The posts that prompt me to think the most often grow out of conversations with others. The reason I’ve not placed anything new in the main part of the blog for a couple of days is that I’ve been occupied in the ‘comments’ section discussing the pros and cons of diagnostic labels with Marian, who authors Different Thoughts. That interchange can be found in the comments thread following my last post: ‘A rose by any other name would smell as sweet’ (see comments numbered ten through eighteen). As you may recall, that previous essay arose out of my reading of two pieces written by Larry, the author of the Hopeworks Community blog. (One of his posts talked about diagnosis, and the other about semantics.) If one were to compile Larry’s work with my essay and the conversation between Marian and me, the result would be a pretty thorough coverage of the pluses and minuses of using a medical/diagnostic model to classify mental conditions.
If you read my responses to Marian, you’ll also see how I ended up regretting some of my words. While sleepless and fatigued at 3:00 am, I got caught up in my emotions, in my desire to protect others from being criticized for their choices, and in my sense that my viewpoints had been brushed off. I succumbed to the strong feelings and diametric divergence of opinions that plague so many discussions in behavioral health. My words conveyed an antagonism that left me feeling bad when I awoke after a few hours of sleep. My biggest concern in writing about mental health often centers on trying not to alienate people who disagree with me. I hope to convince others to broaden their perspectives, and coming down with too much hostility will never accomplish that. So I had to ask myself why my words had gone against my principles. They had become personal attacks rather than dissections of Marian’s analysis or challenges to what she considers factual statements.
I am human. I realize that getting angry and overreacting go hand-in-hand with belonging to this species. So rather than berating myself for violating my standards, it is more useful for me to explore why my defenses broke down. What prompted me to jump into the fray with the kind of vehemence I object to in those who only hammer their opinion into others, and barely listen to the reasoned views of people with whom they disagree? Why did I back away from my belief that words should be used to promote mutual understanding and bring people to common ground, rather than widening divisions and increasing ill-will?
When I first became (peripherally and recently) involved in the activist side of the mental health world, the sharp and frequent contention surprised me. That I walked into this cause without expecting huge controversy must seem silly to others. But I had a utopian picture, coming from my limited and one-sided experience of psychological services in an institution where all the clinicians and clients accepted the same treatment model. In that milieu, everyone worked together to figure out how to help the clients feel better. I had not agreed with everything that organization did, but I respected the practitioners, and found the entire effort admirable. Good people working as a team to accomplish a worthwhile goal satisfies my hopes for human potential. I knew disagreements about treatment approaches existed, and had actually left a previous psychiatrist because I concluded she was harming me. Since my heart boiled with fury about awful and permanent side effects, and years lost with my mind poisoned by too much medication, I should have known that outside of my protected enclave I would find others who harbored similar anger and frustration. And that they would not all agree. It did not take long to catch on to the reality that feelings run very high, agreement is rare, and all sides bring a burden of resentment to the table. The conflict heightens further in the face of the power possessed by doctors, police, and social workers to strip us of our civil rights with only nominal proof of necessity. The fact that lives can be saved or ruined in short order further amplifies the rancor and controversy.
The most pernicious tendency leading to ill-will between people who desire the same end (improved mental health care) is how easily we get locked into believing that ‘our way is the only way’, and that those who disagree with us have nothing valid to offer. Why do we get caught in the trap of imagining we have the one and only answer to mental health issues? Why is it so hard to accept that others may have equally constructive suggestions? Even when two proposed ‘solutions’ are not mutually exclusive, it still can be tough to relax our grip on the cognitive framework we’ve built to guide our recovery. The temptation remains strong to undermine the other person’s ideas in favor of our own. Why do we have such a hard time tolerating alternatives to our approach?
For one thing, we are people who have suffered. If we are fortunate and persistent enough to transcend our distress, chaos and despair, then we feel tremendous gratitude toward the people or methods that escorted us out of hell. We put the process we followed on a pedestal, and feel almost worshipful in our attitude toward it. Our approach, whether it involved taking medication, mindfulness meditation, doing cognitive exercises, or working on our spirituality, feels so important to us that we cannot help but think it almost miraculous, perhaps even divinely inspired. This entity, whatever it is, has saved us from misery, confusion, and destruction. Like a beneficent god, our savior has earned our faith and devotion.
We also cling to our rescuer (whether person, institution, or philosophy), out of fear that we will fall back into the pit if we relax our embrace. We begin to think in nearly magical terms about the engine of our recovery. If we don’t do things just right our punishment might be a one-way bus ride back to the innermost circle of the underworld. Because so much of our well-being seems to depend on fidelity to this fount of salvation, it becomes easy to feel threatened when someone suggests that our cherished path to recovery has bumps and gaps. How could our road be flawed when it has led us away from enslavement by psychic demons? We fear that we might stumble if we allow others to question our route to mental equilibrium, and the road to wellness will then be closed to us. Sometimes, we even react negatively if somebody acknowledges that we have a good answer, but not the total answer. Worst of all is when another person is equally committed to a conflicting view about how to maintain equanimity. So two people end up screaming at each other, each clenching their lifeline with blood-drained knuckles, when they might just as well reach hands out to each other and share their supports.
At the same time as we defend our ‘answer’ against challengers, we feel called to spread the word about the salvation we have been granted. Like people who enter a spiritual tradition that brings them out of darkness and into life, we become evangelical, and want others to benefit from what worked for us. This response is both natural and laudable. Problems arise, however, when two people feel equally strongly about (seemingly) opposite philosophies. Neither wants anything to do with the other’s ‘theology’. Each feels the other is not only wrong, but possibly evil as well. Psychiatrists become demonized. Or people who advocate against medications are accused of endangering lives and families. The two camps quit listening or even talking to each other, and are content to just preach to those who already agree. One does not need to look far in our modern world to see the dangers when people cling with aggression to conflicting creeds. And it is not really a stretch to liken psychological therapies of all kinds to religious devotion and practice. Both church and mental health practices offer ‘answers’ in the midst of confusion. Both provide community and human contact. Both rescue people from despair. Both depend, to a large extent, on blind faith (read, placebo effect).
The demands of unquestioning devotion, and the resulting obstruction of reason, underly the swath of destruction that religious conflicts draw across our society. If people ‘believe’ without wondering whether there is any objective factual foundation for their ideologies, then there is no hope of communication between opposing camps. How can you persuade someone who doesn’t care about facts or logic, and orders their opinions only on the basis of deep-seated emotional attachments? It is like two young boys arguing about who has the better mom. Empiricism and analysis have no role; each kid just ‘knows’ he has the best mother in the world. That may work for children in the school yard, where the worst consequence might be a bloody nose. But in the wider, adult world if people determine who to approve or reject, what to believe or disbelieve, and how to act or treat others by referring to nothing more than powerful sentiments, then we end up with terrorist attacks or high-tech bombardment of civilian populations.
Bringing the analogy back to the world of mental health: in the absence of careful research and good studies it is far too enticing to base one’s opinions on one’s own personal experience. That would be acceptable, perhaps, if every person could be counted on to respond the same way. However, my point from the start has been that we are all unique. We each have different tastes in people, places, and activities. We look at the world from different perspectives, and have different value structures. What seems perfect to one person may be abhorrent to another. If I conclude that my answer must be good for everyone only because it is good for me, I will soon find that most people have little inclination to believe me or even listen. A charismatic person (which I am not) can succeed in attracting a following. But as far as one person convincing the entire community that there is a single answer for all mental health problems, especially if the evidence supporting the ‘cure-all’ is based mainly on his or her individual experience, that is no more likely than having the world’s population agree on one religious faith. Different people need different solutions.
We also face the problem that people change and go through stages. What works for someone at one time may cease to work later on. In my most objective moments, and as much as I regret starting antidepressants in 1995, I have to admit that medications helped me in my thirties. Now, however, after many years of hard work, I have reconciled with past traumas. I adopted a philosophical and spiritual stance that allows me to tolerate thoughts and feelings that would have once been overwhelming. So I don’t feel the need to take mood-elevators anymore. But for me to turn around and tell a twenty-year-old to just live with their imploding emotions might be worse than forgetful or insensitive; it might even lead the person to self-destruct. And yet I have seen myself say just that kind of thing. It is all-too-easy to blind ourselves to how much we differ from those around us, or even from who we used to be or might be tomorrow.
Rancor arises when people become afraid to even consider that their ‘solution’ may have limitations. It seems to threaten us to entertain the notion that the answers we rely upon might let another person down. I believe the reason for this fear may be that if we acknowledge the possibility of our path to salvation failing someone else, then we admit the possibility that it could some day fail us too. When a path becomes so important to us (whether it’s a religion, a treatment philosophy, or just a point of view) that we think our survival depends on it, then we will naturally defend it against all attackers. Even those who mean well, truly want to help, and have well worked out ideas become enemies. Before long everyone who disagrees becomes an adversary rather than a fellow seeker. That is how good people end up screaming at each other, figuratively or in actuality.
That kind of back and forth helps no one. It drives people to become even more rigid in their views, causes hostile attitudes, and completely blocks communication and exchange of ideas. If any progress is to be made, we have to accept that other people are just as smart, just as creative, and just as capable of solving problems as we are. We have to recognize that writing off other people’s ideas as dumb or deluded amounts to tossing out a valuable resource.
There is really no reason for people to discount each other’s ideas about how to promote well-being. In my opinion, if there is a wrong way to solve the problem of troublesome mind conditions, it is to fall into the trap of thinking there is only one solution. If we can accept that more than one effective path may exist, or go even further and realize that using more than one method at a time may be a viable possibility, then we will be more inclined to listen to the ideas of our fellow travelers on the road to recovery.
In fact, it appears to me that most people benefit from using more than one approach. My progression was to start with therapy, and spend years confronting and understanding the effects of the severe trauma in my upbringing. From there I progressed to medications, which showed me how it felt to not be depressed, and proved to me that I did not endure despair simply because I somehow liked to be miserable. I learned that I was perfectly happy to be happy. After some dead-ends, detours, and misdirections, I learned how to use CBT and meditation to modulate my thoughts and feelings. Most recently, I’ve taken up treatment under the ACT model, and have begun to allow my mind freer rein. Along the way I explored AA, Alanon, support groups for adult children of alcoholics, and many other recovery programs. I studied a great deal about brain science and neurophysiology, psychiatry, and numerous self-help strategies. I spent long periods devoted to a couple of different spiritual traditions. My personal experience tells me that all these different methods have value. However, no single one of them worked as a total solution. So there is at least one person on this planet (me) who was not completely ‘cured’ by any of these methods. They all had benefits, but they all had limitations, too. And yet each approach has adherents convinced that they have found the one and only solution.
Not long ago I met (in a workshop) someone who teaches and does therapy in CBT (Cognitive Behavioral Therapy). He is convinced that CBT will solve all mood problems. If I try to tell him that was not my experience, he responds that I just did not do it right. But if a ‘miracle’ treatment is so dependent on being done ‘just right’, how miraculous is it?
Spiritual solutions are the same. If I don’t get the all-encompassing comfort that others get from ‘God’ then the response is that I don’t have enough faith. Or don’t pray enough. Or don’t go to enough services. If I object that I reach profound states of contentment and understanding with spiritual practice, but that I need more, all-too-often I encounter an annoying condescension. The implication is that my desire for additional support shows that I obviously have not reached the spiritual heights inhabited by people who are ‘serious’ about their sacred practice.
Hard-line atheists will say that even if faith helps, it’s only because of placebo effects, or delusion, or some other material explanation. They imply that I am naive if I think there is a supernatural realm in play. I am being non-scientific, and I am quite possibly not too smart. In one view, belief in God is a weakness of the human brain that evolved to help us deal with mortality. When someone tells you that an important part of your mental health regimen is merely a defect in the human genome, it tends to close off further discussion.
For a psychiatrist, if drugs don’t work, the problem is that the proper chemical agents have not yet been found. We just need to keep trying until we stumble upon the right cocktail. There is little acknowledgement that maybe in some cases there is no drug at all that will adequately eliminate the ‘symptom’. My previous psychiatrist had exactly zero knowledge about something as well established as CBT. She felt no need to refer me on for other approaches. She doggedly pursued the holy grail of the right medication cocktail, even as I descended ever further into emotional bankruptcy.
It never stops amazing me how people blind themselves to alternative explanations and methods. It may be because I am so skeptical of ‘truth’ that I have a hard time understanding how somebody can be so wedded to just one way of seeing things. Frankly, I am not sure a single ‘true’ explanation exists in most settings. The complexity of the world is such that one dimensional answers seldom apply. Matter is both wave and particle. That means that an electron, for instance, is both confined to one very small place, and spread over a broad region simultaneously. The situation is analogous to saying that if you look through one window of my house I appear to be seated in a chair, but if you look through a different window, my body is spread like a cloud throughout the entire neighborhood. That was the first paradox I learned in physics.
Another physical paradox is that you cannot know both exactly where an object is, and how fast it is moving at the same time. There is an unbreakable material limit to the precision with which we can pin down ‘the facts’. It is like saying you can know I am in a tiny town called Greeley Hill, but have no idea whether I am standing on the street or driving a race car at 200 miles per hour. Or you determine that I am driving exactly 55 miles per hour, but can only say that I am somewhere in the North America. And it is not just that you can’t figure out the answer; in a fundamental way, precise answers simply do not exist.
Think about it: every object is two completely different things at one time, and absolute truth does not exist. Although I have stated them simplistically, that is nevertheless a pair of facts that lie at the basis of our entire universe. If we live in such an uncertain and ill-defined universe, then should we really be insulting each other because our companion’s paradigm for complicated and poorly understood mental conditions is not the same as ours?
Of course, I have to close by pointing out that all this is just my opinion (except for the statements about fundamental physical reality, which are over-simplified but correct). Maybe I am wrong to accept every person as equally capable of figuring out their own minds. Maybe some people are actually so misguided that I should just ignore what they say. Maybe that would do more to protect others from harm than trying to engage all comers.
And maybe a single solution will be found some day. Everyone will read the same book, practice the same method, and find peace. If that happens, then that ‘answer’ will not only end the mental health dilemma, but will probably also collapse the power of religions to determine how people think. 
For if a validated solution to human angst were to be found, the majority of people would likely drift away from institutions that offer an outdated dogmatism. This would go a long way toward stopping war and strife. People will no longer need to argue about mental health techniques, or a lot of other things, because the answer to their pain will be in hand. To me, that kind of panacea does not sound likely. But I would be thrilled to be proven wrong.
(I modified this post on 2009 August 21, c. 14:40 PDT, mainly trying to clarify the physical principles I cited.)
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