Defining "Mental Health"?

[10]

Mental Health and the Brain:
A Discussion
Fall, 2008

a course at Bryn Mawr College and associated public conversation [11]

What IS "Mental Health"?

Our first session and resulting on-line forum discussion [13] set a context for our continuing conversation based on institutional characterizations of the state of mental health care and our own experiences with it. Among a number of issues that raised is the question of what exactly one means by "mental health." We'll explore that question further this week. To get started

Write one paragraph that gives, as best you can at the moment, what you think is a clear and useful definition of "mental health" and post it as a reply to the question posed in the on-line forum below. Don't worry about its being "right." You will have ample opportunity to suggest revisions to your definition (and other peoples') during the rest of the semester.
Do a quick first time reading of the three papers linked to below. Do this AFTER you have written and posted your one paragraph definition. The upcoming session will consider the extent to which the three readings do or do not provide reasons to change existing definitions of "mental health" and point directions in which such revisions might perhaps be usefully made. Your thoughts about the papers needn't be posted now; you should include them in the forum below as part of our continuing on-line discussion after the Monday session.

Readings for this week

Discussion

The Problem

"the mental health delivery system is fragmented and in disarray" ... New Freedom Commission on Mental Health [17]
"Stigma erodes confidence that mental disorders are real, treatable health conditions" ... National Alliance on Mental Illness [18]
"Policy makers, insurance companies, health and labour policies, and the public at large - all discriminate between physical and mental problems." ... World Health Organization [19]
"In order to get rid of the stigma behind mental illness, it's important to establish that it is indeed a medical disease with biological causes." ... Paul Bloch [20]
"Many of us feel that mental illness should be treated as physical illness, and that treating it as such will destigmatize mental illness. Along those lines of thinking it seems perfectly reasonable to search for a cure, just like scientist would search for a cure for physical illness." ... jrieders [21]
"for it to be construed as a disease locates it within the individual, as something to be "fixed" and ignores the cultural context, which ... can be a significant influence in defining/addressing mental phenomena" .... LauraC [22]
"Even if all disorders (mental and physical) could theoretically be boiled down to some physiological cause, there is no reason to believe that people would not stigmatize them anymore. If we do want to reduce the stigmatism surrounding mental illness, it’s not enough to just prove a medical/biological cause. " ... ryan g [23]
"Many mental health problems, who knows what percentage, are caused by life style choices." ... mbayer [24]
"it depersonalizes the illness experience and may lead to an increased sense of alienation from one’s own mind (body)" ... Sophie F [25]
"If a person, by medical standards, has a mental illness, but they themselves are happy and don't feel that their mental health is compromised, do they still have a mental illness?" ... kmanning [26]
"Is “mental health” an endpoint or an ongoing project of sorts?" ... Sophie F [27]
"All this disagreement about the idea of soul, self, mind and body as being seperate entities makes the study of mental health a fractured and incongruous practice. To which part do we owe the most loyalty and which part needs to be cured?" ... akerle [28]
"I think it's really hard to listen to and believe all of this talk about treatment for mental illnesses when we don't even really know what a mental illness is." ... Karen Ginsburg [29]
"This inability to recognize mental illness astonished me. Has our society reached such a point as we are no loger capable of not only helping but recognizing those that need it the most? ... llamprou [30]

Defining "mental health": a solution?

" A mental illness is a state of mind (be it depressed, manic, etc) that disables one from functioning in a given society" ... Paul Bloch [31]
"Mental Health is a sense of general acceptance and satisfaction with the mental states one is experiencing." ... jrlewis [32]
"Everything I come up with seems to have too many exceptions to be a "definition."" ... Ljones [33]
"I'm wary of any definition that references societal norms" ... ryan g [34]
"Society has to define 'normal' parametres because there is no other way but who are we to judge what makes people happy and what is normal? Certain behaviours may be harmful to society but that doesn't make them abnormal. We just don't like them so we classify them as such" .... akerle [35]
"It can't be all black and white, all the time, either "mental health" or "mental illness."" ... merry2e [36]
"I think it has more to do with the context and the specific person than any all-encompassing definition." ... Paige Sayer [37]
"Mental health isn't necessarily about being happy" ... Riki [38]
"the popular definitions of "mental health" ... are based almost exclusively on what I would not consider to be "mental" activities at all, but rather behavior ... Is behavior a true gauge of mental health? Or is it just the only one we really care about? ... sgibbs [39]
"Perhaps one's mental health is entirely unique to every individual and there is no general definition." ... llamprou [40]
"Much of our discussion seems to be moving in a direction which would suggest that what defines "health" or a "good/normal human specimen" is going to be left up to individual choice. This would mean that an individual human person gets to decide what is good for them and they can say nothing about what is good for their neighbor ... I feel I need to voice a contrary opinion ... We may not ever know with certainty what ought is implied, but there certainly is some ought ... " ... mbayer [41]
"I think we are actually, truly downplaying mental illness if we decide that mental health is basically subjective. " ... ysilverman [42]

Is the "medical model" a good take off point for thinking about/trying to define "mental health"?

Contexts in which the medical model evolved/is most effective:

relatively simple cause/effects relationships (eg. the "germ theory")

near universal agreement on what constitutes a "problem" to be fixed

strong correlations between cause/symptom/treatment which in turns makes isolation and categorization ("diagnosis") productive

presumption that observations by external observers ("objective") are more useful/reliable than internal ("subjective") experiences

usefulness of transferring personal authority to "expert" other

"Mental health" phenomena

"“What this is saying is that all treatments work, at least for some people, and have serious risks for others,” he said. “It’s a trial-and-error process” to match people with the right medication." ... NYTimes, 15 Sept 2008 [43]

"Fifteen years ago his condition would probably not have been called bipolar disorder, and some doctors might hesitate to diagnose it in him even now, preferring other labels that more directly address James’s rage and aggression: Oppositional Defiant Disorder (O.D.D.) or Attention Deficit Hyperactivity Disorder (A.D.H.D.) — both of which have been applied to James as well." NY Times Magazine, 14 Sept 2008 [44]

complex cause/effect relationships

cultural and individual variation, both as normative factors and as causes

weak correlations among causes/symptoms/treatments

individual/subjective factors play prominent roles

diminished personal authority may itself be a problem

In search of some alternative starting points/models for thinking about "mental health" (and perhaps a new definition of it?)

Child rearing

Education

Science [45]

One never gets it "right," but one can always get it less wrong [46]

Wherever one is at any given time, one has the resources to get it less wrong

What is important is not what one can't do but what one can do

Getting it less wrong is best done by borrowing from/contributing to others getting it less wrong in their own ways

Individuals and cultures [47] influence each other

"Mental health" = the capacity to grow/change/evolve/create and recreate meaning for onself and others?

Does this help with the stigma problem? With the culture problem? With other problems? What problems does it not help with? What new problems does it create? Put your thoughts from/following today's discussion in the on-line forum below.

Comments

The definition is not really a good definition [48]

Submitted by llamprou on Mon, 09/22/2008 - 5:24pm.

This post has taken me a while to get up here and a large part of the reason is because the definition that was decided upon last Monday does not sit well with me at all. I don't believe that only the mentally healthy are able to grow/evolve/create and recreate, often times the those that do these things most are those in serious need of mental help.

I may be a little ahead of the curve but I just finished reading the book that I picked to do my report on, it is in the reading list and titled "Divided Minds". The novel tells a story of two twins sisters of which one has schitzophrenia. Both sisters attended and graduated Magna Cum Laude from Brown University, both were able to get into prestigious medical schools. Does this sould like either one of these ladies had any problems with our definition of mental health?

As one reads this book however it becomes clear that neither of the two are actually mentally healthy. Both sisters are suffereing either physiologically or emotionally. I would like to think that when I suffered a serious depression in high school that I was still able to grow/evolve/create and recreate. I think that this definition is in many ways greatly flawed. I think mental health is far more complicated than the ability to do these things.

Unfortunately I do not really have a definition to propose but this definition certainly does not cover all the bases. I think that perhaps what mental health is cannot be defined, and I know that Paul thinks that this is a cop out. Maybe the correct way to assess mental health is in levels, similar to Maslow's Heirarchy of Needs. Is it possible that there is a very basic concept of what consists of mental health and tiers that than can build from that basis.

Really what I want to point out is that "our" definition is flawed and I don't think that any progression can be made from such a flawed notion of what mental health is. Those are just my thoughts and I know it has taken a while to put them up here, but I kept starting this blog trying to defend the definition when really I completely disagree with it.

mental health: right and wrong [49]

Submitted by Paul Grobstein on Mon, 09/22/2008 - 5:53pm.

Sounds like you're worrying too much about someone (you? me?) being "right" (or not being "wrong"?). Maybe there isn't a "correct" way to assess mental health"? But one can get less wrong? I certainly agree that people could graduate from Brown (or Bryn Mawr?) and go to prestigious medical schools .... and still be in "need of mental health help". What are the additional relevant observations in the case of the twin sisters?

What 'destigmatizes' illness...? [50]

Submitted by Paul B on Mon, 09/22/2008 - 12:41pm.

I feel as though society stigmatizes cancer and AIDS because no one completely understands the complexities of these illnesses. Instead, people just associate them with "devious" behavior - like linking AIDS with unprotected sex or syringe sharing. If people were to see AIDS as a sydrome and not as its metaphores, then I think the stigma would vanish...

...So while I now think that mental health/illness is more complicated than the illness model, my original point was that if people saw mental illness as an illness and not as weak character or bad behavior or any other associations, the the stigmas would go away.

Defninition of Mental Health [51]

Submitted by adiflesher on Sun, 09/21/2008 - 11:10pm.

Definition of Mental Health:

It took me a really long time to get to post, but I reallywanted to give the issue of Mental Health, Health and Illness a great deal ofthought before I committed anything to writing.

I want to start of by saying that I really began by feelinga great deal of sympathy to Paul’s position. Having studied psychology, Ibelieve that the DSM is really a very bad way to think about Mental Health andIllness. Furthermore, it seems there are a lot of places in the field of mentalhealth that are poorly served by the medical model. I think Paul made thosepoints quite well. Yet I was still somewhat uneasy with the idea that there isnot such thing as illness when related to mental health.

I spent some time talking to a couple different people inthe field and also re-reading some old articles and these are my conclusionsfor the time being.

First I think that its easy to pick on the illness model, becauseit’s actually a limited model even in medicine. As Paul lays out the medicalmodel, the lack of complexity seems to apply well to a broken arm but not to acase of diabetes or heart disease. Diabetes or heart disease, seem tocorrespond better to Paul’s description of mental illness. They have complex causes and I think theywould best be seen through more complex lenses than medicine currently tends totreat them.

There are ofcourse many holistic approaches that have beenbecoming more popular that deal with illness in a broader context and give “cures”that involve lifestyle on a whole.

So to a certain extent I think the illness model is a bit ofa paper tiger.

But I also had another critique of the model that came outof talking with my father who is a psychologist that works with schizophrenics. I asked my father whether he thoughtthat it helped schizophrenics think about their condition as an illness. Hethought that it was actually quite helpful and did not need to be stigmatizing.

He pointed out that to begin with as a society we tend toview mental health in much more stigmatizing ways than as an illness. For most of our recent history mental illness(or difference) has either been criminalized, treated as demonic or dismissedas just crazy. In contrast to these, the idea of illness is actually a verycompassionate and meaningful advance. Wedon’t stigmatize people for having cancer and we are less likely to stigmatizethem for mental illness.

The Illness model can also help people think about theirconditions from a disease management perspective. A diabetic knows that theyneed to monitor their diet and educate themselves about the feelings that goalong with different levels of blood sugar. In the same way a schizophrenic caneducate themselves about brain differences that accompany schizophrenia and thedifferent ways that this differences can affect their lives.

Having said all of that I feel that the problems of thedisease model extend throughout the field of mental health. For example, is itreally helpful for us to think about ADD from a disease perspective. Here it really seems that we are stretchingthe boundaries of disease into very murky waters indeed.

After a lot of thought, my conclusion is:

1. The disease model is usefulbut limited for both mental health and physical health. All health and lack ofhealth has the potential to be very complex. We should always honor and seek tounderstand diversity as it effects human health.

2. The division betweenphysical and mental is a very problematic one. All mental phenomena have aphysical correlate and vice versa. Back pain (and pain in general) is a mentalphenomena. We must remember this both in the treatment of mental health andphysical health.

3. We need to think deeplyabout a good definition of health and illness that deals with both on aholisitic level, without stigmatizing, but still opening up our ability toreally help each other.

Mental "illness": from spirits to criminality to stigma to ... ? [52]

Submitted by Paul Grobstein on Mon, 09/22/2008 - 10:21am.

Actually, cancer too was indeed stigmatized at one point, as was AIDS. See Susan Sontag's Illness as Metaphor and AIDS and its Metaphors. Maybe there is an interesting pattern here? Maybe human variation is dealt with successively by looking for an external cause, then criminilizing, then stigmatizing, and then .... by acknowledging both variation and complexity and getting down to the particulars of what makes people uncomfortable and what to do about it? And, yes, maybe that's true for both "physical" and "mental" health? I wonder if maybe, by noticing the pattern, we could learn to skip over some of the steps and move directly to "Holistic ... non-stigmatizing ... helping"?

Being personal too [53]

Submitted by Judie McCoyd (guest) on Sun, 09/21/2008 - 8:02pm.

Hi merry2e. Although I have shown the hand of my professional life- I too have struggled with the personal. My brother- never satisfactorily diagnosed (had paranoid schizophrenic; schizo-affective disorder; bi-polar and the ever favorite dually diagnosed, died over the summer after ingesting too much cocaine and Fentenyl. Was he lacking "conscience"? Sometimes. Was he too sensitive and in touch with (painful) reality? Sometimes. Did he qualify for a diagnosis that should have meant helpful services might have been his due- much of the time. Yet, the reality (notice the little 'r') is that few who really struggle with severe mental disorder (a term with which I'm a bit more comfortable than "illness") often get even less in terms of care than those who are the "worried well" who want to self- actualize. I still maintain that offer of a relationship in which to engage and try out one's stories in various ways ( and I agree with Anne's implication that they are stories and Paul's that they are changable and not always consistent) is still the ideal way for allowing "treatment" of the disconnect people struggling with difference from the norm often experience. So it almost returns us to the notion that "mental illness" had much more to do with disconnect from the (social) norms than anything else- yet for those of us who have felt the rush into the pit of darkness and apathy, there seems to be more than just social norms. So what does a truly biopsychosocial definition, or an otherwise multifactorial one begin to look like?

"more than social norms" [54]

Submitted by Paul Grobstein on Mon, 09/22/2008 - 11:16am.

Certainly my personal experience as well. Which isn't to say that social norms are irrelevant (they're not; I'm convinced that my own episodes of depression, for example, would have been distinctly less unpleasant if I'd been living in a different culture), but that there is indeed "something more" involved.

For Judie's "professional life," see "Another periodic participant [55]"

website [56]

Submitted by merry2e on Sun, 09/21/2008 - 6:50pm.

http://www.thinkbody.co.uk/index.html

Some interesting articles for those of you interested in body therapy/mind-body connection...

I am torn once again along with some others! [57]

Submitted by merry2e on Sun, 09/21/2008 - 6:14pm.

I am torn again. My brain cells fell like they are exploding! Mental illness not mental illness! …stemming from my personal experiences with mental health issues in my family which caused a great deal of irresponsibility and abuse from the person who struggled…torn with…the adult who came to terms with these behaviors by learning and knowing it is biological…and torn with… the individual who, herself has grappled with depression and felt “unwell” at times and has moved through it and is discovering…and torn with… the student, who agrees with many of the posts regarding mental health definitions that resonate with Prof Grobsteins…This is bit blunt and personal, but what the heck! We have been talking about the “diagnosis and medical model” issue and how it, in some cases helps the client take responsibility for their mental health. I believe a diagnosis can also help for the family members who are in the wake of negative behaviors that are produced by the “illness.” Maybe I am just in denial but it has partially helped me in coming to terms with my tumultuous relationship with my mother who has struggled with bipolar. AND, though the biology of mental illness has helped me…it still does not take away the responsibility of the person who struggles with mental health issues( reaching out if they need help or accepting help when needed, compliance with therapy or meds if needed). It also does not relinquish ME from responsibility either. Just because my mother struggled does not give me perrmission to continue with my children. I really think that responsibility needs to come into play when we are talking about the mental health definition. I know I am probably repeating myself, but I cannot stress enough how important it is to me for personal responsibility to play a part in the definition. Even people who are struggling need to be held accountable for their “stuff.” Yes, I am stuck on this. Yes, I believe everyone is their own unique entity with qualities that we all have something to cherish. But, what of those who do not have a consciousness? Who simply disregard the well-being of others and life? A few thoughts and I am done rambling for now…I hope no one takes offense to the personal spin on this post! (A bit biased today!)

mental health: "blunt and personal" [58]

Submitted by Paul Grobstein on Mon, 09/22/2008 - 10:58am.

Maybe the "personal" is what we need more of in thinking about mental health? See From the Inside. Maybe its not so much "complexity" that provides the greatest challenge in "mental" as opposed to "physical" health, but rather a generally greater dependence on the "personal"?

An obsession with meaning [59]

Submitted by kmanning on Sun, 09/21/2008 - 10:32am.

I think the idea from Anne's post above "An obsession with meaning"

is very interesting, and reminds us that a definition of mental health as self-understanding and self-evolution is really just an ideal and a norm itself. Just because it involves the evolution of a person towards an undefined goal as opposed to some ideal, does not mean it doesn't leave some people being deficient and some not, in ways that perhaps wont always be in agreement with who thinks they are mentally healthy and who not.

Also, to respond to your thoughts on "being realistic" akerle, I think part of the problem with the mental health world right now is that people started being realistic before having a concrete or unified understanding of what they were being realistic about - prescribing drugs and treatments and writing policies before anyone had any idea what the problem even really was. I too get frustrated with overly abstract discussions about topics that need immediate action, but hey, we're in a seminar, why not start as abstractly as we can and work our way down?

Mental Health...and Reality [60]

Submitted by Anne Dalke on Sun, 09/21/2008 - 9:51am.

I've just finished Jeanette Winterson's novel, Lighthousekeeping, which gives another perspective on the question of whether mental health can be measured in terms of an "awareness of reality":

The psychiatrist…asked me why I had not sought help sooner.
“I don’t need help…I can dress myself, make toast, make love, make money, make sense”….
“Do you keep a diary?”
“I have a collection of silver notebooks.”
“Are they consistent?…do you keep one record of your life, or several? Do you feel you have more than one life perhaps?”
“Of course I do. I would be impossible to tell one single story.”
“Perhaps you should try.”

[and then, from a later session:]

“An obsession with meaning, at the expense of the ordinary shape of life,
might be understood as psychosis….”
“I do not accept that life has an ordinary shape….How would you define psychosis?”
"...out of touch with reality."
Since then, I have been trying to find out what reality is, so that I can touch it.

re "reality" (and mental health) [61]

Submitted by Paul Grobstein on Sun, 09/21/2008 - 1:48pm.

Am myself reading The Echo Maker by Richard Powers, which perhaps ups the ante a bit. The novel revolves around a man who has had an auto accident and comes out of a coma certain that his sister, who has been caring for him, is an imposter (an instance of "Capgras syndrome;" see one of the background readings for this coming week). That in turn begins to raise serious questions both for the sister and for a visiting neurologist (an Oliver Sacks character) about whether each of them actually is or is not who they thought they were. Who's "out of touch with reality"?

And those in turn bring to mind a couple of interesting movies I've seen recently. At the end of the Coen Brothers latest, Burn After Reading, one character asks "What have we learned?" to which the reply is "Not to do that again." The scene ends with the follow up question "What did we do?" and the response "I don't know." Couple that perhaps with the tag line from Charlie Wilson's War, "we'll see," and you get .... reality?

One more article to question some of the assertions [62]

Submitted by Judie McCoyd (guest) on Sun, 09/21/2008 - 9:21am.

This focus on the belief that having a diagnosis or Connecting the biological aspects of mental health issues to functioning somehow leads to less stigmatization and more self- and other- understanding may be based on an incorrect assumption. In one of the most recent Social Science & Medicine journals, an article by Jason Schnittker ("An uncertain revolution: Why the rise of a genetic model of mental illness has not increased tolerance" (2008; 1370-1381)lays waste to this notion. In the spirit of getting it less wrong, foundational assumptions must be questioned.

just being realistic here [63]

Submitted by akerle on Sat, 09/20/2008 - 11:44am.

In reading all of this discussion about mental health/illness and concepts of abstract thought I'm forced to wonder something- what does this all really mean for the population at large? I am all for a world in which we cater to each individual's desire to become more self- actualised but HOW can this happen? What can we actually do to change minds and hearts about mental illness (or whatever we want to call it). At the end of the day...abstract thought is just that: thought. Unless, however, it somehow manifests itself in the real world. This disussion may broaden our minds but can we use these conclusions in a concrete way?

As for my ideas on how to do this- well I can't say that i understand any better than the next person. Perhaps we need to change policy, change the education system but something needs to change s we can see the effects f THIS conversation on the real world.

As I am posting rather late, [64]

Submitted by jrieders on Sun, 09/21/2008 - 7:51pm.

As I am posting rather late, I was finding it hard to say anything that hadn't been said already. When I read the various comments I find myself agreeing with aspects of all the various sides of the table. And I while the arguements are interesting enough, I too want to ask is this useful? Given that patients respond differently to different approaches, some like to identify with a disorder, others don't want to be labeled or feel they are the "normal" ones, I think this is helpful because it gives us different approaches to understanding/coping with/ treating (in the future) mental illness. These perspectives might be somewhat like a toolbox. I think in the end you have to use the perspective that is the most useful.

more thoughts on "diagnosis" [65]

Submitted by kmanning on Sat, 09/20/2008 - 10:36am.

To quote Sarah above talking about one of her patients: "It was abundantly clear to me from our first session that she was very invested in her diagnoses"

If we allow a diagnosis to take the form of more of a description of a person's mental state (as opposed to healthy/ill) and remove value judgments like we have been discussing, I think a diagnosis, and yes I still want to use that particular term, can be extremely useful. If someone is seeking help because they are no longer able to understand themselves and how they can change themselves, a diagnosis of the form I suggest - one that helps a person recognize their behaviors and explain and understand what societal/mental forces might be causing them -might be extremely helpful in restoring a person's ability to understand themselves. The help-giver must of course be very careful not to apply value judgments, but so long as they are, I think someone seeking help for mental health troubles of our new definition can certainly benefit from a diagnosis. We just need to expand what a diagnosis can involve.

Therapeutic Tales [66]

Submitted by Anne Dalke on Fri, 09/19/2008 - 9:50pm.

I am an English teacher, so mostly I read literary texts and talk to folks about interpreting them. This week I had a fascinating conversation with a student about a thesis she wants to write about the genre of "medical memoirs." We talked about the difference between genres--a book read as a literary biography might be expected to focus on the unique experiences of one person, while the same book, read as a medical memoir, might be useful only if that information is generalizable to a larger population. I suggested that, in both cases, the text is an attempt to make sense of what is senseless, to shape what seems shapeless, to order what seems disordered. But then the student observed that that's not always the case; the particular text which interests her--Lucy Grealy's tortured Autobiography of a Face--is very sad, very hard to take, not @ all reassuring to write or read. She asked, "What makes a text therapeutic?" When are the tales we tell helpful, when not?

Telling tales [67]

Submitted by merry2e on Sun, 09/21/2008 - 4:52pm.

Hello Prof Dalke,

I know for my life telling my stories in therapy, etc., have been helpful for releasing past hurts, etc., and I have learned that there is a place and a time to tell them. This reminds me of a story I wrote last Fall semester that hit on some personal issues...and then I felt as though I could not write for months later. Was this helpful? I can see now that it was though the timing was a bit off. And it may just be that a text that one find's very hard to digest is reassuring for another. I used to obsessively read books on concentration camps when I was a child/teen. The more detail, the better. And, though these stories I read were horrible...they taught me of courage and bravery and many other concepts that I needed to learn.

Just a thought.

Meredith

Some concepts that may help [68]

Submitted by Judie McCoyd (guest) on Fri, 09/19/2008 - 4:53pm.

As someone has practiced clinically for 20+ years and who has partnered in the journey of self-awareness/ movement toward a healthier place/attempts to feel better, I have some concepts to offer to the discussion.

First, a number of the posts reference the idea of whether the individual is discomforted by their experience of their mental/ emotional/ interactional state. In the old Freudian terms, this was referred to as having a condition which is ego dystonic, as opposed to ego syntonic where the person feels perfectly fine just the way they are (think Axis II personality disorders). Now, what does it do to your various definitional attempts to think of people who few like because they do not fit into their social milieu well, but who view everyone else as having the problem?

Another thing to grapple with: Freud once said that mental health was the ability to live, love and work productively- what does that one mean for people who are unable to fulfill one of those capacities due to a physical condition rather than a mental/ emotional one?

There is an article on "The social construction of Normality" by Sophie Freud as well as various critiques of mental health models by Thomas Szasz that indicate, to varying intensities, that what gets deemed as mental health is really just an ability to fit into one's environment (with anything revealing a lack of fit deemed as less healthy). Indeed, the change of homosexuality from viewed as diagnosable to a varied lifestyle is often used as an example of the mutability of definitions of mental health and subsequent diagnoses.

As a clinical social worker, I have found that very little about definitions and diagnoses has relevance to the work I am doing with clients. Granted, I am seldom working with people experiencing "SMI" (severe mental illness) although I am often working with people who are experiencing intense emotions and huge destabilizing life changes. Many of these folks could be "diagnosable" with DSM criteria (and some have to be for insurance purposes), yet I seldom if ever find that this provides anything useful for our work together. Invariably, finding out the client's story, their interpretation of it, the ways they believe this defines who they are, and the areas of pain that exist within the story, all provide a much more useful template for our work together. Notably, that work, unlike medical practice, involves formation of a relationship where working together in authentic, warm and perspective- building ways is what moves the work. Again, unlike medical practice, it is not a matter of the therapist giving advice, directly intervening upon the being of the client, nor functioning UPON the client in anyway- merely continually being willing to be in relationship in a way that supports the client when they feel destabilized and destabilizes and stretches the client when they feel self righteous.

Fodder for the mill....

The tyranny of diagnosis [69]

Submitted by kmanning on Thu, 09/18/2008 - 8:20pm.

I found this article in the NYTimes (i don't think it's already been posted, but if so I apologize!) about how doctors are treating only illnesses and not whole patients.

http://www.nytimes.com/2008/09/19/health/chen9-18.html?_r=1&oref=slogin

It's so in line with our discussion as to almost not be new and exciting anymore, but one thing it does illuminate is that this problem of doctors only treating what is wrong or deficient - and not treating a person as a whole person - is not unique to mental health at all.

As I mentioned in class when Prof Grobstein was presenting the medical model of cause - symptom - treatment, I dont think the mental health model needs to be different from this basic backbone of the "medical model". What does need to happen is that we expand the definition of cause to be more than biological. If a person presents with a symptom that is mentally unhealthy (by whatever standard of mental health we conclusively decide upon) the person who is helping them must then look to what could have caused this to be the case. Maybe it's social, maybe it's biological, maybe it's existential, etc. Then, a treatment plan is decided upon, to restore this person to mental healthiness (to being able to understand their current condition and how to change it, or whatever other definition we would like). This treatment plan might involve talk therapy, it might involve drugs, it might involve meditation. Most importantly, it must involve the patient's continuing involvement in self-assessing and assisting their helper is assessing them.

Like Ryan, I am struggling with coming up with step #2 of our mental health definition - how to use the definition to ACT. Somehow, the theory I outline above currently gives me comfort.

What I am not sure of yet though, is what exactly the ultimate "good" in mental health is. Prof grobstein said it is understanding oneself and how to change oneself. In my first definition that I posted I said it was being in a state where one is always seeking happiness/wellness (I believe all humans by nature strive to achieve a greater sense of happiness than that which they presently posses). I like how professor grobstein's definition does not involve an ideal, BUT i also think there can be many different kinds of definitions that dont involve ideals, and do involve the evolving of the patient. I would be very interested in discussing other possibilities for the ultimate "good" of mental health.

Mental health practice and its "ultimate good"? [70]

Submitted by Paul Grobstein on Fri, 09/19/2008 - 11:18am.

Yep, gives me "comfort" too, a practice that might make use of a variety of therapies, in an individualized way, and with continual "self-assessing" and "assisting their helper." With what objective of .... happiness? pain relief? something else? Maybe the brain can help us with this question.

The brain? [71]

Submitted by merry2e on Sun, 09/21/2008 - 4:37pm.

I think Prof Grobstein is suggesting THE BRAIN is involved with all of this! THE BRAIN?!

Katie, I agree ... I think [72]

Submitted by ysilverman on Thu, 09/18/2008 - 11:34pm.

Katie, I agree ... I think that is part of why I felt like our discussion in class almost devolved into semantics. Because whatever we call it, I feel like there can be a very qualitative difference between periods of mental wellness and mental unrest. I can believe that there are people who feel differently minded -- but I also think a lot of people who suffer revel in being diagnosed, in being told that their unhappiness/anxiety/loss of control is not an inherent part of their personality or life or mind, that there are varieties of methods available to work towards alleviating what might reasonably be called symptoms.

As Laura very accurately pointed out above, the brain is an organ, if a complicated one. Yes, all brain illnesses lie on a continuum. And maybe there is no clear demarcation between mental health and mental illness ... But many people who hit "emotional bumps" in the road can say that their outlook on life is *totally* different at some points than it is at others. I am very willing to agree that diagnoses, as they stand, can be as harmful as helpful, but I also completely feel that times of emotional aberration are much like periods of illness. Certainly many people don't feel more emotionally able during those periods of time ...

I hate to personalise this discussion, and at the end of the day I think most of us have gone through periods during which, for whatever reason, we feel less emotionally well. At the same time, I would feel remiss in not acknowledging that at points I have felt very emotionally different -- and that at these points I feel significantly less, and not more, myself. In fact, I feel kind of ... sick.

If someone undergoes a transient period of intense mental pain, different than anything they have experienced prior, is prescribed medication, and after 2-3 months feels markedly better in *every* way, I don't know that simply an emotional evolution has taken place. To me, it still sounds like they were episodically ill ...

Well spoken...er, written. [73]

Submitted by sgibbs on Fri, 09/19/2008 - 5:01pm.

Well spoken...er, written.

I recall a client of mine, a woman in her early 20s, who had been diagnosed with obsessive-compulsive disorder. She also had mood swings, depression, a learning disability, a history of suicidal "gestures" and severe anger management problems. It was abundantly clear to me from our first session that she was very invested in her diagnoses, and in fact, had adopted them as a significant part of her identity. I asked her to describe her OCD rituals to me, and then I asked her if they were "getting in the way of her life." She said "no, not really", and I said, "Ok, let me know if and when they do." She then asked "Do you think I'm a freak?" I said, "nope." Then I moved on. It never came up again in session.

True, not everything needs to be fixed, at least not in the way we may think it does...and "normal" doesn't necessarily mean, um, "normal." :)

Like you, I have also gone through times of emotional "sickness", and have often described it as "not feeling like myself" (this is a common complaint of individuals with depression). As I have said elsewhere in this forum, I believe most individuals to have some sense of what normal is for them...I just recalled another Gestalt term, which is homeostasis...the desire of a system to reach a state of equillibrium. Might this be included in a definition of "mental health"?

Sarah

From "mental" to "emotional" health: behaving and feeling [74]

Submitted by Paul Grobstein on Fri, 09/19/2008 - 11:07am.

There is an interesting shift here from "mental" to "emotional," from how people act to how people feel (which may, of course, in turn affect how they act). And, in particular, to how they experience themselves. To talk more about in weeks to come.

I am not entirely ready to [75]

Submitted by Martin on Thu, 09/18/2008 - 12:53pm.

I am not entirely ready to completely divorce the medical model of health/illness from mental health. I don't think we can accept that the brain is something special and should not be treated in the same way the body is treated. If my arm is broken a doctor fixes it, if my stomach cells can't create a certain enzyme that is need for digestion then a doctor gives me a pill to supplement the enzyme, if my brain is missing an enzyme that keeps me from remembering what happened 5 minutes ago then my doctor should give me a pill too. If something is broken, it should be recognized as such. This does not mean that everything needs to be fixed just because we know that it is broken. Health is just one of many goods in human life that must be ordered and subordinated to one another.

If I had a mutation that gave me an extra arm, I would have to acknowledge that the mutation is abnormal. But I would not need to say it is necessarily a bad thing that needed to be fixed. The arm might enable me to do a lot of new and useful things, but it would also result in my alienation from much of society because having 3 arms is abnormal. I think this is the line of reasoning that is being used to suggest that we should not think of mental illness as an illness at all.

I agree with that assessment on some level. But, there comes a time when these "differences" will effect wether or not someone can live a distinctively human life and I think this is the case more often than not with mental differences. If, through some difference in brain composition and function, a person looses the potency to: engage in community, to acknowledge and try to improve their own understanding of reality, or any other activity that is distinctly human then I think there is reason for saying that person is broken. Having three arms doesn't prevent me from living a human life but being unable to engage reality does.

Side note on reality: I agree entirely with what Grobstein said about human knowledge being partial and perspectival, but the fact that we say we try to get things less wrong implies (correctly I believe) that there is some objective reality to which we are all trying to conform our conceptions to. Each cultural norm is imply the sum of the most popular understandings of reality in a given place. That is why people are so fond of saying that one is not better than the other, simply because it is difficult to tell which one is better than the other. However, rest assured that one understanding of reality is better than another, although I don't know for sure which one it is. I do think it (the best approximation of reality) is mine, and you do think it is yours or else we wouldn't think what we do!

Prof, Grobstein could you elaborate what you mean by a capacity to create meaning?

A fresh perspective... [76]

Submitted by ryan g on Thu, 09/18/2008 - 10:44pm.

I'm going to go out on a limb and say that after last Monday's discussion many of us are feeling a bit lost for words...

(Example... Me in my last post: "My God... !! We can't say anything about anything. Nothing is for real. There is no healthy/ill, good/bad, wrong/right, up/down... Where do we go from here?")

Ok, maybe it's just me. But with that in mind, thank you for bringing some new perspectives to the table, Marty.

I want to dive a bit deeper into some of your ideas... It is suggested that If something is broken, it should be fixed. Someone who is unable to live a life that is distinctively human is broken, and therefore, should be fixed.

This concept of a distinctively human life is interesting to think about. What criteria constitute a distinctively human life? Three were mentioned: 1. able to engage reality 2. participate in community 3. acknowledge and improve understanding of reality. Beyond this, I feel it is left up to us to fill in the blanks intuitively.

However, this maybe isn't so intuitive... as Sophie suggested. Who is to say what a distinctively human life is? The doctors? The politicians? Spiritual leaders? Each and every individual? The task seems overwhelming to say the least.

With this in mind, can we ever really define if a person is broken?

And speaking of broken... if we are defining a broken/not broken dichotomy, I would say that a three armed man is broken. However, it's suggested that we can acknowledge his difference without making value-judgements. Why can't we do this for "mentally broken" people?

Finally, there was also the idea that "getting it less wrong" implied an objective reality. I don't have much to say about that besides for I am slightly envious of your conviction. However, I am not sure that trying to get it less wrong suggests an objective reality. Here's a quote from Dr. G's paper:

"My answer to these challenges is not only that one can indeed do science in the absence of the concepts of truth and reality, but, whatever one (the I-function?) may think, that is in fact, operationally, the way science is done. "Progress" in science is not measured by increasing closeness to "truth" or to the "real"'. It can't be, because neither "truth" nor the "real" is a known location against which proximity can be measured. Progress in science has instead always been (and can't but be) measured in terms of distance from ignorance. Science proceeds not by proving "truth" or "reality" but rather by disproving falsity, not by painting the "right" picture but by painting a picture "less wrong" than prior pictures. And that, rather than either "objectivity" or some other privileged access to "reality" is in fact the basis of the demonstrable power of science.

This is, of course, simply another way of describing "pragmatic multiplism", the notion that inquiry proceeds by assuming that, at any given time, there exist at least two admissible interpretations of available observations, the one currently used and the different one that will, by accounting for available observations as well as some new ones, replace it."

Getting it less wrong without an objective reality [77]

Submitted by Paul Grobstein on Fri, 09/19/2008 - 11:27am.

Yep, thanks. Grobstein would indeed argue that one can get it "less wrong" without presuming/appealing to an "objective reality." And so perhaps part of our problem is that "broken" indeed depends inevitably on a "value judgement"? If so, "where do we go from here?" Maybe the brain can help?

"If something is broken, it [78]

Submitted by Riki on Thu, 09/18/2008 - 9:52pm.

"If something is broken, it should be recognized as such. This does not mean that everything needs to be fixed just because we know that it is broken."

I think it's important to realize that some people don't want to seek help (even if society deems it necessary) because they feel as though aspects of their mental condition allow them to do or create things that they otherwise could not have done. For instance, some people with bipolar disorder don't like treatment because they like what work their mania gives rise to and they feel more creative during their manic episodes. There are many great works of art that probably wouldn't exist if the artists had sought medical help -- Van Gogh, Anne Sexton, Sylvia Plath, Kurt Cobain. That isn't necessarily to say that everyone who suffers from a mental "illness" should abstain from getting help, just that positive things <i>can</i> result from dark times. Sometimes mental "illnesses" should be embraced instead of looked down upon.

more on creativity and "mental health" [79]

Submitted by Paul Grobstein on Sun, 09/21/2008 - 4:44pm.

From a recent senior thesis

"The nature of creativity itself demonstrates that insanity and sanity, and deviance and conformity, are not mutually-exclusive but rather complementary to each other ... they may co-exist within a single person with often unexpected and constructive results .... Creativity will be encouraged in any social setting that successfully accomplishes the balancing act between adherence to accepted thought and acceptance of radical new thought ... Any society will be fertile ground for creativity, if it is capable of retaining some of the rigidity of ice while being able to see that the turbulence of water complements rather than contradicts that rigidity."

I found Riki's comment on [80]

Submitted by vpizzini on Sat, 09/20/2008 - 4:05pm.

I found Riki's comment on certain mental illness and their effect on the creative performance to be very interesting.

However, I also believe that creative talent is not something necessarily linked to a disability, but rather an innate quality that may manifest itself in some individuals more than in others. The cure for disabilities should not, in fact, be something that suppresses a natural talent or a particular quality, but rather something to help this talent or quality to evolve.

Especially in light of the type of society in which we live today, where mental illnesses are somewhat frowned upon, we cannot just appreciate the disabilities of a person only when that proves to be productive in artistic terms, and ignore the individuals in all other contexts. Thus, a cure for mental illnesses would not be aimed at changing the person itself, thereby eliminating a particular creative talent, but, on the contrary, at helping him/her flourish in all fields of his/her social life.

I agree that not everything [81]

Submitted by sgibbs on Fri, 09/19/2008 - 4:42pm.

I agree that not everything that is broken needs to be fixed. I personally feel that there is way to much unnecessary "fixing" that occurs now in our "prozac nation".

But just gotta point out that the artists you mention all committed suicide, three of them before any real treatments existed for their conditions. Yes, these people were talented, creative, amazing, and very, very unhappy. I'd like to venture that if they could talk they might have something to say about the "costs" of their creativity. I think our culture has created a romantic view of the "mad genius", that in actuality may not be so great. Kay Redfield Jamison's "An Unquiet Mind" addresses this very issue with great feeling and eloquence.

Just a thought.

Sarah

I definitely think that our [82]

Submitted by Riki on Sun, 09/21/2008 - 3:42pm.

I definitely think that our culture romanticizes the "mad genius", and in fact I'm guilty of romanticizing depression. It's a painful experience, but I'm not sorry for the things I have carried out of it.

I guess some of it stems [83]

Submitted by ysilverman on Fri, 09/19/2008 - 1:45am.

I guess some of it stems down to whether or not you think that creativity is more valuable than a life lived without bipolar disorder...

In fact, studies have shown that creativity and bipolar disorder are strongly correlated to one another. But they have also shown that family members of people with bipolar disorder who do not present as bipolar also have enhanced creativity. So what if bipolar is on the continuum of creativity, but past the point of mental health on that continuum? All four of the people you mentioned committed suicide before the age of 50.

It is true the mania can produce extreme highs, but depression can produce equally extreme lows -- and as the "mental state" takes its course, it becomes harder and harder to produce *anything* during those often increasingly intense periods of mania.

There are some interesting dicussions on this topic on the web both on serendip (http://serendip.brynmawr.edu/exchange/node/1726 -- Dr. Grobstein has just invited this conversation to find its way over here) and off (http://ideaflow.corante.com/archives/2005/11/10/bipolar_children_more_creative_than_other_kids.php [84]) ... And I'm sure other places as well. And you're right -- some people in both locations find the illness debilitating, while others say they avoid treatment and revel in the mania.

Still, even if there are benefits, the lows can be extremely low. A brilliant friend of mine, who had been hospitalised multiple times, talked of frequent suicidal impulses and attempts during mania (though this person didn't consider herself to be suicidal, and certainly didn't want to die). She certainly doesn't feel she has benefited, regardless of her bursts of creativity.

This page (http://www.pendulum.org/bpnews/archive/001653.html) [85]quotes a study that says people diagnosed with bipolar who take lithium are 8 times less likely to commit suicide than people who are off lithium. Just because there are some positives to something, if it really does kill people, does that make it not an illness?

Bipolar disorder, autism, life, and death [86]

Submitted by Paul Grobstein on Fri, 09/19/2008 - 11:56am.

Thanks for a useful set of links. Kaye Redfield Jamison in her An Unquiet Mind, says

"I have often asked myself whether, given the choice, I would choose to have manic-depressive illness. If lithium were not available to me, or didn't work for me, the answer would be a simple no... and it would be an answer laced with terror. But lithium does work for me, and therefore I can afford to pose the question. Strangely enough, I think I would choose to have it. It's complicated... I honestly believe that as a result of it I have felt more things, more deeply; had more experiences, more intensely; loved more, and have been more loved; laughed more often for having cried more often; appreciated more the springs, for all the winters... Depressed, I have crawled on my hands and knees in order to get across a room and have done it for month after month. But normal or manic I have run faster, thought faster, and loved faster than most I know."

There's an interesting parallel here to Temple Grandin [87], writing about her own experiences with autism. Yes, there are pontential problems but also potential virtues. Maybe the key here is to stop thinking about bi-polar disorder or autism (or .... etc) as in themselves "illnesses" and start thinking instead about what potentials (positive and negative) are associated with particular kinds of human variation and how to help people nake the most of those?

That, of course, sounds a lot like life in general, for everyone. Along those lines, maybe its worth also keeping in mind that life itself "really does kill people"?

" Along those lines, maybe [88]

Submitted by ysilverman on Fri, 09/19/2008 - 1:41pm.

" Along those lines, maybe its worth also keeping in mind that life itself "really does kill people"?"

Touche. Though, I want to say that having thought about it for a long time (certainly longer than this term thus far), I do not think that a healthy (physically or mentally) individual should want/attempt to kill themselves. Others are welcome to disagree.

And, along those lines, there isn't necessarily physical illness, either? Or, something that hastens death isn't an illness, but a change in states? Of course we will all be felled at some point or another, but that doesn't mean that ailments are to be ignored, I don't think. Half the fun of life is evading death ... Or maybe more than half, even.

Still unsure, but... [89]

Submitted by Sophie F on Thu, 09/18/2008 - 4:18pm.

I’m not sure what Professor Grobstein means by “create” meaning. However, inherent in your statements is that you have ascribed meaning to certain behaviors and that meaning is somewhat arbitrary. An arm is broken when it is broken, but how can we asess what range of human behaviors constitutes “broken” in the same way? Especially, when values are not universal, to which you aluded. A broken arm remains so whether in Bryn Mawr, Alaska or… However, behaviors are not so easily reduced to a dichotomy: broken vs. normal. I’m also uncertain about your use of “distinctively human life.” I’m not sure it is reasonable to impose limits upon what makes us human based on behavior, variable and subject to myriad external factors. We may view someone, for example, on the high-functioning continuum of autism to be “sick,” but as we saw in class, the same “pathology” could be ascribed to you or me if a different system of values is employed. In my opinion, that which makes us “distinctively human” cannot be confined to a finite range of behaviors.

I don’t think my “approximation” of reality is better than your approximation of reality, but mine, though ever-changing, works for me.

mental health and "making meaning" [90]

Submitted by Paul Grobstein on Fri, 09/19/2008 - 12:08pm.

Grobstein would, I'm sure, be delighted to further explain what he means by "create" meaning but, I suspect, would prefer to do so in the context of our upcoming conversations about the brain. In the meanwhile, there are some interesting parallels to the work of Viktor Frankl and logotherapy [91].

I'm still fumbling... [92]

Submitted by Sophie F on Thu, 09/18/2008 - 1:09am.

The reason I am inclined to dismiss the notion of mental “illness” as being too narrow a framework within which to understand mental states is not because I think there are not some biological factors that cause some peoples’ brains to create a “reality” that can be directly linked back to distinct, knowable physiological causes. As Sarah mentioned, it makes sense that the brain, too, can become “diseased” like other parts of the body. However, the illness/health paradigm does place mental “health” squarely in the realm of the medical, which may, in some ways, limit our ability to understand the complex, variable and sometimes inexplicable workings of the mind. More than anything, the health/illness dualistic paradigm seems to alienate the people who fall within the “norm” of non-diagnosable behavior. Such that, those who may have obsessive thoughts, or function with less severe depression or perhaps have features of disordered eating, but do not meet the DSM criteria for a diagnosis are left feeling alienated and stigmatized and, perhaps, helpless. As I posted before last weeks class, I believe that no matter one’s diagnosis, for all of us, mental “health” is an ongoing enterprise and not an endpoint. As such, the understanding of how to ameliorate or work with strengths of individuals and within limitations springs not from a disease category, but a holistic understanding and a commitment to work with, not against the mindset of the individual. That being said, what of people who do benefit, personally, from a paradigm that does empower them to see "illness" as being something they "have" and not who they are? I can see the the value of this in some instances and cannot, at this point, seem to reconcile what seem to be conflicting ideas...

Several years ago, I read a book by James Gordon, a psychiatrist, called Manifesto for a New Medicine. I found an interview with him, http://www.healthy.net/scr/interview.asp?ID=225, in which he discusses the limitations of the healthy/sick paradigm. He says, “I was first attracted because I was made uncomfortable by conventional psychiatric treatment. I was working with psychotic people, who seemed not to be sick in the way that people with gall bladder disease or people with heart disease or cancer are sick, yet they were treated as if they were physically ill. They were put in pajamas, and given large doses of medication. I didn?t understand it. It seemed like they had certain difficulties; they were sometimes harder to understand or more erratic than most so-called normal people, but they certainly didn?t seem sick.

So I began to question the whole medical model. That is, that there was a specific disease entity that people had, and a specific kind of pharmacological or surgical treatment for them. I began to question whether for these psychotic people, if we regarded their experience as essentially a human experience, if we created a healing environment in which they would be fully respected, could change the nature of their illness? So I was questioning the whole notion of fixed diagnostic categories.”

JRLewis mentioned that discarding the health/illness paradigm seemed to draw an artificial distinction between mind and body. While, I agree the distinction is artificial, on the contrary, I think re-shaping the dialogue about mental states, along a continuum, with language that is less extreme (healthy vs. ill) creates an environment in which more voices can be heard in the conversation about these mental states and if they are to be shaped or changed, it is not, necessarily, with an end in mind. In my opinion, this is not, simply, an issue of semantics, but an issue of redefining the terrain of what we know as mental illness; and, in so doing, recognize that perhaps there is no destination where mental well-being is concerned, but rather it is the journey that is significant. In the Bipolar Puzzle article from this past Sunday, linked somewhere above, mentioned two instances in which the diagnosis of bipolar in children had been changed, and both were due to the influence of physicians. My question is, in the realm of “mental health” are physicians the people who determine normative behavior?

Ian Hacking, who works in the field of Philosophy of Science, has written widely on the phenomenon he calls “making people up.” (http://foucaultblog.wordpress.com/2007/06/15/ian-hacking-on-making-up-people/ [93]). The thrust of his argument is that the more we study, classify and define people, the better able we are to “control, help, change or emulate…” He then points out that all of our studying, probing and doctoring actually changes people, for we do not exist in a vacuum. In this view, people are who and what they may be; this is not an argument against medicine or against comprehensive treatment for those who present in a mental health practitioner’s office with troubling behavioral patterns. The point, in my mind, is to understand that just as health/illness do not exist unto themselves, without the coalescing of myriad factors (experience, cultural background, age, etc.), nor can we reduce behavior, the workings of the mind to a singular cause and effect. Moreover, in so doing, we create "illness" and categories of people, such as the outmoded category of hysteria, amongst others. To borrow Sarah’s analogy from above, two peoples’ kidneys, whether healthy or not, are a lot more similar than the mental states of those same two people, though their brains may also structurally be similar. Again, biology is essential and to borrow James Gordon’s words, we should attempt to work with the “transformative” powers of biology, but not see a biomedical framework as the "answer" to a “problem.”

"what of people who do [94]

Submitted by Riki on Thu, 09/18/2008 - 9:54pm.

"what of people who do benefit, personally, from a paradigm that does empower them to see "illness" as being something they "have" and not who they are?"

I think a lot of stigma is due to the fact that many people are subjected to labeling, for instance, as being bipolar, and that is how people define them. They aren't seen as another person just like me or you, but rather as a bipolar person. It can be very alienating, which is terrible because people, not just those who are mentally "ill", need to know that they are not alone in their experiences. It's just part of the human condition to search for others so as not to feel so alone.

Also, I think it's interesting to listen to the words people use when describing someone who has a mental "illness". Do they suffer from something, do they have something, is it who they are? I use all of them without giving it much thought...

Labels [95]

Submitted by sgibbs on Fri, 09/19/2008 - 4:30pm.

Rikki -

An excellent point. You are absolutely right that a diagnosis can be very devastating for the individual. Very early in my therapeutic internship, I learned to refer to clients in a specific way: e.g. not "a bipolar". "a borderline", "a schizophrenic", but rather "a person with (or "diagnosed with") bipolar disorder", "a personal with borderline personality disorder", etc, for just that reason.

It's also why I believe strongly in group therapy. Like you said, these experiences can be very alienating, and it can be very helpful to interact with others who are going through something similar, be it depression, panic attacks, or auditory hallucinations.

Most therapists I know (the good ones, anyway) tend to stay away from the term "suffer from", and try to refer instead to specific symptoms or diagnoses. e.g., "the client experiences/reports periods of delusional thinking..." or simply, "diagnosed with...".

In session, I have also used the verb "struggle", since that is often what I see people doing in response to their symptoms...

Sarah

Making up & Changing people [96]

Submitted by Laura Cyckowski on Thu, 09/18/2008 - 7:49pm.

"He then points out that all of our studying, probing and doctoring actually changes people, for we do not exist in a vacuum."

I like the idea of "making people up" and the concept that individual people together influence their culture/society but that activity can in turn change the individuals and so on back and forth. I like concrete examples and one (maybe) that came to mind... why do people who hear voices, those with schizophrenia or what have you, often have hallucinations of a negative nature? One suggestion is that historically most people who heard voices did not neccessarily have negative/threatening/violent ones, and that cultural judgements about hearing voices has biased hallucinations.

"what of people who do benefit, personally, from a paradigm that does empower them to see "illness" as being something they "have" and not who they are?"

I don't think a particular "model" of anything has to be entirely rejected, if there are aspects of it that "work" I think they can be incorporated into a new "model". As Professor Gibbs said in class, many of her clients like thinking about their "condition" as biologically based and that helps them acheive whatever their goals in therapy may be. But it still begs the question, would those people who are empowered by thinking in terms of "illness" feel disempowered to begin with in a new/better model of mental health? If yes, then feeling empowered by thinking in terms of "illness" would seem appropriate. But maybe they could end up feeling more empowered by a new/better model? I think a goal for a new model of mental health would be for all to feel as empowered as possible in the first place and then act from there. I think maybe we have to examine what purpose thinking of something as an illness, not a part of who they are, serves. For my personal experiences of depression, thinking it of an "illness" has been helpful in so far that it releases some of the responsibility and allowed me to look at my experience more objectively and in a way understand it better. On the other hand, thinking of it as an "illness" makes me feel powerless and feel like it has "happened to" me.

So, I guess my conclusion for right now is that because we've acknowledged that individuals are so diverse, on a number of parameters, we can't get caught up in trying to make too broad of generalizations, as there will always seem to be exceptions and unique contexts to consider.

Illness [97]

Submitted by sgibbs on Fri, 09/19/2008 - 4:21pm.

Laura -

Your comments about your personal experience of the term "illness" made me think about another group of clients I have dealt with...substance abusers and addicts. Many therapeutic approaches to treating these clients shun the use of the term "illness" for just the reason you state - it can lead to feelings of powerlessness and reluctance to accept personal responsibility. To some extent I agree, but I don't think using the term illness necessarily leds to complacency - I certainly have not observed that in my clients with schizophrenia, for example.

By analogy, if I get ill with a cold, I might feel like it "happened" to me, but I might also admit that maybe I've been working too hard, and I'm still gonna go buy some cough syrup!

Sarah

I agree with Sophie that the [98]

Submitted by PS2007 on Thu, 09/18/2008 - 1:50pm.

I agree with Sophie that the “healthy vs. ill” language is not just an issue of semantics. The way we use language to frame ideas has huge implications for we feel about them. For example, the whole pro-life vs. anti-choice debate.

I also agree that we cannot draw a distinction between mind and body. In one of my psychology courses, we spent time talking about in other parts of the world where psychological differences are not talked about or considered serious (I wish I could remember where specifically we were speaking about) psychosomatic illnesses are a lot more common.

On a lighter note... [99]

Submitted by kmanning on Wed, 09/17/2008 - 7:15pm.

Yona sent me this video and it seemed a little too similar to what we are discussing to not post.

http://streetbonersandtvcarnage.com/blog/street-carnage-films-presents-sophie-can-walk/

Plus, it will make you smile.

Thanks for sharing this! It [100]

Submitted by Sophie F on Thu, 09/18/2008 - 1:04am.

Thanks for sharing this! It is both adorable and pertinent.

In defense of mental illness [101]

Submitted by sgibbs on Wed, 09/17/2008 - 4:13pm.

I've been thinking about the conversation from Monday, and keep coming back to the same few "thought bytes":

- To perhaps expand on jrlewis' comments (I'm so sorry I don't remember your non-screen name!), the brain is an organ, part of a larger organ system that is the CNS and PNS. Sure, it's complicated, and we don't understand it as well as, say, the kidney (which is pretty amazing, too), but it's comprised of the same stuff. Why, then, is difficult to imagine that this organ can become "diseased"?

Individuals with schizophrenia show dementia, changes in personality, acting out, and progressive loss of brain volume throughout their lives. Individuals with Alzheimer's and Huntington's Disease show the same symptomologies. All three conditions typically show an adult onset, are thought to arise through a combination of genetic and environmental factors, and are currently without cure. Is any one of these more of a "disease state" than the others? Anyone want to make the argument that Alzheimer's is not an illness?

- I don't think that the term "mental illness" can be considered in a vacuum. Rather, it exists in relation to "mental health." "Illness" implies that there was once health, and now there is not. It also implies that the sate of health can be reacquired. The people I know with schizophrenia remember a time when they were "mentally healthy", and they mourn its loss. They also hope for its return, and are eager to learn of advances in research and treatment.

I can certainly see the argument that individuals on the more higher-functioning end of the autism spectrum may not remember a time when their mental state was any different (given the early onset), and thus may understandably take exception with the "illness" label. However, it is my experience that most people with debilitating mental conditions, be it depression or schizophrenia, long to return to their own unique state of mental "health", and have little interest in convincing themselves or others that their condition represents a "different type of normal."

I also have a problem with using words like "growth", "evolve" and even "change" in a definition of mental health. As a therapist, I try to stay away from these sorts of terms, because I feel them to be somewhat condescending, implying that one is "lacking" something or is not "complete" the way they are. This attitude also stems from my adoption of the Gestalt therapeutic approach (http://en.wikipedia.org/wiki/Gestalt_therapy), which essentially rejects the explicit goal of change (becoming what one is not) and replaces it with the goals of awareness and integration (becoming what one is).

Ok, I'm shutting up now.

Gestalt theory [102]

Submitted by kmanning on Wed, 09/17/2008 - 7:09pm.

Sarah, thank you for bringing up Gestalt theory (which I have no understanding of beyond what wikipedia just told me, but sounds very interesting!). Perhaps wikipedia's summary is not exactly correct, but from what it says, it actually appears to be very in line with (my understanding of) professor Grobstein's definition of mental health.

To quote the all-powerful wikipedia on Gestalt therapy:

"The client learns to become aware of what they are doing psychologically and how they can change it. By becoming aware of and transforming their process they develop self acceptance and the ability to experience more in the "now" without so much interference from baggage of the past. The objective of Gestalt therapy, in addition to helping the client overcome symptoms, is to enable him or her to become more fully and creatively alive and to be free from the blocks and unfinished issues that may diminish optimum satisfaction, fulfillment, and growth."

The end goal of Gestaltian therapy thus seems to very much be saying what I interpret Professor Grobstein to be defining mental health as: the ability to perceive of one's own condition and how one can change it.

(I am unsure whether I think one needs to only be aware of how one's situation could be changed, or needs to actually be changing it, in order to be mentally healthy - thoughts?)

Anyway, while I do really like the self-understanding/evolution theory of mental health, and I'd be happy to call it the first step one takes when deciding if someone is "mentally healthy", I worry that in many cases asking this question wont get us very far. Is a child with bi-polar disorder who is threatening the lives of his family members one moment and crying in their laps the next impaired in being able to understand his own condition and how to change it? YES. Now what?

I think the challenge put forth in Culture as Disability, and by the self-understanding/evolution definition of mental health is a very worthy cause that must be addressed, but I also think if we put forth ALL our efforts towards changing cultural norms so there is no longer "mental illness" and "mental deficiencies", we are going to not give "help" to a lot of people who may need it in a more "traditional" mental illness kind of way.

(I apologize for my overuse of quotation marks. I am wary of all adjectives and nouns after our discussion Monday night. And also for not really giving any conclusions in this post - the ideas are still unclear in my mind!)

Gestalt and change [103]

Submitted by sgibbs on Fri, 09/19/2008 - 4:12pm.

Laura and K (sorry I do not know your full name...) -

Great stuff!

Yes! You are absolutely right in interpreting that the purpose of awareness is change...that's perfectly in line with one of the main tenets of Gestalt theory, the Paradoxical Theory of Change, described below by Arnold Beisser http://www.gestalt.org/arnie.htm:

"I will call it the paradoxical theory of change, for reasons that shall become obvious. Briefly stated, it is this: that change occurs when one becomes what he is, not when he tries to become what he is not. Change does not take place through a coercive attempt by the individual or by another person to change him, but it does take place if one takes the time and effort to be what he is -- to be fully invested in his current positions. By rejecting the role of change agent, we make meaningful and orderly change possible.

The Gestalt therapist rejects the role of "changer," for his strategy is to encourage, even insist, that the patient be where and what he is. He believes change does not take place by "trying," coercion, or persuasion, or by insight, interpretation, or any other such means. Rather, change can occur when the patient abandons, at least for the moment, what he would like to become and attempts to be what he is. The premise is that one must stand in one place in order to have firm footing to move and that it is difficult or impossible to move without that footing.

The person seeking change by coming to therapy is in conflict with at least two warring intrapsychic factions. He is constantly moving between what he "should be" and what he thinks he "is," never fully identifying with either. The Gestalt therapist asks the person to invest himself fully in his roles, one at a time. Whichever role he begins with, the patient soon shifts to another. The Gestalt therapist asks simply that he be what he is at the moment. "

Maybe this helps clarify my position. I agree that it matches pretty well with Paul's definition of mental health as well....although I would add the prerequisites of awareness and acceptance as a means to change/growth/evolution...whatever you want to call it. I just tend to stay away from these explicit terms in session with my clients, and instead focus on fostering awareness in the here and now. It also helps to deal with the issue of "normal"... I agree with Laura that while a universal standard of normal is not especially useful in any context, most individuals have some idea of what is normal for them, or are searching for it. My approach is to try and help them discover or re-discover that for themselves.

I guess a part of me also believes that as individuals, we are already "complete"...life is not so much a matter of growth as a matter of discovering what already exists...I hope that makes sense.

Where do we go from here? [104]

Submitted by ryan g on Wed, 09/17/2008 - 9:36pm.

After agreeing with Katy in the class discussion, I want to agree with her digitally.

As I said in class, all of the models of mental health that we have discussed - "culture as disability," "Dr. Grobstein's neuro/bio/cultural model," "Georgia Griffin's revised scientific model"- seem to promote this idea of acceptance in one way or another. In other words, we shouldn't try to "fix" mental "illness," we should strive to erase the fact that we even see anything to fix.

I don't feel like I can effectively argue against any of these right now, nor do I think I want to... In fact, I think I would say I agree with the direction that they all suggest - for not only mental health but health care in general.

That being said... If I am to to discard the cultural framework I have been working in... the idea of a healthy/ill dichotomy... even my beliefs that an organ should function in a certain way... in the interest of being less wrong, I feel like I don't have any ground to stand on anymore.

How can we come up with a practical solution from all this? While some people might be more than happy to have the healthy/ill dichotomy erased (the deaf community is an example that comes to mind), as Katy and sgibbs said, we can't deny that there are a large number of people who are not happy with their mental states and who want help.

In the bio/neuro/cultural model, it was suggested that we cannot wait around for medicine to try and figure things out. We need to address the problem that is facing us NOW. We need a solution. Do we have one? I'm left with a feeling of "what now?"

Oops! [105]

Submitted by kmanning on Wed, 09/17/2008 - 7:19pm.

What I meant to say was NO! The bi-polar child is not able to self-understand/evolve!

I don't know that I'd want [106]

Submitted by Laura Cyckowski on Wed, 09/17/2008 - 6:54pm.

I don't know that I'd want to consider things thought of now as an "illness" (depression, schizophrenia, etc.) as a "different type of normal", but instead maybe as... "natural", something to be acknowledged as normal to happen? A different type of normal might suggest that someone is content being that way permanently, I don't think most people with depression feel that way. But what about also acknowledging some of the positive aspects (creativity for some, new perspectives after "recovery"), etc. "Illness" would seem to ignore those things.

The issue of those terms and Gestalt therapy is interesting. I feel them to be positive, especially evolve, evolving would never imply being complete in anyway. And never having to be complete would take the pressure off of being "normal". I do like the goal of awareness, and self-reflection, as a therapeutic process. But that only seems like the first step... what can you do with that awareness but change (perspectives, attitudes, actions, understandings, etc.)?

Defining "mental health" (or not) - PG thoughts [107]

Submitted by Paul Grobstein on Tue, 09/16/2008 - 3:43pm.

Hmmmmmm. Interesting/useful conversation yesterday evening. Lots of thoughts in reaction to various challenges to my "story." To wit ...

Yeah, I really DO think we could do better by finding a framework other than medicine ("illness," focus on "fixing things," "objective expert") to think about "mental health." And that's NOT an attack on medicine per se, but rather an acknowledgment that the issues/problems/challenges of dealing with behavior/human experience are significantly different from those medicine has so far evolved to effectively deal with. Medicine as a profession could certainly move in new directions, and probably will. But I'm not inclined to presume that we have to depend on the medical profession and wait for that. Just as I'm not inclined to presume that biology/neuroscience will in time give us the answers to difficult questions like what "mental health" actually is and when to "cross the border" with treatment, and wait for those. The problems exist now, and have to be dealt with now.

Equally importantly, my guess, as a biologist/neuroscientist, is that such questions have no "objective" answers, and that future research will bear this out. The brain is not designed to achieve "objective" understandings of "reality." It is designed to make the best sense it can of the information it has, to create "stories" that in turn alter what has to be made sense of, and to revise those stories accordingly. Again and again. There is no fixed "standard" to be reached; there is an inherent, and desirable, subjectivity in all understanding. Deciding what "mental health' is, and when to "cross the border" have always been and will always be questions that have no "objective" answer, questions that one has always had to answer and will always have to answer "subjectively [108]," ie in awareness that there is no "god's eye" view, and that one is always acting out of, and testing, one's current understanding.

The argument here is that "relativism [109]," individual and cultural, is actually not something to be avoided but rather something to be embraced. It, and an associated "subjectivity" is part of the very nature of human behavior/experience (see also Fellow Travelling with Richard Rorty [110]). Diversity [111], among both individuals and cultures, is not a failure to achieve perfection but rather the grist from which new and less wrong things are made. And that movement doesn't depend on any fixed ideal of what is "right" or "good" or "healthy." It depends only on an ability, which all human beings share, to notice things that don't work well NOW by whatever one's standards (individual and cultural) are NOW, to try and fix them, and to learn from those actions, to revise not only our understandings but our standards (individual and cultural). To make effective use of that ability, we need as well a willingness to live with the certainty of the uncertainty [112], and to allow ourselves to be changed by challenging it.

So, back down to earth. What does this have to do with thinking about "mental health"? First, it suggests that we should avoid identifying some humans as "healthy" and others as "ill." Humans differ from one another along a very large number of dimensions, and those differences have complex causal relationships among them. There is always uncertainty about the value and cost of any particular difference, about which ones need to be "fixed." We all have characteristics that are appreciated by ourselves and others, and other characteristics that either we or others (or both) would at the moment prefer we not have. And we would all be better off thinking of ourselves, and others, as a mix of characteristics, some less appealing and others more so (to ourselves and others). Reducing that richness to a single dimension and identifying people as healthy or ill by some arbitrary cutoff along it seems to me not only impossible but counterproductive. Our goal should be to encourage people to enhance their distinctive and valuable differences, not to try and make them all the same.

Second, this perspective suggests that just as we all are varying mixes of characteristics, we all have varying needs for sympathy and assistance from other people. One doesn't need the concept of illness in order to accept help from other people, nor to offer it to others. Indeed, the concept of illness frequently gets in the way of both accepting help ("I should be able to take care of myself") and offering it ("Are they really sick or are they just malingering, trying to take advantage of me, etc?"). Yes, there are, will always be, uncertainties about when/where/how/who to ask for help and to offer help. But it seems to me that trying to codify this in terms of a healthy/ill dichotomy demonstrably creates more problems than it solves.

Third, this perspective suggests that both research and therapeutic practice should focus less on "fixing problems" in some permanent sense and more on opening new directions, for both individuals and humanity at large. The history of efforts to find a "cure for cancer" are instructive in this regard. Cancer is increasingly understood not to be A symptom with A cause and A therapy but rather an intersecting set of symptoms, causes, and therapies nearly as diverse as the affected individuals. Furthermore, the risk of one or another breakdown of the control of cell growth is almost certainly an inevitable consequence of being a complex multicellular organism. There are a host of therapies for cancer but no "cure." It would be astonishing if human behavior/experience were not still more complex ("Because I relish complexity, I chose psychiatry - its more complicated than neurology" ... Nancy Andreasen, NYTimes, Science Times, 16 September 2000 [113]).

This is not at all an argument for not doing more research, but it is an argument for research directed less at what sometimes seems to be the straightforward challenge of finding simple ways to restore the "ideal" or status quo, and more at opening up the range of possible ways to think about what it is to be human, ways that start from a recognition of our complexity (cf A Dissenting Voice as the Genome is Sifted to Fight Disease [114]). And it is not an argument against using particular therapies to try and help particular people in particular cases, but it is an argument that the core of therapeutic practice should not be to "fix" people in the sense of repairing something broken but rather to help people become better able to themselves see and choose from a wider array of possible selves.

Fourth, this perspective encourages us all to see culture not only as something that influences our behavior and standards, but also something that is, and can further be, influenced by our individual behavior and standards. Yes, Culture as Disability [15] diagnoses a problem of cultures without offering a solution. But it would be a mistake to conclude that we therefore have to live with that problem. One could instead read the paper as a challenge: how could we reconceive cultures so they don't have that problem? Yes, doing research on complex entities requires different approaches than that on simpler ones: what kinds of new approaches can we imagine? Yes, "mental health" is at the moment widely thought about in terms of "illness" and its absence. What new, less wrong ways are there to think about it?

Thanks again for everyone's contributions to my thinking more about that question. Looking forward to seeing what new thoughts the conversation yesterday evening triggered in other peoples' minds.

"Deciding what "mental [115]

Submitted by ysilverman on Thu, 09/18/2008 - 1:11pm.

"Deciding what "mental health' is, and when to "cross the border" have always been and will always be questions that have no "objective" answer, questions that one has always had to answer and will always have to answer "subjectively," ie in awareness that there is no "god's eye" view, and that one is always acting out of, and testing, one's current understanding. "

I think that what Professor Grobstein said above (which I quoted) is true: where is the line drawn? What are the parameters of mental illness? Who decides who is sick and who is well? Those questions are complicated and hard to answer, and in our largely imperfect attempts to do so we've created decidedly faulty tools (like the DSM) and made clear mistakes along the way (like including homosexuality IN the DSM). Still, that is the goal of "getting things less wrong," isn't it? To recognize that there are mistakes, and to try and improve on them?

Because I do think there are ways in which mental illness and physical illness are akin to one another, and though they may very well not be analogous, I also think that in class we ignored the fact that a lot of physical illnesses also have many causes, some which are not always that clear. Many people with heart disease are genetically pre-disposed, some don't excersize enough, some smoke, lots have a combination of the four (and other) factors at work ... And some of those people will die of heart attacks, and some will catch it earlier and take treatment that will (likely, though certainly not necessarily work), and some may experience physical ailments ... But even more, there are still gradations in "healthy" hearts. My blood pressure is fine, but I doubt I have the perfect heart ... So, some doctor somewhere has made a relative chouce about what a healthy heart does and doesn't look like.

In mental health, the structure is not drastically different than that, and just because we don't know exactly how to treat something doesn't mean there is no treatment. (If the big issue with disease is that it can cause physical harm and/or death, then the risks of psychological disease are not dissimilar ... )

I tend to agree with you [116]

Submitted by Ljones on Thu, 09/18/2008 - 5:16pm.

I tend to agree with you (this is Yona, right?)

Perhaps the brain is more complex than any of our other organs (admittedly it is) but it is still one of our organs and as such can be diseased just like any of our other organs. There is a continuum of of healthy vs ill for every one of our other organs and like you said, someone somewhere had to decide where to make the cut between healthy and unhealthy.

I think the one of the main differences between mental health and physical health is only that we haven't come to consensus on where to make the cut between healthy and ill. Maybe we won't ever make that hard line (and maybe there isn't one and any distinctions we make will be arbitrary). Maybe the best way to "treat" (for lack of a better word) the people who are on the cusp (i.e. autistic people etc) is to consider them to be different as opposed to diseased.

I don't know... I don't feel like I have any answers, but throwing the medical viewpoint out the window makes me feel like "What's next?" As faulty as it is, looking at mental illness from a medical point of view is the only way that seems practical, the only way that gives me a real guideline of how to move forward.

~Laura

Another Thought [117]

Submitted by jrlewis on Wed, 09/17/2008 - 2:41pm.

My greatest reservation about your proposed model for mental health is that it appears to dissociate mental and physical health. This separation appears to give privilege to specific mental states. I mean those mental states concerning the brain, mind, and soul as opposed to the body or physical experiences. However, I do not think that mental health can be so restricted. Consider the topic of pain management. The mental states that accompany the experience of presence and absence of pain. The anguished anticipation for relief by a narcotic and strong sense of relief following. It seems like a roller coaster ride of moods.

Pain: physical or mental? [118]

Submitted by Paul Grobstein on Sun, 09/21/2008 - 3:21pm.

MY "proposed model" ... "appears to dissociate mental and physical health"? Ouch. NOT intended. My argument was that the "medical model" is effective in certain contexts, but less so in others, not that there is or should be a sharp line drawn between "mental" and "physical." Its a point of equal significance both for doctors and for mental health workers.

Yes, pain is an excellent example. Pain is always "in the head," ie "mental" in the sense of reflecting patterns of activity in the brain. But it is of course also "physical" in exactly that same sense. In some cases, there is an origin in the body outside the brain that a doctor (or someone else) can find; in other cases there isn't, the origin of the pattern of activity is entirely in the brain. It is that difference that I suspect corresponds roughly to what people usually mean by distingushing between "physical" and "mental."

The point here is that "mental" states (as that term in usually used) have physical embodiments and that "physical" states (as that term is usually used) often have "mental" aspects. The point is not to assign things to one or the other category but rather to find ways to make better sense both of the distinction and of the interaction between the two (as, for example, by redefining them as above).

I agree with you! See my [119]

Submitted by sgibbs on Wed, 09/17/2008 - 4:14pm.

I agree with you! See my comments below...

One Thought about Your Model [120]

Submitted by jrlewis on Wed, 09/17/2008 - 2:30pm.

That there is a potential parallel between mental health and education is very appealing to me. It is certain that I am more comfortable in a school building than a doctor’s or therapist’s office. In an educational environment, I also feel more at ease asking for help from friends or faculty. There is usually a protocol for seeking assistance.

It is generally accepted that students will encounter challenges with some of the material in their courses. Yet it is not seen as a sign of weakness that student’s seek help, rather as the mark of a mature student. I would like to see the same perspective adopted with respect to mental health. Currently, it seems to me that the appearance of weakness or helplessness is a significant portion of the stigma associated with mental health.

I like the suggestion that [121]

Submitted by Laura Cyckowski on Tue, 09/16/2008 - 8:24pm.

I like the suggestion that "one doesn't need the concept of illness in order to except help from other people". I think the idea of "help" is one that I get tripped up by when trying to define/think about mental health... While we are replacing the terms/ideas of "illness"/"health" with new ones, the idea too of "help" should be more broadly defined/termed, as an exchange/engagement with other individuals (whether "experts/professionals" or not)/culture. I also think that research of all kinds/in many areas will be important, as the article linked in a post above says "for thousands of years, symptoms of sadness that were 'with cause' were separated from those that were 'without cause.' Only the latter were viewed as mental disorders" [122], without a starting understanding there's nothing to "improve" upon and the more/newer understandings the better.

Sadness [123]

Submitted by sgibbs on Wed, 09/17/2008 - 4:26pm.

Laura - I like your thinking. I read the sadness article yesterday in the Science Times and it really resonated with me. I have worked with a number of clients who had really really good reasons to be depressed: they were dealing with grief (often what we call "complex grief", such as that resulting from a murder or death of an abuser), unemployment, poverty, single parenthood, physical illnesses, stressful living conditions, etc. The first and foremost thing I would tell them is that what they were experiencing was a normal response to their situation. I was amazed by how many of them were relieved and even surprised to hear that! In many cases, it wasn't just the sadness that was the problem, it was the anxiety over whether or not the sadness was "normal." It seems that individuals often feel that they need to "buck up", and worry that admission of sadness in the face of sad circumstances is abonormal or a sign of weakness. Another reason I am a big fan of group therapy - there's nothing that helps like realizing you're not alone in your experience.

Mental Health - A happy way of thinking... [124]

Submitted by Paul B on Tue, 09/16/2008 - 6:05pm.

I’ve made a 180 degree turn from my original ‘biological illness’ view of mental health and illness. I think my attempt to explain mental health fits within the 4 criteria above...

Perhaps mental health is just a method of thinking and interpreting, which facilitates personal happiness.

For example, I’m writing my opinion on this website, and someone disagrees with me. If I were to have 'mental health', I interpret the disagreement as an opportunity to learn another viewpoint and to change or defend my own. I would be happy and excited by the intellectual stimulation. On the other hand, I could have a 'mental unhealth' and interpret the disagreement as an attack against me and my intelligence - in which case, I would be upset.

Mental 'unhealth' isn't neccesarily wrong. In fact, it may be right sometimes. Perhaps having 'mental health' is naive sometimes...

What are your thoughts? feel free to disagree :-)

Interesting article... [125]

Submitted by Sophie F on Tue, 09/16/2008 - 12:03pm.

...written by a psychiatrist about diagnosing depression, from today's NY Times: http://www.nytimes.com/2008/09/16/health/views/16mind.html?8dpc

A Certain Kind of Thing [126]

Submitted by Martin on Mon, 09/15/2008 - 12:25pm.

Much of our discussion seems to be moving in a direction which would suggest that what defines "health" or a "good/normal human specimen" is going to be left up to individual choice. This would mean that an individual human person gets to decide what is good for them and they can say nothing about what is good for their neighbor.

I may be reading this into our conversation and it is in fact not there at all, but if it is there I feel I need to voice a contrary opinion.

Much of western philosophy/religious studies have focused on the question of "What is a human being?" This question obviously implies that a human is a certain kind of thing and we DO NOT get to decide what that is; we simply observe humans in varying contexts and try to see patterns. What a human being is will be expressed in what a human being does. (This refers to the is-ought problem brought up in the Phil Thesis we are reading for today) We may not ever know with certainty what ought is implied in the is, but there certainly is some ought that is implied. A hammer is for banging in nails, that is what what it means to be a hammer. I can use my shoe as a hammer, but that is an abnormal use for my shoe and it does not respect what the shoe is.

P.S. the Thesis I referred to was quite well written; Kudos to the author!

I know this is kind of late, [127]

Submitted by ysilverman on Mon, 09/15/2008 - 4:56pm.

I know this is kind of late, and we'll talk about this in class soon enough but ... I am in Martin's camp here! I think there needs to be some sort of universal parameters for what mental health is and is not ... These may be broad, and they certain should allow for mental crimps and individualities -- but I think we are actually, truly downplaying mental illness if we decide that mental health is basically subjective.

What is "mental health" really? [128]

Submitted by llamprou on Sun, 09/14/2008 - 11:46pm.

I spent the day today doing a million different things, and in doing each of these things I wondered whether or not being mentally impaired - whether it be a physical disorder, or emotional stress/anxiety - would impact my ability to complete the task at hand. I am still not sure exactly what mental health really is. I want to say that a mentally healthy individual is one free of any physiological disorders and also one with their emotional psyche intact. But even so I don't believe that there is a universal definition. So much in the world today is subjective, and there are too many cultures, nationalities and professional disagreements as to what mental health really is. Perhaps one's mental health is entirely unique to every individual and there is no general definition. This would make sense to me because there are levels to emotional happiness and mental stability and not everyone is on the same level. These are just a few personal thoughts but I am anxious to discuss in class tomorrow! Everyone have a good night and to those who read this tomorrow...good morning!

Individual vs. society [129]

Submitted by akerle on Sun, 09/14/2008 - 10:38pm.

I think Sarah made an excellent point. Most of our definititions of mental health have to do with behaviours- normal vs. deviant. Mental health appears to have everything to do with everyone else and less to do with the individual in isolation. As long as the individual is functioning within society then we consider them to be mentally sound.

I tried to ask my psychology professor in freshman year what defined normal and what the basis was for her diagnosis of 'deviance/abnormality'. She said that as soon as individuals were feeling and/or acting in a way that impaired their ability to lead the life they desired then they were diagnosed as mentally ill. I think I accept this definition as a jumping off point. Either way, I do feel that it gives the individual a little more autonomy over their own conscious. Words and ideas imposed on individuals by society (e.g 'responsible') leave me a little unsatisfied.

Society has to define 'normal' parametres because there is no other way but who are we to judge what makes people happy and what is normal? Certain behaviours may be harmful to society but that doesn't make them abnormal. We just don't like them so we classify them as such.

mental health: some more current grist [130]

Submitted by Paul Grobstein on Sun, 09/14/2008 - 10:27am.

Accomplishing big things in small pieces .... from NPR's "I Believe" series
The Bipolar Puzzle [44] ... from NYTimes Magazine

For more on bipolar disorder see Bipolar Disorder and Creative Genius [131] and on-line forum discussion there, most recently Bipolar All My Life [132].

the ethics of pharmacology [133]

Submitted by kmanning on Sun, 09/14/2008 - 1:03pm.

Many things struck me in "The bipolar puzzle," but one of the most troubling was the following quote about bi-polar disorder: "The tricky part, diagnostically, is that out of those seven symptoms, three — distractibility, activity increase and talkativeness — are also symptoms of A.D.H.D. Which means that a severely irritable child who has A.D.H.D. could be, theoretically, only one symptom away from a bipolar diagnosis."

This article really brings to the forefront many of the issues involved in trying to treat mental illness pharmacologically, while the definition of many mental illnesses is still a mixture of both scientific and non-scientific symptoms. If our treatment plans are scientific but our definition of illness is still in part behavioral - and thus influenced by many non-scientifically quantifiable factors - are we using people - and in many cases children - as lab rats?

Here is an postcard ... [134]

Submitted by ysilverman on Sun, 09/14/2008 - 9:58am.

from today's postsecret that struck me as particularly relevant to our current discussion in myriad ways (whether or not true)...

http://2.bp.blogspot.com/_a7jkcMVp5Vg/SMrYoz3OUJI/AAAAAAAAF7o/D27wUCPCUE4/s1600-h/crazy.jpg

-- yrhs

Writing my "mental health" definition [135]

Submitted by merry2e on Sat, 09/13/2008 - 7:23pm.

I am just wondering after reading some of the posts and working on my definition it made me think...what do we have in the middle? It can't be all black and white, all the time, either "mental health" or "mental illness."

Just a thought.

Definitions of mental health: opening bids [136]

Submitted by Paul Grobstein on Fri, 09/12/2008 - 11:26am.

What is meant by "mental health"? Responses posted below as replies to this posting are suggestions (one paragraph or less) made prior to this week's discussion of the question. They should be understood not as anyone's commitment to a final answer but rather as a variety of starting points which can contribute to the continuing evolution of "less wrong" definitions.

ny times article [137]

Submitted by Riki on Sun, 09/21/2008 - 4:04pm.

I don't think anyone has linked to this. In the article, Dr. Goldstein says that "After doing comprehensive studies for common diseases, we can explain only a few percent of the genetic component of most of these traits. For schizophrenia and bipolar disorder, we get almost nothing; for Type 2 diabetes, 20 variants, but they explain only 2 to 3 percent of familial clustering, and so on."

What is mental health? [138]

Submitted by Sophie F on Tue, 09/16/2008 - 12:05pm.

I’m not really sure what “mental health” is in that, perhaps, such categories are useful as general assessment tools, but really can only be defined on a case-by-case basis. Are health and wellness determined by how one thinks, what one feels or how one behaves? Perhaps what one person deems to be healthy, another would deem unhealthy. Is “mental health” an endpoint or an ongoing project of sorts? If mental health, as Martin commented, is to be approximated in the way one would physical health, then it implies a baseline level of self-care and an ability to participate in life without self-harm or harm to others. If one argues that the individual in her environment ultimately shapes reality, then mental health in that context is the flexibility to maintain “balance,” within certain indefinable bounds, that are somewhat unique to that given reality.

I look forward to hearing everyone’s thoughts.

Adding my thoughts a little [139]

Submitted by Laura Cyckowski on Mon, 09/15/2008 - 5:18pm.

Adding my thoughts a little late but my thoughts about a definition for mental health is that it would/should be something flexible/evolving... and that with respect to the q. Sophie raised above that shaping one's "mental health" should also be on-going/evolving. One goal, though, might be to enable individuals to maximize their own personal agency which several people have also seemed to say. Also, I think "mental health" could/should be dependent on/defined by a number of variables... including the individual, but also culture. I feel strongly about each individual defining what mental health is for them, but I'm hesitant to leave out cultural/societal influences based on the "evidence" that for example... people who've recovered from a major depression/suicide attempts acknowledge that they feel differently now and acknowledge that that their thoughts and perceptions that death was the best choice for them were "not theirs". Finally, I'd like to through in self-awareness in the definition of mental health, along the lines of "the unexamined life is not worth living".

I think mental health is a [140]

Submitted by kgins on Mon, 09/15/2008 - 2:38pm.

I think mental health is a combination and result of experiences we have gone through, that take us to the point and position we are in now. I think that things happen, and we react to them, be it physically, emotionally, or otherwise, and mental health is our state after the reaction, be it "healthy" or not.

this is difficult [141]

Submitted by Riki on Mon, 09/15/2008 - 12:50pm.

I had similar thoughts as Paige in that mental health is defined case by case. I do think that there is a biological basis for mental health, as in a need for specific neurotransmitters to fall within a certain range, though I think that the parameters of said range are blurry. I don't think that one has to be mentally healthy to function in society. I think mental health is at times connected to one's mindset. Mental health isn't necessarily about being happy, for I feel as though happiness is not the absence of sadness.

Mental health versus behavioral health [142]

Submitted by sgibbs on Sun, 09/14/2008 - 6:17pm.

Since becoming active in the mental health care industry, I have spent a lot of time helping others to deal with both their thoughts and actions. And it is clear to me that the popular definitions of "mental health" (reflected somewhat in the postings here) are based almost exclusively on what I would not consider to be "mental" activities at all, but rather behaviors. Almost every DSM-IV diagnosis is based primarily on behaviors: duration, number, frequency, intensity, as opposed to thoughts, feelings, etc. So I wonder if when we say "mental health" what we're really saying is "behavioral health," and is it possible that they can exist independently from one another? Case in point: the "recovered" alcoholic who hasn't had a drink in 10 years but still craves it when he feels stressed or sad. Or any person (myself included) who has had violent fantasies in moments of anger that they have not acted upon. Behaviorally healthy, mentally unhealthy? What about a highly functioning sex addict who engages in risky liasons but doesn't think she has a problem? Behaviorally unhealthy, mentally healthy? Is behavior a true gauge of mental health? Or is it just the only one we really care about?

Hope to make it for the discussion tomorrow night.

Hmmm.
Sarah

Mental Health is (maybe) [143]

Submitted by mstokes on Sun, 09/14/2008 - 4:09pm.

the ability to function in one's environment--making informed choices, contributing to and drawing from resources, helping and benefiting from others--in a responsible manner. It assumes a certain self-regulating and self-monitoring capacity, to ensure that one is not exceeding "reasonable" boundaries in relationships or use of resources.

(I look forward to seeing you all Monday night, and apologize for my own migraine-induced brain troubles that caused my absence last week!)

I think someone who is [144]

Submitted by PS2007 on Sun, 09/14/2008 - 2:19pm.

I think someone who is “mentally healthy” has the ability to make choices and perform actions that will contribute to their personal goals. These goals, however, must also be “healthy”. If they are harmful to others or violate societal norms they may not be considered healthy.

I think it is so hard to define mental health because to call someone mentally healthy or ill should be done on a case-by-case basis. One person’s actions may be considered mentally healthy, but another person performing the same actions may be considered mentally ill. I think it has more to do with the context and the specific person than any all-encompassing definition.

Struggling with my definition (looking forward to Monday) [145]

Submitted by merry2e on Sun, 09/14/2008 - 1:42pm.

“Mental health” in individuals would include a level of consciousness and awareness for their own actions, behaviors, words, and understanding their behaviors have an impact on their life and others. Through a healthy awareness of self and responsibility for self, healthy biological changes can occur within the brain. But then…who/what defines healthy?

Look forward to Monday's discussion.

What can be defined normal [146]

Submitted by vpizzini on Sun, 09/14/2008 - 1:39pm.

What can be defined normal and abnormal? It’s always very difficult to define what is normality and normality as mental health. Mental health is seen as the opposite of mental disorder. Only the absence of a visible psychopathology is generally considered normal. However, I believe that this is a very limiting definition, because does not consider the difference that exists between individuals. People differ from one another not just in their intelligence, but also in their feelings, behavior, in their views of themselves and the others, in their views of the world and future. Mental Health is rather an emotional well-being, characterized by the acceptance of oneself and by the adaptation to emotions and reality. It’s a positive state in which various functions are integrated to biological, psychological and social levels.

Writing my "mental health" definition [147]

Submitted by merry2e on Sun, 09/14/2008 - 12:22pm.

Just a thought.

What is mental health? [148]

Submitted by ryan g on Sun, 09/14/2008 - 1:15pm.

Here is my current definition of mental health. I look forward to changing it Monday...

To echo Yona, the only thing that I can say with any certainty right now is that a mentally healthy person should be capable of behaviors that sustain life.

Following this, I agree with the idea that it's easier to define mental health in terms of what it's not. I believe that we all basically experience the same emotions/symptoms. "Mentally ill" people just experience symptoms of greater frequency or magnitude. But then you run into the problem of where do you draw the line...

Finally, I'm wary of any definition that references societal norms. Phrases like "able to contribute" and "productive member" leave me with an unsatisfied feeling.

I'm also having trouble with [149]

Submitted by Ljones on Sun, 09/14/2008 - 10:42am.

I'm also having trouble with the black vs white definition... Everything I come up with seems to have too many exceptions to be a "definition." But I guess a general guideline to mental health would be an ability to function in a society. Although, shamans and oracles way back when were functioning in a society and still would be considered mentally ill by today's standards so... I'm not sure function is the greatest way to measure mental health, but I have no idea how else you could do it.

If physical health is the [150]

Submitted by Martin on Sun, 09/14/2008 - 10:21am.

If physical health is the proper functioning of the body such that the human person is able to do all of the activities that characterize the human way of life, then mental health should likewise be the proper functioning of the mind such that the human person is able to do all of the activities just mentioned. It is important to keep in mind however that excellence in bodily and mental health will vary from person to person and will be relative to the person's position in life. However, there will always be a set of activities (for example: learning, participating in meaningful relationships, self maintenance and preservation) which characterize a distinctly "human" life that one must be capable of doing in order to be considered healthy.

Mental health definition [151]

Submitted by kmanning on Sat, 09/13/2008 - 2:42pm.

Hey everyone,

Here is my mental health definition starting point: Mental healthiness is being in a state where one is making decisions in accordance with a desire for personal happiness/wellness. One must both desire to be happy/well, and also be making decisions that one believes will lead to that end (which of course involves being capable of doing so). Happiness/wellness is a self-defined state, except in cases where it involves a danger to the physical health of the person or others.

My Idea [152]

Submitted by jrlewis on Sat, 09/13/2008 - 2:00pm.

Mental Health is a sense of general acceptance and satisfaction with the mental states one is experiencing. The ability of an individual to adjust to their environment and make meaningful contributions to their society.

Questions and Refinement after Monday Night [153]

Submitted by jrlewis on Wed, 09/17/2008 - 1:55pm.

My definition of mental health consists of two criteria: personal and societal. Yet I am unsure how to treat the tension between them. For example, a person who appears to be a normal individual, making meaningful contributions to society, and also seeking attention for their mental state. Should society accept that this person has privileged access to their own mental status? And consequently, pay for their therapy? Conversely, ought society force people who do not conform to the cultural norms to undergo therapy? Could this situation be resolved with the removal of the stigma associated with mental illness? It appears to me that determining how much diversity can be tolerated by society is a slippery slope.

Mental Health [154]

Submitted by ysilverman on Sat, 09/13/2008 - 11:55am.

A mentally healthy person should be able to perform tasks necessary for sustaining life (be they hygeienic, health-related, social, etc.) without posing a danger to his or her self, or to others. One should be able to derive *some* pleasure from even the banalities of life, and should have self-sustainable mechanisms in place for dealing with challenges and disturbances that arise as a byproduct of the human condition.

(dis)ability to function - key in defining mental illness [155]

Submitted by Paul B on Fri, 09/12/2008 - 4:11pm.

A mental illness is a state of mind (be it depressed, manic, etc) that disables one from functioning in a given society. The difference between someone quirky and mentally ill lies with the ability to function.

Now how do we establish what is functioning in a given society? This is problematic because it's very subjective as it depends on which society one lives in. Even if we consider present day American society, there are many different experiences and perspectives. Nevertheless, maybe there are some behaviors that are universally characterized as dysfunctional (such as harming oneself, etc).

I look forward to hearing others' definitions. It sure is difficult to talk about mental illness without understanding everyone's definition.

Defining "Mental Health"?

Mental Health and the Brain: A Discussion Fall, 2008

Comments

The definition is not really a good definition [48]

mental health: right and wrong [49]

What 'destigmatizes' illness...? [50]

Defninition of Mental Health [51]

Mental "illness": from spirits to criminality to stigma to ... ? [52]

Being personal too [53]

"more than social norms" [54]

website [56]

I am torn once again along with some others! [57]

mental health: "blunt and personal" [58]

An obsession with meaning [59]

Mental Health...and Reality [60]

re "reality" (and mental health) [61]

One more article to question some of the assertions [62]

just being realistic here [63]

As I am posting rather late, [64]

more thoughts on "diagnosis" [65]

Therapeutic Tales [66]

Telling tales [67]

Some concepts that may help [68]

The tyranny of diagnosis [69]

Mental health practice and its "ultimate good"? [70]

The brain? [71]

Katie, I agree ... I think [72]

Well spoken...er, written. [73]

From "mental" to "emotional" health: behaving and feeling [74]

I am not entirely ready to [75]

A fresh perspective... [76]

Getting it less wrong without an objective reality [77]

"If something is broken, it [78]

more on creativity and "mental health" [79]

I found Riki's comment on [80]

I agree that not everything [81]

I definitely think that our [82]

I guess some of it stems [83]

Bipolar disorder, autism, life, and death [86]

" Along those lines, maybe [88]

Still unsure, but... [89]

mental health and "making meaning" [90]

I'm still fumbling... [92]

"what of people who do [94]

Labels [95]

Making up & Changing people [96]

Illness [97]

I agree with Sophie that the [98]

On a lighter note... [99]

Thanks for sharing this! It [100]

In defense of mental illness [101]

Gestalt theory [102]

Gestalt and change [103]

Where do we go from here? [104]

Oops! [105]

I don't know that I'd want [106]

Defining "mental health" (or not) - PG thoughts [107]

"Deciding what "mental [115]

I tend to agree with you [116]

Another Thought [117]

Pain: physical or mental? [118]

I agree with you! See my [119]

One Thought about Your Model [120]

I like the suggestion that [121]

Sadness [123]

Mental Health - A happy way of thinking... [124]

Interesting article... [125]

A Certain Kind of Thing [126]

I know this is kind of late, [127]

What is "mental health" really? [128]

Individual vs. society [129]

mental health: some more current grist [130]

the ethics of pharmacology [133]

Here is an postcard ... [134]

Writing my "mental health" definition [135]

Definitions of mental health: opening bids [136]

ny times article [137]

What is mental health? [138]

Adding my thoughts a little [139]

I think mental health is a [140]

Mental Health and the Brain:
A Discussion
Fall, 2008