Are We Witnessing the Emergence of a New Paradigm?

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Today’s prevailing mental health system still, to a large extent, functions on an old paradigm. This paradigm reduces mental health issues to supposed inherent malfunctioning characteristics of an organism.

This is, however, a specific way of thinking about things.

In this way of thinking, mental distress is seen as static—a predetermined category fixed in time and space, and usually, a body.

Close-up photo of the shift button on a computer keyboard, but it's labeled "Paradigm shift."Knowledge of things does not happen in a vacuum. It is usually embedded within a set of preconceived notions we have about things. There is a construction of knowledge that operates behind the way we think about mental health phenomena.

Thomas Kuhn explained, in his book The Structure of Scientific Revolutions, how currently prevailing assumptions we have of the world guide thinking within scientific communities. Scientific findings operate within what he called paradigms.

Paradigms are widely accepted models within science that constitute a framework of foundational assumptions that guide and shape research and theory, as well as practical scientific findings. Scientific research happens within this framework and it is interpreted within it. The solutions to common problems are found within this framework.

This also has an impact on the way we see things outside of scientific communities. Namely, the knowledge that is constituted in this manner is further transferred into what we regard as “common knowledge” and take for granted in our everyday lives.

The same goes for mental health phenomena.

The currently prevailing paradigm within the mental health field is a biomedical one. It sees mental health issues as categories of malfunction, with origins in (inherent) characteristics of the organism and which are to be treated as such.

“The chemicals in his brain are messed up,” is ubiquitous in public discourse, referencing a supposed biological causation when it comes to mental health—yet sufficient evidence for that has not been found. Gabor Maté has, for example, been speaking for years now against this notion.

The question is also whether this approach has proved to be the most effective when it comes to dealing with mental distress in the long run.

In contrast to the biomedical paradigm, the phenomenological paradigm shows that when one puts mental distress into categories and uses it in a prescriptive manner, there is a risk of losing focus of that person’s unique existence. Things that are detrimental to one’s healing can get lost. Further, the wider meaning of the process can be ignored.

For example, when a person is experiencing low levels of energy and motivation, loss of interest and pleasure, or fatigue, these are considered to be symptoms of the category of depression.

In the predominant biomedical system, these are seen as related to a person’s biology—fixed and predetermined.

However, when this kind of state is explored within the wider context of a person’s life, elements of a subjective sense of loss or a situation that is felt to be unbearable, deep down, are usually found. Perhaps the person has not been able to reverse this situation.

When we look at mental distress from that perspective, loss of motivation and low levels of energy can also be a way in which the organism removes itself from the situation that it does not know how to handle anymore. The subconscious seeks to protect itself, and if it has exhausted all “rational” options, it can resort to other means.

This is a very different perspective from the position that sees this state as a malfunction, an inherent characteristic of an organism that is fixed.

Thomas Kuhn proposed that, within the prevailing scientific paradigm, anomalies occur that the prevailing paradigm cannot satisfactorily answer. New theories are then needed to explain them. This causes a paradigm shift.

Perhaps this is what is currently happening in the field of mental health.

Increasing numbers of people are finding the perspective that sees mental distress as an isolated, static category, fixed within a biological predisposition or malfunction, to be insufficient. They see it as something that does not satisfactorily explain their experience and does not solve their problems.

They are seeking alternative solutions and different approaches to mental distress that offer more possibilities.

There are authors, therapists, researchers, who are working beyond the current model, many of whom are present on this website. They are scattered around the world, but I can see the dots connecting, often coming from the most unexpected places and spheres.

I wonder if these phenomena I am observing are intimations of a new paradigm emerging.

It is hard to describe this new emerging paradigm under one umbrella, since there are various approaches that could fall under it.

However, some of its “umbrella contours” can be noticed:

1.) The new paradigm moves towards seeing mental distress as meaning-making rather than just a deficit or malfunction. There can be a value in the process of mental distress.

As Carl Jung noted, our suffering comes from the unseen and unfelt parts of our psyche. Consequently, it cannot be reduced to a set of static biological determinants or categories. Instead, we should look for the meaning in the symptoms. What are they trying to convey?

2.) Psychological distress is looked at within its environmental context.
Intense emotional states are conceptualized as a complex response to environmental trauma instead of some inherent malfunction of the organism. They are divided into smaller parts of reactive physiological-emotional-behavioral responses that might result in a vicious circle of suffering, looking like a “lump” that is hard to understand and untangle.

However, instead of seeing it in terms of a static category, new approaches put greater emphasis on understanding how the complex webs of those responses work together with the perception of the context to create mental distress. They focus on locating the possibilities within that “lump” for a person to experience new orientation.

3.) Furthermore, there is increased understanding that the wider social context we live in might also be related to trauma.

We live in societal systems that are full of structural violence, such as the marginalization of certain social groups based on some of their characteristics. This kind of violence, embedded in social structures, is passed down through generations. Discrimination due to gender, race, or other characteristics is often deeply embedded within our everyday lives.

We are still only starting to understand how this can affect health. There is, for example, research that shows how racism is associated with poorer mental health. The same is true for discrimination against other social groups. Being continuously exposed to environments that devaluate one’s agency cannot have a positive impact on one’s mental health.

We are beginning to understand this on a societal level. It is becoming increasingly evident that mental distress has to do with one’s wider social context and the complex situations that are often related to those contexts.

4.) There is a growing demand for equality within the new paradigm. This can be observed within the context of the wider tendencies happening around the world in the last two decades; a move from hierarchical structures and a demand for more horizontal approaches within diverse social fields.

For example, we can notice this tendency in the field of politics where citizens are increasingly demanding to be included in the decision-making process. Similar movement can be noticed in the area of mental health.

These are some of the underlying principles that I see connecting different approaches that are arising in the last two decades and that could be interpreted as possible contours of the new paradigm emerging.

We must, of course, be mindful of the fact that paradigms change slowly.

Their “ways” are usually deeply ingrained within our everyday knowledge and this is one of the reasons why this change might take some time. It is the reason why public discourse still often functions on the premises of the old paradigm.

The main question today is how we can aid the emergence of a new paradigm when it comes to practice.

How can we create more awareness of the new orientations and approaches that operate on the above-mentioned principles? How can we embed the above-mentioned contours into concrete mental health support practices?

For example, how can open dialogue practices, as well as practices operating on similar principles, be transferred from local contexts where they have been established to other social contexts?

How can they be made available to wider public?

If we are seeing a new paradigm emerging, and I am hopeful that we are, we need to ask today: What is it that we can do to aid its emergence?

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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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24 COMMENTS

  1. As a previous Psychologist, thereafter victim of drug companies shocking to learn about possibility of ‘chemical imbalance’ may not be factual. My assessment of Bi Polar did not take into account traumatic head injury, as for thousands of patients there is no scientific test for many DSM classifications. There is no doubt that anti psychotics contributed to my cognitive decline, memory loss & mental impairment. Had to find a general doctor to reduce now lowers doses together with hopeful employment as a Criminologist. ‘Disease’ ‘chemical imbalance’ can take away personal power for healing. Dr Carl Jung was barely mentioned during our psychology degree deemed unscientific, cannot be measured. Many years of statistics was a disappointment. For myself & thousands of people on Facebook withdrawal from psychiatric pills is very difficult, for myself almost had a stroke. There was no sorry from government officials or medical people. Facts are DSM classifications are ahistorical, change over time, symptoms overlap with other mental disorders for example it is not uncommon for mental health professionals to disagree an official diagnosis when assessing same patient for preparation of a court report.

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  2. Iva Paska,
    As an independent scholar who is very interested in the emergence of a new perception in ways we see and treat “mental illness”, I find your ideas encouraging. I’m glad the “dots are connecting” and that more will begin to renounce the faulty idea that the brain is like a “machine” that needs to be “fixed”. A new paradigm must be found by looking at what consciousness and mind actually are–this is beyond the realm of science.
    Thank you.

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  3. “Thomas Kuhn proposed that, within the prevailing scientific paradigm, anomalies occur that the prevailing paradigm cannot satisfactorily answer.”

    Millions dying and becoming disabled/chronically ill and gaslit by the health care system is not an anomaly, it’s an epidemic.

    I would replace the word paradigm with: propaganda machine fueled by greed and plays for power which many in society bought into, not because they thought the biomedical model was objective, scientific, rational, or in any way correct, but because it served their agendas and because the people getting hurt had already been sufficiently other-ed that almost no one cared.

    The umbrella points in the new paradigm are great, but did society ever not know these things to be true? It seems to me that a tacit agreement was made to buy into the propaganda machine which served everyone except those who got tagged with the “severely mentally ill” label. It let everyone off the hook for helping out their fellow human being, because everyone started to “know” that the problem of a suffering person was medical, that the solution was for them to be medicated by a psychiatrist or the like, that it was better to stay away from toxic people (the diagnosed or needing-to-be diagnosed mentally ill), and the kind thing to do was instruct them to seek professional help, talk to a therapist about that, etc. This was all part of the propaganda machine. It was never about knowledge. It was about money, power, and the convenience of being able to cut people out of one’s life who make them uncomfortable and still feel good about oneself.

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    • That explains everything that is happening shock pain and moving away from isolation. As part as part of the establishment made a lot of excuses for people charged for a crime, one of my supervisors said “Peter if you feel overloaded just cut & paste any DSM classification for people you are assessing”, thereafter take them to general doctor get them on “something”. Didn’t know this paradigm was keeping people sick had no idea I would become a victim of psychiatric abuse, up went anti psychotic pills month by month, testing “levels of effectiveness” what happened next ? Lost my career due to poor judgment had no idea it was medication causing cognitive decline and anxiety. At the moment it feels like a bad dream. Would get on trains having little memory of my actions…off to psychiatrist next day “Peter this is part of Bi Polar”. Reply “I am having memory problems could it be all this medication ?” “Falling out of bed onto the floor?”. Reply “Book tells me it’s safe!”. Fortunately for myself managed to get away from this person.

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  4. How many more victims will there be until the new paradigm arrives? My adult son who witnessed me suicidal, drugged, labeled, brain shocked, drugged some more, a downward spiral with no actual help or safety anywhere, has been extremely suicidal for years. It’s gotten worse. I can’t tell him to “get help”. We know what that means. I live every day in total isolation and paralyzing fear and grief.
    There are NO resources for people in our situation. None. That’s the reality. Once the mental health system sends you to hell no one will help or even believe you.

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    • KateL,

      That’s the tragedy and injustice of it all. But at least now with the internet there’s a greater chance for things to change.

      And my understanding is that profound change starts quietly at bottom and slowly filters upward, kind of like a reverse “trickle down”. And the powers that be are always the last to find out, meaning they’re usually caught by surprise with their pants down. And for some reason, I think it’s worth waiting for —

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  5. I have a few thoughts and questions, but I fear I will be blocked, deleted and or banned if I mention/ask them. For a website to advocate for those who have been mistreated by so many, it seems paradoxical that those who challenge some of their claims commonly made here are themselves discounted, insulted and abused.

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    • Posting as moderator:

      If you are feeling abused by a specific post, please inform the moderator by emailing me or hitting the “report” button. It is unfair to community members to make blanket assertions that you are being “discounted, insulted or abused” without citing specific instances, not in the comments, but to the moderator to be handled, edited or removed. Everyone is welcome to their own viewpoint, and passionate disagreements to occur and are welcome, but only as long as they remain civil, which means no personal attacks and no generalizations about groups of people based on their belonging to a particular group.

      Please contact me at my email address if you need further clarification. Respectful disagreement is not the same as insults or abuse, and I am here to make sure that we allow the former but not the latter.

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  6. This article does not really say anything, certainly nothing that Thomas Szasz did not articulate years ago or go beyond the doubt any half intelligent person experiences when offered copious drugs for problems in their life.

    For anyone to be taken seriously and propose a real paradigm shift (a model which approximates reality better than the current one), they must provide an articulated description of that model that can be tested, discussed and scrutinised, not just “see the dots connecting, often coming from the most unexpected places and spheres.”-what does that even mean?

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    • I agree Paul. The “new paradigm” suggested here doesn’t sound much different than that of Szasz or RD Laing 50 years ago. IMO, and even bolder step forward needs to take place – a paradigm that fully embraces the inherent spiritual dimension of these experiences. Once that happens, deep healing, for the “patient”, family and society is no longer out of reach.

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  7. One “new” paradigm that is making inroads is radical enactivism in cognitive science. When it comes to helping others a proposal is to strip “therapy” (if you want to call it that) down to the minimum – and that appears to be not more than asking “what is you preferred future” (or a similar question), and “what help do you need to get there” (or some variation of that). All other questions are “ornamentations” which may dress up your help-giving a little but are not essential. Existing “therapies” maybe compared – eg the nurtured heart approach comes close but biomedical psychiatry doesn’t.

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  8. There have been postings about the attached website before, but as one step toward a new paradigm, and about 180 degrees to the current bio-medical belief system, this might be of interest: the Power, Threat, Meaning Framework, which doesn’t obsess with focusing exclusively on the myth of autonomous, individuals, in isolation from their environment, others, etc. From the website, “The main aspects of the Framework are summarised in these questions, which can apply to
    individuals, families or social groups:
    ▪ ‘What has happened to you?’ (How is Power operating in your life?)
    ▪ ‘How did it affect you?’ (What kind of Threats does this pose?)
    ▪ ‘What sense did you make of it?’ (What is the Meaning of these situations and experiences to you?)
    ▪ ‘What did you have to do to survive?’ (What kinds of Threat Response are you using?)
    In addition, the two questions below help us to think about what skills and resources people might have, and how we might pull all these ideas and responses together into a personal narrative or story:
    ▪ ‘What are your strengths?’ (What access to Power resources do you have?)
    ▪ ‘What is your story?’ (How does all this fit together?)”

    https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework

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  9. In point number one Dr. Paska says, “As Carl Jung noted, our suffering comes from the unseen and unfelt parts of our psyche.”

    This was Freud’s hypothesis. And I think it’s the only reasonable thing he ever said.

    But it has always been my sense that an existence of an unconscious and how it affects us has always been part of people’s consciousness, going back to antiquity, as I found this kind of awareness while reading myths of from ancient cultures, or biblical stories and proverbs from different faiths, and especially from reading some of literature’s great classics. Indeed, the wisest characters would invariably make devastatingly perceptive comments regarding people’s motivations and suffering, with some of these coming from the youngest and simplest of characters.

    And from this what do I extrapolate?

    That the scientific paradigm is useless in matters of soul and psyche, as perception and wisdom are not scientific.

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  10. If I may, I will posit that the whole idea of mental health being anomaly is the problem.
    How does a doctor know they do not have mental illness? This is a simple question. If one cannot prove they are healthy, then one cannot judge what is health versus mental illness.
    It is so lopsided.

    Another question: What do racism and mental illness have in common?

    Both disregard human body and autonomy.

    The paradigm shift that I foresee is not pathologizing subjectivity and freeing the body by focusing on its health rather than focusing on the mind (after all the mind is developed much later than the body).

    The brain is information hub. Information comes from the body. Just like the heart circulates blood that was made in the bones.

    We are so confused, it is embarrassing.

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