A recent article published in a scientific journal, discussed the distinguishing between normal and abnormal emotional states and reactions in clinical practice.
Without making the specific article or the work behind it the issue, I want to use it to pivot into an area where I like to take a stand.
This paragraph will be my point of entry to what I would love to become a discussion about attitudes I have found to be pervasive among professional mental health care practitioners, but more seriously also in the overall US culture.
Without making the specific article or the work behind it the issue, I want to use it to pivot into an area where I like to take a stand.
This paragraph will be my point of entry to what I would love to become a discussion about attitudes I have found to be pervasive among professional mental health care practitioners, but more seriously also in the overall US culture.
"Psychiatrists and clinical psychologists are often called upon to reliably distinguish between normal and abnormal emotions. Increasingly this is done with the help of diagnostic category systems developed by professional associations and health organizations like the Diagnostic and Statistical Manual for Mental Disorders (DSM). In consequence, the definition of abnormal emotionality proposed by these classification systems has an extraordinary impact on the diagnosis and treatment of what is perceived as emotional disorders or disturbances."
Source
How did it get to a point at which, as in this depiction, it is not the patient who provides information or serves as the point of reference, for determining whether a state of mind is or is not needing intervention? There are cases when someone else than the person who experience the mental state, should be prime authority in assessing how much of a problem it is; but those are rare.
I also find it strange that we still use the concept of Normal in any other meaning than "according to most common practice". It is especially odd to infuse the concept with evaluative meaning and give it the dignity of science; and it appears completely insane to use it to categorize subjective emotional states and mental experiences.
If only focusing on practicality: how is it not more accurate to discuss outcomes in terms of individual's experiences; focusing on how come ways of feeling and thinking has dysfunctional outcomes and leads to experiencing disability given their context, circumstances, and expectations? Instead of the person seeking or exploring help from a mental health practitioner being the main character in deciding whether, and what, help is required; the focus is on the diagnostic criteria and those bestowed the right to divine when they apply.
I always take the opportunity, when given, to point out that diagnosis is not required to receive care. It is the nature of the system of reimbursement of health care through insurance system in the US, that has made it practically mandatory to have a diagnosis, and that the diagnosis must be one listed in the DSM. It has become accepted as criteria to be met to reimburse costs,
Also, every mental health problem, listed in DSM as a diagnostic entity or not, can be addressed by more than one form of treatment/care/intervention - medical, cognitive or psychodynamic therapy sessions, social or practical support, or any other form of support for well-being and ability.
I also find it strange that we still use the concept of Normal in any other meaning than "according to most common practice". It is especially odd to infuse the concept with evaluative meaning and give it the dignity of science; and it appears completely insane to use it to categorize subjective emotional states and mental experiences.
If only focusing on practicality: how is it not more accurate to discuss outcomes in terms of individual's experiences; focusing on how come ways of feeling and thinking has dysfunctional outcomes and leads to experiencing disability given their context, circumstances, and expectations? Instead of the person seeking or exploring help from a mental health practitioner being the main character in deciding whether, and what, help is required; the focus is on the diagnostic criteria and those bestowed the right to divine when they apply.
I always take the opportunity, when given, to point out that diagnosis is not required to receive care. It is the nature of the system of reimbursement of health care through insurance system in the US, that has made it practically mandatory to have a diagnosis, and that the diagnosis must be one listed in the DSM. It has become accepted as criteria to be met to reimburse costs,
Also, every mental health problem, listed in DSM as a diagnostic entity or not, can be addressed by more than one form of treatment/care/intervention - medical, cognitive or psychodynamic therapy sessions, social or practical support, or any other form of support for well-being and ability.
Who is to blame?
If people has lost the driving seat in their treatment, how did they lose it?
I like to look at this from the point of view other than one that sees the role of the supply side as enough of an explanation. Let's say for the sake of argument that the majority of people whose income largely comes from making, selling, and prescribing psychopharmaca and provide services that in practice require a diagnosis; share the attitudes of the patient not being the one to judge the whether, when, and what of either problem or solution; and of implicitly making diagnostic criteria determinants of good and bad, and right or wrong.
How does that explain that a majority of all the rest of us that make up the demand side of this equation, have been the kind of users of mental health care that either encourage or at least don't do a convincing job dispelling them? It doesn't.
Is it not the case that whether or not we have ever used any mental health service, we are all part of creating a situation in which individuals and patient advocacy groups push for conditions associated with distress and dysfunction to be recognized as “valid”; and not just to get access to insurance coverage for costs otherwise borne by the surrounding family and friends, informal caregivers, the person him- or herself, and society at large. It is just as much to reduce the stigma of not suffering from something unnamed and therefore not quite “real”?
Take fibromyalgia, Post Traumatic Stress Disorder, Traumatic Brain Injury, or any other disabling state of functioning that lacks visible physical manifestations and that has yet to be, or only recently were, encoded as a diagnostic entity. No impaired or atypical functioning of the individual can be blamed for the distress and disability that comes from having to meet one’s social and practical needs by engaging people and social norms that suspects you of fraud, fake, and/or of “just imagining things”.
The responsibility of society (that would be us)
I personally hold that disabled and disability, as well as abnormal and abnormality, are relative to the context; not properties of a condition or person.
I approach disability as a person’s experience of being unable to achieve expected outcomes through the allowed means using the available resources. In this perspective the lack of ability is an outcome determined by factors decided not by any internal condition or personal “trait” but by the social and physical environment; expectations on what and how to achieve certain outcomes, and the resources made available. Attitudes towards mental health, and the degree to which individuals can vary around an idea of what is “Normal” and still find inclusion and facilitation, are a product of the attitudes of all of us.
I find that it helps me be mindful that no matter how disabling an impairment or variation of physical or mental functioning is considered, it does not sentence a person to experience of inability or to being disabled. It means that I, and the whole of the social context generally, simply has to be more creative and conscientious in working with the person to find the configuration of expectations, resources, and environment that maximize him or her being THE central agent in writing his or her life story.
If people has lost the driving seat in their treatment, how did they lose it?
I like to look at this from the point of view other than one that sees the role of the supply side as enough of an explanation. Let's say for the sake of argument that the majority of people whose income largely comes from making, selling, and prescribing psychopharmaca and provide services that in practice require a diagnosis; share the attitudes of the patient not being the one to judge the whether, when, and what of either problem or solution; and of implicitly making diagnostic criteria determinants of good and bad, and right or wrong.
How does that explain that a majority of all the rest of us that make up the demand side of this equation, have been the kind of users of mental health care that either encourage or at least don't do a convincing job dispelling them? It doesn't.
Is it not the case that whether or not we have ever used any mental health service, we are all part of creating a situation in which individuals and patient advocacy groups push for conditions associated with distress and dysfunction to be recognized as “valid”; and not just to get access to insurance coverage for costs otherwise borne by the surrounding family and friends, informal caregivers, the person him- or herself, and society at large. It is just as much to reduce the stigma of not suffering from something unnamed and therefore not quite “real”?
Take fibromyalgia, Post Traumatic Stress Disorder, Traumatic Brain Injury, or any other disabling state of functioning that lacks visible physical manifestations and that has yet to be, or only recently were, encoded as a diagnostic entity. No impaired or atypical functioning of the individual can be blamed for the distress and disability that comes from having to meet one’s social and practical needs by engaging people and social norms that suspects you of fraud, fake, and/or of “just imagining things”.
The responsibility of society (that would be us)
I personally hold that disabled and disability, as well as abnormal and abnormality, are relative to the context; not properties of a condition or person.
I approach disability as a person’s experience of being unable to achieve expected outcomes through the allowed means using the available resources. In this perspective the lack of ability is an outcome determined by factors decided not by any internal condition or personal “trait” but by the social and physical environment; expectations on what and how to achieve certain outcomes, and the resources made available. Attitudes towards mental health, and the degree to which individuals can vary around an idea of what is “Normal” and still find inclusion and facilitation, are a product of the attitudes of all of us.
I find that it helps me be mindful that no matter how disabling an impairment or variation of physical or mental functioning is considered, it does not sentence a person to experience of inability or to being disabled. It means that I, and the whole of the social context generally, simply has to be more creative and conscientious in working with the person to find the configuration of expectations, resources, and environment that maximize him or her being THE central agent in writing his or her life story.