won’t always be right, but our competence in doing this can evolve over time, especially when we collaborate with others, talk things through, etc.
Depression: Many people can see no point whatever in depression, and so they would be just as happy to exterminate all depressed mood as they would to eliminate the polio virus! But there is a lot of evidence that depression has evolved as a way to do things like slow down and accept defeat when that has become inevitable and/or to narrow one’s attention to focus on a problem that must be solved before further progress can be made.
Let’s say a person is experiencing problems in a relationship. Getting depressed might move the person toward giving up on the relationship, and that could be a good thing if the relationship is severely flawed anyway. Or getting depressed could help the person slow down on “business as usual” just enough to be able to sort through what has to be changed to make the relationship work. Of course, like any strategy it can also be used inappropriately or can backfire: a person might get depressed and give up on a relationship that might otherwise have been great, or getting depressed about possibly minor problems might itself cause other problems that then become very serious.
And we might note that while “positive thinking” can be helpful if the depression is not helping at the time or if it is based on perceptions that are inaccurate, it is itself prone to backfiring if for example the “positive thinking” is too simplistic and too “positive” to fit the situation. Investing lots more time and energy into a very bad relationship based on “positive thoughts” about it, for example, can be quite detrimental. (I might note that while CBT is often associated with encouraging “positive” thinking, the more collaborative forms of CBT use more discretion and aim to encourage positive thinking only in situations where it seems likely to be helpful.)
Mania: While being manic can get people into horrible trouble, and set people up for going into a long depression in response, the state of being manic can also be functional in some situations.
One such situation is where a new opportunity has opened up, but taking advantage of it requires an intense burst of energy and enthusiasm, and a willingness to make a sharp and extended break from usual patterns and routines. Only people with an ability to become manic may rise to the top in such situations.
Another type of situation might be where a person has been fed way too many “negative” perspectives on themselves and on the world, and feels mired in that negativity. Getting manic or grandiose, just ignoring all the negative feedback and negative perspectives, might allow the person to get moving again.
In mania, our sense of moderation is lost. But there is some sense in the slogan “all things in moderation, including moderation!” Sometimes moderation is not the best strategy.
So mania can be seen as a high risk but still sometimes useful strategy. Of course, if one is getting more manic than is helpful in their current situation, that can be a huge problem, so people do need to learn to “rein it in” in order to avoid various kinds of disasters.
“Psychotic” Thinking: Psychotic thinking typically involves being open to forms of thinking that are uncommon in one’s culture, and/or to being closed off from, or rejecting, patterns of thinking that are culturally common. This can lead to all sorts of problems or errors, but common sense tells us that this same kind of process can also lead at times to new patterns of thinking that are truly helpful.
Research has shown that when people are trying to solve a problem but have no idea how to solve it in any straightforward way, that they open their mind to seeing all sorts of otherwise improbably patterns, and this can lead to what we think of as “psychotic” perceptions and forms of thinking. It can also, of course, at times lead to finding an approach that does solve the problem, which is why we have probably evolved to sometimes process things this way.
Research has also shown that when we firmly believe something, we are prone to look for evidence that confirms our belief, and to discount evidence that disconfirms it. Getting caught up in what is called “confirmation bias” can make us hold onto crazy beliefs – but it can also help us hold onto a helpful belief even in the face of social pressure to believe otherwise, because we learn to tune out that pressure, and only listen to the source of our truth.
Psychosis itself can best be understood not as an “illness” but as a high risk problem solving process. It can lead to a range of outcomes in the same way as does revolution in a nation, which can result in both utter disasters and also successful reorganizations that lead to thriving at new levels. In my own experience, being somewhat “psychotic” in my youth led to just such a successful reorganization, helping me overcome my earlier psychological deficits. But I’ve also seen family members and others fall into disorganization/attempted reorganization and stay stuck in it. Here again, just as in the case of revolution in nations like Syria, it often seems it is the “helpful” interventions of outsiders that prolongs the conflict and escalates the chaos.
A big problem is that if all of the above forms of mental and emotional functioning are really strategies, actually useful in some situations, then efforts to suppress them long term are inevitably going to be disabling to the person, as they are all in some way part of healthy functioning. Also, it is likely at some point the person’s mind with “fight back” against attempts to disable something which is actually vital to the person, and then, paradoxically, this “fighting back” will seem to make the suppression seem even more necessary. This also helps explain how “symptoms” typically seem to “rebound” whenever attempts at suppression, be they in pill form or mental efforts toward suppression or distraction, are interrupted.
When we instead see mental disturbances and disruptions as being possibly strategic, possibly helpful, then the focus naturally shifts to an emphasis on discernment. This implies a very different relationship with one’s difficult experiences.
Real mental and emotional healing happens when we come to value all the parts of ourselves, and integrate them into one whole, with an ability to call forward the parts of ourselves that fit a current situation. We do need the ability to set boundaries with various parts of ourselves, to temporarily suppress once kind of reaction (such as anger, sadness, etc.) so we can call forward some other approach that may better fit a current situation, but this works best when accompanied by the respectful and loving acceptance of the very parts that we are setting boundaries with – we know they belong with us and have their place, even if they aren’t what we need in the current moment!
When we recognize that a disturbing part of ourselves really belongs to us, then we are also more willing to empathize with it, to “go with it” or look at the world from its perspective for just a bit, to see what it wants to do for us, what need it wants to meet. This allows use to make peace with it, to integrate with it. Peacemaking and integration with parts of the self is often like making peace with family members, or neighbors: it requires a mix of concern for the other, along with some limit setting.
The opposite of integration is dissociation, the state we are in when parts of ourselves function separately and may even battle with each other. Dissociation is often thought of as something a bit exotic, but actually it is part of everyday life to some degree, and like other things, is a helpful strategy when it isn’t overused and so causes problems.
It is commonly known that severe forms of dissociation are usually a response to trauma. In a traumatic situation, our ability to balance opposing tendencies or possible strategies in our minds understandably goes out the window: the need instead is to quickly pick an approach and put all our energy into it, while suppressing everything else. But then when trauma is very intense or prolonged, we can have difficulty returning to balance, discernment and integration.
Instead, we may find ourselves at war with ourselves, even long after the trauma is over. One part of ourselves may want to remember and focus on the trauma and being hypervigilant and distrusting, to avoid chances of the same thing happening again, while another part wants to forget the trauma, and to relax and start trusting again so we can go on with everyday life. There can, of course, also be more complex splits. When we try and suppress some of the split off parts, they can come back as voices, and their seeming autonomy may make us want to focus even more on suppression.
So the paradox is that the more divided we are, the more suppression seems to be the answer, but in the long term suppression just reinforces the problem which is lack of integration. We do need the ability to set boundaries with parts of ourselves or with different emotions, patterns of thinking, strategies, etc., but also to find a place for all of these things and appreciate their efforts to be helpful and the sorts of situations when they actually are helpful.
There’s lots more that could be said on this subject: this blog post is just my attempt to scratch the surface! For those who are interested, many of these subjects are explored in much more detail, with a particular focus on “psychosis,” in a new online course I have just released, titled “Working with Trauma, Dissociation, and Psychosis: CBT and Other Approaches to Understanding and Recovery.” This course provides 6 CE credits to most US professionals, with lifetime access to the course videos etc. It is available until 6/1/16 for just $25, or even free to non-professionals, also just until 6/1/16.
One final point: I should emphasize I am not saying that physical health issues never play a role in creating psychological difficulties. They certainly can: it’s difficult to practice discernment and balance in our strategies when the brain is challenged by various factors ranging from substance abuse to various physical maladies or inflammation to nutritional deficiencies! So it always makes sense to see if any improvements can be made on such fronts, but what doesn’t make sense is to frame psychological reactions themselves as “illnesses” requiring suppression. Let’s move towards a wiser, more nuanced, and compassionate approach that can set the stage for real healing.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Coping strategies that we currently label as “mental disorders,” such as anxiety and depression, could be considered “essential,” but I like to add “at one point in one’s life.”
Most of these were learned in childhood due to loss of secure attachment with parents, traumas such as emotional or physical abuse or neglect, and evolutionary responses.
Many of these adaptive or self-protective emotional or behavioral responses are rooted in the primal need for survival. Anxiety or panic can be seen as fear, aka “fight-flight-or-freeze.” We react with fear to emotional threats just as surely as we do physical threats. Things like the negativity bias are helpful in physical survival — if we know that bears live in caves we tend to look askance at caves and avoid them. But these survival strategies, when learned as a young child, are then often implemented without a balanced cognitive ability to sort through the timing, intensity or appropriateness of these responses, becoming “OCD, anxiety, or depression.”
A child’s brain is just not developmentally able to do much more than react emotionally. A child thrown into “fight-or-flight” repeatedly, even if it is just due to living with a highly anxious or depressed parent, learns to react unthinkingly to any emotional threat, rather than respond mindfully and thoughtfully. Again, this learned behavior becomes labeled as “maladaptive” as an adult, even though it served a purpose earlier in the child’s life.
In my work “Self-Acceptance Psychology,” I outline Five Causative Factors that can be considered together as the reason for essentially all “mental disorders.” The fear or threat response (“fight-or-flight”), fear of social exclusion, shame as an attempt to prevent social exclusion, trauma, and attachment status all connect to trigger Three Shame Management Strategies.
I am proposing Self-Acceptance Psychology as an alternative to the DSM/ICD disease-based diagnostic framework. For much more go to http://www.SelfAcceptancePsychology.com.
Thanks Harper. It’s good to hear of your work along these lines.
Psychosis itself can best be understood not as an “illness” but as a high risk problem solving process.
Again, “psychosis” is a meaningless term which may be used to describe any number of things so it doesn’t make sense to discuss anything using it.
On the larger question, “symptom” is a word applied to behaviors which can have a wide range of origins, causes or meanings. One person’s “symptom” is another’s personality quirk. To label people’s behavior as “symptoms” is presumptuous and offensive in many cases, especially when it does not represent a problem OR a “survival strategy” to the person being labeled as “symptomatic.”
My rough definition for “psychosis” is that it means being out of touch with what others call reality, and/or disorganized, in a way that causes serious problems. Of course we are all somewhat out of touch with what others see as reality, and somewhat disorganized, so none of this is black and white. And a person can be out of touch with what others see as reality, but more in touch than many others with something that may be very important: so it’s sometimes complex.
I hear your argument that we should just give up the word psychosis, but those of us who are trying to be helpful to people with such issues need some way of talking about these kind of problems. Some use the term “extreme states” or “madness” but those don’t have super precise definitions either. In a way I think it’s good the term isn’t very precise, because in reality each person’s experience and problems are unique, there’s always a lot to explore.
But if we want to replace the mainstream approach, we need a coherent alternative view, which realistically frames both the difficulties people experience and suggests better approaches to resolving those problems.
False. The main objective of the anti-psychiatry movement must be to eliminate forced psychiatry. The alternative to forced psychiatry is NO forced psychiatry. It’s quite simple. Depending on who you mean by “we,” I guess.
In my line of work – as an “outpatient” mental health counselor, I tend to see people who voluntarily seek out psychiatric approaches because that’s the only way they know to deal with what seem to be the “symptoms” that disturb them. I try to show them that a different way is possible. I do think the problem starts with the way people are taught to understand what is disturbing them, though there’s all the misinformation, and lack of information, that they get about the drugs on top of that.
I try to show them that a different way is possible.
In other words you mean you encourage them to seek counseling outside the “mental health” system where they don’t have to worry about psychiatric labels and drugs?
The problem, so far as I see it, is that these “strategies”, “symptoms”, whatever you want to call them, arose out of forced psychiatric treatment. I also think they tend to be “strategies” rather than “symptoms” because we aren’t talking about real disease in the first place. Were it not for the initial exclusions of mad folk that forced psychiatry managed, this discussion wouldn’t be taking place. The institution as a survival strategy, if a very ineffective survival strategy, that is, a form of madness to complement any designated form of madness, came of this segregation. The way people get integrated back into community is by the abandonment of such lame strategies. By that I mean that “America’s most vulnerable citizens”, as the propaganda puts it, weren’t so very vulnerable at all, except in so far as it served the purposes of others.
In some sense, seeing as forced psychiatric treatment can make decent employment practically an impossibility, the treatment world does represent a survival strategy. A different strategy, a reasonable strategy, I assume is too much to expect. Reason, after all, and the whole treatment regimen, are completely incompatible. In that case, you would have to deal with people as human beings on an equal basis, and you’re not going to find that in the “mental illness” industry.
Another article that is extremely helpful in a practical way for our family.
“Instead, we may find ourselves at war with ourselves, even long after the trauma is over. One part of ourselves may want to remember and focus on the trauma and being hypervigilant and distrusting, to avoid chances of the same thing happening again, while another part wants to forget the trauma, and to relax and start trusting again so we can go on with everyday life.”
I wonder if this is exactly what we are hearing when we listen to our loved one have arguments with himself about whether or not he is allowed to “be okay”. (I would love to write more details but can’t for privacy reasons as it is not my story to tell……)
It is funny how long it takes (at least for me) to really understand new ideas that are different to my set way of thinking. I don’t know how many times I have watched Eleanor Longden’s video about “Stuart and his Voices” and how much I have thought about compassionate based therapy and yet still didn’t put it together that the ‘arguments’ we are hearing might be related to feelings of lack of self compassion rather than anger towards others or situations, (regardless of how/where the difficulties arose in the first place), and how further developing a compassionate self seems to be so crucial to ultimately solving difficulties.
I try to not say too much in response to my loved one, just make assurances that I am listening and trying to understand, but sometimes when I have made comments back along the lines of recognizing the need for self compassion (…about not blaming oneself etc.), the resulting calmness has been amazing.
Learning to be self-compassionate and self-accepting can be wonderfully powerful methods for reducing self-judgment and self-blaming. Negative self-talk triggers the brain and body into the threat response (“fight-or-flight”), which can lead to “symptoms” labeled as anxiety, depression, psychosis, etc, etc. The core is nearly always a sense of low self-worth or poor shame tolerance that triggers urges to attempt to fix perceived inadequacies through self-blaming. Check out Kristen Neff and Christopher Germer’s research and books on mindful self-compassion. Together they developed an MSC program that is excellent. Best of luck!
This is so good this site- its like a smorgasbord of insight- all the comments were good-th Self Acceptance Psychology looks good too- -and that write-up information was like music to my ears- really spoke to me- I felt like id been to the doctors- everything was looked at and checked- and then had that feeling- like when your leaving and everything is OK – and your feeling really good- thats what it did for me anyway- you really put it all together in my opinion- like a really grown up- evolved- considerate- expose- on why healing and- healthy- non coercive- treatment- matters- explained in an easy going way to- understand- hear-and take- in-and on board -ive already focused on a trigger- and the ignition- now I just need to get into this integration- and see if I can stop it all – the trauma- blowing me out- spinning me out- in such an auto way-, :-)- seen myself in their– all of that- that’s for sure- thanks for all that, everyone- Thanks Ron.
I like this article. A few comments on the “symptom” categories:
Anxiety and Worry – while reading this I was thinking that if our ancestors, the apes and primitive hunter-gatherer humanoids, didn’t experience anxiety and fear, then they wouldn’t have survived very long! The Cro-Magnon that didn’t get scared when he saw the saber-toothed tiger is the one that dropped out of our gene line! In this way it makes little sense to think of anxiety itself as a “symptom” or “illlness”; but rather as an essential life-saving evolutionary strategy. But like you said, it can become too great or too little for the circumstances at hand, and not “fit” the external reality. Or, it can once have fit an earlier, very threatening reality, but not change or tone down to fit a new later reality. This is one aspect of what transference is about in psychology.
Depression – I like the idea that depression is a signal that something is very wrong with some relationship or aspect of one’s life setting, a messenger, and one needs to do something about it. Some old forms of psychoanalytic therapy emphasized the ability to feel depressed and mournful for a limited period of time as evidence of maturity of character growth, versus the immature situations in which people ran away from feelings of loss into manic activity or avoidance.
Mania – I think there is an author called Tom Wootton, who wrote “Bipolar in Order”, who suggests that bipolar states can be adaptive and don’t have to be construed as a negative. I do not agree with his disease model framing, but it is interesting.
I like your idea about how getting grandiose and very active can be a response or fight back against negativity a person has been confronted with. I have experienced this myself. It is not an illness, just an attempt to do well!
Psychotic thinking – I also like the idea of psychosis as a “high risk problem solving process”. This is a a new conceptualization and an interesting one.
In severe psychosis, from the psychodynamic viewpoint, there are specific defenses which distort external reality heavily (I have personal experience of these). One of these is splitting – seeing oneself and others as totally good or totally bad and rejecting/not processing information to the contrary. In most psychotic states the focus is on all-bad views of oneself or other. This defense is very destructive, but it can also be adaptive because by preserving a few “all-good” images of oneself and others, one can avoid feeling hopeless in what may otherwise feel like a hopeless situation (e.g. splitting often develops in situations of severe abuse or deprivation, as a way of emotionally denying the reality of how bad/hopeless things seem, and thus being able to survive emotionally).
Another defense in psychotic is fusion or undifferentiated mergers. This means that the person literally believes themselves to be some other external object that has some quality they want. For example, a psychotic person might think they are Jesus Christ. This can temporarily make them feel powerful, but then obviously it quickly leads to negative effects and massive distortions. It is also profoundly unrealistic. I remember Vamik Volkan talking about “schizophrenic” clients who would walk into his office, put their hand on the chair, and say, “I, the chair, think that this is a comfortable room.” It illustrated how they would tend to feel merged with whatever they were near or touching, and did not have firm boundaries between their sense of themselves and others. In a trusting relationship, the sense of separateness can start to develop and a psychotic person can feel less merged with the environment.
I see the attempt to “suppress” or “Treat” “symptoms” with pills as being kind of like a crude attempt to divert or hold up a river stream by throwing rocks in it to block it. It might briefly work or divert the flow at first. But the pressure builds up behind the barrier, and it will eventually break through in some other way. Meanwhile the blocking of the stream does not change the source/cause of flow of feelings/issues from behind the barrier.
I once had a voice that spoke to me. I am going to copy here a little bit of some writing I am working on for my website about that experience:
By around age 16, I had begun to be terrified, hopeless, and isolated a lot of the time. I was struggling greatly to cope with school, the pressure to have closer friendships and date, and the impending separation from my family that would come at age 18 when I was expected to go to college. It was in my late high school years that I first began hearing the two voices. From about ages 17 to 23, I heard two voices speak to me.
Dudie the White
One was a helpful voice that also had a visual component; it took the form of a friendly ghost that looked like the little ghost Boo from Mario, or the ghost Casper from the cartoon. I would internally hallucinate this ghost and hear it saying encouraging things to me, “You can do it”, “Help is out there”, “Don’t give up”, “Keep trying to find someone” and so on. The origin of these commands was the strong feeling I had that I needed to find someone trustworthy to talk to about the terror and anger I was feeling. They were really the things I wanted to say to myself, but my mind said it this way because imagining a separate entity saying the encouraging words (while remaining unaware at the time that Dudie was a creation of my own mind) made me feel less alone than if I had just talked to myself in the way a healthier person does.
The ghost was named “Dudie”, because I would speak back to it and call it “Dude”, and then one day I began calling it Dudie. Dudie became like a companion that I imagined flying around with me. I imagined it to be a part of myself representing my soul, the vulnerable child-self in me, my heart. I remember imagining Dudie floating down the hallway of my high school with me, watching over me. Only I could see Dudie but not others, at least I thought so at the time. I was always afraid that harm would come to Dudie somehow. It makes me so sad to write this now… to think of how alone and scared I was as a teenager to need to hallucinate a companion ghost.
At the time, I deluded myself that Dudie was real, that a little ghost really was talking to me. It was my mind’s way of tricking myself into feeling that I was not as alone emotionally as I really was. By hearing the voice of Dudie speaking to me, I no longer felt so alone. Looking back, it was a brilliant survival mechanism by which my mind sustained me during periods of unbearable loneliness and fear. It speaks to the mind’s ability to fragment and deceive itself when the person feels they are facing annihilation.
Dudie the Black
Unfortunately, there was another Dudie that was not so encouraging. The first Dudie, the “good” Dudie, was always colored white in my perception, a color which I think symbolized purity, innocence, hope, and goodness. I also think that the fact that Dudie was a ghost may have symbolized that I felt part of myself to be emotionally “dead” and needing resurrection and redemption, although I wasn’t aware of this possibility at the time. The “good” Dudie – the voice which provided hope – was probably based on the few real hopeful experiences I’d had at the time with real people in the outside world. These included the occasional times my mother and I talked intimately, the few times I’d seen a therapist, and a couple of friends who seemed to show genuine interest and kindness. Without them I don’t think any good Dudie would have existed.
Anyway, the second Dudie was a black version of the first, with a mean streak. This voice, symbolized by a black ghost with sharp teeth, would shout at me things like, “You are doomed!”, “You’re going to die!”, “You should kill yourself!”, and when I was walking around my parents’ house, “You are in the House of Horror!”. It would mock me for doing anything wrong and tell me I was bad and evil and deserved to die soon. On occasion it would mock me, mockingly asking me to guess how many days I had left before I committed suicide. This made me so enraged. I remember it was always associated with feeling very afraid and angry, especially with feeling that my existence was threatened. The black Dudie was probably based on my father, who had physically abused me for years and was a terrifying, inscrutable figure, someone who you could never trust and never knew what was really going through his mind.
During the times I felt the most terrified and hopeless, the black Dudie was more present, and the white Dudie would be absent. And during times I felt less unstable, the white Dudie was correspondingly more present. The two ghosts never spoke to each other, and only one was present speaking to me at a given time. There was no grey Dudie. Looking back, this obviously speaks to the splitting (only experiencing all-good or all-bad feelings at a given time) that was occurring in my mind. At first, in my late teens, I was so terrified, and so emotionally isolated from others, that it felt like I was just trying to survive utterly chaotic, unpredictable emotional storms on a minute to minute basis. I couldn’t really reflect on the meaning or origin of the two ghosts as I can now.
This is getting long, but good post Ron and definitely identify with a lot of what you are saying.
For me, not judging “Dudie” as a symptom of an illness and seeing the meaning and adaptive strategy behind these “ghosts” was really important in changing the way my mind worked.
Good insights, BPD. At the risk of sounding self-promotional, in my Self-Acceptance Psychology work I characterize “splitting” as two main adaptive behaviors to deal with trauma, abuse, and lack of parental attachment and the resulting shame and low self-worth.
First, Self-Blaming involves attempting to “fix” oneself to manage feelings of inadequacy (Black Dudie’s recriminations could be considered as very Self-Blaming — You are deeply unworthy to the point that you should die. Depression can be largely framed as mostly Self-Blaming behaviors. Anxiety, especially behaviors such as “OCD,” perfectionism, hyper vigilance to criticism, etc, are also Self-Blaming.
In contrast, another adaptive mechanism is Other-Blaming: lacking in accountability, lashing out at others in anger or blame, refusing to be wrong or accommodate the viewpoints of others, refusing to hear criticism, etc.
Healthy individuals minimize the use of these two strategizes and can be self-accepting, or securely self-attached (Good Dudie!) with accurate self- and other-perceptions, self-compassionate, etc.
In this way, perhaps psychosis is merely very clear awareness of these contrasting responses to a threatening situation playing out in the mind. Fear is a very powerful emotion and we will do many things to try to manage it and calm ourselves down, even if these responses ultimately do not serve us well.
Thanks for reading my little story. Black and White Dudie are gone now, so I guess the Dudie that remains is more grey, although I don’t hear him anymore.
Your two mechanisms are related to an idea proposed by WRD Fairbairn, in a slightly different form: The Moral Defense against Bad Objects (blaming the self to protect the object, in his writing from the 1940s).
Both of these defenses you bring up are basically manifestations of a quantitative deficit of all-good self/other representations (primarily comes from neglect/deprivation), and/or conflict involving internalized trauma which gets replayed and defenses against (primarily comes from abuse). Gerald Adler, e.g. Borderline Psychopathology and Its Treatment was a good writer about this, as was Jeffrey Seinfeld, e.g. The Bad Object: Handling the Negative Therapeutic Reaction in Psychotherapy.
Since we are plugging ourselves 🙂 You might like to see my article, “Splitting Explained”:
So BPD, just checking on your current line — So you apparently don’t agree that psychosis is a meaningless term which means different things to different people, and hence is useless as a term for discussion? If not, do you have a logical reason why not?
Oldhead, I do think it is a pretty vague, generalized term, and partly agree with you.
As a very young person I studied psychoanalytic conceptions of emotional development – how we all need positive relationships, safety, support, etc in order to develop the emotional security to manage our feeling, start to function independently, and form intimate relationships etc. This was the basis of my worldview for many years and explains why I think as I do. I did also read writers like Szasz, Laing, etc. but later.
Following from that reading, I see “psychosis” (mislabeled schizophrenia) as a vague term representing the most severe, early disruptions or blockage of that process. There are two defenses called splitting (seeing oneself and others as all good or all bad and rejecting awareness of the opposite side of the split) and fusion (dedifferentiation, i.e. not being able to see oneself and others as separate entities emotionally). So it does have a certain meaning to me based on my understanding of emotional development and how it can get interrupted by trauma and/or lack of love and support. But I see it as relational, not as an illness. And, of course I know people are different and individual.
I would invite you to read my article about the developmental continuum here – https://bpdtransformation.wordpress.com/2015/10/19/27-the-kleinian-approach-to-understanding-and-healing-borderline-mental-states/
I hope this explains a little bit. I do value your thinking and have learned from how you think about these issues a lot actually. People don’t change their thinking right away; it takes a lot of work and interaction.
Also, I am not trying to be pedantic or speak like a shrink; this is stuff I learned that was and is useful to me.
The main issue I have with some things you say in a critical sense is that you overgeneralize. You may be spot-on in your analysis/understanding of a particular individual’s psychodynamics, but rather than limiting it to that one person with “so-called schizophrenia” you generalize that analysis to other “so-called schizophrenics,” as though saying “so-called” obviates your implicit acceptance of a “category” which doesn’t exist no matter what you call “it.”
I note the link & will read it eventually. But, though I was reading Freud in high school and like you have had some “formal” training in counseling (which I never took that seriously and never even considered trying to make money with), I’m not really that interested in psychological theories; to me the various permutations of people’s pained response to trauma and repression are just that, and the goal should be to overcome the system which feeds on the denial of the human spirit in deference to profits for the .1%.
Ok noted, but let me say I think it might be helpful if you would dwell more often on things that you agreed with or can add to in others’ thinking, rather than entering a discussion only to criticize what you disagree with. This is probably a criticism that could apply to me too.
Actually maybe it’s a projection on your part. I frequently give people props where I consider them deserved. On the other hand I don’t constantly praise my clock for telling the right time, but will be prompted to adjust it when it’s inaccurate. Plus if I agree with something why belabor it, someone already said it.
Haha, “projection”, isn’t that a little bit of shrink speak?
You do give some props, but you can do even better 🙂
And as for your clock, clocks need a lot of reassurance you know. If your clock is not showing its usual activity level and is seemin down in the dumps, you might consider taking it in to your local psychiatrist for a depression screening.
Haha, “projection”, isn’t that a little bit of shrink speak?
Projection is something people do, it’s an action not an illness. Or maybe sometimes a “strategy,” though not generally a well advised one.
You do give some props, but you can do even better 🙂
What am I supposed to be doing here, some sort of self-affirmation therapy?
Anyway, have a good day, see you down the line. 🙂
Thank you Ron for your insightful article. I say they are survival strategies of course. As I see it, they are things people have had to develop, and they come out of the family. They may not reach an epic scale until later, but they started as simply necessary ways to defend against irreparable harm occurring within the family.
I mean, to do what the family does, turning future Einstein’s, Mozart’s, Andy Warhol’s, and Elon Musk’s into Homer Simpson, necessitates that a child be severely harmed. And most go along with it. But sometimes for some reason there are some who at least partially escape.
As I see it, it all comes down to The Family and child exploitation. This is the middle-class family which is held up as an idea. It is not always your family or my family, but more often than not it is. This is what throws people into things like religion, recovery, psychotherapy, and psychiatry.
So we the survivors must organize and find ways to fight back. Live and let live is no answer, it is just another denial system. We need to organize and act, or we will continue to be abused as adults, as will the children of today.
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Thanks for writing and posting the article, I’ve thought for a long time that so-called mental illnesses were just maladaptive coping strategies but it’s since to see it broken down in more detail…would love to see more examples of your paradigm, for example in terms of OCD, various personality disorders, and so on.
(Also good to see that some of these perspectives are making their way into the system insofar as they count for Continuing Education credits, is there a light at the end of the tunnel?)
I think you’re ‘strategy paradigm’ makes complete sense. My theory on anxiety is that its mostly socially motivated, and depression might be to do with adapting to loss.
Why are we gathered around people with “symptoms” trying to figure out how they can get over them and “go on with everyday life?” Why aren’t we focused on finding out what is in our “everyday life” that is causing these “symptoms” and all the unhelpful and unnatural reactions to them such as incarceration, drugging, ECT, etc.?
Because then we would be talking politics, not “health,” and the code would be broken.
Certainly it makes sense to focus on prevention – but it also makes sense to help those who have already been hurt etc. For example it makes sense to try to prevent kids getting broken bones, but you don’t put all the dollars into prevention and neglect the kids who have the broken bones already.
And even if we make our families and schools and society more functional, I think some people will still have problems. Life is tricky, for example some kids get hurt even when they play on reasonably safe playgrounds. We are somewhat chaotic systems, breakdowns can happen, but we put ourselves together better when we can see purpose in all the different parts of ourselves.
The purpose of focusing on what in “everyday life” is causing the “symptoms” would be, first and foremost, to find helpful, holistic responses to stuff that happens in our chaotic systems. If we know the perfectly understandable reason behind someone’s anxiety, or depression, or mania, or “psychotic” thinking, or dissociation, then we can react with compassion and understanding instead of fear and loathing. It is interesting you used the analogy of neglecting kids who have broken bones. In my son’s first encounter with psychiatry, he was admitted to hospital with what could be described as the equivalent of a severely broken leg. Their “treatment” basically consisted of breaking his other leg, then telling us, ok, this kid is completely incapacitated and in extreme pain and the only thing that will help him is for him to take these heavy-duty medications that will numb the pain–but he has to keep taking them. If there had been SOME attempt to understand why he was having difficulty in the first place, perhaps his distress could have been alleviated in a caring, helpful, and healing way. As it was, he was much more than “neglected” as well as further traumatized after already suffering incredibly traumatic experiences.
even if we make our families and schools and society more functional, I think some people will still have problems
That’s scratching the surface. Only a revolutionary social transformation aimed at eliminating corporate rule and militarism will even begin to solve many “personal” problems at a collective level. Although you’ll be amazed at what “regular” people are capable of once they see a glimmer of realistic hope for real change, and a tangible objective to struggle for. The “prevention” that’s needed is political and economic, not medical.
You’re spot on when you suggest that ‘mental illness’ is not a real illness but a strategy used (usually unconsciously) to cope with a difficult situation, be that trauma, loss, abuse, neglect, etc.
Mental illness is not an illness. It’s a natural response to a toxic environment.
Also it’s not only the ‘mental illness’ that’s employed as a strategy to cope, but certain behaviours can be employed to deal with the distress of the ‘mental illness’. Depression for example may not be a real illness, but it is real and sucks big time, so sometimes a person might need something to cope with the coping mechanism. If you are in a dead end job or relationship, your psyche may unconsciously throw feelings of major depression or anxiety at you to kick your butt into gear to either fix the situation or get out of it, but if the environmental/social causes do not change then the depression/anxiety may stick around for longer, and those feelings can be extremely unpleasant so you may look for something to deal with the feelings of the depression/anxiety, such as self-harm, heavy drinking, or drug use. So self-harm, drinking, or taking drugs, although destructive, can sometimes be used as a relief/release from the feelings of whatever it is you’re feeling. So rather than self-harm/drinking/drugging being a ‘symptom of a disease’ it can actually be a conscious coping mechanism (destructive as it may be) to deal with the feelings of depression/anxiety/whatever which was an unconscious coping mechanism produced in response to environmental factors (that dead-end job or relationship) that were not corrected.
I think your point about how people can develop coping mechanisms for their own coping mechanisms that they are having trouble with, is very important! It suggests something which I think is true, which is that we can develop layers of such problems. None of it is well described as “illness” but it can be a mess. Still, it’s discerning what is what, and what is truly helpful in what situation, that helps sort it out.
This is a very good blog.
I prefer the term “coping mechanisms” a little better than “strategies” which implies a more conscious process on the part of the person dealing with these issues.
In my very first blog at MIA in 2012 titled “Addiction, Biological psychiatry, and the Disease Model” I wrote the following description to also cover addiction behaviors in this process:
“In opposition to the disease model we might find it helpful to conceptualize and understand both addiction and symptoms that get labeled as “mental illness,” more simply as useful coping mechanisms that over time get stuck in the “on” position. Let me explain. Human beings are driven to repeat behaviors that are pleasurable and/or take away pain, and they usually have sound cognitive rationalizations for doing so. These tendencies are very much related to our survival as a species, especially when you look at the drive to eat, drink, and procreate. In other forms of pleasure seeking and pain avoidance most people who use alcohol and other mind altering drugs more often feel very good in the earlier stages of their use. This is especially true when there are generally fewer negative consequences associated with their consumption. Some people have also postulated that human beings are, at times, attracted to altered states of consciousness. This can be a way to avoid boredom through experimentation, or, perhaps more often, become a creative way to escape or rise above the resulting discomfort or trauma experienced in a threatening environment. In the beginning stages of drug use, these substances may provide a temporary pleasurable escape from a harsh reality and/or become a very successful short term coping mechanism that actually prevents more dangerous reactive behaviors (including suicide), or perhaps even helps prevent the person from going “crazy.”
“Similarly, extreme states of psychological distress can lead to altered states of consciousness that are mislabeled as a “mental illness” and a “disease,” but could instead be better looked at as a creative and necessary coping mechanism dealing with an experienced and/or perceived hostile and threatening environment. This coping mechanism, as with addiction, may also prevent more extreme reactive behaviors or provide an escape or temporary relief from intense physical or emotional pain.”
“Here is the rub. A problem often arises with both substance use leading to addiction and also with extreme states of psychological distress, when these behaviors and related thought patterns are sustained for extended periods of time, the formerly helpful coping mechanisms can gradually, or even suddenly, turn into their opposite and now become primarily self-destructive, self-defeating, and socially unacceptable*. This is especially true when the short term benefits of the behavior and resulting thought patterns start to shift and begin to cause far more immediate, as well as long term negative consequences for the individual and the people around them. Some people may now actually get stuck in this new state of being and be unable to find their way out by themselves. This is the point when we might say that these once helpful coping mechanisms have now seemingly become stuck in the “on” position. * I am aware that socially unacceptable behavior can be both useful and necessary in changing the world for the better.”
It seems we are on the same page with this one!
One flaw I would see with “coping mechanisms” is just the “mechanical” emphasis. But that term also has some advantages as you suggest. Whatever term we use, the key thing is to recognize the way the same sort of response can help up to some point or in some situation but then not when things are different.
Some people have also postulated that human beings are, at times, attracted to altered states of consciousness.
An noteworthy aside: Timothy Leary (a clinical psychologist by education) once postulated seven levels of human consciousness, corresponding with the chakras, and correlated them with the effects (or foci) of various drugs. Alcohol and narcotics were associated with the lower chakras, speed with the ego, and LSD, psilocybin etc. with the higher, more “spiritual” levels. He also postulated the drive to alter one’s consciousness as equivalent to drives for food, water, air and sex.