Thank you for not listing your diagnoses. It would have framed you within a group of boxes.
Once you were boxed up, it would have distracted us from the moving account of your journey, of the need for relational and spiritual connection. Please keep writing, we need to hear your voice, and re-evaluate how to help each other.
This is the best sentence in the excerpt from your book. “Clinical decision-making, for all patients, should address the attainment of individual goals and the identification and treatment of all modifiable and non- biological factors, rather than focus solely on the diagnosis and treatment of individual diseases” It priorizes what the person wants for their goals, and identifies all their areas in their life that they may be able to change.
Nowhere in the 1000 page DSM 5 does it obligate the psychiatrist to ask the person if they were sexually abused in childhood. Or emotionally neglected, or the other 8 ACE questions. As you say, there is no effort to understand what psychological injuries caused your severe emotional pain.
This is a wonderful piece, with a focus on understanding the person within their web of relationships. I really like the attention to treating the person as a person, understanding their goals and needs, and collaborating with them to help them achieve it. It is the opposite to sticking a diagnosis on them, which distances and diminishes them, and places them in the ‘mentally ill and sick’ role.
Karin, this is a wonderfully written and insightful piece. Thank you for sharing the wisdom that you gleaned through your very long and painful journey. Then again, that often is the only way to gain wisdom, to suffer, and then reflect on that process.
Good point, Steve. Therapy is the best modality to address people’s self-hating thoughts, after being abused. Or to reduce their shame. No other intervention (exercise, acupuncture) is geared to those goals. But it is not designed to address social issues, such as decent health care for all people, for emotional and physical difficulties. Those are legal, political and moral issues, and therapy is not geared to address them. Separate organizations and approaches need to be used to bring change on those levels.
You raise some excellent points about these complex issues. Therapists are like every other profession, such as engineers or nurses, there are some superb practitioners, a large group that do decent work, and a small group that are actually toxic. That is why I recommend that people try two or three therapists, so that they find one who is a good fit for them. The process of measuring also increases the likelihood of progress, but it is not a guarantee. Therapists cannot help everyone all the time, and I am very aware that there are many factors in my clients’ lives that contribute to, or degrade, their emotional well being.
The degree to which excellent therapy can lengthen people’s lifespans is one that I wish was vigorously researched. I could only find a few research studies, but this topic is of enormous importance. The epigenetic changes are not deletions from the chromosome, but are additions or deletions of methyl groups. The telomeres shorten with stress, but it is of enormous importance to research if we can lengthen them again (or greatly decelerate the shortening) and contribute to people’s lifespan.
One of my major goals in life is that the person’s experience of neglect, abuse, loss or trauma is put front and center in all discussions with any health care provider. My hope is that the Psychological Injury Index replace the symptom cluster models such as DSM or ICD. Then, the person and their story is front and center, not an invalid and unreliable label that is kept around for billing codes or some bureaucratic reason that has little relevance to actually healing people.
I wrote an article on this for MIA, and one sentence was “Major studies in the US and Britain found that having five traumas increased the risk of having symptoms of schizophrenia between 53 and 160 times.” It is halfway through the article at https://www.madinamerica.com/2019/01/psychological-injury-model/ under the heading “Childhood trauma as psychological injury.”
What an honest, well-written account of your journey. It perfectly illustrates that childhood trauma is far too often mis-labeled as ‘schizophrenia’, and that as a result, people do not receive the healing that they need. It is fortunate that you had some caring therapists, and I hope that your work again shows the need to assess for psychological injuries first and foremost, and to provide supportive human connection to help people heal from them.
Excellent truth!. There is an amazing study on how treating PTSD healed breaks in the DNA of people who had been traumatized and fled the Middle East. I cover it briefly in my TEDx talk, and the reference to the research is on https://psychologicalinjuryindex.com/ A crucial point was that psychotropic drugs had no impact on healing the breaks in the DNA that traumatized people had. It was only when they received therapy that their DNA became as healthy as people who never had a major trauma. This validates that people heal people.
There is a huge need for more research on how treating emotional wounds improves a person’s physical health as well. I have found a smattering of studies that found that therapy altered methylation patterns in DNA, and Pennebaker did some good work on expressive writing, but if anyone knows of more research, please let me know.
I wanted to present the Psychological Injury Model on MIA to start the dialog, and get the idea out there. As far as I know, I am the only one who has put it in this language. Hence the lack of Google hits on the term ‘Psychological Injury’ The next step is a book, and I am working on consulting with large organizations, as this has major implications for how we think of health and how to improve it.
The glaring defect in the DSM system was pointed out so well by ‘Someone Else’ above. Even though sexual abuse in childhood has a terrible impact on so many people, it is not asked about in DSM. I sat with a client just a few days ago who was working through this pain from decades ago, and although it was the single most important factor that shaped their mental health, the DSM approach would not ask about it, or necessarily record it. Hopefully, the Psychological Injury Index will replace the DSM, and put the person’s experiences front and center.
Thank you for not listing your diagnoses. It would have framed you within a group of boxes.
Once you were boxed up, it would have distracted us from the moving account of your journey, of the need for relational and spiritual connection. Please keep writing, we need to hear your voice, and re-evaluate how to help each other.
Report comment
This is the best sentence in the excerpt from your book. “Clinical decision-making, for all patients, should address the attainment of individual goals and the identification and treatment of all modifiable and non- biological factors, rather than focus solely on the diagnosis and treatment of individual diseases” It priorizes what the person wants for their goals, and identifies all their areas in their life that they may be able to change.
Report comment
Nowhere in the 1000 page DSM 5 does it obligate the psychiatrist to ask the person if they were sexually abused in childhood. Or emotionally neglected, or the other 8 ACE questions. As you say, there is no effort to understand what psychological injuries caused your severe emotional pain.
Report comment
It was well worth it for me. I found it a bit cheaper as a PDF, rather than print version. Very well researched.
Report comment
This is a wonderful piece, with a focus on understanding the person within their web of relationships. I really like the attention to treating the person as a person, understanding their goals and needs, and collaborating with them to help them achieve it. It is the opposite to sticking a diagnosis on them, which distances and diminishes them, and places them in the ‘mentally ill and sick’ role.
Report comment
Karin, this is a wonderfully written and insightful piece. Thank you for sharing the wisdom that you gleaned through your very long and painful journey. Then again, that often is the only way to gain wisdom, to suffer, and then reflect on that process.
Report comment
Good point, Steve. Therapy is the best modality to address people’s self-hating thoughts, after being abused. Or to reduce their shame. No other intervention (exercise, acupuncture) is geared to those goals. But it is not designed to address social issues, such as decent health care for all people, for emotional and physical difficulties. Those are legal, political and moral issues, and therapy is not geared to address them. Separate organizations and approaches need to be used to bring change on those levels.
Report comment
Erin, that was wonderfully written, and I admire your desire to live your life fully in the present, even though you grieve what happened in the past.
Report comment
You raise some excellent points about these complex issues. Therapists are like every other profession, such as engineers or nurses, there are some superb practitioners, a large group that do decent work, and a small group that are actually toxic. That is why I recommend that people try two or three therapists, so that they find one who is a good fit for them. The process of measuring also increases the likelihood of progress, but it is not a guarantee. Therapists cannot help everyone all the time, and I am very aware that there are many factors in my clients’ lives that contribute to, or degrade, their emotional well being.
The degree to which excellent therapy can lengthen people’s lifespans is one that I wish was vigorously researched. I could only find a few research studies, but this topic is of enormous importance. The epigenetic changes are not deletions from the chromosome, but are additions or deletions of methyl groups. The telomeres shorten with stress, but it is of enormous importance to research if we can lengthen them again (or greatly decelerate the shortening) and contribute to people’s lifespan.
Report comment
One of my major goals in life is that the person’s experience of neglect, abuse, loss or trauma is put front and center in all discussions with any health care provider. My hope is that the Psychological Injury Index replace the symptom cluster models such as DSM or ICD. Then, the person and their story is front and center, not an invalid and unreliable label that is kept around for billing codes or some bureaucratic reason that has little relevance to actually healing people.
Report comment
I wrote an article on this for MIA, and one sentence was “Major studies in the US and Britain found that having five traumas increased the risk of having symptoms of schizophrenia between 53 and 160 times.” It is halfway through the article at https://www.madinamerica.com/2019/01/psychological-injury-model/ under the heading “Childhood trauma as psychological injury.”
Report comment
What an honest, well-written account of your journey. It perfectly illustrates that childhood trauma is far too often mis-labeled as ‘schizophrenia’, and that as a result, people do not receive the healing that they need. It is fortunate that you had some caring therapists, and I hope that your work again shows the need to assess for psychological injuries first and foremost, and to provide supportive human connection to help people heal from them.
Report comment
Thank you for your wise comments, Alex. They were helpful.
Report comment
Excellent truth!. There is an amazing study on how treating PTSD healed breaks in the DNA of people who had been traumatized and fled the Middle East. I cover it briefly in my TEDx talk, and the reference to the research is on https://psychologicalinjuryindex.com/ A crucial point was that psychotropic drugs had no impact on healing the breaks in the DNA that traumatized people had. It was only when they received therapy that their DNA became as healthy as people who never had a major trauma. This validates that people heal people.
There is a huge need for more research on how treating emotional wounds improves a person’s physical health as well. I have found a smattering of studies that found that therapy altered methylation patterns in DNA, and Pennebaker did some good work on expressive writing, but if anyone knows of more research, please let me know.
Report comment
I wanted to present the Psychological Injury Model on MIA to start the dialog, and get the idea out there. As far as I know, I am the only one who has put it in this language. Hence the lack of Google hits on the term ‘Psychological Injury’ The next step is a book, and I am working on consulting with large organizations, as this has major implications for how we think of health and how to improve it.
Report comment
The glaring defect in the DSM system was pointed out so well by ‘Someone Else’ above. Even though sexual abuse in childhood has a terrible impact on so many people, it is not asked about in DSM. I sat with a client just a few days ago who was working through this pain from decades ago, and although it was the single most important factor that shaped their mental health, the DSM approach would not ask about it, or necessarily record it. Hopefully, the Psychological Injury Index will replace the DSM, and put the person’s experiences front and center.
Report comment