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Thursday, March 30, 2017

Chapter 3-4: Discrimination, Bias, Prejudice: A Brief History of Social Othering

 We've talked about the challenge of living and meeting our basic needs.  We've talked about how other people's responses can make things worse.  Now we're going to talk about the ways that entire groups or cultures can make things worse for social outsiders.

History is replete with the stories of challenges that individuals and groups have faced and managed to survive.  In fact, history is largely about keeping these collective survival stories alive.

Effectively, this insures that everyone of us is going to grow up with a chip on our shoulder.  There is going to be some tragedy or vulnerability that 'people like us' have faced in the past and, therefore, are carefully on guard against for the future.

No less important, given the overall impoverishment of our relationships – socially, culturally and internationally -  it is practically guaranteed that this chip is going to involve other people.  Maybe it’s the neighbors down the road who beat up or killed Uncle Bennie.  Maybe it’s the side of the family that forged Grandma’s signature and ended up with all her land.  Maybe it’s people up North, down South or on the other side of the world who started, won or lost a brutal war.  Maybe it’s people of a different class, color, creed, gender, identity, orientation, race who are using us, abusing us, wasting our hard-earned resources or keeping us down.  Maybe it's folks who don't speak right, dress right, look right, move right...  Maybe it’s simply the diversity of someone else's needs or values that is upsetting the apple cart.  Maybe it's emerging circumstances that are not exactly the same, but still similar enough to kick off survival reactivity and – from our perspective - threaten the values or resources we believe we need to live safely and well.

The potential reasons are practically endless.  As a practical matter, popular prejudices change all the time, depending on individual, family and cultural experiences and their evolving needs and views.

The take home point is this:  For almost all of us, there are other people who have some kind of special advantage that we lack.  Equally important, the folks with this kind of social or cultural power or privilege almost invariably make our lives worse instead of better.

There are a lot of ways this can happen.  They may highlight our vulnerabilities or even intentionally prey on them. They may judge or exclude us to advance their interests or agendas.  They may set us up, put us down, keep us out or shut us in.

Whatever way they play it, however,  they seem to always end up on top.  When push comes to shove or resources are scarce, they have the wherewithal and use it to use their advantage and our disadvantage.

No matter how much fairness would seem to cut in our favor, they end up first and we end up last. They may have tons more than they need, while we are just barely scraping along.  Yet, they feel entitled to not even notice.

That's what power and privilege tells you:  It's ok that someone doesn't have their basic needs met, because they deserve to be where they are by virtue of who they are - and vice versa.   

It's another way of saying, 'to the victor belongs the spoils.'  The groups that have won the social, political and international battles of the past, claim the privilege to stay on top.  Usually, they also have the social means and power and means to keep it that way.

As a practical matter, these battles are traumatizing for everyone.  They keep us constantly on guard and having to watch our back.  If we have stuff, we're always worried about losing it.  If we don't have stuff, we're always worried about getting it.  Either way, the basic human needs are non-optional for all of us. None of us can endure a constant state of fear that our basic needs might not be met and still live well and be well.

But that is only the tip of the iceberg.  The reality is that many of us are not just growing up with a chip on our shoulder.  We are growing up buried underneath a ton of bricks  - with no meaningful hope of ever digging ourselves out.  

And its not just us.  -- It's our families and our communities - often even entire cultures and nations. In reality, vast numbers of us on this planet are trying to survive without anything near the bare minimums of material, social and developmental resources that every single one of us needs in order to feel well, live well and be well.

Can you begin to imagine how much desperation, fear and mistrust this creates...?  

Or, maybe you don't have to imagine it because you have lived it.  You know all too well what it's like and how unbearably back-breaking and heart-breaking it has been for you, your family, your neighbors, your people....

Few of us can transcend bitterness and envy over the unfairness of seeing others gorge themselves to excess while our families starve on the streets.  Recall the story from the French Revolution about the monarch who lost her head:


Queen:  Why are there riots in the street?  
Advisor:  Your Highness, the people have no bread.   
Queen:  Well, let them eat cake!  

If you need a recipe for the retaliatory violence of terrorism you don't have to look much further for the emotional ingredients than that.  Yet, this kind of oblivious insensitivity is going on every day in America and around the world. It is going on across race, religion, class and gender lines, across abilities, across sizes, across partner preferences, across ages - and that is only to name only a few of the most common sources of social disparity.

It's a vicious and self-perpetuating cycle.  Many of us are born into it.  For others it is a matter of choosing our truth, or the hand we were dealt, or life choices we made perhaps even before we understood the implications.  Whatever it is, we inherit the trauma of prior generations - and the social ranking systems that emerged from this.   Embedded in the collective memories of our families, communities and cultures, are the emotional footprints of the disasters our predecessors justifiably feared, along with the social mores that were evolved to address them.   This is our family and cultural legacy, even if the originating dispute or bloodshed is now centuries old.

 What keeps the cycle going is how we treat each other. Undoubtedly there is room for self-reflection and moral growth on both sides.  At the same time, many of us who ended up with front row seats could stand to do some accounting.  True, we probably paid the going rate for our tickets like everyone else.  True, we are entitled to the fruits of our labor like everyone else.  True, we and/ or our ancestors probably made various efforts and sacrifices to make it possible for us to enjoy the show.  

At the same time, there is a limit to the degree to which we can reasonably exploit our advantage. All too often, those of us in the front row are standing up without any awareness that we are totally blocking the view for others behind us.   Yet they, too, paid for their tickets and also want to see the show.  All too often, we are talking and making a racket and carrying on our own conversation - because after all we have seen so many shows and this is just one more.  Yet, no one else can hear above our clatter - and this includes people who may have paid a huge percentage of their income for the privilege of being at the only show of their life time.


While this is just an analogy, it points out the need to be put ourselves in each others shows and begin to appreciate what a burden or opportunity might mean for someone else.  In a word, it is really easy to forget - especially from a seat of privilege - that life, while hard for everyone, is unbearably harder for those in the back row.  It also behooves us to consider how our actions might look to those who never get to see the show - only our back sides.

Every minute that we front-seaters continue to over-draw our balance of goodwill, we are generating a liability of resentment and frustration that somehow, some way, will result in turned tables and pay back.  In the words of Dr. King:  The arc of history may bend slowly, but bend towards justice it does.  Another way of saying --  Maybe we get tripped in the aisle.  Maybe someone throws a tomato. Maybe a fight or a riot breaks out.  Maybe someone brings in a gun or a grenade.

In the end, it's a game with no winners.  As long as some of us have more than enough, while others of us have way too little, none of us is going to be safe.  Nor will our world or planet be safe either.

No less important, as long as some of us think we don't have enough -- or that it is okay to take what we want without regard to the welfare of others -- no one anywhere is going to be safe.  This is relatively easy to see now that we are in an age of cyber and atomic wars. But it probably has been true for thousands of years.  It became the way of the world the moment humanity - armed with such attitudes - started traveling the world.

So, if we have learned nothing else from the painful experiences of our past - from slavery to genocide to riots, wars and Wall-Street - let us at least learn that.   If we don't get a handle on our collective mistrust and maltreatment, our days on this planet are numbered. We are all affected, everyone, everywhere, by whether there is peace on earth.  It's only a matter of time.

Below are some common examples of the social othering (discrimination, bias and prejudice) that many of us have endured.  You may also have some of your own to add.





  

Tuesday, March 28, 2017

Chapter 3-3: When People Make Bad Things Worse

What far too many of us learn in our deepest darkest hours – our times of greatest need – is that we truly are alone.  There really is no one there for us.  We learn that in the face of unbearable pain we are better off not asking for help.  We are better off trying to figure it out on our own.

It is not only that others can't fix the problem. While that would be nice, for so many of us the social landscape gets far bleaker than this.  What we realize is that, in our known world of human beings, there is no one who sees the world the way we do. Perhaps even more painful, there may be no one who seems to notice or even care why we have come to see the world the way that we do.

If you want to understand so-called behavioral ‘disorders’ - and what is going on with far too many people - this is a really important point to get.  The fact of the matter is that the four demographics that society loves to hate - 'mental illness', 'addictions', 'criminals' and 'the homeless' - all have one thing in common.  An estimated ninety (90!) percent of us are survivors of childhood traumas.

What does this mean.  Well, think about the last chapter - those basic human needs.  We are people for whom basic needs of life have not been met.  On core dimensions of living important to all human beings - physical, material, social, emotional, developmental - our lives have been characterized by fear and uncertainty.

But that's not all.  For much in life that is traumatic, relationships are a known protective factor. Johanne Hari, The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think (Huffington Post 1/20/2015), http://www.goo.gl/okZJGL.  But what if such protection is missing...? Even worse, what if human relationships are a big part of the part the problem - as seems to be the case for far too many of us...?

Here is how the relational impoverishment of modern society plays out to produce the 'behavioral health' movie the industry theatre has been featuring:

People Make Bad Things Worse

(Adapted from Intentional Peer Support by Shery Mead)
Imagine being a kid - maybe you're a toddler, preschooler, grade school age or even a teen. Something happens.  You feel bad.  You go to someone in your life for help.  But instead of making it better, they make it worse.  They laugh or make fun of you.  They ignore you or tell you they're too busy.  They get mad or irritated that you bothered them.  They jump into hyper-drive and fix things in ways that leave you out of your own life.  They miss the point, send you in the wrong direction, impose solutions you didn't want.
They cause more distress not less.  Maybe they actually hurt you or take away stuff you needed. Maybe they expect you to be grateful when you actually feel even more miserable.

Essentially, you end up with two problems instead of one. You still have the problem you started out with.  But you also have the new, added and equally insoluble problem: Now, there's a relationship with an important person in your life that isn't working.

Maybe it is not with every life issue. Maybe it is not with every person.  But it happens enough of the time with enough people that you begin to draw this conclusion:

When you go to human beings for help it gets worse instead of better. 

When human beings fail other human beings in times of great need, the options become very stark. We cope on our own, with what we have.  We fight, flight, or freeze with whatever resources or personal strengths are at our disposal.  Many of us check out emotionally, and some of us never come back.  A lot of us use drugs or alcohol, sex, diversion, pleasure of any kind to distract or kill the unrelenting pain.

A lot of us conclude that life is all about – perhaps only about – looking out for #1.  After all, we’re actively teaching people that when you really need help, other human beings are basically worthless.

The option is to look out for number one – and hope you don’t get caught.  Here you can see the origins of what we call ‘psychopathy’ plain as day embedded in modern social relations as usual.

If you want a better model of behavioral health than the medical model is giving us, think about what this means at different life stages:

If we're really little  when this kind of thing starts to happen (infants, preschool, grade school), we probably don't have much to work with. When feelings get intense and others don't help, the choices are pretty much fantasy, emotions or activity.   We withdraw into our own minds and develop our own worlds, losing touch with much that's happening around us.  We cry a lot, rage a lot or flip it over into a game where everything is funny.  We engage intensely, motor around, get wrapped up in our surroundings, or glued to favorite activities.

A lot of time this is the kind of stuff that gets labeled dissociative, ADHD or oppositional-defiant. A lot of it also goes unnoticed and just looks like regular living.  The important shift here, though, is in our relationships.  More and more, we're turning inward.  More and more, we're relying on stuff instead of people to make our world work.

Think about the impact of this if you're really young.   You barely know anything about life, yet there is no one you truly trust to ask about the life questions that trouble you the most.  Instead of having centuries of passed-down family and community knowledge to draw on, you're trying to figure it out on your own with the limited life experience and the developing  brain of small child.  It's hardly surprising that a lot of us miss the social cues. We didn't 'get the memo' because we never even knew to look.

Help Isn’t Helpful

(Adapted from Intentional Peer Support by Shery Mead)

Now fast forward a few years and get to adolescence.  You're carrying around a lot of questions and pain that you've mostly been handling on your own.  If you're like a lot of us, the way you learned to cope set you apart from your peer group.  So now you've got a decade of marginalization under your belt to compound the initial isolation.

Enter alcohol, drugs, sex, cars, money, mobility, freedom.  In effect, access to a whole new realm of potential 'pain-killers' has just opened up.  And with all that stuff going on inside, we're primed and ready to go.  Experience has taught us that there's no human relief in sight, so the moment the doors open we're off and running without a look back.  This is where a lot of us get labeled with conduct and substance use disorders.

This is also where a lot of us learn that the socially designated helpers make things worse rather than better.  All too often, these systems reinforce our views of human relationships as unresponsive, callous, burdensome. ineffective and out of touch with the reality of our minds and lives.  The policies and protocols of health and welfare offices all too often replicate the social dynamics that injured us in the first place.  It's not very long before we cross the provider industry off the list as well:

Even the 'expert' helpers can't, don't or won't help.  So much for expertise.  We're definitely on our own.

People Totally Suck, Even My Own Kind Rejects Me


(Adapted from Intentional Peer Support by Shery Mead)
Fast forward again to early adulthood.  Now we're old enough to have enough freedom to really do some damage.  We've already been labeled and identified as outsiders.  We already respond and relate to the world in socially-denigrated 'outsider' ways.

As a consequence, we have little felt connection with - and therefore little loyalty to - the rest of humankind.  We may even have tried peer support and found it wanting.  For us, it may just have seemed like more of the same.

Suffice it to say, at this point, a lot of us have become thoroughly convinced that no one has your back when you really need it and human society is basically worthless.  It's a dog eat dog world.  So, if you're going to get what you need to survive, you'd better look out for number one.
Some of us do that 'lawfully'.  Others of us don't.  Again, it's a matter of survival.

Now we become what you call the 'criminals' and the 'sociopaths' and the 'chronic' unreachables. Some of us fight back against these labels.  We register our pain and rage on small or large scales.  We are the ones who do the destructive or violent acts that you call 'senseless', 'amoral', 'unthinkable.' To us they were just another wake up call that you missed the point of.  Big surprise there.


People Who Need People


If the problem is relational, then the solution is relational too.  Huge numbers of us feel disconnected and cut off from the rest of humanity.  Many of us would give our eye teeth for a principled way back.  We don't know how to create it. Moreover, we've been disappointed or betrayed so many times that we don't know whether to trust it if it's offered.

Harm Reduction

Others of us have become so thoroughly disillusioned that we just want to be left alone.  Just give us a way to kill the pain and no reason to hurt you.  We'll leave you alone if you leave us alone.  But if you mess with us or what we need, watch out!  While you might see this as anti-social, many of us feel this  is a valid - even rational - way to feel given what society offered us and what so many of us have been through.  You're best bet, from our point of view, is to limit the harm and damage you've already caused by keeping us reasonably comfortable and entertained.

You might think of it as social welfare or just another 'con'.  But we prefer to call it a dignified, pragmatic 'win-win.  It reduces harm all-around.  And, when you think about it, it's a lot cheaper than court costs and prisons.

Chapter 3-2: The Challenge of Meeting Basic Needs

Human Needs That We All Have


Most of life is not about the big questions.  It’s about the dozens of little ones that add up to either feeling well or lousy.

  • Do we have a safe, comfortable place to live?
  • Do we have clean air to breath, fresh water to drink, good food to eat?
  • Do we have the means to support ourselves and make a living?
  • Are we able to protect the relationships, values, spaces and belongings we care about the most?
  • Do others value us and treat us well?
  • Can we get where we need to go?
  • Do we have time and energy to pursue our dreams, interests, and activities?
  • Do our lives, on the whole, feel meaningful and satisfying?

These are common human needs.  They are not optional.


Human beings everywhere do best – physically, mentally, socially, spiritually - when we can count on certain basic needs being met. That’s why the human community has decided to recognize such basic needs as “human rights.”  Universal Declaration of Human Rights, http://www.un.org/en/universal-declaration-human-rights/

Human rights include things as basic as access to clean water, breathable air, shelter, food, clothing, physical safety, healthcare, the means to make a living and support a family. Human rights also acknowledge that human existence is more than material things.  We need to belong, form relationships and feel like a part of things. We also need the freedom to be ourselves - to explore, learn, develop and to express our ideas, convictions, creativity and potential.

When human needs (rights) are denied or overlooked, it’s bad for everyone. We don’t have what we need to live or be well. This triggers concern and dis-ease in most of us.  If not addressed, this dis-ease can grow into full-blown mental distress – like anxiety or depression. It can also lead to mental and behavioral extremes. This includes intense, prolonged ‘fight-flight-freeze’ responses that can disconnect us from ourselves, each other and the communities we live in.

Basic Human Needs








Socio-Economic Competition


Getting our needs met in the modern world is not just a simple straight-forward process.  All too often, our welfare depends on competing with each other.  The idea is that resources are‘scarce’ and there are only so many available to go around.

It's important to note that we don't just compete with each other for the luxuries.  We also compete for the basics – the life essentials that all of us need to be happy, healthy and reasonably comfortable. Since much of what we compete for is not optional (it is stuff that all of us need), the competition for basic needs creates added stress all around.

To see if concerns like these affect you, check out the survey below:






Monday, March 27, 2017

Chapter 3-1: Life is Challenging - All by Itself

Where Medicine Ends and Life Begins


Just like a lot of other people with a mental health label, I've been told that I have a brain disease, a chemical imbalance and that my problems are biomedical.  While I no longer think of my own experience in these terms, I can see why the medical model of 'mental illness' makes sense to a lot people.  In my own experience, there was – and still is - a lot of going on both mentally and physically that has to be reckoned with.

At the same time, I’m drawn to other questions – questions mostly outside the purview of medicine as it currently is being practiced.  For example:

  • What about our lives, experiences, and stories... ? 
  • What about our personal values, dreams and quest for meaning…?  
  • What about the need, in each of us, to understand ourselves and answer to the truth of our own conscience…?  
  • What about the basic human need for support, acceptance and belonging…? 
  • What about the stress of living – especially if you’re poor, homeless, bullied, abused, or discriminated against by powerful others…?  

Where do factors like these come in...?  How do these things affect us?  What happens if certain crucial material, emotional, social, cultural or existential ingredients are missing…?  How do you tell a hard or under-supported life from a disordered one... ?

Differential diagnosis:  Hard Life or Mental Disorder?


Here is where the rubber meets the road for me. While we don't talk about it much, on some level we all know that life is precious and fragile. To create a single human life, nature arranges for nine months of specialty-designed, comfort-padded, form-fitted, super-insulated, dynamically-adjusted, round-the-clock guarded incubator space. Once out of the womb, there are several years more of intensive care and nurturing that new arrivals ideally get in order to ensure optimum development.
The refuge required is not only physical, but also economic, emotional, intellectual, social, cultural and spiritual.

In other words, the maturation process is complicated, labor intensive and a lot can go wrong. There is no way around it. We are all vulnerable. If any of us lives long enough, there will surely be setbacks and losses. Even worse, the one clear certainty, at the moment of our birth, is that someday we will die.  So will everyone else we love.  It's only a matter of time.

Ashes to ashes, dust to dust …


Add to that the kicker that no one actually has 'the answers' - real answers - to the problems that have plagued human beings since time began. Yeah, there are a lot of theories and philosophies that help people cope with death and loss. There is a lot of religious and social wisdom about how to avoid, escape or transcend the material realities.

No doubt, some approaches hold more promise than others. At the same time, on the tangible, visible planetary level, no one really knows. Everyone has done their level best. Countless scientists, academics, philosophers and saints have devoted their lives to the search for this holy grail.
Yet, no one has succeeded.  As a whole, for the human race, we still have more questions than answers. This is especially true when it comes to the really hard questions - the one's that really matter:


  • Why is there suffering? 
  • Why do bad things happen to good people? 
  • What happens when we die? 
  • What happens to our relationships with the people, animals, beings we love? 

In the final analysis, there are no experts. We all end up the same. Ashes to ashes, dust to dust.

So what's the point?

The fact is, life is challenging - and that explains a lot. There is a lot of going on – mentally, physically, socially, environmentally, existentially - that every one of us is invited to reckon with.
We are born into a world with few if any certainties.  We are all vulnerable to loss and death.  There is no way around it.  No one we know will escape it. No human being yet (despite every one of us trying) has discovered a universally satisfying answer to the common existential questions that nearly all human beings ask.

Long way of saying: There are a lot of ways to get tripped up as a human being. There is a lot about being human that no one really knows.  There are vulnerabilities no one can protect us from.  There are problems that no expert on this planet can fix.

Seen in this light, stumbling or struggling are not 'abnormal.'  Far from it!  They are a natural part of learning how to live.

Thus, we should not pathologize each other for getting stuck, stressed out or even checking out at times. This kind of detour is a fact of life - not a mental disorder.  It is an inherent and predictable part of the journey, given the vulnerability of being human and the level of challenge that life presents.


Part III: If it's Not a Disease, What Is It?

We've spent all of Parts I and II talking about the limitations and shortcomings of the medical model of 'mental illness.'   But what is the alternative…?  Is there anything better out there… ? And if there is , what do we do…?

We will spend the rest of this guide answering these questions.  In this part (Part III), we will talks about the sources of distress and intensity that lead people to the mental health system in the first place.  In the next part (Part IV), we will talk about the ways such concerns get expressed in the human body.  After that, we will spend the rest of this guide explaining what can be done about it by individuals, families, clinicians, policy-makers, communities and concerned citizens.

The hope is to offer a simple, straightforward way of understanding and effectively addressing the numerous and social issues that are currently being siphoned out of public consciousness and siloed for 'treatment' into the behavioral health industry.

Chapter 2-6: Lived Experience of Other Conventional Responses

For many of us, personal experience with medical approaches to 'mental illness' raised some nagging questions.  While many of us continued to hold medicine and science in high regard, we also had to face some facts.  In our case, the medical model hadn't provided the answers we were looking for.  We wanted more than our doctors were offering.  Yet, often our doctors insisted that if they couldn't help us, no one could.

That left us in a precarious position:  Reject expert advice or follow our gut.  A lot of us were too afraid to leave.  We stayed put, often to our detriment.

For others of us, this was the turning point. We were determined to find help that felt to us like real help.  If the experts couldn't or wouldn't help us, then we would just have to find it ourselves.  So we rolled up our sleeves, and we went looking...

Others of us rejected the disease model approach from the outset.  We knew we had issues and problems – we’d hardly be human if we didn’t.  We didn’t want to make life harder for anyone, especially loved ones. Yet, something in us resisted the idea that medication or healthcare protocols were the answer.

We may have conceded that the pills and procedures seemed to work for others, but it just didn’t feel right to us. We believed our distress and intensity had meaning. We wanted to understand ourselves and make sense of what was happening to us. We couldn’t accept that our experiences were ‘just symptoms’ and that all would get better if we could just admit that we had ‘a disease.’

For all of our resistance, secretly, we may have longed for simple solutions.  What a relief it would be to just fit in like everyone else!  But, our conscience wouldn’t let us off the hook.  We couldn’t shake the feeling that something was happening inside of us that was worth knowing more about. Something we couldn't quite put a finger on kept nagging us to go deeper.

Psychotherapy and its Limits


Our inward curiosity led many of us to try psychotherapy.  For some this was the ultimate answer.  It might have taken several sessions – or even several years --  but eventually the lights went on.  We realized what wasn’t working, and we were able to do something about it.  Next thing you knew, we were on our way to the lives we had always wanted.

If that happened, we pretty much became true believers.  We couldn’t sing enough praises for the wise, insightful professionals who helped us get there. To our way of thinking, if everyone just did therapy, the world would be a better place.

Others of us were not as fortunate.  We may have enjoyed the therapy relationship and found it beneficial.  We may have met caring, insightful counselors and had rich, illuminating conversations. We may have looked forward to therapy and faithfully attended multiple sessions per week or month.
The problem was the rest of our lives.  We went home to families, friends and neighbors who had no idea who we really were inside.  More than anything, we wanted to feel accepted and belong.  We longed for real people, in our real lives, who 'got us' and understood.

Natural Supports and their Limits


Some of us were lucky.  Sitting right there, across the kitchen table, we found kindred spirits who really had walked in our shoes. It made all the difference in the world. They helped us gain a beachhead to access the rest of conventional society.  It was only a matter of holding on long enough to secure our full return.

For others of us, the outcomes were not so rosy. Compared to the skill of our therapists, others in our lives just couldn’t measure up.  With professional helpers, our concerns were received with grace, understanding and empathy.  But the same concerns were met with blank stares, awkwardness or outright rejection by family and lifelong friends.  They made excuses, left the room, or changed the subject. They asked if we had talked to our therapist or taken our medications.  They offered inane platitudes or patted us on the head as if we were children or pets.

In all fairness, these people usually cared about us a great deal. They meant to be reassuring and kind. The practical survival focus of modern society, however, had not equipped them to be companions on the inward journey.

The bitter painful outcome of many such conversations was this:  Despite the sincere desire of many well-intentioned others to be helpful, we often walked away feeling empty, demeaned or despairing. More and more, we felt irrelevant and disconnected from the people, relationships and social groups that mattered to us the most.

The very strength of professional psychotherapy was for many of us its greatest weakness.  The conversations with our therapists added a new level of richness and insight to our internal world for which there were few meaningful cultural outlets.  In effect, they made us aware of a new need that, for the most part, only members of the psychotherapy profession were equipped to address.

For some of us, this increased - rather than decreased - our distress.  We already felt different from others. Now we had several more reasons:

  • We were the only people in our known world who thought about this stuff.  
  • We knew things about ourselves that couldn't be shared with our natural supports.  
  • We were rewarded in therapy for our self-focused curiosity, which kept us looking for more and more stuff that socially unsaleable.
  • Holding this information (keeping these social secrets) was stressful in and of itself. 
  • Licensed psychotherapists were, for the most part, the only people who could reliably meet our needs to share and process this socially unsale-able information.
This created a vicious cycle of isolation and dependency that kept many of us wedded to psychotherapy for years on end.


Conventional Society and Its Limits 


At the same time, psychotherapy is only one actor in a very large social drama.  To the contrary, almost none of us says, in our times of great need, I think I'd like to get involved with the mental health system.  For the most part, we'd vastly prefer to find someone in our known lives who we trusted and could help us through.  The mental health system is, at best, Plan B, C, D, or F.  We only use it when there's no one we trust to help us sort our lives  - and none of the other known options our working.  It's the relief of last resort when all other choices fail.

The sad fact of the matter, however, is that modern society does not equip us to offer each other the quality of caring and support we all need when times get rough.  That is not because ordinary people aren't wanted or can't be helpful in hard times.  Far from it!

Indeed, that was the premise of the 'When Johnny and Jane Come Marching Home Project' spear-headed by psychologist Paula Caplan to help vets returning from Iraq and Afghanistan. The idea is that ordinary people following a few simple instructions can learn how to effectively bear witness to a combat veteran's pain in ways that are extremely meaningful to both the veteran and the listener.  If we can learn to do this in a few minutes for war veterans with some of the most horrific and complex PTSD, then we can do it for each other with the garden variety traumas of civilian life.  It's a matter of willingness and intention, as Caplan points out time and again in her website and award-winning book, When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans, http://whenjohnnyandjanecomemarching.weebly.com/the-welcome-johnny-and-jane-home-project.html.

The real problem is that we're mostly not learning from our public relations how to treat each other when important stuff in life goes wrong.  Indeed, a lot of common social practices - judging, fault-finding, ridiculing, competing, comparing, advice-giving, rescuing, calling in experts, liability and PR management, pointing fingers... -  make things worse rather than better on a human level for all concerned.  As a result, as family members, friends and neighbors, we lack the necessary role models for offering the caring and understanding that everyone of us needs when the chips are down and the stakes are high.

This is not a small matter. The reality is that far too many of us are walking around in a silent despair. Some of us manage to keep plodding on despite our misery.  Others of us withdraw more and more into ourselves and our own worlds.  Still others kill the pain with addictions like drugs, alcohol, gambling, food, sex, internet, games, shopping, emotional intensity, interpersonal drama, survival sports, dangerous lifestyles, etc.  Some of us have acted out years of frustration, alienation and marginalization by venting our rage on vulnerable or unsuspecting others.  Even more of us haven’t gotten to the breaking point yet, but we suspect we have it in us if things continue as they are.

In short, a lot of us are suffering and we need some answers.  How do we talk about the stuff that really matters?  How do we find others who are learning to do this too?

That is a big reason this book is being written.  The hope is to put some ideas out there, get some of these conversations started and begin to compare notes.  There’s a lot that each of us has learned already.  Imagine what could happen if we could put together all the different things we know.

This guide attempts to make a start at that.  It reflects much of what I experienced in my own journey and what others have tried to share with me of theirs.  But there is so much more we can learn from each other and from each of us looking deeply into our own experience.

If that appeals to you, as it does to many of us, please keep reading.  And please also join our community we try to make sense, together, of what we have felt, seen, heard and personally experienced to be true on this Peerly Human journey, http://peerlyhuman.blogspot.com/2017/03/peerly-human-weekly-call-schedule.html

Sunday, March 26, 2017

Chapter 2-5: Lived Experience of Medicine-Based Approaches

Appeal of the Disease Model


Many of us feel that the medical model of mental illness has done us a lot of good.

1. It gave us a clear explanation of what was wrong with us:  We had genetic predispositions to chemical imbalances.

2. It gave us a clear path forward:  Doctors could offer us medicines and medical treatments that would cure or stall the progression of our brain disorders just like they do with other bodily illnesses. 

3. We no longer had to blame ourselves:  We had a legitimate illness that, like other illnesses, was not our fault.

4. We had a tool to fight back against discrimination:  Our problems were not a result of moral failing.  Like most other illnesses, they resulted from factors beyond our control.  

5. We had a tool to access needed services:  We were sick people.  Like other sick people, deserved access to the care and resources that we needed to heal.

As an added bonus, lots of us met caring healthcare professionals who helped to lessen our physical and emotional suffering.  Perhaps they understood us and helped us to understand ourselves.  Perhaps they stuck by us when no one else would.  Perhaps they helped us learn to cope or avoid dangerous pitfalls.  Perhaps called us back from the brink of despair. When we blamed ourselves, perhaps they reassured us that our struggles were not our fault.  We are not bad people, they told us, but rather sick ones, with treatable conditions.

For some of us, this was exactly what we needed or wanted.  It may have been far better than anyone had treated us before.  Or, maybe we were so ashamed it was all that we felt we deserved.  It maybe, pragmatically, it simply worked and helped us get where we wanted to go.

As a result, many of our lives improved, perhaps even more than we had dared to dream possible. With the help of medications, cognitive behavioral therapy – or even more invasive procedures like electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) or psychosurgery – some of us found we were able to regain lost capacities or access abilities that we never before knew we had.

Those of us in this group tend to be enthusiastic about conventional medical approaches.  From our point of view, the advances of medicine and modern science have helped us repair the damage done by our 'illness' and and get on to lives we feel good about living.  We are grateful that science has progressed this far.  We embraced the conventional treatment paradigm and urge everyone to follow their provider's instructions to the hilt.

Limits of the Disease Model

On the other hand, many of us simply didn’t respond to conventional treatment in this way. Some of us were forced into it against our will, which made it all the worse.  More often, however, we started out with the same strong faith in medical and scientific approaches as most people have.  But even when we gave it our all, we didn’t get the results we hoped for.

We tried everything known to modern psychiatry and still got worse instead of better over time.  We tried stronger and stronger medications.  We practiced cognitive and behavioral strategies faithfully. We went from doctor to doctor, diagnosis to diagnosis, but nothing seemed to work.  We felt like guinea pigs.  We were in and out of institutions.  We lived in terror that electroshock, brain implants, and lobotomies were the only options left to us.

In the end, many of us tried these treatments of last resort as well.  For some of us, shock, brain implants or even lobotomies ended up being surprising miracle cures.  For others, they were torturous and debilitating. We were never the same again.  We lost capacity instead of regaining it.  Treasured memories and feelings - the day our child was born, the reasons we fell in love with our spouse, our entire college education - were permanently erased.  We lost all hope of a better future, and often years off of our natural lives as well.  Some of us died on the treatment table or in the operating room.

Adding insult to injury, many of us learned – only after the fact – that the chemical imbalance theory was just that – a theory.  There wasn’t a shred of evidence to support it.  It was just a nice analogy that doctors used to explain to us the need to take drugs and procedures that they or others felt would be helpful.  We also learned that, as discussed in Chapter 4, the evidence supporting the high-risk medical approaches we had been subjected to wasn't all that solid either.

Suffice it to say, many of us have come face-to-face with the limits of what medical science has to offer.  Despite our own best efforts and the many professionals who may have sincerely wanted to help, we didn’t progress to our satisfaction.  At best, medicine and science had taken us only a part of the way.  And, far too many of us found ourselves worse off than when we started.

Thursday, March 23, 2017

Chapter 2-4: Why Your Horoscope is as Valid as Your Diagnosis

(in progress)

Both as a theoretical construct and a system of classification, the disease model of mental illness leaves much to be desired.  Unlike other medical disciplines, there is no proven etiology for specific disorders. Despite millions of dollars in research, there are no detectible viruses, bacterium, neurotransmitter surpluses or deficits, hormonal surpluses or deficits, organ malfunctions, genetic abnormalities, injuries to bone or tissue, nutritional deficits or the like. Instead, mental health providers base their judgments on clusters of phenomena that, to them, seem to go together.

In this regard, the DSM operates far more like your newspaper horoscope than legitimate science. Instead of observing the movements in planets and stars, clinicians are observing clusters of mental and bodily developments.  When certain phenomena emerge together, they make predictions about your current status and future needs.  (This gives new meaning to the phrase: "I need to look in your chart.")

Just like astrology, the clusters and their associated ramifications have a lot of intuitive appeal that seems to ring true for some people.  Unfortunately, the general patterns aren't clear enough on a broad population basis to yield a reliable picture of what is going on underneath the surface.  You might as well say, “I’m a libra” as “I’m bipolar.”  They both tell you about as much about yourself.

As a result, these categories hinder efforts to develop treatment approaches that provide verifiable, consistently satisfying results.  Given the current outcome data, the average person might do about as well consulting the stars as by following the treatment plan developed by a licensed mental health provider.

Adding Insult to Injury


Add in conventional prejudice around the 'mental illness' labels, and it gets even worse.  It's like your provider looking only at your horoscope and taking that as the end all and be all of what is happening in your life.  Pretty soon, family, friends and everyone else you know are following the provider lead. Next thing you know, all of your complaints are seen and interpreted through the lens of your horoscope. Other issues you're having -very real ones - aren't taken seriously, because hey, "the moon is in the 7th house and Mercury is aligned with Mars, so what do you expect will be happening in your life...?

The simple fact is a lot of us are grieving real life losses - the loss of jobs, careers, community standing, financial security, family roles, spouses divorce us, courts take our kids, friends abandon us, neighbors look the other way.... These losses all too often follow and directly result from - not just precede and 'cause' - a psychiatric diagnosis.  Yet our very real pain is minimized or dismissed.  Everyone knows that people with our horoscope [diagnosis] can't expect much.  So probably we don't feel much either....

Arbitrary Privilege


The arbitrariness of the medical model has yet another disturbing dimension.  As a practical matter, there are countless non-disease approaches that people use to make sense of the experience and guide their approach to life.  Many of these approaches have – or may have - similar reliability, validity and outcomes as conventional mental health.  There are personality measures like the Enneagram and Myers-Briggs that describe common themes in human behavior and that many people find helpful in understanding and relating to others.  There are practices like acupuncture, naturopathy, reflexology, reiki, cranio-sacral therapy, massage, yoga, meditation, chiropractic, osteopathy, art, coaching.

Practitioners of these and similar modalities can reasonably claim to offer both mental and behavioral benefits to people in distress that – dollar for dollar – would be just as efficacious and far more enjoyable than traditional mental health treatment.  Like psychiatry, these alternative modalities all claim skill at:

  • identifying the causes of human distress, 
  • remedying existing problems, and 
  • preventing potential future catastrophes 
for individuals and/ or their loved ones.

Moreover, if vested with the research dollars and sophisticated methods available to the Pharmaceutical industry, quite possibly many alternative approaches could demonstrate efficacy equal to modern psychiatry.  This is not an exaggeration. The fact is, armed with the resources, tactics and scope of influence available to Pharma, quite possibly  phrenologists (who measure skulls), fortune tellers (who look at the lines in hands), and reflexologists (who track the patterns in feet) would all by FDA approved and Medicare re-imbursed. The 'science' is just that slimy.  

Seen in this light, the bias toward medical methods and interpretations is alarming.  None of the non-medical alternatives come close to enjoying the public standing granted to medical model providers. They rarely if ever qualify for government research grants, private insurance or public reimbursement.  They never get to force their recommendations on unwilling subjects.  And they certainly don’t get asked by courts to opine whether someone should lose their freedom based on yesterday’s horoscope or an overly long toe.

Chapter 2-3: The Real Dirt on Medical Model Outcomes

(in progress)

If you want to understand the problems with medical model outcomes, the most definitive source is Robert Whitaker's work and website, MadinAmerica.com.  This is really the most careful and comprehensive analysis of the research to date.  Bob won a national investigative journalism award in 2010 for documenting the link between Pharma, psychiatry and dramatically worsening medical model outcomes. Bob's work is so thought provoking and persuasive that it has convinced many career psychiatrists of the urgent nice to rethink these issues.

Since no one makes the case better or more clearly than Bob, I refer you to the parts of his work that, for me, have been the most personally illuminating.

Resources:  





About

Chapter 2-2: Social Determinants of Behavioral Health

The social determinants of health are well-known.  There really are some things that all of us need in order to live and be well.  According to the World Health Organization:

'Poor social and economic circumstances affect health throughout life. People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top. Nor are the effects confined to the poor: the social gradient in health runs right across society, so that even among middle-class office workers, lower ranking staff suffer much more disease and earlier death than higher ranking staff.' 
'Both material and psychosocial causes contribute to these differences and their effects extend to most diseases and causes of death. Disadvantage has many forms and may be absolute or relative. It can include having few family assets, having a poorer education during adolescence, having insecure employment, becoming stuck in a hazardous or dead-end job, living in poor housing, trying to bring up a family in difficult circumstances and living on an inadequate retirement pension.' 
'These disadvantages tend to concentrate among the same people, and their effects on health accumulate during life. The longer people live in stressful economic and social circumstances, the greater the physiological wear and tear they suffer, and the less likely they are to enjoy a healthy old age.'

Social determinants of health: the solid facts (2nd ed.) p. 10 (Wilkinson, R. & Marmot, M. eds. 2003), http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf.

Here is how this plays out - as a practical matter - in behavioral health.  In behavioral health demographics, adverse life experiences are nearly universal. An estimated ninety (90!) percent of those in the public mental health system are ‘trauma survivors.’ We have grown up without reliable access to same basic needs that the United Nations recognized as essential over six decades ago. Universal Declaration of Human Rights, http://www.un.org/en/universal-declaration-human-rights/

The same applies to the other so-called ‘problem’ groups in our society.  Yep, ninety (90!) percent or more of us in substance use, criminal justice, and homeless settings are ‘trauma survivors’ as well.
This is not just about individual needs, but also family needs and the needs of entire communities. These issues affect all of us across demographics.

Don’t believe it?  Check out the following:


Yet, for all the fanfare about the need for more ‘trauma-informed care,’ there has been little systemic response directed toward basic human needs.  Equally disturbing, behavioral health system involvement has become an independent, exacerbating source of harm for many.

The results speak for themselves.

Resources:


Boisvert CM, Faust D  (2002) Iatrogenic symptoms in psychotherapy: A theoretical exploration of the potential impact of labels, language, and belief system. Am J Psychother. 2002;56(2):244-59

Cassani, M (August 9, 2014)  Treatment resistant mental illness? or Iatrogenic (drug-induced) illness?, https://beyondmeds.com/2014/08/09/treatment-resistant-mental-illness-or-iatrogenic-drug-induced-illness/ (and resources cited therein)

National Council on Disability (January 20, 2000), From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves, http://www.ncd.gov/rawmedia_repository/21553992_2d13_4dcb_a1c4_ee6c9e9434e8.pdf

Chapter 2-1: Why The Disease Model of Mental Illness is (erhm...) Dying

(in progress)

In recent years, the disease model of 'mental illness' has taken a lot of hits.  There have always been critics outside of the mental health professions.  But, more and more, the criticism is mounting from within.  In this chapter, we trace the rise and fall of the 'mental illness' theory that has been advanced by modern medicine.

History of the Medical Model


Historically, there have been varied explanations for the kinds of human behaviors that defy explanation. There are a lot of troubling experiences happening both inside and outside of human minds and bodies.  So it's natural that people from all eras and cultures would try to make sense of them.

Throughout the centuries, theories have included things like: possession by demons, divine displeasure, the imbalance of the bodily ‘humours’ (blood, yellow bile, black bile, phlegm), bad genes, dysfunctional families, repressed sexuality, bad teeth, misshapen skulls, being too smart, being to dumb...  The list goes on.

In Western medicine, it was Hippocrates who won out.  He piloted the brain theory and the disease approach that, in modified form, still holds pre-eminence today.

Modern Adaptations


The modern understanding of the ancient Hippocratic paradigm is articulated in two separate, but overlapping models.  These include (1) the mental disorders described by the ‘DSM’ and (2) the medical model of ‘mental illness’.   Both models have significant practical, theoretic and empirical limitations, as we point out below.

1. The DSM Model of ‘mental disorders’


The DSM Model is based on the Diagnostic and Statistical Manual of Mental Disorders published by American Psychiatric Association.  The DSM - and its European counterpart the ICD -  are used by mental health professionals to diagnose mental disorders like depression, ADHD, bipolar, borderline personality and schizophrenia.

While often thought to be ‘scientific’, the DSM is largely the product of insider turf wars, political compromise, industry needs and billing concerns.   It is said to be atheoretical, but unquestionably the DSM views certain aspects of human experience as abnormal/ disorders.  Possibly, this is just a nod to the practicalities of healthcare reimbursement.  However, the process of distinguishing the truly abnormal (insurance pays) from the common effects of a stressful life (you pay) has left something to be desired.

Rote symptom checklists determine whether your anxiety, mood, grief, trauma, substance use, sexuality is ‘normal’ or ‘disordered.’  At a minimum, this is a lousy way to get to know another human being on the worst day of their life. Painful experiences, like getting fired, ending up homeless or being raped in shelter housing are routinely ignored or overlooked. It’s like the teacher pronouncing you ‘learning disordered’ without asking if you studied.

Reliability and validity have proved problematic as well. Individual diagnoses tend to vary, as do predictions of violence and suicide.  Given that single bad call can change the course of a lifetime, concerns like these led whistleblower Paula Caplan, Ph.D., to report to the Washington Post in 2012: “Psychiatry’s bible, the DSM, is doing more harm than good.”

Since that time, things have gotten worse for the DSM, not better.  In a stunning reversal, world-renowned psychiatrist, Allen Frances, MD – the man who spear-headed the modern DSM classification system - described DSM-5 as ‘deeply flawed and scientifically unsound.’ A former Director of the National Institute of Mental Health (think science, research, evidence-based), Dr Steven Hyman, called DSM-5 ‘totally wrong, an absolute scientific nightmare.’  In April 2013, the NIMH formally went on record as looking for a more valid approach.  According to then-director Thomas Insel, MD, ‘Patients…deserve better.’

2. The Medical Model of ‘mental illness’


In contrast to the DSM, the Medical Model has a crystal clear vision:

‘Mental illness’ is a real disease.  It is caused by pre-existing genetic, biochemical or physiologic abnormalities. Those affected are susceptible to disregarding personal welfare or that of others. Aggressive treatment (drugs, shock, CBT) is required to correct or mitigate deficiencies.

For all its theoretical congruence, the medical model hasn’t fared much better than the DSM. Treating ‘mental illness’ takes a whopping 15-25 years (on average!) off of the average life span.  The promised ‘chemical imbalances’ and bio-markers still haven’t materialized in the research.  Disability rates have sky-rocketed.  Long-term outcomes and relapse rates have worsened overall.   Many suspect that prescribed drugs increase violence and suicide.

Accordingly, in May 2013, the UK Division of Clinical Psychology called for the end of biomedical disease model of ‘mental.  In the professional opinion of these psychologists, both the SM and ICD classifications systems possess limited practical and research utility.  The disease model on which they are based is significantly flawed and a paradigm shift is desperately needed to address the impact of psychosocial factors on mental distress and human behavior.  

Resources:

Caplan, PJ (1995). They Say You’re Crazy: How The World’s Most Powerful Psychiatrists Decide Who’s Normal  (Perseus Books: www.aw.com/gb).

Caplan, PJ (April 27, 2012). Psychiatry’s bible, the DSM, is doing more harm than good, https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html?utm_term=.bf2d94b01bb8

Cassani, M (August 9, 2014)  Treatment resistant mental illness? or Iatrogenic (drug-induced) illness?, https://beyondmeds.com/2014/08/09/treatment-resistant-mental-illness-or-iatrogenic-drug-induced-illness/ (resources cited therein)

Division of Clinical Psychology Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses: Time for a Paradigm Shift, https://www.madinamerica.com/wp-content/uploads/2013/05/DCP-Position-Statement-on-Classification.pdf

Insel, T (April 29, 2013). Transforming Diagnosis, https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

Johnstone, L (May 2013) UK Clinical Psychologists Call for the Abandonment of Psychiatric Diagnosis and the ‘Disease’ Model, https://www.madinamerica.com/2013/05/uk-clinical-psychologists-call-for-the-abandonment-of-psychiatric-diagnosis-and-the-disease-model/?platform=hootsuite.

Scull, A, Madness and Meaning (April 22, 2015), https://www.theparisreview.org/blog/2015/04/22/madness-and-meaning/

Whitaker, RH (2010). Anatomy of an Epidemic. New York: Random House.

Wikipedia, Humorism, https://en.wikipedia.org/wiki/Humorism

Chapter 1-2: The ‘GUTs’ (Grand Unified Theory) of Conventional Behavioral Health

(in progress)

In the past several decades, it has become common in other fields – like physics – to wonder if there might be some kind of ‘Grand Unified Theory’ (GUT) that makes sense of the entire known physical world.  For the most part, that hasn’t happened in behavioral health.  Thus, troubling social phenomena – like ‘mental illness’, ‘addictions’, bullying, discrimination, disability, abuse, neglect, poverty, violence, crime, victimization, homelessness – are still seen as largely separate issues.  At the same time, there is tremendous overlap.  The fact is, these misfortunes tend to cluster and recur in the same people.  So it’s more likely that if you have one of these issues, you’ll have a second.  And, if you already have two, you’re more likely to have a third.  Have three?  Then you’ll probably have a fourth! -   And so on…

What’s the connection here?  Are these phenomena really distinct?  Or, like physics, is there an underlying common thread that connects them?  Equally important, if they are related, what is the relationship and what does this tell us about where to go from here?  Are there reasoned approaches we can take, not just individually, but also as neighbors, families, friends, neighbors – as communities, schools, healthcare providers  - even as businesses, investors and insurers?  Are there actual concrete, affordable, achievable things we can do to minimize problems and promote solutions in the areas of human well-being that we value the most.

This manual came about as a result of asking questions like these.  They are just a small sampling of the questions I had that conventional behavioral health doesn’t satisfyingly answer.  Some questions, like those above, were motivated by intellectual curiosity:  Things looked and felt related to me, but how...?

Other questions I had were personal and intensely, painful.  They included questions like:

  • Why do I get verbally attacking when I feel vulnerable? 
  • Why does it feel like an addiction? 
  • Why does it feel like aggression to others, but inside I actually feel beat up and traumatized? 
  • Why can’t I seem to stop doing this attacking behavior despite years of trying and all it has cost me, personally, professionally, socially?   
I sat with some of these questions for decades.  Finally, for myself at least, I think I have some answers.

What follows here is theory not a fact.  However, for me it works with an elegance and comprehensiveness that nothing else has.  I think this is the case for several reasons:


  1. The theory I present below is grounded in accepted understandings of human biology.
  2. It incorporates modern developments in our understanding of necessary ingredients to human psychosocial well-being.  
  3. It is derived from years of puzzling through my own experiences of heightened reactivity and those of others.
  4.  I’ve had the opportunity to observe and experience a wide range of ‘helper’ responses across numerous life contexts and to draw my own conclusions about what seems to make things better or worse for those concerned. 


However, the most important thing is not whether it fits for me.  It’s whether it fits for you and others. Your questions, concerns and exceptions are a vital part of developing an accurate, reliable paradigm. Only in this way, with the contributions of all of us, will be begin to make sense of the vast, diverse range of thoughts, feelings and actions that our species is capable of manifesting.

Accordingly, this manual will lay out what, for me, has become a sort of Grand Unified Theory (GUT) of Psychosocial Functioning.  If the answers I suggest don't speak to you, maybe they inspire you to make your own inquiry.  Maybe you or someone you know will supply the insights needed to take us all to the next level.

Regardless, my hope in writing this is to make a beginning.  There are still way too many problems that conventional behavioral health doesn’t come close to fixing. To the contrary, the sad fact is that far too often – and for far too many of us -- conventional approaches actually may make things worse.

Possibly, together, we can change that.  As users, survivors and allies, perhaps we can learn to sit together with our honest questions –  all the stuff we’ve been told by ‘helpers’ that doesn’t fit for us. If we can own our questions and our experiences – rather than just caving to the experts and going along to get along - then maybe, somehow, some day, we can come up with some answers that honestly do make sense to us.  It’s a great way not only to help ourselves, but also to save future generations from some of the pain and confusion we are going through as individuals – and a people – right now.

Not Broken Biology: Getting Beyond the Disease Model Paradigm of 'Mental Illness'

Table of Contents


Part I: Why This Guide Is Being Written


Chapter 1-1: The Manual I Would Have Wanted for Me
http://peerlyhuman.blogspot.com/2017/03/chapter-1-maniacally-sane.html

Chapter 1-2: The 'GUTs' (Grand Unified Theory) of Conventional Behavioral Health
http://peerlyhuman.blogspot.com/2017/03/chapter-2-gutting-conventional.html

Chapter 1-3: Aren't You Just Quibbling with Language?
http://peerlyhuman.blogspot.com/2017/04/chapter-1-3-arent-you-just-quibbling.html


Part II:  A Defective Theory of Mental Defects


Chapter 2-1: Why The Disease Model of Mental Illness is (erhm...) Dying
http://peerlyhuman.blogspot.com/2017/03/chapter-1-defective-theories-of-mental.html

Chapter 2-2: Social Determinants of Behavioral Health
http://peerlyhuman.blogspot.com/2017/03/chapter-2-social-determinants-of.html

Chapter 2-3: The Real Dirt on Medical Model Outcomes
http://peerlyhuman.blogspot.com/2017/03/chapter-3-medical-model-outcomes.html

Chapter 2-4: Why Your Horoscope is as Valid as Your Disagnosis
http://peerlyhuman.blogspot.com/2017/03/chapter-4-horoscope-doctors.html

Chapter 2-5: Lived Experience of Medicine-Based Approaches
http://peerlyhuman.blogspot.com/2017/03/lived-experience-of-medicine-based.html

Chapter 2-6: Lived Experience of Other Conventional Responses
http://peerlyhuman.blogspot.com/2017/03/chapter-6-lived-experience-of-other.html


Part III: If It's Not a Disease, What Is It?

http://peerlyhuman.blogspot.com/2017/03/part-ii-if-its-not-disease-what-is-it.html


Chapter 3-1: Life is Challenging - All By Itself
http://peerlyhuman.blogspot.com/2017/03/chapter-3-1-life-is-challenging-all-by.html

Chapter 3-2: Human Needs That We All Have
http://peerlyhuman.blogspot.com/2017/03/chapter-3-2-challenge-of-meeting-basic.html

Chapter 3-3: When People Make Bad Things Worse
http://peerlyhuman.blogspot.com/2017/03/chapter-3-3-when-people-make-bad-things.html

Chapter 3-4:  Discrimination, Bias, Prejudice: A Brief History of Social Othering
http://peerlyhuman.blogspot.com/2017/03/chapter-3-4-discrimination-bias.html

Chapter 3-5: Social and Institutional Betrayal
http://peerlyhuman.blogspot.com/2017/04/chapter-5-social-and-institutional.html

Chapter 3-6: Resulting Harms and Losses
http://peerlyhuman.blogspot.com/2017/04/chapter-3-6-resulting-harms-and-losses.html



Part IV: Not Broken Biology - The Normal Biology We Call 'Crazy'
http://peerlyhuman.blogspot.com/2017/04/part-iv-not-broken-biology-normal.html

Chapter 4-1: It Looks Like Bipolar and Acts Like Bipolar, But…
http://peerlyhuman.blogspot.com/2017/04/chapter-4-1-it-looks-like-bipolar-and.html

Chapter 4-2. Why It’s Not Bipolar
http://peerlyhuman.blogspot.com/2017/04/chapter-2-why-its-not-bipolar.html

Chapter 4-3. Why Normal Responses So Often Look 'Crazy'
http://peerlyhuman.blogspot.com/2017/04/chapter-4-3-why-normal-reactions-so.html


Chapter 4-4. Gearing Up for Survival: The Human Survival Response in a Nutshell
http://peerlyhuman.blogspot.com/2017/04/chapter-4-4-gearing-up-for-survival.html 


Chapter 4-5: Explaining So-Called ‘Mental Illness’
http://peerlyhuman.blogspot.com/2017/04/chapter-6-explaining-so-called-mental.html


Chapter 4-6:  Explaining Particular ‘Disorders’ and Symptoms
http://peerlyhuman.blogspot.com/2017/04/chapter-4-6-explaining-particular.html


Chapter 4-7: Why The Dis-Ease Keeps Getting Worse
http://peerlyhuman.blogspot.com/2017/04/chapter-4-7-why-dis-ease-keeps-getting.html


Chapter 4-8: Why ‘Mental Illness’ is a Vicious Cycle and a Catch-22
http://peerlyhuman.blogspot.com/2017/04/chapter-4-8-why-mental-illness-is.html


Part V: Where to Go From Here

(in progress)

Chapter 5-1: Why We Need a New ‘Recovery’
http://peerlyhuman.blogspot.com/2017/04/chapter-5-1-why-we-need-new-recovery.html

Chapter 5-2. Turning Off High-Stakes Reactivity
http://peerlyhuman.blogspot.com/2017/04/chapter-1-turning-off-high-stakes-system.html

Chapter 5-3: Putting the "Experts" in Their Place 
http://peerlyhuman.blogspot.com/2017/04/chapter-5-3-putting-experts-in-their.html

Chapter 5-4:  De-Coding the Messages of High Stakes Reactivity
http://peerlyhuman.blogspot.com/2017/04/chapter-5-4-do-you-want-to-save-your.html

Chapter 5-5: Working With High Stakes Reactivity/ Common Problem, Common Solution


Chapter 5-6: Changing Your Relationship to High Stakes Reactivity


Chapter 5-7: When It’s Your Own High-Stakes Reactivity


Chapter 5-8: When Someone Else is in High Stakes Reactivity


Chapter 5-9: When You’re Both in High Stakes Reactivity


Part VI: Messages to the Behavioral Health System


Chapter 1: Rethinking Professional Roles 131
Chapter 2: Redefining ‘Ethical’ 132
Chapter 3: Why Mutual Regard Works 133
Chapter 4: Why Coercion, Force, & Confrontation Make Things Worse 134
Costing Us Our Conscience: The unbearably high price of conventional mental health 135


Part VII: Message to Lawyers, Lawmakers and Activists


Chapter 1: Moratorium on Diagnosis 139
Chapter 2: Consumer Protection 140
Chapter 3: Expert Witlesses 141
Chapter 4: Meaningful Research 142
Chapter 5: Experts by Experience 143
Chapter 6: Community Alternatives 144
Chapter 7: Minimum Standards for Community Health 145


Part VIII. Message to the Caring Public


Chapter 1:Why Psychiatric Labels Are More Deadly Than Guns 155
Chapter 2: Have You Noticed the Two Americas in Mental Health? 164
Chapter 3: The REAL Threat to Public Safety is Marginalization 167
Chapter 4: Bury My Heart At Wounded Psyche 175
Chapter 5: "I Am Proud to Be Maladjusted" - Dr. Martin Luther King, Jr. 180
Chapter 6: Iatrogenic Advocates - Modern Guardians of "The Mentally Ill" 148
Chapter 7: Lived Experience Must Get A Fair Hearing 153




Appendix: 12 Steps for Everyone


Introduction: What is Peerly Human?
Chapter 1: Reality is the Problem 90
Chapter 2: Reality Suggests Some Possible Solutions 92
Chapter 3: Ready to Try Differently…? 99
Chapter 4: Who Am I, Really…? 100
Chapter 5: Finding People Who Make it Better Instead of Worse 111
Chapter 6: Sifting and Winnowing 112
Chapter 7: Getting to the Heart and Soul of the Matter 113
Chapter 8: Uncovering Our Tracks 114
Chapter 9: Recognition and Reconciliation 115
Chapter 10: Maintaining Integrity 116
Chapter 11: Rinse, Repeat 117
Chapter 12: Living Into the ‘Soul Force’ 118


To read more of this guide: 


Not Broken Biology: Getting Beyond the Disease Model Paradigm of 'Mental Illness' http://peerlyhuman.blogspot.com/2017/03/not-broken-biology-getting-beyond.html

Chapter 1-1: The Manual I Would Have Wanted for Me

(in progress)
It is a bit unnerving to write this. What follows basically proposes a new paradigm for psychosocial well-being.  It takes current understandings of behavioral health, and turns them on their head.  It suggests that there is a simple, straight-forward, elegant way of making sense of major social issues like ‘mental illness’, ‘addiction’, ‘violence’, and ‘crime.’   It also points to clear, understandable, practical strategies for addressing these issues on individual, social and cultural levels.

As a person who has been labelled mentally ill – as well as someone who has worked in the field – I am well-aware of the implications.  Any non-expert who makes such claims in modern times will at the very least be labeled ‘grandiose.’  On short order, a lot of us can expect to be on a back ward some where getting shot up with the latest rendition of bipolar meds.

At the same time, the results for me of this shift in perspective have been revolutionary.  I have had 8 official diagnoses and about that many ‘rule outs.’  I have tried over 20 meds, and countless alternative treatments.  However, it wasn’t until I put a few simple facts together about myself, human physiology and normal psychosocial functioning, that I was able to make sense of what was happening for me and to effectively do something about it.  What I have works for me. I suspect it can work for at least some others, possibly a lot of others.

In sum, this is the manual I would have wanted for me, if I had known what I know now at age 16 when I first entered the mental health system. It explains what I’m up against and what I have to work with.  It is straight forward, plain language and practical. I can – and do – use it on a day to day basis to make sense of my experience and decide how to respond.  Better yet, it doesn’t require me to think of myself – or my reactions – as ill, disordered or inappropriate.  To the contrary, it helps me to find the hidden strength, value, and wisdom in personal idiosyncracies that conventional approaches tend to marginalize.

If this manual helps you reflect on your own experience – and perhaps develop something that works even better for you – then it has served an important purpose.  Hopefully it will do other things as well:


  1. Help family members understand and effectively relate to each other across very different viewpoints and realities
  2. Help clinicians appreciate the value of the people and experiences they are currently labeling ‘mentally ill’, ‘disordered’, ‘antisocial’ or ‘psychotic.’
  3. Help professional organizations advocate for the internal and systemic changes required to effectively assist the vulnerable citizens they claim to serve.
  4. Help politicians credibly articulate the changes in policy and resource allocation that are needed to meaningfully create and maintain public health that will benefit those at all levels of society
  5. Help the general public understand why such changes are needed, how they can be achieved and the concrete benefits they can expect from their efforts.


Obviously, that’s a tall order.  So let’s get started.