Thursday, September 24, 2020

Comments by Kallena

Showing 34 of 34 comments.

  • Just to add in more detail Chaya – my bad experiences of therapy date back to over 35 years ago and went on for over 7 years. The good was over the past 15+ years.

    I am exceedingly grateful I risked a therapeutic relationship again. I really wouldn’t be here at all if I hadn’t.

  • Sorry you were irked by my response Nathan. I’ll wear the label of “therapist apologist” though as, over many years, I’ve had very both very bad experiences of therapy and also had very good experience of it. The good changed me and my life and am sure I would not be alive today without it. My life is so much better for having stuck with therapy and so yes, I do hope others can find experiences that help them as much, no matter what those experiences end up being.

    And, I’d make analogous statements to anyone who was writing about any type of experience that has helped me, and others I know personally, as much as this has. I wouldn’t regarding anything that I’d only ever experienced as harmful.

  • Hi Chaya –
    I have very extensive experience of therapy, from the very bad and definitely abusive to very, very good and I work in a related health care field. The bad damaged me terribly and caused harm but, the good has helped more than anything and literally changed my life. I don’t believe I’d be alive today without it.

    Because it’s helped me the way it has, I’d very much like to think it could help everyone but, people are different so, even though I’d like to hope that everyone could be helped, I doubt that it could. It’s also very dependent on each person finding the right therapist for them as the quality of the relationship between the two people is the most important thing and there will always be some people who simply do not ‘click’.

    Interesting – I put in the paragraph that I felt particularly sad about – but it hasn’t posted. Here it is:

    “Many people get attached to that one person who listens to them go on and on because it’s their professional role. Perhaps I’ve had the sense that therapy may not be for me because I do get so attached. Not knowing what triggers are going on for the therapist makes it easier to idealize them, which plays into the attachment. Yet, if they did share their triggers all the time, therapy might not be as therapeutic, and might be more like a conversation between two people on equal ground.”

    I hope that makes more sense of my next paragraph, as it was meant as a direct response to this, not as a general comment.

    Finally, I’m sorry that my writing that “I hope you manage to, in time…” came across as projections, rather than hopes. I wrote that last part as I do hope that in the end, more people manage to have as positive and life-changing an experience of therapy as I have had. I am though clear that whether anyone does is absolutely up to them, as well as, most likely, to chance.

    I wish you all the best for the future.

  • So sad to hear you’ve had such unfortunate experiences of therapy. It was especially hard to read your paragraph:

    Therapy, when it works, aims to actually heal this need for “getting so attached”. Yes, idealising the therapist is tough as it means an inevitable power imbalance develops in the relationship but, that’s really the point. The process of therapy allows that idealisation to be gradually erode as no person can maintain such an idealised status, no matter how hard they try. A good enough therapist, like a good enough parent, will do their best to acknowledge their own faults in the relationship and let you down gently, as you gradually learn to rely more on your own emotional resources and not need those of the therapist so much.

    There is in fact an awful lot of “science” of therapy out there, particularly work developing our understanding of the intersubjective relationships between people, the ways we develop emotionally as human beings, in relationship to other human beings around us, from infancy and before. The literature is vast. What there may be less of is human beings who are actually capable of being that “good enough therapist”, like the “good enough parent”, particularly in the context of all the societal and political restrictions to ongoing relationships such as your therapist experienced when her agency would no longer accept your particular insurance.

    I do hope you manage to, in time, to trust yourself enough to risk finding another therapist who will be able to stay with you, in all your idealisation of them, as well as hold you safely enough through their inevitable failings of the heights you elevate them to. Sharing this journey with someone who is capable of staying with you along the way can have the capacity to help you develop in ways that make you life fuller than it otherwise might be.

  • Hi Julie,

    You are really fortunate to be able to find this article a “laugh”. Sadly, this issue is not funny at all to those many people who are like this.

    It’s unfortunate that your experience has been of people misdiagnosed, it’s very unfortunate when that happens. Most studies report that it’s in fact much more common for people who do, in fact, have DID, to not be recognised as such and spend many years (average cited = 7 years) in and out of the psych system, receiving mis-diagnoses such as bi-polar or schizophrenia, before they are accurately diagnosed as dissociative. My own experience of over 30 years matches this work and is also that most psychiatrists refuse to acknowledge DID as real and so simply don’t diagnose people with it. Many more today refuse to treat people with it as they are considered just “too hard”.

    Re your comment that DID is not too common, the most usually cited numbers these days are anywhere from 1-3% of the population which is, in fact, a very great many people (these numbers are congruent in studies across the US, Australia/NZ, Europe and the Middle East). So it is likely more common than schizophrenia and as many as may have bi-polar (if those are labels you use, I’m not suggesting I do) and the ways these many people experience their multiplicity will vary greatly. The numbers are also highlighted by the incredible proliferation of international groups such as the hearing voices network. Hearing voices is a very common experience with DID, and one of the primary reason so many people are misdiagnosed.

    The belief that DID is uncommon is, as you also mention, closely tied to the belief that the types of experiences that cause it must also be extraordinarily uncommon. Do you remember the textbooks of psychiatry which still, in the 1980s, were claiming that incest occurred in only 1 in a million families? As Dr. Colin Ross, who has worked with people who have experienced trauma for many decades has said, he began to wonder at that time, if incest truly was so uncommon, how was it that 47 of the expected 100 victims of incest in the whole of the US had managed to find themselves in his one little consulting room in one medical centre in one city all at the same time? Another doctor I knew once said to me: “You’d be so surprised to hear how many of the women who have post-natal depression come out with stories of incest – you’d be really surprised…”. Unfortunately, I doubt I’d be surprised at all. These experiences highlight how incredibly wrong it is to assume that severe child abuse is “uncommon”.

    I do though find it rather extraordinary to hear that you know people who have (apparently successfully?) ‘played the role’ of having DID for many years when they have not, apparently, really been this way. Knowing what it’s like to be many, I find it very difficult to believe that anyone could sustain the fiction of having many parts convincingly enough over time as the complexity of systems can be quite extraordinary and emotionally extreme so, to those who are familiar with dissociation it is also rather clear when someone is faking it. The blatant presentation of ‘different parts’ to outsiders without any apparent external trigger for that part being present (as seems to be the case for the character in this movie) can be a common indicator that someone may be ‘faking it’. The vast majority of people with DID do not show their parts flagrantly to outsiders. Again, numbers cited in the literature are that only around 6-7% of those with DID will present their different parts flagrantly to outsiders, so the numbers of people like that really are extremely small. I do also wonder at what motivation anyone might have to fake DID, and would think this would be very important to understand for anyone who feels they need to fake this, as it truly is not a pleasant or easy way to be.

    I know you acknowledge how important it is to recognise the real experiences of those who are validly ‘like this’, but, it’s societal beliefs such as these that DID and severe child abuse are so rare, together with the perpetuation of sensationalised representations of what it is to be multiple, like that in this movie, which make living with DID so extraordinarily difficult as those of us who do have to continually negotiate a never-ending gamut of disbelief both of our current experience and also of the causes of that experience in the first place.

    And, you know, it’s also rather insulting to be referred to as “an excellent commodity”. Yes, the treatment for DID is very intensive and long but, it’s difficulty due to the severe trauma reactions contained in various parts (usually meaning there are many issues with severe self-harm and suicidality) also makes it extremely demanding for any therapist so, many also refuse to work with people with DID and most people I’ve come across (of probably hundreds) have a great deal of difficulty finding a therapist who is both capable and able to help them. If people do find a therapist who is able to help, the treatment for DID is also extremely effective and absolute resolution and moving on from this way of being is very possible.

    The comments in this thread are only confirming again just how stigmatized and de-legitimized those who do live with DID really are and, with that, exactly how damaging this movie is to so many.

  • Thanks Sera.

    Personally I have no objection if people use the word “alters” when writing generally about DID. It’s considered a more old-fashioned term these days but, there may still be people who prefer it to others.
    It’s different when referring to someone’s personal experience of having parts. Then it’s important to acknowledge the terminology they prefer to use themselves. Just another aspect of acknowledging and accepting the validity each person’s understanding of their own internal experience, which you clearly do.

  • As I mentioned before, I find it very sad that others commenting in this thread find it too difficult to accept others’ way of being in the world and the way other people choose to interpret and express the way they feel themselves to be.

    Of course I know that the effects of mother-daughter incest are extreme. I also find it rather condescending that you presume I don’t. I have included the possibility you cite in my answer above when I stated: “Most of us have spent lifetimes rejecting the parts of ourselves who are anything at all like our abusers and doing our utmost to actively not be like those who abused us.”

    The concept of “internalised abusers”, which is exactly what you are describing, is a very common one in DID and not isolated to mother-daughter incest alone at all. In fact, it is extremely common. You are using the terminology of demonic possession. In the trauma and dissociation literature (which I prefer as a way of explaining my experience), it’s generally referred to as “an internalised abuser part”. Often these parts look and speak and behave exactly as the actual abuser did and even believe themselves to actually be that person.

    But, this doesn’t negate the other aspect of DID that I stressed, that all people like this have “an overall general personality style”, expressed by their overall system of parts, which means that the system overall will not allow ‘out’ a part to behave in a way that the system overall does not like or accept. “Internalised abuser” parts generally act internally and abuse other parts within the system while the other parts are terrified of that part. It is the person with DID themselves who usually suffers abuse from these internalised abusers, not other people around them.

    The exception to this is those extremely few people with DID who do end up to be overall sadistic and/or psychopathic, like the main character in the movie “Split”. But, there is no reason for there to be more people with DID who are like this than there are in the general population.

    Your comment to me here highlights just how difficult it is for anyone to openly admit to being dissociative, even more than any other “mental illness” label (there is difficulty in using the term “mental illness” for DID as in the vast majority of cases it is an adaptive reaction to extreme trauma). Always implicit in admitting to living with dissociative identity disorder is also the admission of having experienced some kind of extreme abuse during childhood and this tends to elicit both very disbelieving and also voyeuristic reactions from people.

    There are many more people speaking out about experiences of depression, anxiety or schizophrenia and people generally accept that each person will experience these things and prefer to understand them in their own individual ways.

    The societal myths associated with this particular label are extreme, and often associated with a reluctance to accept that child abuse severe enough to have caused such symptoms can ever really have happened. Sensationalising it, as usually happens in the entertainment industry, is a way of distancing from the reality.

    Even in forums like this one people assume we do not know what we are talking about and disbelieve our experience, presuming they understand us better than we do ourselves. This is exactly why the harm caused by this particular movie, and the way it portrays the lead character with DID, is also extreme.

  • Hi Sera – much thanks for this article which is an unusual one on this movie in that it’s clear you’ve seen the whole thing, rather than just the shorts, so from that perspective this piece has been very informative for me. Most people I’ve met who are upset about this movie are too triggered by it to see the whole thing in the first place – including me.

    I lived with dissociative identity disorder for over 50 years of my life until achieving integration (or fusion) of my parts some years ago now and have studied dissociation and particularly DID for many years, so feel I have some basis for commenting on this topic. I also work as a health and mental health care professional. I have spoken to many people who have DID or know others with DID who are extremely upset by this movie.

    The biggest problems I see with it – besides the (typical to the entertainment industry) extraordinary sensationalising of the state of being multiple – is that it casts a person with DID as the perpetrator of child abuse. Just about all of us who live like this have experienced abuse, usually by more than one perpetrator and we carry PTSD type memories (and parts) that constantly remind us of the abuse we experienced. Most of us have spent lifetimes rejecting the parts of ourselves who are anything at all like our abusers and doing our utmost to actively not be like those who abused us.

    To then imply that we ourselves are ‘like’ the people who abused us is the most horrifically painful and re-traumatising insult there could possibly be.

    As you have also mentioned, sure, there can be some people with DID who end up being abusive to others – I have known at least one. But, the vast majority of people like myself are much more likely to be abused by others and re-traumatised again and again and this movie participates in that re-traumatisation.

    The other aspects of the movie, that it sensationalises what being multiple is like and in drawing on some accurate scientific knowledge re dissociation yet ignoring the broader context in which these facets of dissociation manifest, such as the different types of parts, how they might switch, different physiologies between parts etc. only add to the difficulties we face in a world where far too many people, including mental health care professionals, still will not accept that this experience of being multiple is real.

    It’s true there is no such thing as having many ‘personalities’. Even those of us with many parts still have an overall personality style as our parts function, whether we are aware of it yet or not, as a system. I’ve seen nothing in this movie to indicate there is any portrayal of the reasons for switching and the subtle interactions between parts. There are always reasons, triggers in the environment, for any particular part being out. Yet, at the same time, if one particular part wants to behave in a way that is unacceptable to the system overall, the overall system will, usually unconsciously, manage to not allow that part out to behave in that way. There also appears to be no portrayal of what is one of the most fundamental aspects of DID – the extent of utterly disabling internal terror that is associated with many internal parts.

    Sad also to see comments in this thread that are disbelieving of the state of being multiple and critical of the diagnosis of DID per se (and note: believing in DID and ‘being multiple’ doesn’t equate with believing in bio-psychiatric approach to mental illness and yes, there have been many instances of problematic ‘diagnosis of DID’). People may have varied ways of interpreting their own internal psychic experience and prefer to use varied words for explaining their experience but, that does not make it OK to deny the validity of another’s lived experience and their preferred ways of expressing their experience. The generally cited numbers of people who live with DID are anywhere from 1-3% of the population so, really very, very large numbers indeed.

    I always hoped that MIA threads were a place where the many varied ways of being human in this world would be accepted yet, even here the really extraordinary degree of stigma and disbelief those of us who live this way are subjected to is prevalent. Just goes to show how deep the sensationalising and associated disbelief, which is also tied to our society’s unwillingness to accept and acknowledge just how prevalent severe early childhood abuse really is, can be.

  • Beautifully expressed, highlighting so much of what is wrong and missing from the current approaches to this thing that is called “mental illness”, so much of which can very reasonably be re-named as totally reasonable and understandable responses to distressing and traumatic life experiences when a person did not have sufficient loving and empathic support to manage to cope.

    The point that many of these experiences can be traced back to what are known as “attachment disruptions” is important – we usually do not ‘remember’ what happened to us and how we felt as infants and very young children but, experiences at these times of life can be defining in how we are or are not able to ‘manage’ circumstances in later life. Of course – what is ‘traumatic’ for an infant is extremely different than what is traumatic for an adult who has words to describe their experience and who most likely will not die if left alone for too long without a carer to provide for their most basic needs.

    I am not quite so sceptical of developments in knowledge in neurobiological fields as others commenting here however – the primary caveat on this field is that the brain is plastic so, anything that has been ‘learned’ (neurons that fire together wire together in relationships with those around us), can also be re-learned in different relationships with different people around us.

    Your lead question: “What would a trauma informed society look like” really highlights the extent to which the current profit-motivated society we have is trauma-inducing, rather than trauma mitigating, and just how fundamental the changes to achieve a trauma-informed society would need to be.

  • You have a lot of wisdom, Carrie.

    The popular “restitution narrative” stories aren’t really a reflection of who we are as human beings. They are a prop to cling to for those who are too afraid to truly see that we are inevitably changed by all we experience. There never can be a ‘return to the health there was prior to becoming unwell’ as we are changed, we have much to grieve as we inevitably lost something we had before we became unwell, even if it is losing the hopes and dreams for our future that our illness or trauma prevented us from achieving.

    There is only “process”, and change. A continual ongoing process of movement, sometimes a step forward and two back, but still, movement. And – change. The only true inevitable is change. And, we need to grieve what was before we can move on. Loss is inevitable.

    Sometimes just managing to stay in the moment by being able to focus on some small thing in now – that might be the only way of keeping on going but – that, in the end, is what life and “recovery” is about. Just that keeping on going. Where to, exactly, we can never really know.

    You show a lot of wisdom and maturity having grasped that already. Far too many people never learn that there is never any ‘going back to how we were before something happened’. Far too many people can’t face the pain of recognising and owning the pain of loss yet, it’s all our emotions, including the painful ones, that make us human.

    Beautifully written. Thank you.

  • Hi suzzeeb – this is all dependent on your definition of “trauma”.

    In terms of our earliest development, there does not need to be anything that happens that can be remembered that actually ‘fits’ with the types of things that we normally associate with the word (things that might also qualify for the term “child abuse”).

    For an infant, it can be experienced as “traumatic” if there is simply a not ‘good enough fit’ between the infant’s temperament and the temperament of the primary carer. An infant feels a sense of distress – for whatever reason – and the carer, despite wanting to do their best, can be unable to find a way of soothing the infant and instead responds to the infant in a way that the infant may not relate to which then increases the experience of distress, rather than soothes it. To an infant – if that happens repeatedly – that can be traumatic and can easily result in the person, as they grow, not being able to learn how to soothe themselves (calm their anxiety and not feel anxious), as this is a skill that we are not born with. It is learned in the first few years of life via repeated experiences of being soothed, then distressed, then soothed again and again by a carer who is ‘well-enough attuned’ to the needs of the infant.

    A carer may be trying to soothe their baby as hard as they can yet – somehow – it just doesn’t work and so, it may happen that the young person, as they grow, learn that their ‘default way of being’ is “anxious” and they are unable to soothe the sense of tension and fear in themselves as they simply never learned how to.

  • Along the lines of my favourite too BPDTransformation.
    The most important thing though, rather than the actual theoretical model followed by the practitioner, is always the ‘fit’ between therapist and client.
    It’s the relationship itself that heals, as so much research repeatedly shows, and any of the many forms of psychoanalytic psychotherapy allows this relationship to develop.
    Much of the work from Winnicott and then Kohut’s psychology of the self onwards, incorporating also the many advances from Bowlby, Ainsworth, Trevarthan et al’s work on infant development and attachment theory and more recently, findings in developmental neuroscience that support their earlier findings, have been invaluable to the development of understanding in how this form of therapy ‘works’.
    Intersubjective systems theory (Stolorow and Atwood) has added much toward explaining how this type of relational holding can best be fostered.

  • Hi kayla – so sorry to hear you are being told such appalling things by “a therapist”. A decent therapist should be capable of hearing what you have to say about your experiences and how you feel about your situation, not label you because you don’t feel what they suggest is right for you.

    CBT doesn’t work for many people with significant experiences of childhood abuse anyway as people with such experiences have learned from the very beginnings (as Dr. B has described with the case of Eddie), that human beings in general are simply terrifying and so, there is good reason to be very scared of them and want to hide from them. It can take a much deeper kind of therapy than CBT, a kind that is about feelings and relationships – learning for the first time ever that a relationship with another human being can, in fact, be ‘safe enough’, to help.

    Of course you have very legitimate reasons to be anxious – even terrified and, it can be very common for people who have experienced severe childhood traumas to also feel very depressed as a result of that.

    Having very good reasons to be anxious (terrified) and very good reasons to feel depressed can often go together. That still doesn’t mean that the cause of the depression is bio-chemical – just as you have good reason to be anxious, you have good reason to feel depressed and it’s addressing the reasons that helps most.

    This isn’t the same as ‘identifying the reasons’ though. Just knowing why you feel so bad (what some of your bad early experiences were) isn’t enough to change the way you learned so early on to feel about and with other people.

    The good part is that with therapy of the kind as described in this piece by Dr. B – therapy that actually addresses the causes of your distress and helps you learn that a relationship with another human being can be safe, unlike your first experience of a relationship with another human being which definitely was not safe for you, this can change and you can, in time, feel better.

    In the end though there is no “typical person” with any type of experiences really. Everyone is, and their experiences are, unique. But, it sounds very very reasonable for someone with your types of childhood experiences to feel very very anxious and upset, even depressed for much of the time.

    Hope you are able to find a therapist who is capable of being with you through your fear and pain, who can help you learn that your flashbacks are in the past, and no longer need to feel as if you are experiencing what happened then, now. That helps, in the long term, as many short-term ways of doing therapy (or treating with drugs) don’t.

  • Very well described.

    Thank you. I wish more people understood this process – and the fact that it can be undone and changed, later in life via a different, healing relationship (therapy) as you have described happened finally for Eddie.

    Most psychiatrists simply don’t want to admit that the basis for our feelings and emotions is in our experiences as that removes their stated ‘area of expertise’ from the domain of ‘medicine’ completely.

  • Hi Bradford – a “depot injection” is a wonderful way to force people who do not want to take their meds to ‘ake them – it’s an injection of the meds that is slow-release over time, meaning that once given, the person does not need to take meds regularly (daily) to remain under their influence.

    The effects of the injection remain (as if the person was taking the meds as tablets daily or as prescribed) for a month or more and thus only require the prescribing psychiatrist to ‘get their hands on the person’ so much less often, yet still ensure that there can be no so-called ‘non-compliance’ (please – I know the horrible implications of those words and am using established bio-psychiatric terminology deliberately) with the prescribed medication regimen.

    They are often used when restricting people to what here in Australia are called “community treatment orders” – for those who are considered well enough to ‘manage in the community’ – yet not trusted to keep on taking the meds as prescribed by their psychiatrists without regular supervision (incarceration and force).

  • Despite the best efforts of many, obviously nothing has changed with regards to the way the authorities respond to and manage complaints about members of the psychiatric profession here in Victoria in decades.

    This may have something to do with the fact that so many of those who were the ‘leaders in the profession’ 30 years ago still hold prominent and leading positions in the so-called “mental health” industry in this country now. The dominant paradigm of care here is very much a bio-medical one, with ECT obviously also supported, despite the utter lack of evidence for it’s efficacy and much evidence ti causes harm.

    The only training course in adult psychotherapy accredited by the College of Psychiatrists for advanced training in this city was ended a year ago due to not enough interest from qualified practitioners/teachers to take over from the older generation who could no longer sustain the task of maintaining the course. What hope for the profession to change and evolve when there simply is no-one either interested or qualified to teach the younger generation of students and professionals any approach other than the purely bio-medical?

  • Thank you.

    Such a relief to have someone clearly state and refute the misinformation still so often being peddled in the name of “de-stigmatising mental illness”.

    Far too much bio-medical propaganda that has already long ago been disproven by the actual scientific data still being peddled as apparent ‘fact’, all in the name of supposedly ‘helping’ those with such lived experiences. In the long term all this causes much more harm than good.

    Thank you again for using your knowledge, experience and access to a forum to be heard to promulgate a more clear and accurate description of the state of knowledge in this field.

  • What a lovely thing to see some actual clear thinking on the issue of the use of psychiatric medications: someone who understands the difference between “express[ing] my opinion, to “service users,” on how antipsychotics should be used” and “hav[ing] an opinion on what the scientific literature has to say about the use of antipsychotics”.

    The whole field of psychiatry does not seem to be able to tell the difference between these two things, constantly ignoring and misrepresenting what their own scientific literature actually shows, conflating this data with their personal/professional opinions with how they think medications should be used and how they and the pharmaceutical companies making them want them to be used.

    Allen Frances is amongst the many who, for whatever reasons, repeatedly fail to recognise this essential difference. Given he personally urged you to engage in this dialogue and make your position on the use of psychiatric medications known, I would hope he (amongst many others) has the capacity for enough insight to recognise this central point you have clarified.

    I look forward to a response from him and would very much like to see him demonstrate a capacity for equally clear analysis and expression of his perspective.

    Keep it up Robert. x

  • Hi oldhead –

    I really have no comment on why I might seem to “equate” brains and minds” as if it appears to you that I do, from the quote you cite above, then I must have expressed myself in a way that has led you to misunderstand me.

    To expand: I actually wrote/typed: “brains/minds/bodies” in the first instance in the section you quote and so, it my have been appropriate to have typed the same the same in the second instance.

    The reason I did not is that the research findings I am aware of and was referring to with the phrase you cite that clearly link “us” to those around us (as referred to in the paragraphs around the phrase you cite) come from the field of developmental neurobiology and relate specifically to neurobiological – that is – brain to brain communication and development (more specifically right brain to right brain). I could also have expanded what I wrote/typed in both instances to “brains and/or minds and/or bodies” but I consider it self-evident that the brain is an organ of the body and felt I did not need to literally duplicate my statement by including both the second time.

    I included the word “minds” in both instances as I do not consider the words “mind” and “brain” to refer to the same thing but do consider them to be inextricably interlinked and so, an inclusion of the concept of “mind” seems to me to be relevant to any discussion of “brain and/or body”. I could possibly also have included the concepts of “self”, “spirit” and/or “soul”, to be even more inclusive of the varied perspectives and experiences of the many people who read these pages, as all can be relevant to any discussion of who we are and how we come to be who we are as human beings – inextricably linked – but in communicating any perspective there inevitably comes a time where we have to draw a line for the sake of clarity and specificity.

    I am not aware of any consensus in any field of knowledge, whether physiological/neurobiological, psychological, theological/religious (though many individual religions will take a definitive statement on mind and/or soul and/or spirit the position of one religion may not agree with that of another) or even spiritual on what “the mind” (or self, or soul, or spirit) might truly be and where any line between the brain and mind – if one might even exist – might be drawn either.

    You do not appear to seem to think I am equating minds with bodies or brains with bodies from what I have written so – I do not really understand why it may appear that I may be equating brains with minds.

  • Hi Sera,

    your piece here comes down to the core of what so-called “modern psychiatry” seems to be actively denying: that each human being is unique in themselves, their context and experiences and so the way to understand each person’s experiences must be as unique and specific to each individual as they are themselves.

    Yes, there can be some value in “classification and categorisation” in helping to promote communication and understanding but – not at the expense of forgetting that we all live, grow and develop in relationships with others and in context.

    Hearing voices is possibly one of the most obvious examples of an experience that the psychiatric approach has de-humanised by describing and labelling it as understandable in only the one, disease-model way. For many, the experience of voices that others can not hear is not a negative one, for others their voices are much better managed by learning to understand and co-operate with them.

    To automatically assume that someone hearing voices must have those voices silenced can cause so much harm… x

  • Hello Norbert,

    thank you for this article highlighting the inherent Cartesian dualism in the dominant psychiatric (and psychological) approach to attempting to ‘heal human beings’.

    I was going to comment though much along the same lines already highlighted by BPDTransformation, that much of how you describe your “relational perspective paradigm’ is already well known from varied schools and theories of psychology and psychotherapy – particularly those highlighted by BPDTransformation.

    To add one more to the list of writers, theorists and clinicians already mentioned, the work of Allan Schore (1994 etc) in unifying the fields of developmental neurobiology and psychodynamics, specifically highlights that we all, as human beings, develop and grow within an intersubjective field. Our brains/minds/bodies are not separate and do not grow and develop to be as they are in isolation, but in literal communication and interaction with the brains/minds of those around us, our primary carers, especially during what has become known as the “critical first 1000 days” – the period from the beginning of the third trimester in utero, to the end of the third year of life.

    It is also the nature of the brain (and it’s bodily connection) to be plastic so, as these connections were originally developed (and continue to develop throughout life) intersubjectively in interaction with those in our environment, these same patterns of connectivity, emotions, feelings and behaviours can, in fact be altered over time, again in interaction with an “other” in our environment. This is the basis of why psychotherapy in fact “works”.

    To cite Allan Schore: “Both science and clinical theory agree that psychotherapy is basically relational and emotional, and so we now think that emotionally and intersubjectively being with the patient is more important than rationally explaining the patient’s behavior to himself. The core self system is relational and emotional, and lateralized to the right hemisphere, and not the analytical left brain. As we empathically “follow the affect” and facilitate the patient experiencing a “heightened affective moment,” we’re intuitively inhibiting the dominance of the left and “leaning right.” (http://www.psychotherapy.net/interview/allan-schore-neuroscience-psychotherapy , 2015)

    Sadly though, after over 30 years of experience both as at times a client/patient of psychiatrists and colleague of many more, I am in agreement with BPDTransformations that to expect most of those those beholden to the dominant psychiatric system to recognise what even over 30 years neurobiological research and well over 50 years of psychodynamic research has repeatedly shown to be the true, intersubjective nature of human beings is really ‘pie-in-the-sky’.

    At least we do though now have many confirmed and reproducible bodies of knowledge that prove their Cartesian dualist, linear and contextless approach wrong and in time, more and more people are accessing and will access these works and build on them, inevitably increasing the momentum of the paradigm shift that is, I believe, already underway. As Thomas Kuhn has shown, this is though a very, very slow process.

  • Hi Alex –

    not sure if this is coming up as a reply to your comment to me as the format for some reason doesn’t look as though it is allowing me to reply to you – but leaves this looking as if I’m ‘replying to myself’.

    Thanks for highlighting that phrase in what I wrote: “Without them [words] we can’t communicate anything at all…”.

    You are right. I was hasty in my response with that phrase. I agree with what you write that a very great deal of communication is non-verbal, and especially that it is experienced on a “feeling level”. That this level of communication can in fact be a lot more intense than words alone.

    It is how we feel and experience our interactions with others and the world around us that gives them meaning – not the words used in those interactions alone as that phrase implied. Yes, often people use the same words yet attribute opposing meanings to them and most definitely, especially when discussing an issue such as “stigma”, it is behaviours that in fact speak louder than words.

    Words are necessary when we are attempting to understand one another’s opinions and perspectives and are attempting to communicate. As here – re-phrasing and checking – are these “words being used as I understand you to be using them” is in a format such as this, the only way to reach some degree of clarity re we are communicating similar views and reaching any consensus of understanding or not.

    Thank you again – I agree with the points you highlight.

  • Hi James –

    agree with you that words and so, some means of categorisation are important. Without them we can’t communicate anything at all and I think from what you write we are in agreement overall on this.

    What I was attempting to emphasise was purely in reference to the original comment you referred to here that “disability is physical or it is not a disability”, though I possibly did not do so too clearly (maybe illustrating the difficulty with use of words and labels sometimes). So, my emphasis was not so much that phenomena in all these realms involve psychological underpinnings (which they must), but that all actually involve the physical, bodily realm.

    Experiences in all these realms, no matter their origin, are felt as emotions/feelings in our bodies – which are actual experiences of altered bodily states – changes in hormonal functioning, neurochemical balance, balance of the nervous system etc. These bodily changes at levels too deep to see are the basis of all our feelings – good and bad and so are physical ‘abilities’. Or, if the experience of our resulting emotions (and thoughts) becomes too overwhelming, the physiological changes in our bodies can be no less physical and a ‘disability’ (to again use some words that I don’t like) than to break a leg.

    So, to label an experience as “purely psychological” or purely spiritual or social and therefore any ‘disability’, even if it can’t be easily seen as physical as ‘not physical ‘is in fact, a misnomer. Despite this, I most certainly do not believe that we should ignore all means of classification of these experiences as the use of different words to describe them can, while on one level being reductionist and dualistic, also express and give meaning, which is essential.

  • Hi James – it’s been a pleasure to finally see you come in and post again, bringing some sense of coherency to what had become a tedious tit for tat type thread clogging my inbox. First time I posted here on MiA (though I’ve followed the page for a fair while) and wasn’t quite expecting it to be like this.

    Re this comment from Frank that “disability is physical or it’s not disability”, I agree with your response to it but, would also like to query: How can we even separate out what is physical and what is not? Does “physical” mean it has to be visible to another person? If so, then yes. Many things we struggle with aren’t physical. Another way of separating out these domains is by the origin of their cause -as you indicate: psychological, social or spiritual.

    But – these domains in which we struggle – the psychological, social and spiritual – are experienced as emotions and feelings and these are, in fact, physical entities/changes/processes occurring in the body and, despite these not being able to be seen from the outside without extremely high-tech hormonal and chemical analyses, the feelings and emotions in our bodies can and do cause physical responses that can be utterly overwhelming and unmanageable.

    So, on that level, I’d suggest that to attempt to separate “physical disability and struggle” from “non-physical disability and struggle” is spurious in the first place and it’s obvious, as you say, that all people need help from others who must also be fallible, whatever the cause of their suffering.

    Looking forward to your next instalment.

  • Hi Someone else,

    this is getting way off the topic of this article but yes – I do have references for this. Just some quick examples from what is available on the net: http://www.entrepreneur.com/article/249952 http://archpsyc.jamanetwork.com/article.aspx?articleID=1211984
    http://link.springer.com/article/10.1023/A:1016557824657#page-1
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116797/

    Research on this dates back many years already, so the literature is really quite vast, eg: https://books.google.com.au/books?hl=en&lr=&id=oR8hpcQwc2QC&oi=fnd&pg=PA180&dq=trauma+alters+the+genome&ots=Av9rlQNGBS&sig=IUrJOblgvuuqh_-sunGQ7TxSFZc#v=onepage&q&f=false

    Just to mention that genetics and epigenetics are most definitely not the same thing as and do not lead to “eugenics” though.

  • Hi Someone else –

    very interested in where from my posted comments you find any indication that I have a “eugenics theory”?

    Personally, I believe that everyone is unique and experiences can’t be generalised. What can be discovered and somewhat generalised though is what types and degrees of experiences have what impacts on people in what kinds of ways. You mention the effects of wars – the impacts of such events on both individuals and whole societies have been studied in many ways so there’s no need to simply believe or not believe whether such extreme traumas can have fundamental and lasting impacts that can or can’t be ‘passed on’ – we know they can.

    Where or whether this gets to eugenics though I don’t understand in the least. Everyone still, intergenerational trauma or not, has to travel their own personal journey and discover for themselves if they believe it is spiritual or otherwise.

    Language is always a problematic issue in any discussion of these sorts of issues. We are limited in the words we have available to describe any experience yet, how one person interprets that word may be different based on their own history and experience to how another may interpret and use that same word – whether they are words used as psychiatric labels or not.

  • Thanks Steve.

    I agree that “emotional distress” is a much more accurate and appropriate term, though language itself can be very difficult and reductionist of any and all human experience. Unfortunately, we do have to try to find the best words possible to manage to communicate what we wish.

    Everyone’s own experience is unique, but re the potential for genetic pre-disposition to react to distress beyond ones own history of personal experience and context, I’d include here the fact that trauma can in fact alter the genome and thus, this altered genome is then be passed on to future generations. This then amplifies any pre-disposition a person may have to suffer unmanageable emotional distress and adds to the potential for the “cycle of abuse”.

  • Hi James – a very thoughtful piece. Stigma in “mental health” is a topic talked and written about much, these days.

    I am in Australia and here, “Mental Health Week” is very heavily promoted and supported by many government and not for profit organisations with the aim of “reducing the stigma of mental health”. Yet – all to often I’m left wondering – does no-one even notice the inherent stigma in the terms “”mental” health and/or illness” – in and of themselves?

    In using these terms, we are still buying in to the old separation of mind/brain and body myth – the dualism that even so much work over several decades now in fields as apparently “purely scientific” as developmental neurobiology has clearly shown to be an utter myth, as well as the bio-psychiatric model of “mental illness” as a “brain disease”.

    It’s well known in many areas now (though still promoted to the general public by government and psychiatric organisations) that the “chemical imbalance theory” of depression and possibly all “mental illness” is a lie (though I acknowledge that in some instances the influence of genetic and pre-disposing physical vulnerabilities can be a much greater factor than in others). We, as human beings, have feelings and emotions. In examining the criteria for diagnosis for just about any so-called “mental disorder” in that diagnostic bible, the DSM, just about all criteria that need to be met for diagnosis of so-called “mental illness” refer to ongoing difficulties in managing a particular feeling/emotion. Much research is now showing that even those symptoms that have been labelled as ‘psychotic’, such as hearing voices, hallucinations, derealisation etc, may in fact at times be more strongly correlated with factors such as dissociation and past experiences of trauma and abuse and so, are more likely to be varying defences in managing emotions that are ‘unmanageable’ – rather than “illness” (mental or otherwise).

    Are our feelings and emotions “mental”? Any person will know that the emotions they feel are felt not just in the brain but also in the body. Neurobiological research has repeatedly confirmed the links between the brain, nervous system, endocrine system and immune system functioning (amongst others), as well as confirming that our capacity to manage our feelings is primarily influenced by factors external to ourselves such as interpersonal relationships and stress.

    What this means is that yes, there are times when we can be reduced to not being able to function as well as this modern society, which emphasises the need to be “happy and productive”, requires of it’s good enough citizens. It also means that to be overwhelmed by our emotions is just as disabling physically in the body, as well as “mentally”, as being overwhelmed by a virus to which the body responds with a high fever. Labelling those who are overwhelmed in this context by their very real feelings and emotions as “mentally – yet not physically or environmentally – ill”, while I understand the need to overcome the “just get over it” attitude, is still inherently stigmatising of itself.

    I don’t pretend to have an answer to this labelling conundrum but, feel it is one that at least needs airing. To acknowledge in public that one is “mentally ill”, possibly at least partially because of the push to de-stigmatise and educate that people can not “just get over it”, carries with it associations of permanent disability, thus making the person appear unreliable as an employee or even friend and acquaintance. As you highlight, it takes a deeper personal relationship to begin to see past these surface stigmatising labels and understand that the person is real and experiencing things that are not strange and scary but in fact, quite understandable, yet at the same time a person does need extra consideration and concessions and can not live up to societal expectations to be “happy and productive enough”.

    But, might not the whole of society be better served by learning that humans are fallible beings who can not function at 100% effeciency in any and all circumstances and conditions, and that when things get too tough, we do need the help and support of others around us to manage our feelings. We are and need to be connected to those around us so survive those times when our emotions and feelings become overwhelming. That our environments matter, that our own personal feelings matter and we both need and deserve help. That in many instances it might just be our societal expectations that are unrealistic – not that some individuals are “mentally ill”.

    Sure, this would be a paradigm shift of enormous proportions but, as with the de-bunking of the biological brain illness model of mental illness in the first place, the momentum can build and these moves can and do happen. And in the end, who really feels good about perceiving themselves as “mental”?