As a psychotherapist, I ask clients at intake what other therapists they’ve seen and, boy, the stories that come pouring out of really lousy therapists. I do know there are times when I’ve had to guide a client toward a decision that is self-protective (in severe abuse situations), but I do try to let the client do the deciding as much as possible. And I DO support cutting off toxic family relationships! The lack of graduate training in chronic relational trauma, family dysfunctions, and the impact of sociopathic/narcissistic parents is appalling. I do a lot of family and couples therapy and many are referred to me. Prior therapists never spot the narcissistic/coercive/abusive partner and dynamics, leaving the victim to suffer with “anxiety and depression”, which is really the result of emotional abuse. Leaving an abusive relationship is often the best way to treat emotional issues that are often labeled and drugged in the current system.
Your article was helpful for those of us in the profession who work to wean clients of medications. Best of luck with your journey!
Bravo! Keep up the pressure. Those of us in the trenches keep trying, client by client, to educate on these issues but it feels like a Sisyphean task. The myth of chemical imbalance is firmly implanted in the cultural zeitgeist and will take several generations to eradicate. Heartbreaking to see the lives destroyed. But they don’t listen to me, because their PCP or psychiatrist “MUST” be smarter and more well informed than I am.
This is such a heartbreaking story. The photos show a shocking change physically. Psychiatrists must be forced to admit that the trauma of these treatments to a person’s sense of self is harmful. I work with the compassion-based interventions, which recognize the power of shame as an emotion. Just imagine the feelings of unworthiness that come from being diagnosed as “psychotic”, prescribed endless lists of medications to “fix a broken brain,” and being forcibly detained against one’s will. This labeling is a severe humiliation and a trauma compounded by the damage of the medications. Using a shame-informed case formulation in psychotherapy and ditching the “medical model” will save thousands of lives a year.
Thank you again Dr. Hickey for very detailed and rational counter-arguments. I know how much work this type of analysis takes, and so appreciate your efforts. Keep it up!
We do need a model to help clinicians and service users understand why their emotions and behaviors are maladaptive for them. I understand many feel we should accept each person individually and unconditionally and that is where interventions should end, and there is much merit in meeting each person via their own experience. But there is considerable scientific knowledge and evidence on certain topics, such as trauma, attachment, the power of shame as an emotion, fear of social exclusion and the threat response, to warrant using this information to help people and provide a structured way to do so. I use my model in every interaction with service users and they find it very helpful, very de-stigmatizing, and very affirming. I do not ever mention DSM labels. Compassion-Focused Therapy is a well-researched and effective model that is a great aid to many who suffer. To dismiss all professional expertise and research out of hand strips away what useful tools already developed.
I am not selling any products… My information is free on my website. Happy to send any other information via email.
I have tried to speak out against the medical model and DSM on this website via comments and have been aggressively attacked BECAUSE I was a professional. I was dismissed out of hand due to being a psychologist, rather than having my support and opinion valued. I offered to blog for MIA, but was told that because of my view (against the DSM???) I would be attacked. I have written what I believe is a reasonable replacement for the DSM that incorporates trauma, attachment/developmental trauma, emotions and neurobiological causes of psychological problems, yet I can get no support on this site BECAUSE I am a psychologist. It’s all well and good for people to say we professionals should speak up against the DSM, but if we are personally attacked for doing so then it won’t happen. I have given up promoting my model to anti-psychiatry and critical psychiatry audiences for this reason.
I would suggest a different understanding of this case based on my extensive work with the emotion of shame. Elizabeth has low self-worth and is submissive, resulting in fatigue when around others or âintroversion.â People with low self-worth have poor shame tolerance, causing them to struggle with even simple social interactions, because for them every conversation includes the experience of their own inner critic abusing them about their faults and failures, then additional fear that others will find fault. This causes stress and eventual exhaustion and a desire to retreat to solitude. I label these type of people Self-blamers and they are often raised by abusive, domineering, narcissistic parents, such as Elizabethâs mother, who is what I call an Other-Blamer.
Notice how the mother criticizes relentlessly? Who wouldnât feel shame and low self-worth under that onslaught? Who wouldnât want to avoid that abuse by hiding in her room?
Notice also the boundary violations by the mother â arranging unwanted social engagements â a typical narcissistic or Other-Blamer behavior. The core of poor shame tolerance for Other-Blamers is lack of accountability, which results in things like impulsivity and poor financial management, which the mother presented with.
I strongly suggest mental health professionals gain an understanding of shame and how it affects human behavior, especially relationships. Certainly, there are some people who are more prone to valuing solitude and others who a temperamentally more outgoing, but If find with clients that the urge to retreat from human contact not only violates evolutionary urges to connect and bond with others, but is far more due to being raised by a narcissistically abusive person than anything else.
The clinical intervention to use is Compassion-Focused Therapy or Mindful Self-Compassion which directly address improving shame tolerance and secure self-attachment, along with education on the effect of Other-blamers who blame shift to their victims. which increases shame intolerance and low self-worth.
Oldhead, I’m not sure I understand this cryptic “comment.” Please explain.
Excellent. I completely agree, and I have proposed a model that uses five factors for the causes of emotional distress: The Threat Response, Fear of Social Exclusion, Shame, Trauma and Attachment/Developmental Trauma. More at http://www.HarperWest.co. Have you considered adding the trauma of the narcissistic and emotionally abusive parent? I find this is far more prevalent than the abusive boss. Narcissistic parents are subtle, but in their demands for attention the child learns his/her needs do not matter and learns to submit in unhealthy ways to the parents. Children then disconnect from a sense of self and over-attune to the needs of others. Notably, narcissistic parents lead a child to feel rejected (Fear of Social Exclusion), feel low self-worth (Shame), feel unlovable (Attachment Trauma), and these all trigger the Fear response in the brain and body. Best of luck. It sounds like we have many common approaches.
I meant it is not “illness.” This term is inaccurate. But there can be causative factors of emotional distress, as I listed. This is well-researched and I list those sources in my book. The research on trauma and attachment trauma is extensive and shows high correlation to emotional distress.
100% true. I’ve considered the threat response one of the Five Causative Factors of supposed mental illness for some time now. Please check out http://www.HarperWest.co for my paradigm for reframing mental illness as normal, adaptive responses to fear/threat, shame, fear of social exclusion, chronic and attachment trauma. I can share a journal article I’ve written based on my book Self-Acceptance Psychology. Keep up the work on this topic.
Jessica, I would love to have you read my work presenting an alternative to the DSM that uses trauma and attachment trauma, along with fear responses, fear of social exclusion and shame as five explanatory factors for all mental illness, rather than “disease”. I outline it at http://www.HarperWest.co, spoke at the October 2018 ISEPP meeting on it and have a journal article and book on the subject. Contact me through my website if you’d like to read the journal article and I can send it to you.
Thanks you so much, Rosalee, for your kind comments and I’m sorry you and so many others have struggled with this dysfunctional system. I was thrilled several years ago when Robert Whitaker approved me as a blogger on this website several years ago, but then disappointed when the site administrator decided I would not be allowed to blog on MIA. But I try to keep up the work to address the problems with the DSM and medical model any way I can.
By its nature, a brief blog comment is “narrow” and simplistic but perhaps you could consider reading my book, which at 120 pages and 60,000 words does better justice to this complex and powerful concept.
Poor shame tolerance is actually the root cause of relationship problems, such as described here, and individual mental health problems. I will speak about shame intolerance and mental health at the ISEPP conference on Oct. 20. I work with couples and see blame-shifting and lack of accountability as the main problem in these imbalanced relationships. On my website and in my writing, I call the husband’s behavior Other-blaming, often paired with a Self-blamer. Both lack healthy shame/guilt tolerance, so manage it by blame-shifting, because the shame feels so unbearable. Here is a blog on this exact topic. http://www.harperwest.co/relationships/. Lots more in my PDF book Self-Acceptance Psychology, which explains that: If shame is the problem, self-acceptance is the answer.
Coincidentally, I was blogging about “autism” and have included a link to Dr. Timimi’s article in that blog. Check it out here: http://www.harperwest.co/redefining-autism/
Sorry for being self-promotional, but in my book Self-Acceptance Psychology I go beyond complaining about psychiatry’s lack of scientific bases for their “diagnoses.” I offer a simple, but powerful new paradigm to describe and understand human behavior. It challenges the traditional ways of defining âmental disorders,â and reframes emotional and behavioral problems as adaptive and self-protective responses to fear, complex or chronic trauma, shame, and lack of secure attachment. These Five Causative Factors lead to an inability to handle shame in healthy ways. It identifies poor shame tolerance as a key factor in development of anxiety, depression, personality disorders and other supposed mental illnesses. People adopt one of three Blame-Shifting Strategies that define essentially all unhealthy behaviors in relationships with self and others. More at http://www.HarperWest.co If you support my ideas, I’d appreciate your support on social media to get the word out.
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One of the words I share with clients is “Indignation” — Anger due to injustice or inequity. I encourage them to use that idea, because “anger” can take on a meaning of impulsive, irrational acting out that is loaded with judgment. Indignation is self-protective and completely appropriate when mistreated or abused. I also like that the root word is from “dignity,” which means a lot to me Maybe I’m just a word geek!
These kind of stories make me so angry. Any mental health professional still pushing meds should have their license yanked. And the shaming, judgmental, and rejecting nonsense about why you wouldn’t succeed and who you should date is shockingly unethical behavior. I’m appalled.
Agreed. A well-trained psychotherapist addresses the emotions in the room in the moment, rather than dismissing or avoiding or confronting them with judgment. I am EFT trained (Emotionally Focused Therapy) and privilege emotions as a predictor and driver of behavior. And there are usually primary emotions (shame is the most powerful one) and attachment fears/needs (rejection/belonging) that must be accessed and understood by the client to address anger.
As a psychotherapist, I completely agree and always use a trauma-informed and attachment-informed approach to people I work with. I have a framed saying facing me in my office: Those who need the most love often act in very unlovable ways. In fact, I have developed Self-Acceptance Psychology a paradigm for understanding human behavior that is based on the idea that complex trauma and attachment trauma, along with our natural human need for love and acceptance, often lead to poor shame tolerance. “Anger is shame’s bodyguard” is another saying that I use to reframe irritability with others — often because one is irritable at the self and self-rejecting. Lashing out at others in self-protection may feel safe and helpful, but does harm relationships. More on shame intolerance and the solution — self-acceptance — at http://www.HarperWest.co
As one of the co-authors of “Dangerous Case of Donald Trump” I can say that our message is that Trump is dangerous. We don’t need to diagnose to assess dangerousness and there is ample evidence in the public record of his propensity toward violence, violating the rights of others, believing he is above the law, impulsivity, recklessness, harm, lack of empathy and compassion, abusive behavior, lack of moral judgment, etc, etc. Part of the challenge related to “stigma” is that the DSM/ICD lumps personality/character issues in with those with things like anxiety and depression. As I write about extensively on my website (www.HarperWest.co), we should consider a framework of assessing emotional and behavioral problems with an understanding that most are caused by poor shame tolerance. Blame-shifting is the result, with Other-Blamers like Trump behaving in ways that would be judged as immoral. The DSM might label these people Narcissistic or Sociopathic. Self-Blamers and Blame Avoiders do not generally behave in ways that society judges as immoral. Until we make this distinction with assessment this problem will continue. I believe we all — mental professionals or not — should and must judge those who behave immorally and address that issue. When the person doing so controls nuclear weapons, it is absolutely a danger to society.
Excellent. As a psychotherapist, I educate every incoming client about the myth of “chemical imbalance” and “mental illness” to provide them hope, self-efficacy. and self-acceptance. I find it fascinating that the DSM completely and fastidiously ignores some facts we know about human psychology: 1) emotions are a big influencer of human behavior 2) the emotions of fear and shame are especially important 3) complex and acute trauma are a major cause of self-protective and self-adaptive emotional responses and behaviors 4) attachment patterns learned in childhood influence emotional responses and behavior. How much training did I have on these topics in years of undergraduate and graduate school? About 30 minutes on attachment theory in children, none about adult attachment patterns. None on trauma or emotions. It is appalling. Thank goodness I had the determination to learn on my own about these topics and the influence every session with clients. Keep up the good work!
A good analysis of the problem, to which I would add: 1) Those of us offering solutions are locked out because we are “part of the system.” I am not allowed to blog on MIA because I would be attacked as a professional. Yet I am offering a replacement model for the DSM, but have great difficulty getting a hearing for these ideas because I am a professional. 2) The survivor movement must broaden its focus and inclusivity to include those who do not have “severe mental disorders” as this is a vast segment of the population that is being ignored in this movement. Millions of people have mild anxiety/depression/etc and may take a prescription or see a psychotherapist, but never have experience in inpatient treatment, ECT, antipsychotic medications, etc. Labeling organizations with names such as “hearing voices” brings support to some, but also excludes and frightens others. 2) I believe we must challenge the DSM as a weak point. It lacks validity and reliability, is based on subjective decisions rather than science, etc etc, as outlined by many. This will also be a major battle, just as attacking Big Pharma, but it is essential. The myth/belief system that “mental disorders” are biological diseases must be discarded before we can reframe “mental disorders” as normal, adaptive human responses to trauma, attachment insecurity and emotions such as fear, loneliness and shame. Lots more at http://www.HarperWest.co
Thank you so much for the solid information and links. I advocate daily against medication and for therapy because it works and doesn’t have side effects! I focus on interventions to improve self-acceptance and shame tolerance through mindful self-compassion training as it directly addresses the REAL causes of emotional problems, which is low self-worth due to trauma and attachment insecurity.
This is the sort of dismissive name calling that I am talking about and will not be helpful in generating supporters to your cause. Fortunately, I have a very thick skin, but not all others do and will quickly abandon any support if this is the type of reaction they are going to get. I will not apologize for supporting facts, truth and science of evidence-based practices. How will such a revolution decide on the appropriate responses to psychiatry if not by science? By the roll of a dice? By popular vote? Why should we not use science to help those who suffer with emotional distress? Serious, why not? Sure, the DSM and the disease model of “mental health” are not based on facts or evidence, but there is no reason to dismiss science because of that.
This is a wonderful list of resolutions, however, this website does not actually advocate change. Rather, it is primarily about venting about the problem. I am a psychotherapist who suggested a blog on a new system of conceptualizing “mental health” that has been very well reviewed by those in the anti-psychiatry field, including one blogger at MIA. Yet I was told that because I was a mental health professional my ideas would be viewed with hostility by readers of this website and my blog was rejected. If reasonable, evidence-based suggestions to replace the DSM are rejected out of hand because they come from someone with a degree, then good luck with your revolution! Many successful revolutionaries worked within the constraints of the system and enlisted those on the inside. “Blowing up the system” is rarely effective or successful.
Thank you! The emphasis on “psychiatric” (aka drugging) interventions is heavily emphasized in these bills. Why not emphasize psychosocial supports, including psychotherapy and parenting education, as first-line interventions rather than medication? Where is emphasis on trauma-informed and attachment-informed therapy and assessment, which ARE research-based and evidence-based? All legitimate clinicians who keep up with the research know that developmental trauma and attachment insecurity are causes of emotional/behavioral problems rather than “diseases” of the brain. Please oppose both of these bills.
I have proposed one revolutionary paradigm shift — rethinking the DSM/ICD “diagnostic system” that is based on the biomedical/disease model. My Self-Acceptance Psychology is based on actual research on the effect of childhood trauma and attachment trauma, along with well-accepted facts about the threat response (“fight-or-flight”), shame and fear of social exclusion. This model fully explains all “mental disorders” as normal, if maladaptive, responses to these factors and makes complete sense to those who read it. I address the power of shame as an emotional driver of most “mental disorders.” Emotions such as shame are the cause of emotional and behavioral distress, not imagined neurochemical imbalances.
However, the likelihood that this or any other paradigm shift takes hold is nonexistent because of 1) the inertia of public opinion now that the “neurochemical” myth has taken hold 2) lack of financial backing at the level that Big Pharma is able to exert to fight against this accepted myth 3) clinicians who are afraid to stand up to the American Psychiatric Association and its assumed and presumed authority over the diagnostic system.
I just handed out 500 business cards at a psychotherapy conference trying to generate support for Self-Acceptance Psychology and got essentially no response. The profession must open its eyes to the falsehoods of disease model. Every person who comes into my office harmed by false “diagnoses”, stigma, shame and medication breaks my heart.
Bravo! Wholeheartedly agree. As a psychotherapist, I have NEVER seen a supposed case of “ADHD” or child behavior issues without also finding trauma, attachment trauma, parents with high levels of anxiety or just inappropriate and permissive parenting. We must stop “diagnosing,” drugging and stigmatizing these children when the parents must be addressed as a very likely cause of this problem. Parents do not want to hear this “blame” but where else should this blame be placed? And, actually, it is the parents’ lack of ability to handle blame that is another source of the problem.
Excellent, forthright and thoughtful analysis, Dr. Levine. As a professional who comments here and is attempting to help counteract First-Order Psychiatry, my comments frequently get attacked for specious reasons or ignore, perhaps for the same reason. Correctly identifying the enemy and consolidating supporters is key in developing a coalition. Coalitions are made up of groups or people who may not believe EXACTLY as you do, but are aligned with you enough that you can group together to accomplish a goal. Just as political parties are made up of people who may disagree around the edges, but agree enough about core concepts to band together to gain power. It is frustrating to be proposing an alternative to the DSM/ICD yet be blasted because I do not meet someone’s definition of perfect alignment with their beliefs. For those who are open-minded enough to consider it: http://www.SelfAcceptancePsychology.com
Dr. Breggin, along with your excellent reiteration of the dangers of psychiatric medications, I also appreciated your mention of the influence of shame on some mass murderers.
– âThe Munich shooterâs manifesto âfocused on personal humiliations.ââ
âMany mass murders are driven by two distinct and largely separate sets of motivation. One set can be called personal ideology, where the individual develops a rationalized hatred for his family, peers, or other groups, often attributed to acts of bullying and humiliation.â
In my work âSelf-Acceptance Psychologyâ (www.SelfAcceptancePsychology.com) I highlight the tremendous power of shame to influence human behavior. I identify three main âShame Management Strategiesâ people adopt: Self-Blaming, Other-Blaming, and Blame Avoiding. As in your examples, the evidence is often available that indicates mass murderers are severe âOther-Blamers,â perhaps made worse by psychiatric medications and the shaming experience of âdiagnosisâ and âtreatmentâ for a âpermanent brain disorder.â
âOther-Blamersâ have such deep feelings of inadequacy they cannot be resilient when they experience humiliation, embarrassment or rejection. As James Holmes’ case indicates, failing out of graduate school and being rejected by a girlfriend may have been the triggers that overwhelmed his ability to tolerate shame and sent him on a rampage fueled by his desire to blame others for his problems. A deep lack of accountability and inability to hear criticism are key behavioral aspects of âOther-Blamers.â
We must stop being mired in the false âdiagnosesâ of the DSM/ICD and look accurately at what drives human behavior or we will continue to fail to understand, assess and predict it â and prevent this type of behavior in the future.
Chaya – I am so happy you found a helpful therapist. We are out there. . .
I am a psychotherapist who very strongly does NOT NOT NOT believe in stigmatizing DSM labels, the “disease model,” and psychiatric drugs. In fact, my website, blog and YouTube channel outline this very clearly.
Go to http://www.SelfAcceptancePsychology.com And I tell my clients in the first meeting about my beliefs to reduce stigma and help them feel more comfortable that I am not judging them. As I outline in “Self-Acceptance Psychology” problems of thinking, feeling, and behaving (“mental disorders”) are due to Five Causative Factors that are normal and understandable: trauma or attachment trauma, fear (“fight-or-flight”), shame, and the natural fear of social exclusion.
I believe, and have been told by my many happy clients, that I am a compassionate, accepting therapist who is not just out to make money or promote my own agendas onto my clients. In fact, I gave up a lucrative corporate career in midlife to go to graduate school to become a clinical psychologist — and make LESS money.
So since I do not arbitrarily and blindly label others as “mentally ill,” I would appreciate that all of us in the mental health profession were also not labeled as somehow, due solely to our professional titles, as morally bankrupt, worthless, corrupt, etc etc. Many of us would love to change the psychiatric-based system and make it more focused on client-center, accepting, compassionate, helpful, productive therapy, not drugs and more drugs.
Oh, and I, too, was very, very lucky to have stumbled upon an excellent therapist (in a bar!) at a point in my life when I was absolutely in need of one and didn’t even know it. Her help was life-changing and actually led to me becoming a psychologist. There are good therapists out there…
Michael, I am so grateful to hear your viewpoint, because I, too, have to undo this damage done to parents and children when psychiatrists “educate” about the alleged disease model of “mental illness.” So many children come to therapy with the belief that their brains are damaged and will be for life. This, of course, hampers any efforts at therapy, worsens their self-image and promotes helplessness in parent and child.
So in the first session I educate parents and children/adolescents on the fact that the “damaged brain” concept is completely unsupported by research. What makes far more sense is the child has been trained to react to fear/threat with normal “fight-or-flight” responses and become dysregulated. I offer parenting education on brain development, on how their interactions with the child may be causing fear/anxiety, even inadvertently through permissive parenting or being overly verbal or being anxious or depressed themselves. I work with parents to improve attachment (insecure attachment being another cause of emotional distress). I investigate any traumas the child may have experienced and work on changing the cognitive and emotional response to that. All of these ideas are encompassed in Self-Acceptance Psychology. (www.SelfAcceptancePsychology.com) Iâve developed a concept called Self-Acceptance Psychology that explains the real, root causes of âmental disordersâ such as behaviors labeled as âanxiety,â âdepression,â âbi-polar,â and âADHD.â It reframes these as normal, natural behaviors resulting from low self-worth, fear, shame, self-criticism and a desperate need for love and belonging (attachment). These can be easily and effectively addressed without medications by learning to generate self-acceptance. Yet the psychiatry profession continues to medicalize âmental disordersâ and push pills, rather than advocate for safe, effective psychotherapy and self-help. Keep up the good work!
Trauma is, absolutely, one of the major causes of alleged âmental disorders.â As a psychotherapist, I can dig into a personâs history just for a few minutes and nearly always arrive at an explanation for why they ended up âdepressed,â or âanxious,â etc.
But it does not doom a person to a lifelong diagnosis and I clearly communicate this to my clients. Many are helped tremendously when their experience is normalized and explained as NOT due to brain malfunctioning, but to life experiences. This gives them hope, as it should.
When we look at trauma, we must consider attachment trauma, a major factor in explaining human behavior in significant ways. I also educate on how that personâs experience as a child can lead to low self-worth, feelings of shame, and emotional over-reaction or under-reaction when shamed or rejected. Parental lack of emotional nurturing and warmth â perhaps worsened by addictions, their own emotional problems, or their own lack of secure attachment â can directly cause poor social and emotional functioning in the child and, later, adult. The need for close emotional connection to others is essential for us as social animals.
I also educate on the effect of natural, normal human responses, such as the threat/fear response (âfight-or-flightâ), the need for social acceptance, and the effect of shame when rejected, even if due to insecure attachment.
All of these ideas are included in Self-Acceptance Psychology, which is a simple, but powerful new paradigm to describe and understand human behavior. It challenges the traditional ways of defining âmental disorders,â yet is based on well-accepted and well-researched psychological concepts. Self-Acceptance Psychology reframes emotional and behavioral problems as adaptive and self-protective responses to fear, trauma, shame, and lack of secure attachment. This conceptual framework has many benefits and can lead to long-term, permanent change. http://www.SelfAcceptancePsychology.com
Good insights, BPD. At the risk of sounding self-promotional, in my Self-Acceptance Psychology work I characterize “splitting” as two main adaptive behaviors to deal with trauma, abuse, and lack of parental attachment and the resulting shame and low self-worth.
First, Self-Blaming involves attempting to “fix” oneself to manage feelings of inadequacy (Black Dudie’s recriminations could be considered as very Self-Blaming — You are deeply unworthy to the point that you should die. Depression can be largely framed as mostly Self-Blaming behaviors. Anxiety, especially behaviors such as “OCD,” perfectionism, hyper vigilance to criticism, etc, are also Self-Blaming.
In contrast, another adaptive mechanism is Other-Blaming: lacking in accountability, lashing out at others in anger or blame, refusing to be wrong or accommodate the viewpoints of others, refusing to hear criticism, etc.
Healthy individuals minimize the use of these two strategizes and can be self-accepting, or securely self-attached (Good Dudie!) with accurate self- and other-perceptions, self-compassionate, etc.
In this way, perhaps psychosis is merely very clear awareness of these contrasting responses to a threatening situation playing out in the mind. Fear is a very powerful emotion and we will do many things to try to manage it and calm ourselves down, even if these responses ultimately do not serve us well.
Learning to be self-compassionate and self-accepting can be wonderfully powerful methods for reducing self-judgment and self-blaming. Negative self-talk triggers the brain and body into the threat response (“fight-or-flight”), which can lead to “symptoms” labeled as anxiety, depression, psychosis, etc, etc. The core is nearly always a sense of low self-worth or poor shame tolerance that triggers urges to attempt to fix perceived inadequacies through self-blaming. Check out Kristen Neff and Christopher Germer’s research and books on mindful self-compassion. Together they developed an MSC program that is excellent. Best of luck!
Coping strategies that we currently label as âmental disorders,â such as anxiety and depression, could be considered âessential,â but I like to add âat one point in oneâs life.â
Most of these were learned in childhood due to loss of secure attachment with parents, traumas such as emotional or physical abuse or neglect, and evolutionary responses.
Many of these adaptive or self-protective emotional or behavioral responses are rooted in the primal need for survival. Anxiety or panic can be seen as fear, aka âfight-flight-or-freeze.â We react with fear to emotional threats just as surely as we do physical threats. Things like the negativity bias are helpful in physical survival â if we know that bears live in caves we tend to look askance at caves and avoid them. But these survival strategies, when learned as a young child, are then often implemented without a balanced cognitive ability to sort through the timing, intensity or appropriateness of these responses, becoming “OCD, anxiety, or depression.”
A childâs brain is just not developmentally able to do much more than react emotionally. A child thrown into âfight-or-flightâ repeatedly, even if it is just due to living with a highly anxious or depressed parent, learns to react unthinkingly to any emotional threat, rather than respond mindfully and thoughtfully. Again, this learned behavior becomes labeled as âmaladaptiveâ as an adult, even though it served a purpose earlier in the childâs life.
In my work âSelf-Acceptance Psychology,â I outline Five Causative Factors that can be considered together as the reason for essentially all âmental disorders.â The fear or threat response (âfight-or-flightâ), fear of social exclusion, shame as an attempt to prevent social exclusion, trauma, and attachment status all connect to trigger Three Shame Management Strategies.
I am proposing Self-Acceptance Psychology as an alternative to the DSM/ICD disease-based diagnostic framework. For much more go to http://www.SelfAcceptancePsychology.com.
Very well said, Steve. I was shocked in psychology graduate school how many students had NEVER been in therapy themselves, despite a “recommendation” that they do so. Many were also on psychoactive meds! A couple even had active addictions. Some had such high anxiety that they could not give presentations in class without severe panic . Many were irresponsible and could barely be attentive to the professor. How are these individuals going to remain attentive, accepting, present, calm and centered when addressing a patient’s high anxiety, high shame, or a conflict-laden family or couple session?
All therapists of any stripe should be screened for their own psychological issues. They need to understand their attachment issues, how they regulate (or don’t) their emotions, their trauma history, and then come to a sense of self-acceptance. Self-Compassion is essential before one can generate compassion for others.
It is so disappointing to me that we continue to lament this obvious fact — that by treating those suffering with emotional distress as if they are “ill” or “defective,” they will experience stigma, passivity, etc, as you outline, Gary.
But there are solutions, rather than just eliminating mental healthcare providers.
As an outpatient psychotherapist, I always view the client’s behaviors as self-protective and adaptive — rather than defective. They are struggling to manage developmental/attachment trauma, parental abuse or neglect, lack of parental attachment, lack of emotional and social skills, and other environmental insults in the best way they know how.
To help, I directly tell them that diagnostic labels such as “obsessive-compulsive disorder” or “ADHD” are not based on science, research or common sense, and to disregard them completely. These behaviors are based on a lot of well-known, well-researched facts about human behavior.
I initially focus on normalizing the experience of “anxiety,” or “depression.” To do this I educate on the fear/threat response (“fight-or-flight”). I teach that to the brain, internal messages trigger the fear response (“I am a terrible person.”), identically to external threats (a mugger or car accident.) This helps people realize they are the master of their own anxiety and depression and gives hope and reduces stigma. I then work to explore and deepen emotions, especially the experience of shame or low self-worth. Those with low self-worth are self-critical, which triggers the fear response. I teach mindfulness meditation and breathing exercises to improve self-awareness, attentional focus and self-calming. I work to help a person develop self-compassion, self-attachment and self-acceptance, which has been proven to reduce self-shaming and, therefore, anxiety. They are also less likely to look to others for approval and attachment, which improves relationships.
Yes, too many therapists hold the framework that clients are diseased, incompetent and “less-than”, which only further diminishes their self-worth.
If more therapists provided acceptance, normalization and education on the workings of the brain and emotions, fewer people would experience stigma and they would gain hope for change. None of what I teach is new — yet it is not taught in US graduate schools and largely ignored by DSM/ICD-based frameworks for diagnosis and intervention. Details on my protocols are at http://www.SelfAcceptancePsychology.com
Don’t be confused by the labels psychiatrists have arbitrarily come up with. “ADHD” is merely anxiety or even more simply– fear. As a clinician, I have NEVER seen a child with “ADHD” behaviors that did not have one or more of the following experiences: 1) a parent or parents who was also anxious, impulsive, oppositional; 2) the parental relationship was high-conflict; 3) the child had experienced developmental trauma or attachment trauma; 4) parents had poor emotional intelligence skills and failed to be emotionally attuned to the child; 5) parents used fear-based, consequence-based, behavioral-based parenting styles. Children are very emotionally skilled and highly attuned to the emotional status of their parents. Children either model behavior of parents or, due to natural “emotional contagion”, pick up on the anxiety of their parents. ADHD is a child experiencing “fight-or-flight” who developmentally lacks the cognitive abilities to manage or regulate his or her emotions, largely because the parents are dysregulated when they should be regulated. Children learn to regulate their emotions from parents who are regulated and calm. I always focus interventions on parenting changes, especially improving attachment behaviors, improving emotional listening and attunement skills, love-based parenting versus fear-based/behavioral-based parenting, mindfulness and self-calming — FOR THE PARENTS. Then I engage with the child to teach mindfulness skills as well. No one wants to blame the parents — but where exactly do children learn emotional, social and behavioral skills if not from parents? If we don’t blame the parents and correct their behaviors, then the children get blamed, stigmatized and shamed. Too many children come to therapy ashamed and suffering with low self-worth, believing they are defective, mentally ill and even unlovable. Given a choice between blaming parents and blaming children, the choice seems clear. For more, go to http://www.SelfAcceptancePsychology.com
As a clinical psychologist, when every client enters my therapy room — adult or child or family — I clearly educate them that the myths perpetrated by psychiatry and Big Pharma are false. There is almost certainly nothing biologically or genetically damaged or diseased about their brain. For children, this normalization is essential. As I explain on http://www.SelfAcceptancePsychology.com the core issue in those with “depression” or “anxiety” or “ADHD” or “behavioral problems” is a sense of feeling unworthy, unlovable or ashamed. Pathologizing these normal emotional responses only worsens a person’s sense of aloneness and separateness. We all have primal responses to fear (hyper-vigilance to threat which can show up as over-reactive emotions or the hypersensitivity to sensory inputs the blogger described), to social exclusion, to shame, to lack of bonding or attachment to family members, or to developmental trauma (parental rejection, abuse, neglect, etc.). Labeling normal emotional responses as diseased and different is fundamentally shaming and harmful to people. We must stop the DSM/ICD falsehoods. I urge clinicians to read more at http://www.SelfAcceptancePsychology.com
As I discuss in âSelf-Acceptance Psychology,â (www.SelfAcceptancePsychology.com), the âdepressionâ and âmaniaâ can be more parsimoniously and accurately understood to be over-reactions to the threat response (aka âfight-or-flight). Trauma, including attachment trauma, is very common in âschizophrenicâ patients. Trauma increases hyper vigilance to and emotional reactivity to threat. Mania can be seen as this over-reaction, while depression is the opposite response, with the body and mind collapsing from an over-stimulation of stress.
Fear is one of the most powerful emotions we experience and has wide-ranging effects on physiology, emotions, moods, attitudes, cognitions, and behaviors. Yet despite the volumes of research and factual evidence on the threat response and its tremendous primal influence on human emotions and physiology, the current disease model essentially ignores this fundamental fact when describing human behavior.
Since all emotions are valuable responses, it makes one wonder: If fear is to be considered a âmental disorder,â then why is happiness not considered a âmental disorderâ? It is time to reframe and de-stigmatize these mistaken, but commonly held, beliefs about emotions: Fear, and as a result schizophrenia, is not a âmental disorder.â
âWhen prescribed loosely,â meds are problematic, according to Dr. Frances. But we must assume the prescribing is being done based on the DSM, which is inherently âlooseâ in its diagnostic accuracy and relevance, as you so ably elucidate here. So how can prescribing NOT be done loosely, even when it is intended to be done just for âclear-cut psychiatric disordersâ and not for âeveryday difficultiesâ. The current system is a Jello mold on top of a Jello mold on top of a Jello mold. –Harper West,MA, LLP
As a psychotherapist, I ask clients at intake what other therapists they’ve seen and, boy, the stories that come pouring out of really lousy therapists. I do know there are times when I’ve had to guide a client toward a decision that is self-protective (in severe abuse situations), but I do try to let the client do the deciding as much as possible. And I DO support cutting off toxic family relationships! The lack of graduate training in chronic relational trauma, family dysfunctions, and the impact of sociopathic/narcissistic parents is appalling. I do a lot of family and couples therapy and many are referred to me. Prior therapists never spot the narcissistic/coercive/abusive partner and dynamics, leaving the victim to suffer with “anxiety and depression”, which is really the result of emotional abuse. Leaving an abusive relationship is often the best way to treat emotional issues that are often labeled and drugged in the current system.
Your article was helpful for those of us in the profession who work to wean clients of medications. Best of luck with your journey!
Bravo! Keep up the pressure. Those of us in the trenches keep trying, client by client, to educate on these issues but it feels like a Sisyphean task. The myth of chemical imbalance is firmly implanted in the cultural zeitgeist and will take several generations to eradicate. Heartbreaking to see the lives destroyed. But they don’t listen to me, because their PCP or psychiatrist “MUST” be smarter and more well informed than I am.
This is such a heartbreaking story. The photos show a shocking change physically. Psychiatrists must be forced to admit that the trauma of these treatments to a person’s sense of self is harmful. I work with the compassion-based interventions, which recognize the power of shame as an emotion. Just imagine the feelings of unworthiness that come from being diagnosed as “psychotic”, prescribed endless lists of medications to “fix a broken brain,” and being forcibly detained against one’s will. This labeling is a severe humiliation and a trauma compounded by the damage of the medications. Using a shame-informed case formulation in psychotherapy and ditching the “medical model” will save thousands of lives a year.
Thank you again Dr. Hickey for very detailed and rational counter-arguments. I know how much work this type of analysis takes, and so appreciate your efforts. Keep it up!
We do need a model to help clinicians and service users understand why their emotions and behaviors are maladaptive for them. I understand many feel we should accept each person individually and unconditionally and that is where interventions should end, and there is much merit in meeting each person via their own experience. But there is considerable scientific knowledge and evidence on certain topics, such as trauma, attachment, the power of shame as an emotion, fear of social exclusion and the threat response, to warrant using this information to help people and provide a structured way to do so. I use my model in every interaction with service users and they find it very helpful, very de-stigmatizing, and very affirming. I do not ever mention DSM labels. Compassion-Focused Therapy is a well-researched and effective model that is a great aid to many who suffer. To dismiss all professional expertise and research out of hand strips away what useful tools already developed.
I am not selling any products… My information is free on my website. Happy to send any other information via email.
I have tried to speak out against the medical model and DSM on this website via comments and have been aggressively attacked BECAUSE I was a professional. I was dismissed out of hand due to being a psychologist, rather than having my support and opinion valued. I offered to blog for MIA, but was told that because of my view (against the DSM???) I would be attacked. I have written what I believe is a reasonable replacement for the DSM that incorporates trauma, attachment/developmental trauma, emotions and neurobiological causes of psychological problems, yet I can get no support on this site BECAUSE I am a psychologist. It’s all well and good for people to say we professionals should speak up against the DSM, but if we are personally attacked for doing so then it won’t happen. I have given up promoting my model to anti-psychiatry and critical psychiatry audiences for this reason.
I would suggest a different understanding of this case based on my extensive work with the emotion of shame. Elizabeth has low self-worth and is submissive, resulting in fatigue when around others or âintroversion.â People with low self-worth have poor shame tolerance, causing them to struggle with even simple social interactions, because for them every conversation includes the experience of their own inner critic abusing them about their faults and failures, then additional fear that others will find fault. This causes stress and eventual exhaustion and a desire to retreat to solitude. I label these type of people Self-blamers and they are often raised by abusive, domineering, narcissistic parents, such as Elizabethâs mother, who is what I call an Other-Blamer.
Notice how the mother criticizes relentlessly? Who wouldnât feel shame and low self-worth under that onslaught? Who wouldnât want to avoid that abuse by hiding in her room?
Notice also the boundary violations by the mother â arranging unwanted social engagements â a typical narcissistic or Other-Blamer behavior. The core of poor shame tolerance for Other-Blamers is lack of accountability, which results in things like impulsivity and poor financial management, which the mother presented with.
I strongly suggest mental health professionals gain an understanding of shame and how it affects human behavior, especially relationships. Certainly, there are some people who are more prone to valuing solitude and others who a temperamentally more outgoing, but If find with clients that the urge to retreat from human contact not only violates evolutionary urges to connect and bond with others, but is far more due to being raised by a narcissistically abusive person than anything else.
The clinical intervention to use is Compassion-Focused Therapy or Mindful Self-Compassion which directly address improving shame tolerance and secure self-attachment, along with education on the effect of Other-blamers who blame shift to their victims. which increases shame intolerance and low self-worth.
Oldhead, I’m not sure I understand this cryptic “comment.” Please explain.
Excellent. I completely agree, and I have proposed a model that uses five factors for the causes of emotional distress: The Threat Response, Fear of Social Exclusion, Shame, Trauma and Attachment/Developmental Trauma. More at http://www.HarperWest.co. Have you considered adding the trauma of the narcissistic and emotionally abusive parent? I find this is far more prevalent than the abusive boss. Narcissistic parents are subtle, but in their demands for attention the child learns his/her needs do not matter and learns to submit in unhealthy ways to the parents. Children then disconnect from a sense of self and over-attune to the needs of others. Notably, narcissistic parents lead a child to feel rejected (Fear of Social Exclusion), feel low self-worth (Shame), feel unlovable (Attachment Trauma), and these all trigger the Fear response in the brain and body. Best of luck. It sounds like we have many common approaches.
I meant it is not “illness.” This term is inaccurate. But there can be causative factors of emotional distress, as I listed. This is well-researched and I list those sources in my book. The research on trauma and attachment trauma is extensive and shows high correlation to emotional distress.
100% true. I’ve considered the threat response one of the Five Causative Factors of supposed mental illness for some time now. Please check out http://www.HarperWest.co for my paradigm for reframing mental illness as normal, adaptive responses to fear/threat, shame, fear of social exclusion, chronic and attachment trauma. I can share a journal article I’ve written based on my book Self-Acceptance Psychology. Keep up the work on this topic.
Jessica, I would love to have you read my work presenting an alternative to the DSM that uses trauma and attachment trauma, along with fear responses, fear of social exclusion and shame as five explanatory factors for all mental illness, rather than “disease”. I outline it at http://www.HarperWest.co, spoke at the October 2018 ISEPP meeting on it and have a journal article and book on the subject. Contact me through my website if you’d like to read the journal article and I can send it to you.
Thanks you so much, Rosalee, for your kind comments and I’m sorry you and so many others have struggled with this dysfunctional system. I was thrilled several years ago when Robert Whitaker approved me as a blogger on this website several years ago, but then disappointed when the site administrator decided I would not be allowed to blog on MIA. But I try to keep up the work to address the problems with the DSM and medical model any way I can.
By its nature, a brief blog comment is “narrow” and simplistic but perhaps you could consider reading my book, which at 120 pages and 60,000 words does better justice to this complex and powerful concept.
Poor shame tolerance is actually the root cause of relationship problems, such as described here, and individual mental health problems. I will speak about shame intolerance and mental health at the ISEPP conference on Oct. 20. I work with couples and see blame-shifting and lack of accountability as the main problem in these imbalanced relationships. On my website and in my writing, I call the husband’s behavior Other-blaming, often paired with a Self-blamer. Both lack healthy shame/guilt tolerance, so manage it by blame-shifting, because the shame feels so unbearable. Here is a blog on this exact topic. http://www.harperwest.co/relationships/. Lots more in my PDF book Self-Acceptance Psychology, which explains that: If shame is the problem, self-acceptance is the answer.
Coincidentally, I was blogging about “autism” and have included a link to Dr. Timimi’s article in that blog. Check it out here: http://www.harperwest.co/redefining-autism/
Sorry for being self-promotional, but in my book Self-Acceptance Psychology I go beyond complaining about psychiatry’s lack of scientific bases for their “diagnoses.” I offer a simple, but powerful new paradigm to describe and understand human behavior. It challenges the traditional ways of defining âmental disorders,â and reframes emotional and behavioral problems as adaptive and self-protective responses to fear, complex or chronic trauma, shame, and lack of secure attachment. These Five Causative Factors lead to an inability to handle shame in healthy ways. It identifies poor shame tolerance as a key factor in development of anxiety, depression, personality disorders and other supposed mental illnesses. People adopt one of three Blame-Shifting Strategies that define essentially all unhealthy behaviors in relationships with self and others. More at http://www.HarperWest.co If you support my ideas, I’d appreciate your support on social media to get the word out.
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One of the words I share with clients is “Indignation” — Anger due to injustice or inequity. I encourage them to use that idea, because “anger” can take on a meaning of impulsive, irrational acting out that is loaded with judgment. Indignation is self-protective and completely appropriate when mistreated or abused. I also like that the root word is from “dignity,” which means a lot to me Maybe I’m just a word geek!
These kind of stories make me so angry. Any mental health professional still pushing meds should have their license yanked. And the shaming, judgmental, and rejecting nonsense about why you wouldn’t succeed and who you should date is shockingly unethical behavior. I’m appalled.
Agreed. A well-trained psychotherapist addresses the emotions in the room in the moment, rather than dismissing or avoiding or confronting them with judgment. I am EFT trained (Emotionally Focused Therapy) and privilege emotions as a predictor and driver of behavior. And there are usually primary emotions (shame is the most powerful one) and attachment fears/needs (rejection/belonging) that must be accessed and understood by the client to address anger.
As a psychotherapist, I completely agree and always use a trauma-informed and attachment-informed approach to people I work with. I have a framed saying facing me in my office: Those who need the most love often act in very unlovable ways. In fact, I have developed Self-Acceptance Psychology a paradigm for understanding human behavior that is based on the idea that complex trauma and attachment trauma, along with our natural human need for love and acceptance, often lead to poor shame tolerance. “Anger is shame’s bodyguard” is another saying that I use to reframe irritability with others — often because one is irritable at the self and self-rejecting. Lashing out at others in self-protection may feel safe and helpful, but does harm relationships. More on shame intolerance and the solution — self-acceptance — at http://www.HarperWest.co
As one of the co-authors of “Dangerous Case of Donald Trump” I can say that our message is that Trump is dangerous. We don’t need to diagnose to assess dangerousness and there is ample evidence in the public record of his propensity toward violence, violating the rights of others, believing he is above the law, impulsivity, recklessness, harm, lack of empathy and compassion, abusive behavior, lack of moral judgment, etc, etc. Part of the challenge related to “stigma” is that the DSM/ICD lumps personality/character issues in with those with things like anxiety and depression. As I write about extensively on my website (www.HarperWest.co), we should consider a framework of assessing emotional and behavioral problems with an understanding that most are caused by poor shame tolerance. Blame-shifting is the result, with Other-Blamers like Trump behaving in ways that would be judged as immoral. The DSM might label these people Narcissistic or Sociopathic. Self-Blamers and Blame Avoiders do not generally behave in ways that society judges as immoral. Until we make this distinction with assessment this problem will continue. I believe we all — mental professionals or not — should and must judge those who behave immorally and address that issue. When the person doing so controls nuclear weapons, it is absolutely a danger to society.
Excellent. As a psychotherapist, I educate every incoming client about the myth of “chemical imbalance” and “mental illness” to provide them hope, self-efficacy. and self-acceptance. I find it fascinating that the DSM completely and fastidiously ignores some facts we know about human psychology: 1) emotions are a big influencer of human behavior 2) the emotions of fear and shame are especially important 3) complex and acute trauma are a major cause of self-protective and self-adaptive emotional responses and behaviors 4) attachment patterns learned in childhood influence emotional responses and behavior. How much training did I have on these topics in years of undergraduate and graduate school? About 30 minutes on attachment theory in children, none about adult attachment patterns. None on trauma or emotions. It is appalling. Thank goodness I had the determination to learn on my own about these topics and the influence every session with clients. Keep up the good work!
A good analysis of the problem, to which I would add: 1) Those of us offering solutions are locked out because we are “part of the system.” I am not allowed to blog on MIA because I would be attacked as a professional. Yet I am offering a replacement model for the DSM, but have great difficulty getting a hearing for these ideas because I am a professional. 2) The survivor movement must broaden its focus and inclusivity to include those who do not have “severe mental disorders” as this is a vast segment of the population that is being ignored in this movement. Millions of people have mild anxiety/depression/etc and may take a prescription or see a psychotherapist, but never have experience in inpatient treatment, ECT, antipsychotic medications, etc. Labeling organizations with names such as “hearing voices” brings support to some, but also excludes and frightens others. 2) I believe we must challenge the DSM as a weak point. It lacks validity and reliability, is based on subjective decisions rather than science, etc etc, as outlined by many. This will also be a major battle, just as attacking Big Pharma, but it is essential. The myth/belief system that “mental disorders” are biological diseases must be discarded before we can reframe “mental disorders” as normal, adaptive human responses to trauma, attachment insecurity and emotions such as fear, loneliness and shame. Lots more at http://www.HarperWest.co
Thank you so much for the solid information and links. I advocate daily against medication and for therapy because it works and doesn’t have side effects! I focus on interventions to improve self-acceptance and shame tolerance through mindful self-compassion training as it directly addresses the REAL causes of emotional problems, which is low self-worth due to trauma and attachment insecurity.
This is the sort of dismissive name calling that I am talking about and will not be helpful in generating supporters to your cause. Fortunately, I have a very thick skin, but not all others do and will quickly abandon any support if this is the type of reaction they are going to get. I will not apologize for supporting facts, truth and science of evidence-based practices. How will such a revolution decide on the appropriate responses to psychiatry if not by science? By the roll of a dice? By popular vote? Why should we not use science to help those who suffer with emotional distress? Serious, why not? Sure, the DSM and the disease model of “mental health” are not based on facts or evidence, but there is no reason to dismiss science because of that.
This is a wonderful list of resolutions, however, this website does not actually advocate change. Rather, it is primarily about venting about the problem. I am a psychotherapist who suggested a blog on a new system of conceptualizing “mental health” that has been very well reviewed by those in the anti-psychiatry field, including one blogger at MIA. Yet I was told that because I was a mental health professional my ideas would be viewed with hostility by readers of this website and my blog was rejected. If reasonable, evidence-based suggestions to replace the DSM are rejected out of hand because they come from someone with a degree, then good luck with your revolution! Many successful revolutionaries worked within the constraints of the system and enlisted those on the inside. “Blowing up the system” is rarely effective or successful.
Thank you! The emphasis on “psychiatric” (aka drugging) interventions is heavily emphasized in these bills. Why not emphasize psychosocial supports, including psychotherapy and parenting education, as first-line interventions rather than medication? Where is emphasis on trauma-informed and attachment-informed therapy and assessment, which ARE research-based and evidence-based? All legitimate clinicians who keep up with the research know that developmental trauma and attachment insecurity are causes of emotional/behavioral problems rather than “diseases” of the brain. Please oppose both of these bills.
I have proposed one revolutionary paradigm shift — rethinking the DSM/ICD “diagnostic system” that is based on the biomedical/disease model. My Self-Acceptance Psychology is based on actual research on the effect of childhood trauma and attachment trauma, along with well-accepted facts about the threat response (“fight-or-flight”), shame and fear of social exclusion. This model fully explains all “mental disorders” as normal, if maladaptive, responses to these factors and makes complete sense to those who read it. I address the power of shame as an emotional driver of most “mental disorders.” Emotions such as shame are the cause of emotional and behavioral distress, not imagined neurochemical imbalances.
However, the likelihood that this or any other paradigm shift takes hold is nonexistent because of 1) the inertia of public opinion now that the “neurochemical” myth has taken hold 2) lack of financial backing at the level that Big Pharma is able to exert to fight against this accepted myth 3) clinicians who are afraid to stand up to the American Psychiatric Association and its assumed and presumed authority over the diagnostic system.
I just handed out 500 business cards at a psychotherapy conference trying to generate support for Self-Acceptance Psychology and got essentially no response. The profession must open its eyes to the falsehoods of disease model. Every person who comes into my office harmed by false “diagnoses”, stigma, shame and medication breaks my heart.
Bravo! Wholeheartedly agree. As a psychotherapist, I have NEVER seen a supposed case of “ADHD” or child behavior issues without also finding trauma, attachment trauma, parents with high levels of anxiety or just inappropriate and permissive parenting. We must stop “diagnosing,” drugging and stigmatizing these children when the parents must be addressed as a very likely cause of this problem. Parents do not want to hear this “blame” but where else should this blame be placed? And, actually, it is the parents’ lack of ability to handle blame that is another source of the problem.
Excellent, forthright and thoughtful analysis, Dr. Levine. As a professional who comments here and is attempting to help counteract First-Order Psychiatry, my comments frequently get attacked for specious reasons or ignore, perhaps for the same reason. Correctly identifying the enemy and consolidating supporters is key in developing a coalition. Coalitions are made up of groups or people who may not believe EXACTLY as you do, but are aligned with you enough that you can group together to accomplish a goal. Just as political parties are made up of people who may disagree around the edges, but agree enough about core concepts to band together to gain power. It is frustrating to be proposing an alternative to the DSM/ICD yet be blasted because I do not meet someone’s definition of perfect alignment with their beliefs. For those who are open-minded enough to consider it: http://www.SelfAcceptancePsychology.com
Dr. Breggin, along with your excellent reiteration of the dangers of psychiatric medications, I also appreciated your mention of the influence of shame on some mass murderers.
– âThe Munich shooterâs manifesto âfocused on personal humiliations.ââ
âMany mass murders are driven by two distinct and largely separate sets of motivation. One set can be called personal ideology, where the individual develops a rationalized hatred for his family, peers, or other groups, often attributed to acts of bullying and humiliation.â
In my work âSelf-Acceptance Psychologyâ (www.SelfAcceptancePsychology.com) I highlight the tremendous power of shame to influence human behavior. I identify three main âShame Management Strategiesâ people adopt: Self-Blaming, Other-Blaming, and Blame Avoiding. As in your examples, the evidence is often available that indicates mass murderers are severe âOther-Blamers,â perhaps made worse by psychiatric medications and the shaming experience of âdiagnosisâ and âtreatmentâ for a âpermanent brain disorder.â
âOther-Blamersâ have such deep feelings of inadequacy they cannot be resilient when they experience humiliation, embarrassment or rejection. As James Holmes’ case indicates, failing out of graduate school and being rejected by a girlfriend may have been the triggers that overwhelmed his ability to tolerate shame and sent him on a rampage fueled by his desire to blame others for his problems. A deep lack of accountability and inability to hear criticism are key behavioral aspects of âOther-Blamers.â
We must stop being mired in the false âdiagnosesâ of the DSM/ICD and look accurately at what drives human behavior or we will continue to fail to understand, assess and predict it â and prevent this type of behavior in the future.
Chaya – I am so happy you found a helpful therapist. We are out there. . .
I am a psychotherapist who very strongly does NOT NOT NOT believe in stigmatizing DSM labels, the “disease model,” and psychiatric drugs. In fact, my website, blog and YouTube channel outline this very clearly.
Go to http://www.SelfAcceptancePsychology.com And I tell my clients in the first meeting about my beliefs to reduce stigma and help them feel more comfortable that I am not judging them. As I outline in “Self-Acceptance Psychology” problems of thinking, feeling, and behaving (“mental disorders”) are due to Five Causative Factors that are normal and understandable: trauma or attachment trauma, fear (“fight-or-flight”), shame, and the natural fear of social exclusion.
I believe, and have been told by my many happy clients, that I am a compassionate, accepting therapist who is not just out to make money or promote my own agendas onto my clients. In fact, I gave up a lucrative corporate career in midlife to go to graduate school to become a clinical psychologist — and make LESS money.
So since I do not arbitrarily and blindly label others as “mentally ill,” I would appreciate that all of us in the mental health profession were also not labeled as somehow, due solely to our professional titles, as morally bankrupt, worthless, corrupt, etc etc. Many of us would love to change the psychiatric-based system and make it more focused on client-center, accepting, compassionate, helpful, productive therapy, not drugs and more drugs.
Oh, and I, too, was very, very lucky to have stumbled upon an excellent therapist (in a bar!) at a point in my life when I was absolutely in need of one and didn’t even know it. Her help was life-changing and actually led to me becoming a psychologist. There are good therapists out there…
Michael, I am so grateful to hear your viewpoint, because I, too, have to undo this damage done to parents and children when psychiatrists “educate” about the alleged disease model of “mental illness.” So many children come to therapy with the belief that their brains are damaged and will be for life. This, of course, hampers any efforts at therapy, worsens their self-image and promotes helplessness in parent and child.
So in the first session I educate parents and children/adolescents on the fact that the “damaged brain” concept is completely unsupported by research. What makes far more sense is the child has been trained to react to fear/threat with normal “fight-or-flight” responses and become dysregulated. I offer parenting education on brain development, on how their interactions with the child may be causing fear/anxiety, even inadvertently through permissive parenting or being overly verbal or being anxious or depressed themselves. I work with parents to improve attachment (insecure attachment being another cause of emotional distress). I investigate any traumas the child may have experienced and work on changing the cognitive and emotional response to that. All of these ideas are encompassed in Self-Acceptance Psychology. (www.SelfAcceptancePsychology.com) Iâve developed a concept called Self-Acceptance Psychology that explains the real, root causes of âmental disordersâ such as behaviors labeled as âanxiety,â âdepression,â âbi-polar,â and âADHD.â It reframes these as normal, natural behaviors resulting from low self-worth, fear, shame, self-criticism and a desperate need for love and belonging (attachment). These can be easily and effectively addressed without medications by learning to generate self-acceptance. Yet the psychiatry profession continues to medicalize âmental disordersâ and push pills, rather than advocate for safe, effective psychotherapy and self-help. Keep up the good work!
Trauma is, absolutely, one of the major causes of alleged âmental disorders.â As a psychotherapist, I can dig into a personâs history just for a few minutes and nearly always arrive at an explanation for why they ended up âdepressed,â or âanxious,â etc.
But it does not doom a person to a lifelong diagnosis and I clearly communicate this to my clients. Many are helped tremendously when their experience is normalized and explained as NOT due to brain malfunctioning, but to life experiences. This gives them hope, as it should.
When we look at trauma, we must consider attachment trauma, a major factor in explaining human behavior in significant ways. I also educate on how that personâs experience as a child can lead to low self-worth, feelings of shame, and emotional over-reaction or under-reaction when shamed or rejected. Parental lack of emotional nurturing and warmth â perhaps worsened by addictions, their own emotional problems, or their own lack of secure attachment â can directly cause poor social and emotional functioning in the child and, later, adult. The need for close emotional connection to others is essential for us as social animals.
I also educate on the effect of natural, normal human responses, such as the threat/fear response (âfight-or-flightâ), the need for social acceptance, and the effect of shame when rejected, even if due to insecure attachment.
All of these ideas are included in Self-Acceptance Psychology, which is a simple, but powerful new paradigm to describe and understand human behavior. It challenges the traditional ways of defining âmental disorders,â yet is based on well-accepted and well-researched psychological concepts. Self-Acceptance Psychology reframes emotional and behavioral problems as adaptive and self-protective responses to fear, trauma, shame, and lack of secure attachment. This conceptual framework has many benefits and can lead to long-term, permanent change. http://www.SelfAcceptancePsychology.com
Good insights, BPD. At the risk of sounding self-promotional, in my Self-Acceptance Psychology work I characterize “splitting” as two main adaptive behaviors to deal with trauma, abuse, and lack of parental attachment and the resulting shame and low self-worth.
First, Self-Blaming involves attempting to “fix” oneself to manage feelings of inadequacy (Black Dudie’s recriminations could be considered as very Self-Blaming — You are deeply unworthy to the point that you should die. Depression can be largely framed as mostly Self-Blaming behaviors. Anxiety, especially behaviors such as “OCD,” perfectionism, hyper vigilance to criticism, etc, are also Self-Blaming.
In contrast, another adaptive mechanism is Other-Blaming: lacking in accountability, lashing out at others in anger or blame, refusing to be wrong or accommodate the viewpoints of others, refusing to hear criticism, etc.
Healthy individuals minimize the use of these two strategizes and can be self-accepting, or securely self-attached (Good Dudie!) with accurate self- and other-perceptions, self-compassionate, etc.
In this way, perhaps psychosis is merely very clear awareness of these contrasting responses to a threatening situation playing out in the mind. Fear is a very powerful emotion and we will do many things to try to manage it and calm ourselves down, even if these responses ultimately do not serve us well.
Learning to be self-compassionate and self-accepting can be wonderfully powerful methods for reducing self-judgment and self-blaming. Negative self-talk triggers the brain and body into the threat response (“fight-or-flight”), which can lead to “symptoms” labeled as anxiety, depression, psychosis, etc, etc. The core is nearly always a sense of low self-worth or poor shame tolerance that triggers urges to attempt to fix perceived inadequacies through self-blaming. Check out Kristen Neff and Christopher Germer’s research and books on mindful self-compassion. Together they developed an MSC program that is excellent. Best of luck!
Coping strategies that we currently label as âmental disorders,â such as anxiety and depression, could be considered âessential,â but I like to add âat one point in oneâs life.â
Most of these were learned in childhood due to loss of secure attachment with parents, traumas such as emotional or physical abuse or neglect, and evolutionary responses.
Many of these adaptive or self-protective emotional or behavioral responses are rooted in the primal need for survival. Anxiety or panic can be seen as fear, aka âfight-flight-or-freeze.â We react with fear to emotional threats just as surely as we do physical threats. Things like the negativity bias are helpful in physical survival â if we know that bears live in caves we tend to look askance at caves and avoid them. But these survival strategies, when learned as a young child, are then often implemented without a balanced cognitive ability to sort through the timing, intensity or appropriateness of these responses, becoming “OCD, anxiety, or depression.”
A childâs brain is just not developmentally able to do much more than react emotionally. A child thrown into âfight-or-flightâ repeatedly, even if it is just due to living with a highly anxious or depressed parent, learns to react unthinkingly to any emotional threat, rather than respond mindfully and thoughtfully. Again, this learned behavior becomes labeled as âmaladaptiveâ as an adult, even though it served a purpose earlier in the childâs life.
In my work âSelf-Acceptance Psychology,â I outline Five Causative Factors that can be considered together as the reason for essentially all âmental disorders.â The fear or threat response (âfight-or-flightâ), fear of social exclusion, shame as an attempt to prevent social exclusion, trauma, and attachment status all connect to trigger Three Shame Management Strategies.
I am proposing Self-Acceptance Psychology as an alternative to the DSM/ICD disease-based diagnostic framework. For much more go to http://www.SelfAcceptancePsychology.com.
Very well said, Steve. I was shocked in psychology graduate school how many students had NEVER been in therapy themselves, despite a “recommendation” that they do so. Many were also on psychoactive meds! A couple even had active addictions. Some had such high anxiety that they could not give presentations in class without severe panic . Many were irresponsible and could barely be attentive to the professor. How are these individuals going to remain attentive, accepting, present, calm and centered when addressing a patient’s high anxiety, high shame, or a conflict-laden family or couple session?
All therapists of any stripe should be screened for their own psychological issues. They need to understand their attachment issues, how they regulate (or don’t) their emotions, their trauma history, and then come to a sense of self-acceptance. Self-Compassion is essential before one can generate compassion for others.
It is so disappointing to me that we continue to lament this obvious fact — that by treating those suffering with emotional distress as if they are “ill” or “defective,” they will experience stigma, passivity, etc, as you outline, Gary.
But there are solutions, rather than just eliminating mental healthcare providers.
As an outpatient psychotherapist, I always view the client’s behaviors as self-protective and adaptive — rather than defective. They are struggling to manage developmental/attachment trauma, parental abuse or neglect, lack of parental attachment, lack of emotional and social skills, and other environmental insults in the best way they know how.
To help, I directly tell them that diagnostic labels such as “obsessive-compulsive disorder” or “ADHD” are not based on science, research or common sense, and to disregard them completely. These behaviors are based on a lot of well-known, well-researched facts about human behavior.
I initially focus on normalizing the experience of “anxiety,” or “depression.” To do this I educate on the fear/threat response (“fight-or-flight”). I teach that to the brain, internal messages trigger the fear response (“I am a terrible person.”), identically to external threats (a mugger or car accident.) This helps people realize they are the master of their own anxiety and depression and gives hope and reduces stigma. I then work to explore and deepen emotions, especially the experience of shame or low self-worth. Those with low self-worth are self-critical, which triggers the fear response. I teach mindfulness meditation and breathing exercises to improve self-awareness, attentional focus and self-calming. I work to help a person develop self-compassion, self-attachment and self-acceptance, which has been proven to reduce self-shaming and, therefore, anxiety. They are also less likely to look to others for approval and attachment, which improves relationships.
Yes, too many therapists hold the framework that clients are diseased, incompetent and “less-than”, which only further diminishes their self-worth.
If more therapists provided acceptance, normalization and education on the workings of the brain and emotions, fewer people would experience stigma and they would gain hope for change. None of what I teach is new — yet it is not taught in US graduate schools and largely ignored by DSM/ICD-based frameworks for diagnosis and intervention. Details on my protocols are at http://www.SelfAcceptancePsychology.com
Don’t be confused by the labels psychiatrists have arbitrarily come up with. “ADHD” is merely anxiety or even more simply– fear. As a clinician, I have NEVER seen a child with “ADHD” behaviors that did not have one or more of the following experiences: 1) a parent or parents who was also anxious, impulsive, oppositional; 2) the parental relationship was high-conflict; 3) the child had experienced developmental trauma or attachment trauma; 4) parents had poor emotional intelligence skills and failed to be emotionally attuned to the child; 5) parents used fear-based, consequence-based, behavioral-based parenting styles. Children are very emotionally skilled and highly attuned to the emotional status of their parents. Children either model behavior of parents or, due to natural “emotional contagion”, pick up on the anxiety of their parents. ADHD is a child experiencing “fight-or-flight” who developmentally lacks the cognitive abilities to manage or regulate his or her emotions, largely because the parents are dysregulated when they should be regulated. Children learn to regulate their emotions from parents who are regulated and calm. I always focus interventions on parenting changes, especially improving attachment behaviors, improving emotional listening and attunement skills, love-based parenting versus fear-based/behavioral-based parenting, mindfulness and self-calming — FOR THE PARENTS. Then I engage with the child to teach mindfulness skills as well. No one wants to blame the parents — but where exactly do children learn emotional, social and behavioral skills if not from parents? If we don’t blame the parents and correct their behaviors, then the children get blamed, stigmatized and shamed. Too many children come to therapy ashamed and suffering with low self-worth, believing they are defective, mentally ill and even unlovable. Given a choice between blaming parents and blaming children, the choice seems clear. For more, go to http://www.SelfAcceptancePsychology.com
As a clinical psychologist, when every client enters my therapy room — adult or child or family — I clearly educate them that the myths perpetrated by psychiatry and Big Pharma are false. There is almost certainly nothing biologically or genetically damaged or diseased about their brain. For children, this normalization is essential. As I explain on http://www.SelfAcceptancePsychology.com the core issue in those with “depression” or “anxiety” or “ADHD” or “behavioral problems” is a sense of feeling unworthy, unlovable or ashamed. Pathologizing these normal emotional responses only worsens a person’s sense of aloneness and separateness. We all have primal responses to fear (hyper-vigilance to threat which can show up as over-reactive emotions or the hypersensitivity to sensory inputs the blogger described), to social exclusion, to shame, to lack of bonding or attachment to family members, or to developmental trauma (parental rejection, abuse, neglect, etc.). Labeling normal emotional responses as diseased and different is fundamentally shaming and harmful to people. We must stop the DSM/ICD falsehoods. I urge clinicians to read more at http://www.SelfAcceptancePsychology.com
As I discuss in âSelf-Acceptance Psychology,â (www.SelfAcceptancePsychology.com), the âdepressionâ and âmaniaâ can be more parsimoniously and accurately understood to be over-reactions to the threat response (aka âfight-or-flight). Trauma, including attachment trauma, is very common in âschizophrenicâ patients. Trauma increases hyper vigilance to and emotional reactivity to threat. Mania can be seen as this over-reaction, while depression is the opposite response, with the body and mind collapsing from an over-stimulation of stress.
Fear is one of the most powerful emotions we experience and has wide-ranging effects on physiology, emotions, moods, attitudes, cognitions, and behaviors. Yet despite the volumes of research and factual evidence on the threat response and its tremendous primal influence on human emotions and physiology, the current disease model essentially ignores this fundamental fact when describing human behavior.
Since all emotions are valuable responses, it makes one wonder: If fear is to be considered a âmental disorder,â then why is happiness not considered a âmental disorderâ? It is time to reframe and de-stigmatize these mistaken, but commonly held, beliefs about emotions: Fear, and as a result schizophrenia, is not a âmental disorder.â
âWhen prescribed loosely,â meds are problematic, according to Dr. Frances. But we must assume the prescribing is being done based on the DSM, which is inherently âlooseâ in its diagnostic accuracy and relevance, as you so ably elucidate here. So how can prescribing NOT be done loosely, even when it is intended to be done just for âclear-cut psychiatric disordersâ and not for âeveryday difficultiesâ. The current system is a Jello mold on top of a Jello mold on top of a Jello mold. –Harper West,MA, LLP