7 Ambitions for a Mental Health Revolution
The future of mental health interview series concludes
Posted May 09, 2016
I hope that you’ve enjoyed the future of mental health interview series. More than 110 interviews have appeared! You can find the complete roster with live links to the interviews here. If you’ve missed some of the interviews, do take a look at the roster: there are many valuable and eye-opening interviews to be had. In this post I’d like to provide a few concluding thoughts, including a few top tips for reducing mental distress. If you’d like to keep abreast of the future of mental health movement, please visit here. And now, for some concluding thoughts.
Millions of people worldwide—among them mental health professionals, psychiatric survivors, parents of “diagnosed” children, enlightened legislators, academic researchers and alternative mental health practitioners—know that our current mental health paradigm, dominated by a flawed pseudo-medical model and by the indiscriminant use of chemical interventions, ought to be rejected. Nothing short of a revolution is needed. But what should that revolution look like?
I think that we might hold out seven ambitions for such a revolution. These seven ambitions—understanding human nature, disputing reductionist paradigms, adopting an activist mindset, identifying what actually helps to reduce human distress, shifting professional practice, articulating and promoting a new, more intellectually rigorous paradigm, and creating and supporting new helping alternatives—can be the place where good science, humanist values, and a genuine desire to help come together for the betterment of our species.
In the meantime, and whether or not the revolution comes, helping professionals can begin to shift in the direction of better practice. The first shift is the oddly radical shift from looking for assorted leaks in the plumbing to acknowledging that life is difficult. That is the primary shift required of helping professionals today. Additional shifts include the shift from “I need to look like an expert” to “I need to be human”; the shift in the direction of paying more attention to the role of socioeconomic conditions and other social and cultural realities in the lives of clients; and the shift in the direction of better clarity on the difference between a “difficult person” and a “mentally disordered person.” Mental health professionals can do a better job of helping their clients simply by making shifts of this sort, ones that, while easy to understand and implement, nevertheless amount to a radical change in the helping paradigm.
And what about the whole “diagnosis” business? There are two schools of thought with regard to what ought to replace the DSM and the ICD and the “diagnostic” model that they promote. One school of thought has it that alternative diagnostic schemes are what are wanted: that is, new schemes that retain the word “diagnosis” and that allow practitioners to continue to “diagnose something” and then “treat it.” A second school of thought has it that alternatives to diagnosis are what are wanted: that is, what are wanted are alternatives that flatly reject the idea that “diagnosing” and “treating” are going on and that affirm that helping distressed individuals is neither a medical activity nor a pseudo-medical activity. I believe in this latter approach.
I’ve proposed a “life formulation model” in keeping with this second approach. It rejects the activities of “diagnosing” and “treating” and helps a practitioner do a robust job of characterizing what is going on in her client’s life. In the life formulation model, a practitioner would describe her relationship with her client in seven ways: 1) the client’s expressed concerns; 2) the client’s circumstances of note; 3) the client’s life purposes, dreams, and goals; 4) the client’s behavioral and emotional considerations; 5) the client’s challenges as inferred by the provider; 6) the provider’s concerns; and 7) the provider’s recommendations. There would be no DSM language or pseudo-medical language used in this model, no new diagnostic language introduced, and everything would be described in “plain English.”
Among the virtues of this model is that it doesn’t conflate or confuse the client’s concerns with the provider’s concerns and it not only avoids the word “diagnosis” and the very idea of “diagnosis” but it also avoids the word “psychological” and announces that a service provider is helping people in distress with their problems with living and not exclusively with their “psyche.” To learn more about this model, about my proposed mental health helper of the future, the human experience specialist, and other ideas I have for the future of mental health services provision, please take a look at The Future of Mental Health: Deconstructing the Mental Disorder Paradigm, available from Transaction Publishers.
And if you are a sufferer and encountering difficulties currently named things like clinical depression, bipolar disorder, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, attention deficit disorder, schizophrenia, and so on? Where can you turn? You will have gleaned from these interviews that there is no simple answer and no agreed-upon answer. Where you turn must necessarily relate to what is going on—it matters whether you are sad because you hate your job, sad because your winters are too long, sad because you never wanted children and now have three, sad because you’ve been rather melancholy from birth, sad because you can’t control your drinking, and so on—all that of course matters, not incidentally but centrally and profoundly.
Whether or not you know exactly what is causing your distress—or which multiple factors are causing your distress—you still want that distress reduced. What should you do? I think there are several efforts you might make:
+ First, protect yourself. If your family life is toxic, if your physical wellbeing is threatened, if you are living under siege, you have action to take. You can’t heal if the trauma is ongoing, you can’t grow and change in an environment where you’re demeaned or diminished, you can’t stand up and live when you are also in danger or in hiding. How well can you feel in a sick environment? Find some way out, no matter how arduous that journey to freedom may prove.
+ Second, do not isolate. Brooding about your circumstances, stewing with your feelings, and standing alone and isolated, will only worsen your situation. You may have many powerful reasons for isolating: you may feel embarrassed, too angry to reach out, doubtful that anyone will understand you or care about you, scared that you’ll lose control—and even your freedom—if you share your truth with another person, and more. Still, isolating isn’t the answer.
+ Third, talk to someone who is able and willing to listen, someone whose first impulse isn’t to fix you, save you, or treat you. If that person is a mental health professional, what you talk about, and even whether talking is encouraged, will depend a great deal on the heart and skillset of the individual practitioner. If you aim yourself in the direction of professional help, cross your fingers that you land in the office of someone who is wise, skilled, and supportive.
+ Fourth, reject the idea that some diagnosis will serve you or define you. It may comfort you to feel like you “have something” and it may even prove useful to agree to a chemical intervention, but you will have better luck healing if you accept that life is challenging and that you have the job of bravely and skillfully negotiating those challenges, rather than believing and acting as if the plumbing is broken. You may be metaphorically broken—but that is very different from being organically or medically broken.
+ Fifth, consider the variety of resources available to you. Even without financial resources, you can still read, educate yourself, attend free support group meetings, receive peer support and get involved in peer support activities, and talk to someone—a friend, a relative, a peer, a pastoral counselor—who is willing and able to listen.
+ Sixth, try to give life a thumb’s up. Life may not deserve that thumb’s up—it may have harmed you, failed you, and even tormented you—and yet you still have a life left to live. You can live that life chaotically, anxiously, in despair, or otherwise defeated or you can decide to live according to the life purposes you choose and with some version of a positive attitude that you likewise choose.
The interviews in this collection provide you with many ideas in addition to these six. I do hope that you’ve found these interviews interesting and useful. You can find a complete list of the interviews, with links to each one, at this page—there are more than a hundred of them available. If you’d like to send me your thoughts or comments or recommend someone for me to interview in a second series of interviews (you can also recommend yourself), just drop me an email to email@example.com. Thanks for reading!