I want to have a genuine discussion about mental illness, based purely on a pragmatic interpretation of professional psychology and the ramifications of diagnosis. Ideally I’d like you to also engage friends or family who work in the mental health field and share this link with them as I am hoping for some clarification on the validity of my observations below and perhaps some suggestions on further reading material. I have attempted to condense my thoughts and keep them reasonably organised but on both counts I may not have succeeded.
Lately I’ve been really surprised by the creativity used in shaping the diagnostic requirements of mental illnesses by health professionals and the proliferation of diagnosis offered to patients.
The discipline of psychology is arguably a “soft science”, tending to rely on the subjective measurement of patients disclosed symptoms rather than falsifiable evidence.
Even when psychologists attempt to devise experiments that can offer some statistically sound insight, more often than not it cannot be replicated. The failure of methodology witnessed in the ego depletion theory is a cogent example of the difficulties faced when undertaking an academic examination of human behaviour. (Ego Depletion)
With this in mind it is extremely perplexing to see the discipline of Psychology fail to heed this contradiction endemic to the study of human consciousness. The paucity of valuable data it can build upon via experimentation is a clear sign that psychology as it currently stands provides little real world application in a clinical setting. The American Psychological association defines the practice of psychology as
“Help(ing) people learn to cope more effectively with life issues and mental health problems” and that “Psychologists help by using a variety of techniques based on the best available research and consider someone’s unique values, characteristics, goals and circumstances” (APA)
It is justifiable then to note that its reliance on “best available research” is on face value, quite alarming. With replication of datasets difficult it falls upon the individual psychologist to as stated above, “consider someone’s unique values, characteristics, goals and circumstances” (APA)
This I believe is where the real value of psychology can be found, though its effectiveness is dependent on the talent and experience of individual psychologists. One I might add that is almost impossible to effectively evaluate in training. My intention hereafter is to question whether this particular technique is even followed in a clinical setting and how the discipline is at its foundation, flawed.
While the tri-factor behavioural model of bio-psycho-social in medicine and practiced psychology has gone some way in alleviating the subjective bias in identifying the validity of purported symptoms over the former purely biological focus on treatment, I feel it’s still mostly ineffective when you consider the outcome is measured against a diagnostic derived from an almost obsessive dissection of non atypical human behaviours into a litany of micro groups. Made worse by the ticking of boxes of these generic symptoms and counting the results. “You scored 15 out of 20, you are suffering from (new mental illness of the month)” (Bio Psycho Social Model 25 Years Later, Carrió et al) (The rise and fall of the biopsychosocial model, Ghaemi)
I have many concerns over this practice. Firstly, these rather ephemeral classifications consist of various symptoms almost every person could identify with and second, the almost neurotic pedantry that has now overtaken the field in relation to descriptors for an ever increasing catalogue of mental ailments that all share similar symptoms. Ailments I might add, that are still, consistently partitioned into further sub-sub groupings every time the DSM is revised.
This convolution has led the discipline away from its professional mandate of easing mental anguish (in terms of practiced psychology) towards an anaemic and counterproductive obsession with systemisation by way of taxonomy.
As a discipline, psychology has the difficult tasks of dealing with the inherent complexity of both biology and consciousness. With so many unknowns still inherent to both, a level of cautious pragmatism should be utilised in any diagnosis, not just statistical relevance.
Though continuous revision is the basis of good science when new data is confirmed I can’t help but feel these dubious newly created terms for mental afflictions are becoming, in all honesty, farcical. Based more on poor methodology than good science.
Apparently it’s de rigueur in the field of psychology these days to deconstruct the infinitely complex state of the human condition and into ever more nebulous mental diseases. As if we are all in some way just waiting for an applicable label to provide us with justification for our own lack of introspective awareness.
In truth, if we use psychology as a baseline, every human suffers from some level of mental illness. (David C. Geary, “The Origin of Mind” APA, 2004) Geary suggests that some forms of depression are merely the manifestation of an evolutionary cognitive innovation, “Certain types of depression may be advantageous. The lethargy and disrupted mental state can help us disengage from unattainable goals, evolution likely favor(ing) individuals who pause and reassess ambitions, instead of wasting energy being blindly optimistic” This theory also suggests that “In its mildest form, bipolar disorder can increase productivity and creativity. Bipolar individuals (and their relatives) also often have more sex than average people” (Geary Interview)
Having been diagnosed on multiple occasions from psychiatrists and psychologists with Bi Polar disorder Type II, among many others, I finally have evolutionary and psychological justification for my voracious libido and insufferable lengthy Facebook posts! I’m creative I can’t help it!
I’m not alone in my convenient exculpation since “natural selection also likely held the door open for disorders such as attention deficit. Quickly abandoning a low stimulus situation was more helpful for male hunters than female gatherers, which may explain why boys are five times more likely than girls to be hyperactive” (Ness Interview)
What were once cognitive innovations that developed throughout human evolution are now labeled as a mental illness, purely because their requisite function is no longer valued as useful in modern society. ADHD, Bi Polar and many other modern psychological conditions have been reclassified, so much so that any quality present in an individual that runs contrary to modern definitions of competency are now considered a mental affliction. Though in any anthropological interpretation, these disorders are a natural state of human experience.
In truth, we cannot be happy well adjusted people all the time. Personality, context and genes have a large effect on our behaviour. Despite this, the devaluation of formerly useful traits in the modern era is extremely troubling. Linking a patients sense of self worth by the economic utility they provide in society is a gross injustice.
I have accepted this as the status quo in psychology and although I’m not entirely comfortable in an office environment, I try to use my particular personality quirks, sorry, mental illness, to foster working conditions where I can be productive. My proclivity for mania can be effectively channeled in the right kind of environment toward extremely productive pursuits. This is only because I refute the assumption that my diagnosis is an illness that needs to be cured. This is not to say it has not caused hardship or problems with relationships and work in the past but I can do this because I believe it does not have total control over my behaviour.
Sadly, for those unaware of the disingenuous medical re-evaluation of individual capabilities through the lens of the economic worth, the results can be debilitating.
For many who are not genetically inclined to possess characteristics that are valued in modern economic industries, the individual is punished with stigmatised diagnoses. Often leading them to the faulty assumption that they are hopelessly broken and are forever doomed to suffer. For many whose symptoms are not clinically severe, this simply gives them a fatalistic outlook. After all, “the doctor said I have a disease, therefore I am exonerated of any personal responsibility”
Who would imagine that psychology would eventually lead to the very cause of a patients continual suffering?
Psychology’s counter argument is that these illnesses are only considered harmful when there is a reasonable impairment of function and in many instances this is absolutely true. Severe depression possesses no evolutionary purpose, hindering a sufferers ability to think clearly.
Perhaps the accusations I’ve aimed at psychology are unfair. After all, any good psychologist is aware that these classified illnesses are only problematic when there is an extreme negative effect on a patients wellbeing and ability to function in daily life.
Though as someone who has used psychological services in the past, there is a huge variance in the quality of care in the profession, just like any other industry. However, while my mechanic may be useless, at least the consequence of his incompetence is inconvenience rather than life altering.
Bad psychologists working with faulty data that advise patients who have little to no understanding of modern psychology only leads to ineffective treatment. Sometimes with extremely dire consequences for patient health.
The mix of unprofessional behaviour and spurious apriorism is dangerous and self defeating. Exacerbated by the disciplines insistence on applying labels to patients subjective and wildly varying experience.
While a label can provide assurance and an understanding of what possible treatment would be most effective, it’s up to the patient to do the work and posses a willingness to change their behaviour. More often than not, this label is used by the patient as a convenient scapegoat for apathetic inaction. ” it isn’t my fault, I have BPD, or Bi Polar, or Generalised Anxiety Disorder, or Seasonal Affective Disorder, the list goes on and on.
This simply results in dilatory inaction and complete repudiation of the necessary requirement to overcome their affliction, namely intense introspection in partnership with a qualified mental health professional in conjunction with proactive changes to routine. These symptoms are very real, their severity however is difficult to measure, often resulting in a diagnosis that is not particularly useful and is therefore misinterpreted by patients.
A vast number of patients who visit a psychologist, do so only once. On receiving their diagnosis many never return. This is extremely surprising, since so many of them suddenly develop an almost pathological insistence on immunity from judgement, regardless of fractious conduct. All of this after a single one hour visit.
This irresponsible behaviour simply allows patients to forever throw their hands up at any challenge in their life and state “I can’t do it, my diagnosed condition prevents me succeeding” It is obvious to anyone who has experienced the mental health profession that any mental illness has variance in severity. Two people with the same classification can possess significant asymmetrical deviation in both pathology and culpability. I’ve met people with Bi Polar, and I’ve met people with BI POLAR, the extremes between the two are incomparable.
The question this raises is whether there is any merit in classification at all unless a patient is competent enough to use it as prescriptive and not as an expedient vindication for martyrdom. All too often it is the latter. This is a failure by the psychologist and perhaps more so, the patient. You can lead a bi polar maniac to water but you can’t make him think. (Oh I’m quite proud of that one)
With this in mind, I have often pondered where we draw the line between responsibility of action and consequence of affliction? Do all disorders no matter how dilute of intensity, give exoneration for behaviour? Does an illnesses descriptive sub grouping mean it manifests in the same variety of ways for all patients? No, it doesn’t. Yet instead of starting from the premise that no two individual cases are the same, both patients and psychologists can often fail in their requisite responsibilities.
The mind is an extremely complex organ prone to the failures inherent in biology and the litany of illogical contradictory emotions it fosters.
The nature of sense experience is such that our comprehension does not extend outside our own minds. We may devise words or labels that ascribe a definitional equivalent but still, we make our own limited estimations based solely on what we have learned from our experience, both emotional and practical.
I can no more imagine how you felt at one moment than anyone else, I simply conjure a comparable feeling from my past and offer it to you when needed. My words may express a sense of understanding yet they are a mere simulacrum, feigned imitations stripped of their most valuable context.
Therefore, when I hear that someone has been given a recent diagnosis I always ask what will they do now. Unsurprisingly it’s often the beginning of a lifelong process of self inflicted victimisation, now classified by psychology as histrionic personality disorder. The implicit irony in this is not lost on me.
Rarely, do these patients profess a willingness to continue treatment or make any significant change in their lifestyle.
This common outcome is an example of both psychologists and patients abandoning their respective duties.
For the psychologist it is to offer a practical diagnosis and an ongoing treatment plan, one which should include a clear explanation to the patient of why they have been given the diagnosis. Additionally, it should be implicitly stated that the diagnosis is only useful in so far as categorisation, not justification and that while the illness makes some things harder, in modernity at least, it doesn’t make life impossible.
In return the patient must accept that though the problem is identified, the solution is only possible with hard work and a willingness to change. With the knowledge of a cause they can now ensure they take the steps needed to control or lessen the effects. If they are referred to a doctor or psychiatrist for drug dispensation, then they should think carefully on whether or not their symptoms are a significant hindrance to their life. If they do, medication is an excellent option. Not only will it lessens the severity, it will allow them to work with their health professional to devise strategies and methods to cope.
This is what should occur, but in reality the inverse is true, Anti depressants and other psychological pharmaceuticals tend to be parcelled out with ease and the amount of people currently using them who do not regularly see a mental health professional is quite disturbing.
Now, let me preface my previous statements before I go on. I am In no way denying mental illness isn’t for some, horrendously debilitating. Symptoms can be a continual scourge on the minds of those who suffer. There are many cases where mental illness is so profoundly severe that someone may no longer be capable of the lucidity required to help themselves.
I can attest to this since I’ve experienced debilitating depression at many points in my life. I was lucky enough to be able to get through it and still live a relatively functional life during those periods. With some minor breakdowns along the way.
My intention is not to accuse people suffering from mental illness as disingenuous fakes but I simply wish to identify the systemic failure in both the research and practical application of psychology.
I previously mentioned that the symptom list for some of these categorised illnesses are rather, comprehensive in the same way they are ambiguous, despite their attempts at segregation, many share so many cross similarities that there is simply no use for them.
In fact, some of the symptom descriptions look like they could have been torn from the pages of a fifteen year old teenage girls diary. As an example please peruse the definition of BPD, or Borderline Personality Disorder, summarised from the psychology bible the DSM.
Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.
Instability in goals, aspirations, values, or career plans.
Compromised ability to recognise the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.
Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.
Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.
Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.
Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.
Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.
Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.
(DSM 5 BPD)
Do these symptoms sound familiar? That’s probably because you experience many of them in a day. I don’t know a single person who doesn’t feel most of these emotional symptoms regularly. It’s simply part of living in the modern age. Now mix these symptoms around, take some, remove some and suddenly you have another disorder.
Meaningless.
What real value does the BPD sufferer receive from this? With such an extensive list of contradictory behaviours and emotions what academic utility could it possibly possess for research? What practical use does it give a psychologist? None really save for the convenience of isolating a specific treatment plan to start at. Regardless, this will only be useful if the patient wants to help themselves and the psychologist continually revises and adjusts it as both move through the long process of therapy towards recovery.
Instead of spending energy on endless sub classification for diseases, psychology should be isolating specific behaviours in individuals and devising a health plan to combat those specific traits. You do not need 50 variances of diagnoses when the symptom list is so extensive and vague. Large scale studies are fraught with complications when measurements are derived from subjective criteria.
In summation, I believe that psychology has a valuable role to play in the treatment of mental illness however its reliance on dubiously collated data means that the utility of a psychologist in assisting a patient is based entirely on how effective they are in communication and the pragmatic treatment plans they create on an individual basis.
Anything less is a waste of everyone’s time.
REFERENCES
EGO DEPLETION
Click to access Baumeister%20et%20al.%20(1998).pdf
Click to access willpower-limited-resource.pdf
http://www.slate.com/articles/health_and_science/cover_story/2016/03/ego_depletion_an_influential_theory_in_psychology_may_have_just_been_debunked.html
http://www.ncbi.nlm.nih.gov/pubmed/20876879?dopt=Abstract
Click to access running-on-empty.pdf
http://www.slate.com/articles/business/productivity/2014/10/decision_fatigue_ego_depletion_how_to_make_better_decisions.html
Click to access gailliotetal07JPSP.pdf
http://www.theatlantic.com/health/archive/2012/04/the-chocolate-and-radish-experiment-that-birthed-the-modern-conception-of-willpower/255544/
Click to access Sripada-Kessler-Jonides-Commentary_final2-002.pdf
Click to access RRR-comment-BaumeisterVohs-revised-March17-002.pdf
http://www.vox.com/2016/3/22/11284528/explain-replication-crisis-psychology
Click to access PubBiasSelfControlEgo.pdf
APA
http://www.apa.org/helpcenter/about-psychologists.aspx
CARRIO
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466742/
GHAEMI
http://bjp.rcpsych.org/content/195/1/3
GEARY INTERVIEW
http://www.livescience.com/5082-insane.html#sthash.SiZtrMee.dpuf
NESS INTERVIEW
http://www.livescience.com/5082-insane.html#sthash.SiZtrMee.dpuf
DSM BPD
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=17