Sunday, April 23, 2017

Disorder Vs. Reaction

Disorder Vs. Reaction

            As my time in abnormal psych class ends, I’m reflecting on the most important thing I’ve learned from that class.

            The DSM (Diagnostic and Statistical Manual) has a very long, contradictory history. The title itself sounds like a guide book for fixing your car. Instead, it’s a list of mental maladies, and their symptoms. It doesn’t list how to treat the disorders, or why the disorders occur. All it does is give a description of each form of mental illness. Depression, Bipolar Disorder, and Anxiety Disorder are all there. There’s even been a few disorders that were removed, and some that have recently been added. It’s a fluid document that is capable of being changed. These changes occur due to politics, culture, and the persistence of pharmaceutical companies. That doesn’t mean that psychology is quackery, or that all the illnesses in the DSM are illegitimate. What it means is that we must be careful how we label mental “illness.”

            I learned during my studies that the illnesses weren’t always called disorders. They were once referred to as reactions; meaning that one experienced a form of psychological irritation, which then lead discomfort. One became depressed, for example, not from being disordered mentally, but from a reaction to a stimulus that caused the depression. The key then is to find the stimulus, and remove it. Or, more likely, explore the stimulus to defuse its potency.

That has always been my basic knowledge of therapy; find the cause, find the “cure.” I’ve since learned that it isn’t so much about finding a cure. It’s more about finding a way to cope. Good therapy is about helping someone manage their mental health, rather than fixing them. We are people not machines. We mend, but we do not have magic spanners to do it for us. If a therapist literally could use a tool box to fix people, they would. But, it’s not that simple. It never was, and never will be. Even the ancient shamans knew that.   

            When I first heard of psychology, I was a child. I was exposed to the stereotypical image of a client reclining on a sofa, as their therapist took notes. I saw this in cartoons, movies, television shows, etc. We’ve all seen that image. I was surprised to find that my first therapist, Jessica, did not do that. Instead, she faced me, and sat on the carpeted floor, as did I. Though, there were a few occasions where I did recline on a sofa, and she did sit in plush recliner. When talking with Julie, she sat in a leather “captain’s chair,” and I sat on a sofa across from her. At no point did I ever lay down on it. Though looking back on it now, I kind of wished I had, just to play up the image.

            That image came to us from Sigmund Freud, as this was how he conducted his sessions. He wanted his patients to be comfortable, as they’d be talking to him for an hour. But even more so, they’d be talking about difficult things. They needed something to lay back on, especially when in heightened emotional states. Not much has changed since then. Therapists still need their sofas.

I’ve also noticed that they need photos of plants, and loud carpeting. When it comes time to decorate my office, I’ll make sure to avoid orange (inside joke I can’t reveal), or “baby food” green. These seem to be the most common colors in therapist’s offices these days. I’d opt for real plants as well, not just pictures of nature.

Either way, the idea is to create a safe space where the client, or patient, can talk. They need to feel safe. Above all, they need to feel it’s okay to be human.

That brings me back to the concept of disorder vs. reaction.

To say that someone has a disorder would be to suggest that there is such a thing as an “order.” What constitutes an “order” for mental health? We could simply say that it’s someone that acts like everyone else. But, what if everyone else is off their chump? I’m reminded of the H.G. Wells story The Country of the Blind, in which a group of isolated people believe they are living inside the Earth, instead of on top of it. They are all blind due to inbreeding, and as a result, believe whatever they are told. They cannot see the world for themselves, so they relied solely on belief.

How often is the world like that?

In the country of the blind, the one-eyed man may very well be king. They are the outsider, but that doesn’t mean they special apart from anyone else. They just see things differently. As a professor once told me, “Normal is just average. It’s not necessarily healthy.” I’d rather be healthy instead of normal.

Maybe that person with anxiety disorder is just more sensitive to stress? Maybe the person with depression feels deeply, and needs to explore those feelings?

There are conditions such as bipolar disorder, or schizophrenia, which are indeed real biogenic and psychogenic illnesses. A person with either condition will need medication, as well as talk therapy. The medication itself isn’t a cure, but leveling mechanism. It brings the person to a state where they can focus long enough to talk about what irks them, and provokes their respective condition.

That brings me to the condition itself.

When I had depression, I knew it had a root cause. It wasn’t something I caught like the common cold. It had a point of origin that needed to be traced. Similarly, my anxiety also has a similar point of origin. I was able to trace the depression, and lift it. But, I’m still not sure about the point of origin for the anxiety. That needs a little bit of work still. Though I improved greatly with therapy. Again, it’s about management, not a definitive “cure.”

I’m only an expert on my own experiences. I can’t speak for other people who have, or have had, similar conditions. What I can say is that you are not your diagnosis. The diagnosis is a way of understanding what is wrong. It helps you to put a name on it, so that you can explore it. But it doesn’t label you. You can have bipolar disorder, but that doesn’t mean you are bipolar. I’ve heard it remarked that a cancer patient doesn’t say, “I am cancer.” Or a patient with the flu doesn’t say, “I am flu.” The label is there to explain the condition, not the person.

The symptoms themselves are part of the condition, but they are only just that; symptoms. They are the signs of a root cause, not the cause itself.

As Viktor Frankl once wrote, “Depression is not a sign of illness, but a sign of existential crisis.” It means that something isn’t being addressed, or something hasn’t been explored that should be. It can cause disorder in a person’s life. But the ailment itself is reaction to something upsetting that happened to the person.

Post-traumatic stress disorder, likewise is a reaction. It makes sense that one would be upset if they were in combat, and saw lives being taken around them. It makes sense that one experiences trauma, and then feels a heightened state of alert, to protect one’s own existence. It even makes sense that one may feel anger, frustration, even remorse after such events. These are not signs of weakness, but signs of humanness.

            While I acknowledge the reality of mental illness, I also acknowledge our difficulty with expressing empathy for it. I feel that is now changing in our culture. I see it more so across the pond than I do in my own backyard. I don’t think America is quite there yet for the frank discussions that mental health advocates are having in the U.K. and Europe. But I sure hope they get there soon.

I think part of that lack of empathy is fear. Fear that one may have such ailments, and not be treatable. Is it possible to find a cure for being human? No. But what we can find is a greater understanding of being human. We can learn that disorders do not make us monsters. They make us acknowledge our own frailty, and the reality of living in a world that was always difficult.

We are all, in a way, reacting to something. Our emotions; love, hate, anger, slightly being annoyed, massively annoyed, and even mildly pissy on a Wednesday afternoon stuck in traffic, are all signs of reactions. There is inspiration to love, just as there is inspiration to anger. Could there not also be inspiration to sadness, or joy?

I believe then that the key to understanding mental illness is to treat the person, not the condition. Using that method, we will then understand not only the stimulus that caused the illness, we will understand something far greater. We will understand the person, and ourselves.

Text Copyright Riley Joyce 2017

Above image: Copies of the various versions of the DSM. Copyright, Riley Joyce 2014.
Below image: autumn leaf after rain. Copyright, Riley Joyce 2016

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