Mental Health Is Our Common Wealth

Fear and Grief Are Not Mental Illness (... and Never Were): A Mad in America Urgent Conversation.

Kermit ColeJustin Karter
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“The pandemic is a portal. We can walk through it with our dead ideas. Or we can walk lightly, ready to imagine another world.” —Arundhati Roy

 

Please join us for an MIA “Urgent Conversation” about diagnosis and treatment in response to trauma in the COVID era.

Please register HERE.

 

 

Concepts of mental “illness” have always been employed to explain people whose degree of distress threatens to overwhelm our ability to understand and respond. However, in times of shared stress such as war, veterans’ extreme reactions—shell shock after World War I, battle fatigue after World War II, PTSD after the Vietnam war—were understood in context, and society responded with support, gratitude, and a healthy awareness of the majority’s good fortune in being spared the same fate. Similarly, after natural disasters, or childhood trauma, we are often (if not always) able to understand in context reactions that might otherwise be seen as “psychotic,” and give people what they need.

Absent observable traumas, however, those who have fallen on the back side of society’s bell curve and suffered the consequences are often misunderstood, if they were heard at all. Their unmet efforts to be understood may become increasingly strident or bizarre, or they may give up completely, in the face of a society that has yet to hear the words of those whose experiences reflect society’s unrealized potential to care for its own.

In the COVID era we are all affected to at least some degree by these unmet ideals. So far empathy for those in distress is sufficient to direct energy and money toward supporting people in distress, without thinking they are mentally “ill.” Peter Kinderman, in discussions leading up to this panel, spoke of the U.K.’s notable response to those in crisis as a shared social response to trauma, rather than as a “mental health epidemic.” However the time may come that worries about frugality and a loss of collective will—fueled by the opportunity of profit—will lead to a search for “cures” for otherwise perfectly explicable trauma.

In the midst of this pandemic, tools of pathologization continue to proliferate. The American Psychiatric Association currently has a proposal to add “Prolonged Grief Disorder“* as a new diagnosis to DSM-5 (Depressive Disorders). In a time when many are losing loved ones and unable to bury or grieve their deaths in accordance with their wishes and traditions, efforts to characterize diverse responses to grief as disordered and abnormal are particularly egregious. In addition, the US is moving toward expanding universal depression screening in primary care for adolescents.** Standard screening instruments are unable to account for heightened symptoms resulting from social and environmental stressors, and therefore risk diagnosing an ever-increasing number of young people with mental disorders for simply exhibiting normative responses to world-changing circumstances amid increasing uncertainty and precarity.

Many have noted that Sweden has chosen to not go the route of a nation-wide lockdown, and have so far avoided mass infections. Panelist Carina Håkansson notes, however, that this success is in the context of Sweden’s leadership exhibiting a significantly different approach than has characterized the past decades of psychiatric diagnosis: an ability to publicly say “We don’t know.” Carina points out in addition that there ARE things we do know that have informed Sweden’s success so far in containing the virus: that we need to cooperate, that we need to look after each other, and we need to have solidarity.

Panelist Noel Hunter spoke of her personal journey through New York’s COVID crisis, and the similarity to her experience with psychiatric diagnosis and treatment. In the context of inexact or entirely absent criteria for diagnosis, she relates, she experienced yet again being disenfranchised and feeling gaslit by an entrenched system of treatment that had little or no help to offer. Laura Delano’s experience with withdrawal from psychiatric medication and the diagnoses that incurred them provide an important lens and skill set with which to assess the perils and opportunities we are encountering now.

We hope that as we emerge from the COVID crisis we can avoid repeating the last decades’ mistakes—mistakes referenced in Thomas Insel’s famous statement shortly before leaving his stewardship of the NIMH that “while DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each … The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

The opportunity to shape our understanding of mental health and its contributors, reflecting the ways that we are all responsible for—and share in—it, could not be more compelling than it is now. Join us to discuss how we can use this moment to strengthen our capacity to understand each other’s distresses, and respond to them as we move into the uncertain future together. Now, as ever, none of us is stronger than the most vulnerable among us. As the world has been driven into retreat, and the global economy is faltering, there could not be a better or more necessary time to reflect on the possibility that, in very real ways, mental health is our common wealth.

*The “Prolonged Grief” proposal is open for public comment on American Psychiatric Association website: https://www.psychiatry.org/psychiatrists/practice/dsm/proposed-changes

**The U.S. Preventive Services Task Force posted this week a draft research plan on screening for depression, anxiety, and suicide risk in children and adolescents. The draft research plan is available for review and public comment from April 30, 2020, through May 27, 2020. To review the draft research plan and submit comments, go here.

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

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]
Justin Karter
MIA Research News Editor: Justin Karter is a writer, researcher and community organizer with graduate degrees in both journalism and community psychology. He is a doctoral candidate in Counseling Psychology at UMass Boston, an active member of the Society for Humanistic Psychology, and is currently working on several scholarly projects at the intersection of psychology, social theory, and political philosophy.

20 COMMENTS

  1. “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

    “consensus” is a tricky word. Following along with an idea is not consensus, and so, psychiatry is not even consensual within their community. Consensus cannot be proven or disproven and so we cannot even factually use the word. Psychiatry is not only oppressive to it’s clients and the world in general, but oppressive within it’s hive.

    I don’t consider it “clinical” to be observing behaviours. That is ONLY within the dictionary of psychiatry and even general medicine, which oddly enough, the majority of misinformed public has adopted.

    Social constructs, however much in delusions, cannot ever be called “clinical”.

    I doubt any opinion of the public regarding one more “diagnosis” will carry any weight. It is curious though… If it is a “clinical” or “illness” or “pathology”, then why the opinions? Obviously cancer specialists do not have a place to leave “public opinion”.

    Psychiatric “diagnosis” are after all “opinion”, marketed as “disorders”. More and more, the word disorder is used, those sly foxes that they are. They refrain from using words such as “abnormal”. Psychiatry cannot exist without linguistics. It sure takes a ton of work to try and keep the boat afloat. And ALL for personal reasons of maintaining a job. It has zero to do with wanting to see a fellow man do better.

    A true pathogen, the virus that we all need to be inoculated against is psychiatry. Covid is nothing compared to that man in the chair.

  2. And what exactly is “prolonged grief”?
    So it is psychiatry that sets the time of normal duration? And HOW exactly is this done? By a scientific method?
    And what solution is there for their “prolonged grief”?
    So “disorder” is basically a word that replaces “abnormal”, a “disorder” is a deviation from “normal”. Yet psychiatry cannot and will not use this word. For some reason they believe they can defend the word “disorder” more convincingly than if they say “abnormal”.
    Does that word sound “more medical” to the gullible?
    I’m just so embarrassed for a society that buys this shit. I don’t know why. Why am I embarrassed for psychiatry?
    It must be a painful existence for many psychiatrists, to keep living this lie, and there is absolutely no possibility that eventually a psychiatrist could not come to the conclusion that it is all a lie. It is only if he lives in a total delusion that he could keep doing what he does.
    I think it’s the grief that psychiatrists don’t want to feel. The grief of abandoning their identity. There are therapists to help them deal with it, although sometimes, you can suffer from a prolonged or even endless grief, yet it is still not a disorder.
    To leave psychiatry behind, is like leaving family that might be “toxic” (a word I HATE), so we will say, leaving a system that keeps you in it’s grasp, a grasp that is not conducive to one’s full potential, or ones full expression and acceptance.
    Psychiatrists limit their peers, limit them to not being able to be expressive in the full sense. The reason we have so many religions and even within, so many sects and denomination, is because of expression about beliefs. Many were indeed killed for veering from beliefs.
    There is absolutely NO POSSIBILITY that all shrinks believe the same thing. They are simply pressured by peers, ideals, money and pride/honor and the fear of losing something, and the fear of anxiety and grief.

    • I love your last paragraph! I think it gets to the core of why very few within the ranks question the basic assumptions of psychiatry. I was a dissident voice in the “mental health” field and I can tell you, it is not a comfortable position!

      I do take issue, though, with your assertion that “there is absolutely no possibility that eventually a psychiatrist could not come to the conclusion that it is all a lie.” There are certainly psychiatrists and other “mental health” workers who have come to this conclusion from observing the fact, though admittedly, it is a small minority by my observation. I would suggest that it is very difficult to work in this field at all after having drawing such a conclusion, and most who do so will be unable to live with themselves if they continue to practice as they have done in the past. So they mostly leave an do private work or find another profession. Very few remain in the public “mental health” system once they see what it is actually doing, and those that do, I admire for their courage.

      • I totally agree Steve…I definitely know that there are psychiatrists that leave.
        I never finished my sentence, thanks for the heads up.
        (Correction)
        “…no possibility to come to the conclusion that it is all a lie, without acting or leaving”

    • I wish I had known this so many years ago OH.
      I have experienced pangs of shame, about being “anti-psychiatry”, well not really “shame”, but an internal knowledge, that “it” can’t be broached or talked about even in some alternative “mental health” circles. And that is a “shame”.

      I get it, I get that we can’t always become militant in “nice” public settings lol.

    • Speaking of wealth, I felt obliged a few days ago to contribute a tiny token to MIA, PURELY based on the therapy I have received from the site existing, from the site having members who I have benefitted by reading.

      Money is a funny thing. Theoretically we could just print a bunch, couldn’t we? lol

      I hope this covid thing is not impacting MIA and staff too much, realizing how we all need to buy groceries.

    • Of course. We are heretics, we should be proud.
      I would not have it any other way. They reveal themselves by using this against people. I doubt they would get much respect even from pro psychiatry folks.

      I mean it is getting SO pathetic. They are acting FAR from educated, far from any dignity left. They have much less dignity than the inmates.

      I am SO VERY HAPPY that my family has no shrinks in it’s background.

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