“Impairment: Says Who?”: The Fundamental Question of Mental Health Treatment

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One of the defining features in the socially constructed mental disorders in the DSM is the concept of “impairment.” In order to get a diagnosis for certain mental conditions, significant distress or disturbance in functioning in certain areas of life is required. Functional impairment may seem like a clear criterion on the surface, but in practical application, it is not in the slightest.

Some important questions to consider are: “Who defines the concept of impairment?” and “How is clinically significant distress analyzed as a construct?” Impairment itself is subjective, and the amount of discourse this topic has in the mental health system is sorely lacking considering its importance in clinical settings.

A male doctor looks slightly angry at a woman who looks sad in profileWhen is someone impaired in functioning? If the client gets to decide when they are impaired, answering the question is entirely in their hands. However, as happens so often in the mental health system, this is defined by other people: parents, clinicians, courts, employers, and so on. Rather than the client seeking therapy, medication, or hospitalization when they feel it is the right for them, others decide that they “need it.” This is where a lot of damage starts.

A parent may see that a formerly high-performing child is experiencing distress from inescapable bullying at school and thus avoiding going on certain days. The parent hires a mental health practitioner, keeper of the social order, to look for signs of distress and impairment in the child. The practitioner determines that the child is experiencing shame, sadness, and a decline in adherence to their scheduled activities. The practitioner then diagnoses them with Major Depression. The diagnostic paradigm encourages people to see the child’s behavior as being caused by illness, rather than understood as an adaptive avoidance of oppression. The child is pathologized, reeducated, and potentially drugged, made to see themselves as ill for not upholding the order that their parents may desire for them.

A clinician may be brought a person who is dressed in a manner society considers bizarre. The person believes grandiose about things themselves which the clinician thinks are untrue and culturally inappropriate. The person being assessed treads off the beaten path, engages in copious intercourse, and upsets some people with their brazen nonadherence to social conditioning. They may feel perfectly comfortable with their personality, but the clinician views them as a manic individual to be reeducated and drugged into normalcy.

A family member may see someone close to them begin to hear voices which are not real and then withdraw from social events. In an environment where society can define impairment, the voice hearer’s withdrawal is viewed from the family member’s point of view as an impairment in social functioning rather than from the voice hearer’s point of view as a step back from society to process their thoughts. The voice hearer is pathologized as a psychotic individual to be locked away and drugged into a being that the family member and clinician perceive as functioning in a more normal way.

Police of an oppressive state may discover an underprivileged individual trapped in exploitative or otherwise abusive circumstances is thinking about suicide. Instead of engaging with the individual and trying to understand the situation, the police force the suicidal individual into a locked ward to be given coercive treatment. Consensual dialogue is not considered viable, as the suicidal individual has been unpersoned. They are overseen and incarcerated by people with biased motives, denied almost all human rights. Their situation is not fixed by their arrest; in fact, it may get even worse, as they can fall behind on obligations foisted upon them by the social order. They are, however, coerced into behaving in a way their keepers find satisfactory for long enough to be released. Suicide, in the eyes of the government, is always irrational and wrong; policies penalizing it must be enacted, regardless of the effectiveness of those policies.

Every person previously listed is a complex being with their own concepts of healthy behavior, correct decisions, and the role of experience in a greater social context. The individuals subjected to coercive treatment may be experiencing very real distress leading up to it, but view the role of their distress differently than those around them do. For a variety of different reasons, individualizing and pathologizing people’s behaviors can bring comfort to mental health practitioners, family members, and society as a whole. Untangling a web of cruelty, oppression, and trauma is more difficult than neatly categorizing and drugging people in an attempt to fix them as individuals while ignoring the problematic structures they are immersed in.

Puritanical, strict norms about what is considered acceptable thought and behavior have been a consistent issue with mental health treatment. When used as a form of social control, toxic countertransference becomes evident: the client is no longer a person with self-determination, but the embodiment of an illness in need of reeducation and drugging. International human rights and treatment guidelines have lacked importance to those in charge of regulating the psychiatric system, as people who think and behave in certain ways must be made “healthy” according to what society defines as normal. Innocent oppressed or eccentric people are “insane,” and thus are subjected to the “sane” man’s burden to correct them.

There have been many criticisms of the mental health system throughout the years, but many of the most striking ones boil down to the concept of impairment, who defines it, and how to address it. The use of psychiatry as social control has been contentious for decades, and the debate becomes ever more relevant as increasing numbers of people are being subjected to coercion. Am I impaired when I say so, or when you say so? And if it’s when I say so, do I get to define the limits and nature of that impairment, or do you?

When faced with criticism about people other than the patient defining impairment, defenders of psychiatric coercion often bring up increasingly “extreme” examples which are not representative of typical victims of coercion. Before addressing these extreme examples, it is important to stop and ask if such extreme examples are simply being used to justify the widespread use of psychiatric oppression in cases that have no resemblance to what is presented. However, even in such “extreme” cases, rarely does the person bringing them up address what steps were taken before resorting to coercion.

For example, they may talk about an individual in an apparently altered state of mind who is yelling about how he is going to kill himself because the government is after him. He believes killing himself is the only way to get the government to stop being after him. This, to the coercive psychiatry defender, is a situation where forcibly locking him up and drugging him would surely be appropriate. However, the critic would stop and say: what else can be done here? A man has a potentially life-threatening misconception; how can it be managed or corrected?

I have talked to such a man in a life-threatening delusional episode myself. I was also the alleged government operative that he believed was out to get him. He was yelling that he would kill me by killing himself. Your standard coercive psychiatrist would call 911 here; I did not. I was patient. I insisted he would be fine. I continued talking to him and distracting him. It took some patience, but he got through the emergency eventually. It took maybe 10-15 minutes of talking, and he calmed down and woke up fine the next day. This worked by treating him as a man with a misconception who could be reasoned with, rather than an embodied illness in need of psychiatric control whether he wanted it or not.

Losing patience with someone who is acutely distressed or disturbed is never the right way to handle a situation. There are always better means, such as starting by simply talking to the person. Plenty of people, all over the world, talk others down from immediate life-threatening situations without arresting those people into wards or drugging them. Having policies authorizing force in place merely terrorizes people or prevents them from opening up. Treating people with extreme distress, or even dangerous misconceptions about reality, as fully human and able to be reasoned with is the most humane way to go about things, even in life-threatening circumstances.

Forced hospitalization and forced drugging are examples of toxic countertransference for this reason: People are disturbed by someone’s thoughts and behaviors, so they lock that person away and drug them into compliance. It has nothing to do with beneficence towards the distressed individual; it is about out-of-sight, out-of-mind social control. They assume that people with extreme emotions and sometimes misconceptions are too ill to be reasoned with; that ableist assumption propels them to justify things they would otherwise consider to be crimes against humanity.

To be truly humane, the distressed person’s experiences, desires, and wishes should always be centered. Treating people, even people with dangerous misconceptions, as fully human and not “too impaired” to be reasoned with is always the best way to go. It would be helpful if, instead of defenders of coercive psychiatry concocting imaginary and increasingly extreme scenarios to defend the status quo, they would address the fundamental problems with their premises. Once you challenge their ideas, they tend to move the goalposts further and further into hypotheticals that never occur in reality or are so rare they have no relevance to standard clinical practice. Their opinions only thrive by completely ignoring the mass-scale violations of bodily autonomy that are occurring.

Regardless of whether one buys into the pathological paradigm regarding distress and delusion, humanizing therapeutic methods should always be used. It’s a framework that has consistently aged well, and one no one would look back at in a few decades just to wonder how humanity went so wrong. People look back and say they cannot believe how lobotomies used to be done, and they are likely to look back not believing the forced hospitalization and drugging of today used to be done. However, no one would ever look back and say, “I can’t believe you treated that suicidal person like a human and reasoned with them to deescalate the situation.” Thinking about everything in healthcare, especially psychiatry, in a broader historical context can help to increase understanding and vision for the future.

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Crystal Nelson
Crystal is a student of clinical mental health counseling at West Coast University. Her undergraduate background was in physics at the University of Washington, but she realized over time that her greater passion is in mental health advocacy. Upon learning about the corruption in the American mental health system and some of its nonprofit fronts, she took to digging deeper. She began connecting with survivors and other advocates to pursue positive patient outcomes over profits.

46 COMMENTS

  1. Crystal,
    I do think the examples you gave do show ‘impairment’, but the better question might be, “why?”

    When our son was being bullied at the church we were attending, we left and found one where he was treated correctly. There was nothing wrong with our son. It was a toxic environment that needed to be addressed.

    When my wife began hearing voices and other ‘extreme’ things, we…very slowly…began to deal with the trauma she had experienced. It’s not that she isn’t ‘impaired’ somewhat but there is a reason for the ‘impairment’ and it’s not the ‘mental illness’ garbage typically spouted, but like Mad in America advocates, it’s typically trauma driven. Deal with the trauma (and dissociation) and then the ‘impairment’ should cease. If not, it may take a little more effort, but it’s still no excuse to treat the person inhumanely. Just affirm, validate, empathize and whatever else the person needs to help them back to a more healthy life.
    Sam

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    • Hi Sam,

      Thank you for your comment! I think there is a such thing as impairment, but you are right in that it’s best to find the root cause. I don’t think it’s always trauma, at least not as traditionally defined. There are other contributors, such as physical health problems, oppression, and a lack of purpose, though I suppose one could include those as trauma.

      Addressing root causes is really crucial, but not something I get into too often since root causes are so individual. I think it’s important to examine what impairment even is to begin with though, because parents who want their kid to behave a certain way can get their kid dragged in to get “treated” for ADHD, or ODD, or bipolar, etc. even if there is no obvious problem to outsiders. The parent can pick out things they think are problems and pick the psychiatrist to drug those problems. There is no real standard that’s even semi-objective for these things.

      There are also plenty of people who are, say, bipolar, but it is not a disorder for them once they fit their life around it. For example, maybe a 9-5 is not right for them, and they work in more creative bursts. For them, arranging their life around their tendencies may be better than trying to get deemed “disordered” and take pills in an attempt to fit in with a cultural norm. Making these kinds of accommodations is easier said than done in the world we live in, though.

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      • I am a permanently and mentally totally disabled person by society’s set standard. My decades of experience taught me that the bottom line root cause is the trauma created by living in a patriarchal system. Patriarchy is THE problem in the world that births every other problem in the world including the concept of impairment and subsequent “treatment”.

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      • Thank you for your comment it was very true to me. Abuse of a child should never be named an illness just because the victim is experiencing nightmares and everything else that goes along with that. I suffer every day from very traumatic experiences I’ve been through.

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      • I love the article also, it is so good to hear. I’ve spent a lifetime finding cures for the part of my upbringing that silenced me, cultural and circumstantial. Then I helped a small number of others through details of their usual distress, got my youngest brother with his disabilities to stop having ongoing seizures, when I helped him be calmer when discussing his performance in the physical world with others – previously he would get aggressive as if a boss or helper was trying to belittle him, or he would mentally drop out, gradually drop out of paying attention, and start seizures. When I helped him by pacing the lessons he did not get at home, about looking at physical tasks with another person (he was born clumsy and with developmental disabilities, so he could not imitate behavior like folding clothes or doing chores, and was praised instead of helped to learn). Once he realized that he can learn from another person, not have to ignore them since they never went carefully enough to see him try to do a task on his own, it helped him feel less fear around listening to me and to bosses. I taught him (over 2 months_) to safely ride the subway system, which helped him calmly ride public transportation through his life. I’ve wanted to write and teach from my stories – struggle with organization and ways to teach small bits along the way. Long story with him, I also helped my sister move away from debilitating treatment, she was diagnosed with bipolar – but in our family, teaching skills and working together was never taught or practiced, mother hired maids or did all chores alone – so we left home unprepared to keep up.

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  2. Thank you. From the perspective of a psych nurse who has seen the damage caused by good well-intentions resulting in care coercion, this is refreshing and spot-on. The system is too quick to pigeon hole patients into the most common diagnostic category because it gives caregivers a recipe to follow and providers a billable DSM category. Often listening and thinking critically about the human experience the person is having will result in next steps that don’t involve the biggest interventions and may result in people choosing to voluntarily get care which leads to better outcomes. If it becomes apparent a patient needs the next level intervention, listening and thinking critically will get you to that conclusion anyways. Hats off to this approach.

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    • Hi Mari,

      Thank you for your comment! I experienced psychiatric coercion, and quite a lot of it, mostly when I was a kid. I genuinely had no idea people thought they were helping! I thought they were intentionally punishing me. It seemed so obviously cruel, especially over and over again as I kept getting “worse”. I wish I had known that a lot of people are very ignorant and think it actually helps.

      I read that typically, kids like me would have been managed at home rather than institutionalized. It’s possible they were trying to keep me out of my abusive household in a way that my mother would agree to, but so many things were just done over my head that I had no idea what factors were going into the decisions being made.

      While it’s true some people have been helped by psychiatric coercion, at no point has psychiatry been good at predicting who that will be. It’s consistently created large amounts of damage, usually with little to nothing tried before resorting to coercion. In fact, when I’ve asked people who had negative experiences, almost all of them said they weren’t even asked why they didn’t want a given intervention! It’s usually treated like a crime, and people are arrested into the ward. They don’t even get a chance to send out calls and texts about what’s happening to them to friends, family, teachers, employers… Just awful.

      I hope to see a day when these systems are replaced by much better methods.

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    • Psychiatry is a multi-billion dollar industry and growing every year- now with Primary doctors diagnosing, labeling and drugging. Then comes the Psych RN’s, Psych PA’s, Psych NP’s as well as all those psychologists prescribing and drugging. Outcomes do not matter in psychiatry since it is a criminal business enterprise where everyone profits except the “patient” now called the “consumer” of services and drugs.

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    • Well said!! It’s mostly just haste and convenience for the group (they call it the “safety” of the group – but safety could be assured by simply and kindly removing the person, or removing the group, temporarily for a day or so, enough time for an agitated person to calm down, rest a bit, and when calmer, explain what went wrong in that situation. But once that convenient “solution” is implemented, the person is drugged and the group seems more stable – but no better understanding or learning has happened. Same issues will return, larger next time, with all the mistreatment.

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  3. Thank you for this article, Crystal. It makes so much sense — common sense — and yet what you’re proposing is viewed as “radical” and “dangerous”, which just goes to show how off course society has veered around issues of personhood and autonomy.

    Can you be having an emotional crisis or be experiencing some form of unshared reality and still be treated like a full human being? To me, the answer should be obvious, but the bar is so low that this is what’s being debated.

    The complicating factor with regard to impairment is that once a person is being “treated” for “mental illness”, the prescribed drugs and the myriad traumas that the system can, and often does, inflict on patients can often lead to actual or greater impairment. It’s not recognized, though, and is simply attributed to the person’s “mental illness”, and once that cycle begins, it can be very hard to escape.

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    • Hi Kate,
      Thank you for your comment!

      I totally see what you mean with the issues of psychiatry contributing to disability. I’ve seen it destroy so many lives, including my own, and I’m so glad I escaped. They kept traumatizing me more and more, adding on more diagnoses and interventions, including a lot of coercive interventions, as I got worse and worse. They convinced me I had a “lifelong,” severe psychotic diagnosis based on one psychotic break I had as a teenager during all their torture. They kept saying everything was disease progression, not all the damages of what they were doing to my young mind. It made me feel so hopeless.

      My teachers watched me become zombified, get taken in and out of school, and lose my personality and intellectual power. They knew something was up, but didn’t know what to do. Apparently they knew who was causing my problems, but not the extent of what was going on at home. When I went to university, the diagnoses kept piling on in early adulthood from the remnant trauma. The diagnoses and interventions continued even after coercive electroshock treatments. (They got me to take those right when I turned 18, trapped in a locked ward, not knowing what I was really getting into and unable to research it.)

      I am so glad I escaped the cult eventually and got my life back together. I wish the same for every survivor.

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  4. Once again. what you have written shows a deep understanding of what psychiatrists almost always do in the name of “help”. It is hard to believe that a large portion of the public accept this, and believe unquestioningly in psychiatry, and the destructive nonsense it propagates, as if they believed in a cult. I think that is actually what it is, for the most part.

    While I do think there are a few psychiatrists who actually want to help people and have some useful knowledge, they are rare, and pretty much strongly opposed by their colleagues. When Loren Mosher, while still in a high position in the NIMH, started to criticize his colleagues for doing more to damage their patients than to help them, he was fired from his job and nearly removed from his profession. Of course! Cults don’t allow any criticism of their practices.

    I was honored as a lawyer to have help from Dr. Mosher in getting clients of mine out of the clutches of psychiatry, and in working with him.

    We need to get the public free from their cult beliefs here, and educate them as to what most people need when they are in distress: caring and emotional support, When we look at what is happening to our country now, with so much hatred and threats toward others having become the norm, we need to learn to care about one another. If we don’t. our society will be in big trouble.

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    • How can I get in touch with someone to help get my adult daughter out of summit behavioral hospital in Ohio. She was sentence there after she had an allergic reaction to a change in medication she was taking for schizophrenia. She was given eight years and has been there going on ten because the newly attending psychiatrist says she needs inpatient treatment. (After almost 10 years)

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      • Billie,

        I was able to prevent a loved one – who was suffering from inadvertent, but blatant (for me, at least), non-psychiatric malpractice – which ultimately resulted in a psych hospitalization in a NE Ohio hospital, get out recently. It’s not the same situation at all, but this info might help, and we are in the same area.

        Try politely explaining to the doctor that you mean no offense, but that you are a critical psychiatry person, and psychopharmacological researcher.

        Politely remind the psychiatrist that he/she was taught in med school that the anticholinergic drugs (which includes both the antidepressants and antipsychotics) can create the “positive symptoms of schizophrenia,” via anticholinergic toxidrome.

        https://en.wikipedia.org/wiki/Toxidrome

        And politely remind the psychiatrist that the antipsychotics / neuroleptics can also create the “negative symptoms of schizophrenia,” via neuroleptic induced deficit syndrome.

        https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

        And then politely suggest that … after 10 years … perhaps your daughter is allergic to the anticholinergic drugs? And hyperbolically trying to wean her off drugs, that can create the symptoms of “schizophrenia” – and a drug holiday, of sorts – would be in order? Being weaned off the antipsychotics is not any easy road, however, I’ll forewarn you.

        But I find that being respectful and diplomatic, while also having the scientific truth on your side, tends to wake the doctors up, and behave in a more rational and respectful manner.

        Since I’m in your area, and if you’d like to meet in real life to discuss this, or have me try to function as an advocate for your daughter. Probably the best way to reach me would be for you to ask Steve McCrea (here at MiA) to email me. I can give him my phone number, and you may give me a call.

        Great blog, by the way, Crystal … filled with common sense, and very rational … things our current “mental health system” seem to lack, sadly. Thank you.

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  5. Thank you, Crystal. You’ve addressed the crux of the problem with the mental health industry: its rush to judgment.

    Psychiatry’s adoption of its disease model (circa 1980) has generated a tragic suspension of critical thinking that results in condoning cruelty towards people who lack an ability to effectively advocate for themselves. So much needles hell could be avoided if people working in the system were taught to use patience instead coercion.

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    • Thank you! I agree so much. People ask what an alternative to forced treatment laws are. The thing is, they do way more harm than good and we’d be better off getting rid of them even without a replacement. However, were emergency services not were trained in on-site emotional CPR and we had therapeutic housing initiatives, that would be best.

      Right now, zero things are tried before coercion. They escalate the situation as the person is now a liability. Typically they don’t even ask why the person doesn’t want the intervention. They don’t even care if there is a true emergency to begin with. People learn not to open up from knowing about this policy or having it happen to them. It’s devastating.

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  6. Hey Crystal

    Stick with physics.

    My sibling suicided 40 years ago and I only wish someone had forced an involuntary hold on him to be treated by a qualified physician MD stuffed with pills and mandated therapy!

    Idealism is terrific but not when it comes to mental health.

    Advocate for something you may understand one day when you loose the most important person in your world to suicide.

    Please read some of Edwin Schneidman’s books and become educated on suicide.

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    • Lisa,

      My brother was dosed on Haldol and Thorazine and died in his early 50s. Yes, he was stuffed with pills and mandated therapy, until he managed to escape.

      I’m not sure how you can conclude that the author of this essay is not educated. This is not a matter of idealism. It’s a matter of not being tortured and ruled over by a profession that’s equal parts pseudo-science, propaganda, and authoritarianism.

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    • Forced psychiatry doesn’t stop suicide, and the threat of it stops people from opening up. Suicide is lower in countries that don’t institutionalize people for this, or do it a lot less.

      I have done extensive research on this subject and wrote an article about it called “The War on Suicide Is Making Things Worse.” I am very educated on this topic, and I know the damage of your worldview. I highly doubt you have done any research on the topic of forced treatment laws and suicide.

      Maybe you should research these subjects instead of making so many assumptions. Prohibition doesn’t stop suicide.

      Unfortunately, because of these laws, your sibling couldn’t get actual help had they opened up. They would most likely have been very damaged. Your views have led to massive harm and death to many people.

      Maybe demonstrate yourself to be safe to open up to so we don’t lose any more people, assuming your goal is actually saving lives and not punishing people.

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    • I lost the most important person in my life to suicide, my mother, after DECADES of forced psychiatric treatment and incarceration and ABUSE in the name of “healing”, she was utterly destroyed by it.
      Do I wish every damn day that she was still here?
      Yeah, I selfishly do, because *I* needed and wanted her here.
      Yet that tortured her in ways I am only just starting to understand.
      I am so sorry for your loss, but have you ever thought perhaps your brother found some well deserved peace?
      My mother was SO BROKEN by the very systems the set out to “help” her that I truly think she is better off at peace, a peace she NEVER would have found while living.
      Sometimes we have to separate what WE want from what is best for the individual involved. And that is almost NEVER forced care or treatment.
      I have been hospitalized against my will twice.
      Given my mother’s history, that was the WORST possible thing for me.
      I don’t trust ANY mental health professionals now, and I have to sail these rocky seas alone, for as long as I can before I drown.
      It shouldn’t have to be this way.
      Please truly think about what your brother really wanted, and realize that forcing him into a messed up system just to keep him alive because YOU need and want him alive, is selfish.
      I can say that because I have been there, and to ask my mother to stay another f*cking day would have been pure, gross selfishness on my part.
      She was broken beyond fixing by the very treatment you wanted forced on your brother, some people just aren’t meant for this callous world we live in, unfortunately.
      I will probably take my own life one of these days, unless I can get some financial support that I ironically cannot afford to even pursue in the first place.
      It’s such a complicated issue, your stance is exactly what this article was about, exactly what this author was arguing AGAINST.
      I am truly so so sorry for your loss, I know personally how bad it hurts, I do.
      But think about how badly your brother hurt.
      If nothing could ameliorate that, why would you want him to keep suffering?
      My mother overdosed 19 years ago this year, (12/23/04) and it broke me fundamentally, but I have learned to navigate it and see it for it was, her only way to find a peace she desperately deserved and never had for a MOMENT in life.
      Keeping her here for me would have been the most selfish thing i ever did.
      She already stayed longer than she wanted, to make sure i was taken care of (she left the night after I announced my marriage engagement, she thought he would take care of me. She couldn’t have known…)
      Anyway.
      I am so sorry for your pain, but try to see it from your brother’s perspective.
      That’s what I have spent the last 19 years doing, and I understand her decision now, as much as it gutted me and took my heart away.
      It did, it broke me in TWO.
      But she is at peace now, and that means more than anything else…
      Best of luck healing, my friend…

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  7. I guess operationally impairment can be understood: lacking full functional or structural integrity.

    Drink too much, impaired you can’t drive.

    Can’t keep learning, impaired to learn, etc. Different from regressing. Lack of progress implies progress is possible.

    One thing is impairment has to be significant in mental disorders.

    The question is, I guess not how one defines impairment, but how to meassure significance.

    Methodologically?, on a Bell-Curve if normally distributed, etc. Caveats and all. A minimum requirement of “functional… integrity” would be pass/fail, I guess. Not very savy, but worked for drunk driving tests.

    For those outside the norm, the outliers, there are gaps in that I guess.

    So are anxious, depressed, etc., persons impaired?.

    Well, it’s not about judgement and expectations, not about narratives, interpretation and pseudoscience, but about meassurement, I think.

    That takes the bias, prejudice, etc., out of the issue.

    The functionality that can’t be meassured can’t be considered impaired.

    Dressing might be impaired if one cannot button one’s shirt, not that it’s buttons are left or right. Pass/fail. Tying one’s shoes is pass/fail. Those are neurological tests btw.

    Unmatching socks colors might be impaired if I can’t see the colors, but perhaps not because I like them that way: red and green or blue.

    I don’t care about english literature and my grades fell can’t be impairment, it’s a choice, ceteris paribus.

    Can less than functional capacity in a significant way be meassured for feeling good?. I guess not.

    Can that be done for socializing?. Is there a valid meassure for sociability regardless of cause?. Causes are relevant, but that adds another variable that has to be meassured independently of the other: impairment. To make a causal claim of the impairment, both have to be meassured, as variables, and also not mere correlations.

    Visual acuity, hearing impairment, etc., can be meassured. Their limits for disability, etc., are established.

    So, kind of a moot point, there has to be a validated meassurement for that: significant impairment.

    Extending: I guess it’s predictable how much significant impairment population wise there would be if 50% of the population IS depressed, 25% anxious, 5-10% bipolar, 1% with schizophrenia, and anywhere between 5-15% with a personality disorder. That should add to around 80%, multiple diagnoses. Most, I guess untreated, and therefore pressumed impaired.

    I haven’t done the math, but I guess it’s doable.

    I bet such numbers, making a cut off of impairment, the minimum, to be considered “mental disorder” impairment, like whatever the bottom 5% can’t do*, would predict a world very different we are living right now.

    Supporting my claim that there aren’t that many “mentaly disordered” individuals.

    There weren’t that many before and the world is spinning at top speed: hasn’t been impaired significantly. I guess, specially with SO many untreated, undertreated folks, per the psychiatric rhetoric. And the little if at all effectivenes of it’s treatments.

    So, in short, impared, says who?: the statistics specifically applying to you.

    In the 1930s one could not apply IQ stats to minorities who didn’t spoke english for instance, etc. One cannot use the same IQ table for people taking neuroleptics, etc.

    That requires knowing the variables, hidden, etc., and it’s effects, that apply to the meassurement. Case very illustrative is IQ.

    Circularities, fads, fallacies, etc. Poor understanding of concepts, meassurements, variables, etc.

    But meassuring significant impairment might be possible when such data exists for A specific individual in A specific circumstance.

    * Ironically, nowadays, where are we gonna get the control population with so many “mentally disordered” individuals in the world?. From the 20% who have no diagnosis?, they could be impaired to be mentally ill!, there is no way to disprove having no mental disorder diagnosis is an impairment by mental issues: fads, fallacies, irrationality, circularities, etc…

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    • Thank you! It’s true that so many people have been given a diagnosis, and it’s hard to see any seriousness to any of the labels. If psychiatry had at least some tests, subjective as they may be, for impairment, there might be something of a standard. Currently, there is no clear test being done in most cases.

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  8. Dear Miss Nelson, as someone who has dealt with the mental health systems in the south, i.e. South Carolina, for many years with three different occasions over a roughly 25-30 year span, and yes two occasions because I was said to be different, odd, strange etc. and pressured into mental health therapy! And the third incident was court ordered for a evaluation due to a mad ex spouses relationship with a local deputy and false accusations that really hurt financially due to employment problems thereafter! And let me tell you that to rectify all three bouts with the self proclaimed Gods of the mental health system, and their unchallenged perfect diagnosis evaluations and protocols, I paid out of pocket for two in-state and one out of state evaluations from private celebrated mental health professionals to challenge the systems neverending maze of red tape ! It has certainly been nothing short of a true nightmare dear. So , believe me when I say that the real truth here in your story is pretty much right on que dear ! Now although it may not be all the time but, young lady, I believe in my heart that you have to be in the 75-80% range my dear! I’m an old fart now but I want you to know that I am very proud of you for putting this in words for all to see as this tree has many more branches to it, including poverty, crime, etc. and this is a great analysis of what is happening to innocent people at an alarming rate right now in America ! My hat is off to you my dear ! Thank you so much!

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  9. Great article. Thank you Crystal.

    Until there is widespread recognition that contemporary approaches to mental illness bear parallels to historical colonization tactics, achieving consensus on mental health care practices will remain elusive. Historically, colonization involved overt acts of aggression, such as land expropriation and genocide, prior to the rise of capitalist ideologies. In contrast, contemporary strategies, influenced by capitalist frameworks, often prioritize pharmacological interventions, subtly reinforcing the notion that an individual’s value is contingent upon their productivity and their implicit agreement. This modern approach, while differing in context and scale from historical colonization, shares a fundamental similarity in its underlying philosophy: the marginalization and control of certain populations. It is imperative for the broader population to understand that although the methods and scales have evolved, the core process of imposing dominant norms and values on diverse groups continues, albeit in a transformed guise.
    Recognizing this continuity is crucial for fostering a more inclusive and equitable approach to mental health. The person internalized the colonization so even if we change mid course, the individual is still possessed by its internalized carry-on abuse. It is a form of doubleminded situation! We must free them and allow them to free themselves in tandem. We=Them!

    The emotional dimensions of this issue will likely elicit profound feelings of shame and cruelty among the majority, who witness the subtle indoctrination that occurs at the expense of said majority’s comfortable lifestyle (we do not want to experience a person stressed in the subway!). This process, aimed at molding individuals to conform to specific norms and lifestyles, also instills a pervasive fear that such manipulative tactics could manifest in more overt forms of authoritarianism or totalitarianism if left unchallenged (not hyperbola). The gradual encroachment on personal freedoms and autonomy underscores the insidious nature of power dynamics within societies, highlighting the necessity for vigilance and critical awareness to safeguard against such incremental usurpations of individual agency.

    Drawing from personal experience, I have navigated the complex journey of defecting from a society characterized by such dynamics, only to find myself encountering the nascent stages of its cultural influence once again in a different context because the majority is rich and happy, I felt spooked!

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  10. Psychiatric jargon that simplistically categorizes thoughts, emotions, and behavioral patterns as being “impaired,” “dysfunctional,” “pathological,”maladjusted,” “disturbed,” “eccentric,” and so forth is based on a false analogy to medical terminology. The complexities of human cognition and conduct cannot be reduced to, much less “diagnosed” in, terms that are wholly based on cultural norms prevailing at a certain moment in time. Such unwarranted misappropriation of scientific and medical language is not only misleading but also fraught with harmful consequences for the patients (i.e. victims) subjected to treatment by so-called clinicians, therapists, licensed social workers, and others posing as mental health “professionals.”

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  11. Thank you Crystal!

    It is heartbreaking and frustrating to realise that so many vulnerable people are being traumatised by the very same system where they or their families are told to go for help.
    The road to hell, it seems so often, is paved with good intentions.

    You have expressed these important issues clearly and I will share widely. Our very broken system needs to be regularly exposed as being a contributing cause of the mental health crisis and most certainly not the solution in its current form.

    We do need to find better ways to help each other and sharing what doesn’t work is part of that.

    Please keep on speaking out loudly and often!

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  12. I can’t believe that you wrote this. I am in awe!!!
    I am an LPC that has been screaming this message at the top of my voice to my peers, and anyone else that would listen, for about 25 years.
    I didn’t just tell people I worked with I also educated my clients with this exact same message. You tell me your quality of life, you tell me when things are not the way they need to be for your life expectation and your well-being. Who am I to determine that for you?
    In 30 years of practice I never hospitalized one client although, I was advised to hospitalize hundreds. I learned that there is essentially nothing you can do in a locked psychiatric ward that you cannot do outside of the hospital, except create more trauma for that person.
    People need to understand that “help is asked for”. People making decisions for other people is nothing but intrusive and demoralizing. People need to understand they don’t get to decide what is normal for me, or for you, or for the person sitting next to them. One of the things I used to tell my clients was that the word “abnormal”, in the world of psychiatry, is defined as “anything that you do that makes me uncomfortable. “. Pure Garbage! l

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  13. I wish you luck going against a 60 billion dollar criminal enterprise in the USA alone! Psychiatry as practiced today is about giving up on the person; diagnose, label and drug. Next! PSYCHIATRY not “medicine” and what matters most is how the psychiatrist feels about the patient and not how the patient feels. Failure means success and outcomes don’t really matter! They will admit that they have horribly poor long term outcomes for Schizophrenia and Bipolar as well as many others like Anorexia yet the question if poor outcomes are a guarantee then why bother “treating” and drugging someone to early death?

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  14. Thank you for this clear and powerful article arguing against the reflexive need to pathologize human behavior. This is the first time someone has given such concrete examples instead of just abstractly talking about the issue at hand.

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