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

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

Health Care Alternatives and Reality – Series – Pt. 5

 

The Myth of Mental Illness

The above is the title of an important book by Thomas Szasz. Mental illness still dominates a significant portion of our health care system and it still has major conceptual problems. Of course, as a clinical psychologist, I was schooled in it. I actually came to love Carl Jung’s work a lot more than Sigmund Freud’s but his work still dominates.

Alternative Realities

And so we again return to where we live on the cusp. Over the decades I found nonphysical problems related to mental and cognitive issues to be far removed from “illness” and often nuanced. And when we move away from the dominant model, we find suitable alternatives. Unfortunately the insurance industry dominates the field and therefore may dictate treatment or at least what it is called. What it is called will often influence what is done. Substantial reform is needed.

Some of the Issues

When my wife and I personally confronted issues for remarried families (aka stepfamilies) we learned important lessons. An important initial lesson was that the process is a matter of adjustment, not psychopathology. Certainly there were some people with substantial disturbance from other causes but we learned to begin with our model of adjustment. The  couple was focused on initially. Too often the mother or stepmother was put in therapy as if they were the problem although they may have shown the greatest distress initially. And we were resistant to putting children in therapy because adjusting to a new family was not pathological in almost all cases. Because of our approach we could structure an information system and found that generally the family could take over adjustment and handle their own future after very few sessions. See our book Stepfamilies: Professionals and Stepcouples in Partnership by Mala S. Burt, M.S.W. and Roger B. Burt, Ph.D.

Another major issue is what is termed post traumatic distress disorder or PTSD. The military is wrestling with removing the word disorder because it proves to be a bar to veterans getting help with their adjustment. Does anyone really believe that someone should go to war and kill people daily or risk being killed daily while suffering stress and not need to cope with management and an enduring reaction. I shared my perception with some friends who were veterans and found them in tears when I suggested they were not “sick” although there were still issues decades after their war experience. 

Enduring and Broad Issues

Those are just two examples of the reality of a world far more nuanced than what is described as mental illness. We can go on between things like personality diversity, numerous personal management needs as we pass through stages of our life. When I first came into the field the predominant viewpoint was that our development was finished in early adulthood. Absurd.

Management of life experience continues throughout life and it would be best if we approached our lives in that fashion. Take an area of life experience and we see that there is change, stress and adaptation. It would help if we defined a type of insurance that was appropriate and took these issues out of the hands of insurance companies focused exclusively on profit.

Life on the Cusp

Yes, here is that cusp again. Each of us is different with a raft of different experiences. We work for stability and commonality and often success. But it would help if we understood the richness of our diversity in the sense that much of the issues are not pathological and that our views from the cusp feed creativity, diversity and innovation. And life can be difficult, even jarring. From time to time we need to seek expertise and guidance but we generally do not need to cast it all into psychopathology. There are problems out there with profound biological origins where the person needs substantive help but very often management and guidance are what is needed.

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

Diagnosis and the Real World

Under what diagnoses do you suffer? (Curious question isn’t it?)

Let’s Begin Here

Two definitions come to mind at once as we look at this post. Psychiatry is defined as: “the study and treatment of mental illness, emotional disturbance, and abnormal behavior.” Psychology has a variety of definition but I prefer: the study of human and animal behavior. The numerous other definitions suggest we aren’t actually sure what psychology is and I share that position. in fact, there is even a philosophical element which suits me just fine.

In Clinical Psychology

When we move on to the clinical area we quickly brush up against mental illness and as a student we quickly learn that diagnoses are generally expected. But how does mental illness fit with the broader definition of the study of human behavior. It seems like it must be a subcategory. What I found was that it is a restless subcategory and won’t keep its mouth shut.

Or at least it becomes a problem when we visit that devise place called the real world. And, of course, I believe in the cusp of reality which means I have questions. Are you hearing the pounding of philosophy at the door?

Then There Is Diagnosis

Freud defined a great deal of what is psychiatry and we entered a world of illness which required treatment and so there must be a diagnosis. The whole process was to be applauded because it moved emotionally disturbed people out of intervention for possession by demons  generally under the oversight of the church. They were in better, more compassionate, hands then. But not all of mental health people were devoted to Freud’s teachings. And that included Carl Jung who took us out into the world at large in a variety of ways. I won’t try to explore him. Take a look yourself.

What’s the Point?

It seems we are lost in a forest of exploration. There are those who believe in specific diagnoses for mental illness and in some case it yields helpful intervention. But there are others of us who believe it is far more complex than that. Sometimes diagnoses lead us down narrow corridors and sometimes it is more effective to shy away from an illness model and take the path to looking for functional factors and something I will call life management.

In This Age

Isn’t it interesting that as we rush forward into the future we are still mired in definitions and differing camps of adherents when it comes to what we call health care. At least we have latched onto prevention and a variety of preventive procedures. Those continue to need exploration and so do our responses to things happening to us that deserve attention.

That’s enough of the meshing of philosophical exploration with the real world. In future posts I’ll move deeper into the world of what we call mental illness and alternative forms of response which includes what I call self management.

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

Orlando! The Meaning and Impact of Mental Illness II

 

Have you had contact with mental health professions?

An Ongoing Dispute

When I wrote the initial copy for this post it was entitled The Myth of Mental Illness. That was also the title of the 1961 book by Thomas Szasz that I hold in high regard. He questioned the foundation of psychiatry as do I. His case gets stronger as time passes.

The fact is, I chose to become a psychologist for reasons I’m still uncovering. Probably the chief among them was my need to deal with my mother’s severe depressions. They seem to have been the result of personality problems but mostly reflected a genetically based vitamin D deficiency. I had set out to study particle physics but an unforgivably bad calculus professor turned me off on the mathematics which I viewed as fundamental. And so I found my way into a field I’m still disputing.

Decades later I have concluded that the term mental illness should be relegated to the dustbin of history. Recently I saw that someone had come up with a “diagnosis” for people who are concerned about healthy eating. Diagnosing them has the implication of viewing such a justifiable concern as an aberration or some kind of deviation of behavior.

The Beginning

In college I found the study of psychology interesting but that there were two parts. The clinical people were usually over in the medical settings and the academic setting was closer to experimental studies. They declared psychology was a science. Early on I was not impressed by the science part. I could see philosophy among other things. In the end I went to Duke University to study experimental psychology but within days asked to move to the clinical program which they granted. Steadily I was introduced to psychology, psychiatry and psychotherapy.

I was not prepared for the authoritarian nature of psychiatry. I attended Grand Rounds and saw patients paraded on stage while their history of “mental illness” was presented and discussed. (I should say this was decades ago and things have probably changed.) I also learned that psychiatric residents were not permitted to declare a diagnosis. A senior staff member would step forward and deliver the definitive word. 

There were times when graduate students such as myself went to clinical meetings and presented findings from our testing. Our findings were frequently used to harass and haze both medical students and residents. The effect was to build a wall between psychiatry and medicine in general.

Learning By Doing

I realized after the fact that I often was given very difficult cases. One of them was a very pretty, very dysfunctional and hysterical young woman. In her interest I managed to get her diagnosis changed from schizophrenia to a less damaging diagnosis which meant she might get more flexible and dedicated treatment in the years ahead. But one day I got a call from the emergency room. I found her seated on a gurney. A terrified intern was in attendance. In front of her he informed me (and her) that if she had sliced at her arm and throat in a different direction that she would have bled to death. It seemed he had not been prepared for this kind of management.

My supervisor asked that I be very careful with this young woman and said he assumed she had already driven three therapists into research partly because of her extreme behavior and seduction efforts. Her late night forays and partying led to a pregnancy and she wanted an abortion. The nature of the times was such that she had to seek out senior psychiatric staff on her own and plead for a diagnosis to permit an abortion. She was unsuccessful.

We struggled on and she managed to achieve more stable functioning. I assumed there would be a long road ahead. In all regards I found the system deeply flawed.

Moving On

After graduation I went to Baltimore to work in a community mental health program. Our group of dedicated twenty somethings formulated reality based approaches for the people of the community and were faced with obstruction by our seniors in that they had a much deeper self serving agenda.

To be continued:

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

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 Insanity

 

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, and how good they are at life management.

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 and in our current political crisis how do you assess reality?

 

Join us and enter for an opportunity to win a free autographed paperback copy of Gaia’s Majesty-Mission Called: Women in Power
To enter, email rogerbburt@gmail.com . Drawing every two weeks. Each person entering will receive the first two chapters of the book by return email.

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

Thank You For Your Service

 

 

Have you ever had a stress reaction?

Have We Defined Stress Incorrectly?
Maybe our recent wars did not create an apocalypse for our nation, but we’re now facing some consequences of the wars. An apocalypse is ongoing for many of the residents of the Middle East but there is also significant distress among some people in our nation.

Some of that distress will be referred to as mental illness. I am not a huge fan of the medical model as it relates to mental and emotional functioning because I think there are often other more useful ways to look at some of the things that happen to us. We created the concept of mental health so that we could remove mental and emotional suffering from the hands of the church. It is no longer common to describe people as being possessed by the devil or demons. But sometimes viewing something as an illness is not useful either.

World War II Is Still With Us

Long before there was the currently popular Post Traumatic Stress Disorder we had war related stress problems but they were not diagnosed nor helped very effectively. We hear a great deal about PTSD currently. It almost sounds like it is a new problem.

I had a couple of awakenings in my practice over the years. In one instance a man came to see me about an ill-defined depression which had been nagging at him. We talked for several sessions until at last he said, “I think you need to meet my father”. His father had been a bomber pilot in World War II and had flown on both missions to destroy the Ploesti oil fields in Rumania. In each attack they lost 90% of the planes. His father had passed survivor guilt on to his son.

In another instance I was dealing with a young Jewish woman. Again, we were getting nowhere until she asked to bring her grandmother in. Her grandmother was a survivor of the Aushwitz concentration camp and had passed on this heritage within the family.

More Recent Events

It should not surprise anyone that we have similar problems for people who served in Vietnam and more recently in Afghanistan and Iraq. The revelations have been ongoing. From time to time I have occasion to talk with veterans. In one instance when I told a man that reactions to this stress were essentially normal there were tears in his eyes. He was grateful and said, “I thought I was mentally ill.”

Normalizing the Experience

The military is beginning to work to drop the D from PTSD because calling it a disorder is serving as a bar to seeking help. People don’t like being called mentally ill. The fact is that the types of reactions we are seeing should be characterized as normal reactions to prolonged stress. Exactly how is a person to feel when they spend every day killing people and having people trying to kill them? Since we don’t have a draft we have sent people back for multiple tours of duty which is utterly irresponsible.

Thank You For Your Service

Yes, we should thank them for their service but we are too often not giving them service in return. I used an image of a homeless serviceman for this post because it exemplifies the service we are not giving. They should not be suffering. Too often the wait times for those seeking help is much too long and there should be no veterans homeless on the street.

We are failing to step up to our obligations. Politicians are threatening more war and few are really responding to and supporting the response to real need created by past wars. The fact is that there are understandable reactions to prolonged stress and they can be dealt with.

On Another Note

There are other kinds of conflicts which we can view symbolically. Join us and enter for an opportunity to win a free autographed paperback copy of        Gaia’s Majesty-Mission Called: Women in Power  
To enter, email rogerbburt@gmail.com . Drawing every two weeks. Each person entering will receive the first two chapters of the book by return email.

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

The Tragedy of Post Traumatic Stress Disorder

Not the Tragedy You Might Think

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Have you ever had a reaction to a painful or terrifying event?

Not all things in our inner life and parts of reality are what we would want. We have an image or images of how things are supposed to be. If we are fortunate these images are not seriously violated. But sometimes they are.

Sometimes life is devastating and devastation can come suddenly in many forms or slowly and insidiously. A terrible storm, a horrifying accident may visit long term consequences on us.

Up front I need to say that this post is not simply about trauma and stress. The term usually noted with the short form of PTSD most often makes us think of returning veterans. But, of course, it isn’t confined to veterans. It is my perception as a psychologist that we need a wholesale revision of the meaning and even the use of the term.

Diagnostic Labels

Long ago we removed many difficult personal issues from the care of the church and said particular kinds of suffering people were not being tortured or possessed by demons. Instead we took them to doctors and defined them as suffering from mental illness and give them a diagnosis. Well and good up to a point. A compassionate response and management was better than exorcism.

But now we use the medical model for ever so many things and it is time to redefine our intervention and perception of cause. In this blog the focus is on battlefield trauma. But trauma is not confined to the battlefield and there can be many contributing factors.

Origins of PTSD

In wartime we send our people into zones where people are trying to kill them on a daily basis and they are supposed to kill on a daily basis.Then we send them home and tell them to have a nice day. We are asking a huge adjustment overnight. And recently I heard an officer speak about the nature of the experience and that it includes close personal support from fellow military people. Suddenly, when they leave service they have to give up this essential daily support even while they are to leave the killing fields. We are asking a lot and we tell them they have a disorder—a mental illness. There is typically stigma attached to mental illness and it places a barrier to getting help for what is fundamentally an adjustment.

A Personal Experience

Decades ago I was in a terrible auto accident which sent me into years of pain and recovery. And then more recently I was sitting at a stoplight when a man came around the corner too fast, spilled his coffee on himself and he ran full speed into my car which was totaled. I escaped with only a bruise. But within 48 hours I was anxious, having terrible dreams and a variety of other reactions. As a psychologist I knew I was thrown into PTS because it called up my prior accident. I called a psychologist friends and in four sessions we detailed the reaction and separated it from my current life. The bottom line here is that I had a reaction, not a mental illness and I went to someone to help me through my reaction.

The Real Tragedy of PTSD

Too often the outcome of trauma continues but it can typically be attenuated if the person seeks support and understanding which can be on a personal basis or a group setting. But it is important that they don’t feel stigmatized by being called “mentally ill”. The military is working to use PTS rather than PTSD which is important. It can be dealt with but not if we don’t respond correctly.

Mental Illness in General

We have work to do. Our lives are filled with stress and simple change. Over time we have multiple adjustments sequentially or at once. Guidance and clarification often is crucial and disturbing definitions and often unnecessary psychotropic medications may not be helpful.

Wisdom is needed to handle our world as it is and wisdom should lead us to a complete rethinking of the mental health field. It is complex. Yes, we have anxiety and some people constitutionally have more anxiety than others. It is manageable. Yes, we have depression and in my case my bouts with it were a function of an inherited vitamin D deficiency. I won’t even attempt to detail all the ins and outs of what has been thrown on the heap of “mental illness”. Basically it is clearly time for a complete restudy and reevaluaiton.

What is your catalogue of stress factors and adjustments needed in your life?

Roger B. Burt’s Amazon home page

Orlando! The Meaning and Impact of Mental Illness II

 

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Have you had contact with mental health professions?

An Ongoing Dispute

When I wrote the initial copy for this post it was entitled The Myth of Mental Illness. That was also the title of the 1961 book by Thomas Szasz that I hold in high regard. He questioned the foundation of psychiatry as do I. His case gets stronger as time passes.

The fact is, I chose to become a psychologist for reasons I’m still uncovering. Probably the chief among them was my need to deal with my mother’s severe depressions. They seem to have been the result of personality problems but mostly reflected a genetically based vitamin D deficiency. I had set out to study particle physics but an unforgivably bad calculus professor turned me off on the mathematics which I viewed as fundamental. And so I found my way into a field I’m still disputing.

Decades later I have concluded that the term mental illness should be relegated to the dustbin of history. Recently I saw that someone had come up with a “diagnosis” for people who are concerned about healthy eating. Diagnosing them has the implication of viewing such a justifiable concern as an aberration or some kind of deviation of behavior.

The Beginning

In college I found the study of psychology interesting but that there were two parts. The clinical people were usually over in the medical settings and the academic setting was closer to experimental studies. They declared psychology was a science. Early on I was not impressed by the science part. I could see philosophy among other things. In the end I went to Duke University to study experimental psychology but within days asked to move to the clinical program which they granted. Steadily I was introduced to psychology, psychiatry and psychotherapy.

I was not prepared for the authoritarian nature of psychiatry. I attended Grand Rounds and saw patients paraded on stage while their history of “mental illness” was presented and discussed. (I should say this was decades ago and things have probably changed.) I also learned that psychiatric residents were not permitted to declare a diagnosis. A senior staff member would step forward and deliver the definitive word.

There were times when graduate students such as myself went to clinical meetings and presented findings from our testing. Our findings were frequently used to harass and haze both medical students and residents. The effect was to build a wall between psychiatry and medicine in general.

Learning By Doing

I realized after the fact that I often was given very difficult cases. One of them was a very pretty, very dysfunctional and hysterical young woman. In her interest I managed to get her diagnosis changed from schizophrenia to a less damaging diagnosis which meant she might get more flexible and dedicated treatment in the years ahead. But one day I got a call from the emergency room. I found her seated on a gurney. A terrified intern was in attendance. In front of her he informed me (and her) that if she had sliced at her arm and throat in a different direction that she would have bled to death. It seemed he had not been prepared for this kind of management.

My supervisor asked that I be very careful with this young woman and said he assumed she had already driven three therapists into research partly because of her extreme behavior and seduction efforts. Her late night forays and partying led to a pregnancy and she wanted an abortion. The nature of the times was such that she had to seek out senior psychiatric staff on her own and plead for a diagnosis to permit an abortion. She was unsuccessful.

We struggled on and she managed to achieve more stable functioning. I assumed there would be a long road ahead. In all regards I found the system deeply flawed.

Moving On

After graduation I went to Baltimore to work in a community mental health program. Our group of dedicated twenty somethings formulated reality based approaches for the people of the community and were faced with obstruction by our seniors in that they had a much deeper self serving agenda.

To be continued.

Gaia’s Majesty: Discovery Amazon page

Roger B. Burt’s Amazon home page

Orlando! The Meaning and Impact of Mental Illness I

 

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Another Terrible Warning

On what did you focus about this tragedy?

The recent massacre in Orlando, which is described as hate inspired terrorism, also raises the specter of mental illness along with a lot of other concerns which include effects coming from the political arena. Prejudice and failure to act in the national interest had a significant effect along with the manipulations by power hungry people who claim to be acting from a religious viewpoint. The true meaning of the attack has to be hunted out from the forest of offered opinions and the data which might give us clarity.

The perpetuator claimed allegiance to ISIS and had a checkered history. It is simplistic to reduce it to an act of terrorism. Other points may have more clarity. His history suggests a young man who was hunting for an identity and suffered deep conflict. Just now it has come out that he was visiting gay nightclubs. It may have been that in his personal crisis he was seeking intelligence for his attack. There is another possibility. The view of him suggests that he may have been a person who was facing uncertainty about his sexual orientation. In the end he may have struck out at what might have been his identity home. We probably will never know, but his life experience hints at a larger picture.

He appeared to have been insecure and identity issues are highlighted frequently. And it certainly may have been that the core was his sexual conflict. That conflict may have ramped up recently and who he thought he might be collided with other world themes. But, for us, perhaps the central issue is attending to a process. We can attach a diagnosis reflecting a view of mental illness and end our thinking there or we can look toward a process revealing how multifaceted is human life.

Reevaluation and Reframing Needed

We can hope that the horror of what happened in Orlando does not get lost in a haze of political backbiting. This is an opportunity to do a substantive reassessment of many things from our political stances, to the meaning of “mental illness”, to how we approach the needs of people who are under some form of internal and personal attack. Our services for people in crisis have been impaired and throwing money at it is not the answer. We need to thoroughly rethink out approach and how we offer services. There are many competing interests with which we need to contend.

In the Days Ahead
We have a lot to reconsider. Recent events have broadened the focus of this post as it was originally written. I will be going into matters of history which are illuminating. It is all too easy to accept “experts” but being an expert is often a reflection of the times. What served us at one time may have had purpose and utility just then. Later we may need to do a serious reframing. Now is such a time. And what is happening seems to go well beyond one recent event. We seem to be on the cusp of important change. Lets go exploring.

What have you concluded?
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