Ok, a bit of a warning. This post has a lot of humor and is a bit on the mental health geeky side too. Apparently, the infamous satire website “The Onion” has decided to take on the APA and the DSM-5. To read the full article, please look here. (Remember, this is considered “Fake News” and is satire driven). In the article, The Onion basically diagnoses APA with “Obsessive Categorization of Medical Conditions” given the thousands of hour spent reviewing hundreds of diagnoses every year to make sure they are completely accurate and applicable.
Here’s a really quick education moment for those of you unfamiliar with these terms.
APA: The American Psychological Association. This group does a great deal of research for mental health and are responsible for the creation, monitoring and maintenance of the DSM.
DSM-5: This is the fifth edition of the Diagnostic Statistical Manual that is used by counselors, psychiatrists and other doctors to diagnose and categorize mental health illnesses.
Both the APA and the DSM-5 are critical to our field. I am 100% sure that we should use these tools wisely. I believe that responsible diagnosing is not only part of being an competent counselor, but of being an ethical person. At the same time, I think it’s important that we understand that these two fields come from what we call the “medical model” of mental health. In other words, similar to your Primary Care Physician, these groups look at a list of symptoms, determine what’s wrong with you and then attempt to “fix it.” I am not saying they all do, but as a system, this is what has been created.
So, that makes sense, right? I mean so many of my clients come to me wanting me to “fix them” or to make the symptoms “go away.” Instead, what they often hear from me are things like this:
This is within the range of normal human experience.
What would you really like to do? Would you be willing to do it even if ____ didn’t go away?
You’re not broken! What you’ve been doing isn’t working. Think you might be willing to try something else?
Ok, stay with me. Let’s unpack these just a bit.
1. Normal Human Experience
Much of what we know to be symptoms of mental health illness are within the normal human experience. Meaning that most of us will experience it at some point in our lifespan, to one degree or another. Don’t believe me? Let’s try it.
Psychosis: Most people experiencing auditory or visual hallucinations think they are automatically “crazy” and broken. And, yet the mere experience of them is within the range of normal human experiences. For example, have you ever heard someone call your name only for them to say no one called it? Or, have you ever thought for sure you saw a shadow in the hallway only to get up, turn on the light and nothing was there? Have you ever felt your phone vibrate only to discover no missed calls or texts? Our brains are constantly weeding through tons of external stimuli and sometimes the interpretation side of our brain lets us down. (Please note, when these get to the point that they are troublesome, or impede your ability to live the life you want to live, or result in real or imagined threat of harm to yourself or others, then you need to seek treatment that may include talk therapy, psychotropic medications, or both.)
Intrusive Thoughts Associated with OCD: Have you ever been driving down the road and all of a sudden thought, “What if I ran my car off the road right now?” Perhaps you have been minding your own business at a park and thought “Why is he laughing at me” while passing another jogger. These are normal thoughts and when we are not experiencing OCD they come and they go. The part of our brain responsible for determining their salience (how important a thought is), says that’s not important and we move on. (Please note, intrusive thoughts that cause harm to you or others, or keep you from living the life you want could indicate a need for treatment).
Suicidal Thoughts: I know many of you are thinking “WAIT A HOT PICKING MINUTE!”. And, I have to tell you it’s true. Thoughts of death, to include passive suicidal thoughts are within the normal human experience. My own came during a particularly stressful period in my life. I was on a plane over 15 years ago and the thought came, “If it wouldn’t be so hard for my mom, today would be a great day for a plane crash.” While it’s within the normal range of human experience, it’s also a way for our body and mind to say, “Hey, you’ve got some stuff to work out. What you’re doing isn’t working!” I am grateful I sought immediate help an a competent compassionate therapist taught me how to look at my thoughts for what they are: thoughts. (Please note: If you have suicidal thoughts, if they are recurrent or lasting or come with a plan, please contact your local crisis hotline or the national suicide prevention hotline 1-800-273-8255, dial 911 or report to your local emergency room).
2. Values and Action
When we think about the life we want to live, we are in essence thinking of our values. What’ actually important to us? Not what’s important to our family. Not what we think should be important. What IS important to us? What’s important enough that we’d take action toward them? Now, will you take that action, even if it means that depression comes along for the ride? What about if anxiety was sitting in the backseat? What if there was a chance you’d have an intrusive thought?
You see, one of the saddest realities of mental health difficulties is that it keeps us from living the life we want. In exchange, failure to go after that life increases the mental health symptoms. When we isolate during depression if we value connection with others, it can lead to increased depressive symptoms like negative self-talk, and emotional dysregulation. I am by no means saying “pick yourself up by the bootstraps and get going.” Mental health challenges are HARD, they are uncomfortable and the symptoms are REAL. What I am saying is that you don’t have to wait until you’re healed to start doing the things that are important to you. Find one thing that is in line with your values and try it out.
3. What you’re doing isn’t working.
I sat opposite a client this week and shared this statement: As humans, we often do the thing that gets us the exact opposite of what we want. In other words, when we need more love and attention from people, we often act in very unloving ways. When we want more joy in our lives, we often spend time thinking about all the things that have gone wrong in life. When we want to succeed at work, we spend tons of time trying to better our weaknesses.
Many of the people that sit on my couch, have a whole list of coping skills they’ve used and they just aren’t working. Many of them worked at some point: when I drank I forgot, cutting helped ease the pain, the silent treatment used to make my partner pursue me, etc. But, they aren’t working any more. And that’s ok! And if you want to live the life you say you do, we have to consider maybe changing it up a bit.
As I said repeatedly in this article there are times where just reading a blog like this is not enough. Perhaps you need to see a counselor, someone who is highly trained to help you on this journey. Perhaps you need psychotropic medications to help teach your body (the physical brain) to change how it reacts. While you are not broken, you may have very deep wounds. Perhaps those wounds are caused by others or by years of negative self-talk. Whatever your situation, there’s help and there is hope! Please reach out to a competent counselor in your area and begin the journey to living the life you want today.