Time to Revise the Medical Model (PTSD)

The Medical Model and Diagnosis

By now I think it should be clear that I have serious reservations about the medical model and that includes diagnoses. As I’ve said, granted ,taking people out of the realm of possession by demons was a distinct move forward. But now it is time to reevaluate a great deal about what we call mental illness.. Once we have a diagnosis then we are supposed to have a clear course forward. As a psychologist I must say I do not agree with that viewpoint. I’ve seen psychiatrists recommending long term intensive psychotherapy for heroin addicts. I prefer to think of long term guidance and support to gain a viable life course. The difference is notable. Such can be said in many other places.

A Lifetime Issue

Now we have what is called PTSD or post traumatic stress disorder.  It seems to have arisen as a recognized disorder during the Vietnam War. Actually it was discussed at least as far back as World War II and possibly World War I as such things as shell shock. Probably though we have always recognized forms of battle fatigue etc. The problem now is that the disorder often gets in the way of people getting help. The military is struggling with simply adopting post traumatic stress and dropping the word disorder. And we need a clear view that reacting to living months in an environment where you are trying to kill people or be killed may overwhelm people. In fact many don’t seem overwhelmed but some simply shut down and close themselves off. I’ve met such cold and distant people.

What’s The Point?

The point is that we have yet to come to terms with the reality of human existence. It is not an indication of mental illness if a person is reacting to a high stress environment or sudden trauma. It is much more reassuring to tell someone they are having a normal and understandable reaction. Granted reactions can vary from person to person but that is to be expected.

We still seem to not have clarity about these facts. There have been several times when I discussed such a reaction with a veteran in a social occasion and they were then in tears. Often they would express relief that they weren’t pathological and that a burden had been lifted.

Just Recently

And just recently we seem to have jumped a barrier. Particularly after the mass murder in a school in Florida the students began to speak about PTSD. Yes! Of course! You go to school on a quiet day and suddenly someone is running through the halls killing your fellow students and friends. What would be wrong is if the other students didn’t have a reaction. They need to accept feelings and work to deal with them either personally or with others. But a reaction is to be expected and may be variable but above all it should be accepted as reality. Life delivers blows to us and we have to respond and cope.

Can we now take a different approach to trauma. Diagnosis really doesn’t show us the way forward. Each person may well have a different reaction or way of handling it. They may need to discuss tactics but need to accept that a reaction is understandable and is not pathological.

A Personal Story

I  can share a personal story. In 1984 I had a catastrophic auto accident when someone drove in my driver’s door at high speed. I went through years of surgery and recovery. Then ten years later I was waiting at a traffic light when a man turned a corner at high speed, spilled his coffee on himself and totaled my car. I got off with a light blow to my head. But within twenty-four hours I recognized that I had been hurled back to the other accident. I called a colleague and we spent three sessions discussing it and my reaction. I was then able to put away my experience with PTS.

The Bottom Line

Life can be difficult, dangerous and terrifying. We need not deal with such events and our reaction with a diagnosis and a declaration of mental illness. And we need to deal with insurance companies and their practices. If it is not pathology then they won’t pay for someone getting help with management of a reaction. But help is often essential. The bottom line here is that there is such a thing as life management which is crucial. And life management often requires help with understanding, restructuring and engagement of coping tactics. Its time to reframe mental illness and life management.

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

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Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

Health Care Alternatives and Reality – Series – Pt. 2

Overcoming Innocence

A Lifelong Process

In a previous post I wrote about the lessons I learned from my father, a surgeon.  While he loved his profession, he also had deep reservations which he spoke to me about. It seems I took it in at a deep level because I was not exactly a rebel at such a young age. But over time I found myself having to clear my perception of all kinds of health care alternatives. And each time I found myself examining alternative pathways. And, looking back I think what was happening was that my intuitive personality was dictating that I search for alternatives and possibilities.

Searching Psychology

When I began my studies in college I was told psychology was a science. Well, of sorts. Definitely not hard science entirely. There was experimental psychology and there was clinical psychology. When I was accepted into graduate school at Duke it was in the experimental psychology program. it was a matter of a very few weeks before I walked into the chairman’s office and requested a change to clinical. Graciously he agreed.

Interface with Medicine

Early on we began clinical experience at Duke University Medical Center and eventually I did my internship there. It was eye opening. Up close and personal I interfaced with people I admired and some who horrified me even though they were highly respected. The echoes of my father’s positions were significant.

Now I’m Looking Back

Here it is decades later and I see a process of search and discovery. In this series I’m going to share my thoughts about health care and “treatment of illness”. Notice that there are quotation marks there. There are realities and there are dicta. I found myself weaving through a system which I saw as needing substantive modernization and reevaluation if not downright reform at all levels.

Rushing At the Future

And now we find ourselves being pressed into information technology and changes we are only now beginning to understand. The title of this blog is Cusp of Reality and I firmly believe that medicine resides on a vibrating cusp as well. In coming posts I’ll  be sharing my view of health care realities, misgivings about illness and diagnosis. I’ll be referring to revisions of definitions of illness, the difference between illness and life management. While much of what I experienced was in the psychological sphere, it is impossible to separate it from physiological, cultural and logical influences as well. We are on a rough road into the future and we need to explore and study what may lie before us. There I am again as the intuitive personality type facing a world of possibilities. But much of my viewpoint is conditioned  by experience. Jump on board and let’s explore together. 

What are your biggest concerns about health care?

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

Sanity Versus Insnaity

 

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Do you know what insanity is?

No Clarity

As a clinical psychologist I have come to mistrust the definitions of sanity and insanity. And for that matter I also question the clarity of what is or is not reality. That is why this blog is called cuspofreality.

Most of us would like to believe we have a firm grip on reality but the “reality” is that we are deeply influenced by the context, our personality, our mood, culture and on and on. Reality changes from moment to moment as does the perception of what is or is not sanity.

What a Surprise!

Not long ago there was a great deal of excitement when someone showed the same dress as white and gold or blue and black. It was an internet sensation. How could the same dress be those different colors. It was, of course, explainable in terms of the type of light, how we looked at it, etc. But it shook people’s believe in what was reality. Could it really be both sets of colors? Sorry to say, yes it can be or at least can be perceived as such.

We do, indeed, spend most of our lives believing in that thing we call reality. And people who see things differently from us, whether it is visually or cognitively, are simply wrong. I know. I have the proper perspective.

Facing the Task, Not the Diagnosis

For those of us in the mental health field, when we have to help people who are struggling with their emotional and cognitive lives, we often have to spend time determining the role of insanity. After decades in the field all I can say is that I dislike having to make such a determination. I’m not sure the label is helpful. I prefer to think in terms of how well the person copes in the world and how effective they are in relating to other people, including their coworkers.

If a person is harmless and happy with how they see the world, in many ways it is not important to define exactly how sane they are or are not. Labels may be rather pointless. Often we need not face the fact that most of us have varying forms of reality from which we relate to the world. There are, in fact, people who are quite insane in a fashion we can all agree on. Some people have a biochemical disorder which means their reality is fickle and they have terrible problems relating to other people.

Contextual Adjustment

What is the point you may ask? Sometimes we just have to adjust our belief as it relates to what is fair, correct, moral or just plain effective. And I am led back to the matter of the empowerment of women. We come from a history in which women’s rights were restricted. It is as if they were flawed and incapable of being truly independent. We are now rethinking this belief. And in doing so we are casting aside thoughts of sanity versus insanity or even incapacity. Perhaps we simply have to move to what is fair, correct and appropriate. We are already seeing the benefits. No matter how we view it, it is surely going to be a struggle.

How have you had to adjust your view of things in the past?

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