Wednesday, 26 February 2014

Who came up with the diagnostic word “disorder”?

I just can’t wrap my mind around this: Using the word “disorder” to tell people that they have a mental illness that is nothing to be ashamed of, it’s just like diabetes or any other physical illness.

How can any amount of anti-stigma campaigns neutralize the wrongness that this word conveys?

: a confused or messy state : a lack of order or organization
: a state or situation in which there is a lot of noise, crime, violent behavior, etc.
medical : a physical or mental condition that is not normal or healthy
Full Definition of DISORDER
:  lack of order <clothes in disorder>
:  breach of the peace or public order <troubled times marked by social disorders>
:  an abnormal physical or mental condition <a liver disorder> <a personality disorder>
Examples of DISORDER
The mayor is concerned that a rally could create public disorder.
problems of crime and social disorder
Millions of people suffer from some form of personality disorder.

 Related to DISORDER 
chance-medley, confusion, disarrangement, disarray, dishevelment, chaos, disorderedness, disorderliness, disorganization, free-for-all, havoc, heck, hell, jumble, mare's nest, mess, messiness, misorder, muddle, muss, shambles, snake pit, tumble, welter
order, orderliness
Related Words
anarchy, lawlessness, misrule, riot; knot, snarl, tangle; labyrinth, maze, web; maelstrom, storm; bollix, clutter, litter, mishmash, shuffle; hodgepodge, medley, miscellany, morass, motley
Near Antonyms
method, pattern, plan, system 


edited on Feb 6, 2015
This is not about being addicted to being helped, it's about being addicted to helping. 

In my frame, addictions are a natural defense against the isolation that comes with being shunned by our herd because of wounds caused by border violations and other trauma. And that is an explanation, not an excuse - everyone owns responsibility for dealing with their addictions. 

One common and very “normal”, even “positive” addiction is help addiction … distancing oneself from harm to one's own childhood vulnerability by helping others. I was a help addict for many years, and I now see this as a near relative of violence: Instead of “I am powerful, I am not helpless”, I did “I am helping, I am not helpless”.

I also did the logic of nice:

And the judging of people I helped:

Link here in case you can't see the clip:

Brené Brown: Are You Judging Those Who Ask For Help? 

Quoting from the video clip:
“How many of you are comfortable asking for help?” Few hands go up.
“How many of you would rather give help than ask for help?” Nearly all hands in the audience go up.
“When you cannot accept and ask for help without self-judgment, then when you offer other people help, you are always doing so with judgment.”

Well-meaning professional mental helpers can show symptoms of help addiction: judgement, aggression, emotional shutdown, and whingeing when harmful help is criticized. 

Help addiction is related to violence, and ...

Shutdown, which can be lauded as “professional detachment”, can lead to harmful labeling and the humiliating mental help that a patient advocate called Jake describes here. Aggression often occurs without witnesses, and whingeing is an effective defense against criticism.

Linking to a blog post by Monica Cassini: Healer heal thyself (to the mental health professional)
Clinicians are trained to never, ever identify with the client. Why? What is wrong with recognizing shared humanity, even a weakness or flaw, and bonding in that? In providing a safe container from that understanding? The mere instruction to avoid such intimacy at all costs seems like a violent denial of oneself and clients both. It seems indicative of a deep fear of ones own dark parts. How do we help others find their way out of the dark if we hide from our own darkness? Such identification may not always be appropriate to share, no doubt, it may also not be present with many clients. But when it is present and appropriate to share from such a place, with adequate boundaries in place, it can be an incredibly healing experience for both parties. 
And I recently came across a blog post by Clare Slaney, where she  writes bluntly and honestly about help addiction: 
"If you want to be loved and liked, don't go into psychotherapy."
She links to an interview with Estela Welldon:

When we treat patients as poor souls in need of our expertise we distance ourselves from them and patronise them. As a matter of principle, we are all equals. And it’s dead true that therapy attracts do-gooders, people in massive need of care themselves who find satisfaction in exerting control over others. Therapists come into training because we’re interested in our own inner lives above and beyond almost everything else; we’re a desperately solipsistic lot and we’re all a bit bonkers. Therapists have to accept that about ourselves to keep the privileges that we’re given under control.

[Welldon] says she has an "enormous amount of violence myself, and I think the patients know that too.”

Hoorah. Many of us are seething with violence a lot of the time but we’ve learned to tone it down, disguise it, pretend it’s something else because that’s what gets rewarded and it’s why so much of Paganism is pathetic. Sitting with some friends the other day one said, ‘If one more person tells me I’m strong, I’ll scream.’ Another replied, ‘Tell them you’re not strong, you’re violent, that’ll shut them up,’ and we laughed with recognition and pleasure. Religions in particular tell us we must be meek and mild, totally accepting, utterly non-judgemental and it’s a very rare person who can come close to that even occasionally. Patients who are wild with fury, often very justifiably, don’t want to be met by someone who would really like them to talk about rainbows and puppies and the power of forgiveness. Whilst it’s often important for a woman patient to have a woman therapist there must also be room for a woman to meet with a male therapist who’s au fait with his responses to sex and gender and is comfortable with a woman who needs to rage or talk honestly about her dangerous feelings around her children. I’ve met too many women therapists who make their fear and disapproval of women’s rage and violence all too obvious.

I don't have a solution to this,  just a suggestion. Check how you communicate with people you help. If you are being helped, check how the helper communicates:

Tuesday, 18 February 2014

Definition of mentalization / mentalisation

 Via @Sigrun_

Here is the English study that these definitions come from:

Different approaches to understanding patients in general practice in Denmark: aqualitative study

Mentalization involves being aware of and absorbing and understanding mental conditions in oneself and others. Many mental processes are involved – not only thoughts and emotions, but also needs, wishes and fantasies. In all social interactions, for example in the relation between patient and doctor, the ability to perceive and interpret the intentions, impressions and emotions of oneself and others is central. 

This definition is by Bengt Mattsson, professor emeritus at the unit for general medicine, University of Gothenburg, from his article “Om läkares olika fallenhet att relatera till patienter”. The title can be roughly translated as “On doctors’ different ways of relating to patients”.

The study he describes found four different ways of relating to patients, many of whom had mental problems:

Mentalizing: Emotionally engaged, welcoming attitude, accepting of differences, curious and intent on understanding thoughts, emotions and impressions. Often able to connect with the patients’ situation from a broad overview.

Limited mentalization ability: Interested in the problem but could not always see a connection with other life situations. Limited interest and curiosity, uneven seriousness and respect for the patient.

Rejecting: Limited patience, could dismiss the patient’s perspective, did not reflect much over their own role in the interaction. Might scoff at patients with mental problems.

Biomedical: Focus on categorization, diagnostics, rating scales and medical treatment. The doctors were neutral and did not wish to be involved in psychological circumstances. The narratives of patients were considered information to be fitted into a biomedical frame.

Monday, 17 February 2014

Link to David Healy's blog:
"Get Real: Peter Gøtzsche Responds"

I'm posting a lot of links today, partly because they are links to interesting viewpoints and information, and partly because I'll probably be quoting from them in later posts.

This one is from the blog of @DrDavidHealy, and it begins like this:  

Get Real: Peter Gøtzsche Responds

Editorial Note: Two weeks ago we ran Peter Gøtzsche’s Psychiatry Gone Astray. There was a context – a Danish  doctor had been found responsible for the suicide of a young man put on antidepressants. This and Peter’s article stirred up debate in Denmark drawing a hard to credit defensive response from senior Danish Psychiatrists.
Peter’s blog was critiqued by George Dawson on Real Psychiatry. An anonymous tweeter @psycrit said “a post about @DrDavidHealy‘s nuttiness turns into an amazing discussion, with unbelievably high-quality comments”. Apparently my nuttiness lies in having anything by Peter G on the site. 
There should be new word for this kind of ad hominem attack – which also flavor’s Dr Dawson’s post. It’s ad hominem by association or ad parahominem.
- See more at:

Links from @Huwtube

Today Psychodiagnosticator (@Huwtube) posted this in his blog: 

Agendas and Anxieties: CBT for Psychosis

He begins like this: 
I have been watching discussion about the latest CBTp trial with interest and some weariness.

And here are some interesting links that I found in his feed:

Find The Gap: Or, why researchers squabble so much.

mind the gap

The post and the comments section is interesting to a confused layperson like me, and somewhere in there Sarah Knowles writes what I have been thinking:
For me, one of the core values of the scientific method is the fact that you’re expected to change your mind based on the evidence, in which case the idea that scientists are just sticking to their guns regardless is very worrying. 


Psychiatrist; Clinical Associate Professor of Psychiatry, NYU School of Medicine
Neuroscientist; Canada Research Chair in Philosophy & Psychiatry, McGill University

The Americanization of Mental Illness

Alex Trochut

Published: January 8, 2010

AMERICANS, particularly if they are of a certain leftward-leaning, college-educated type, worry about our country’s blunders into other cultures.

Research Article

Cognitive MechanismsUnderlying Recovered-MemoryExperiences of Childhood SexualAbuse

Elke Geraerts,1,2 D. Stephen Lindsay,3 Harald Merckelbach,2 Marko Jelicic,2 Linsey Raymaekers,2
Michelle M. Arnold,1 and Jonathan W. Schooler4
University of St. Andrews, 2
Maastricht University, 3
University of Victoria, and 4
University of California, Santa Barbara

Link: On compassion

Friday, 14 February 2014

Steve Onyett

Friday, 14 February 2014


 A friend used to phone once in a while and ask me to «Please say the wonderful word".

And I would say the wonderful word:


And we would both be silent for a moment, 
basking in the wonder of this word, this concept: 


When we are secure in the centre of our own world, 
it is natural to let others be the centre of their world. 

Where else is there to be?

Other than in the centre of our world?

People can be outside themselves. Beside themselves.

Maybe in a self-ish place, an invasive place, where they displace others from their rightful spot in the centre of their own world.

They can also be in a self-less place ... in constant displacement from the centre of their own world.

And I am more frightened of people who strive to be self-less than of people who push into my space.

Because ... because it's relatively easy to notice when someone is actively pushing.

As for people who aspire to self-lessness ... they're like a mother-in-law someone described once: "She is so invisible that I keep bumping into her all the time."

I can set clear borders to protect against open invasions and self-ish behaviour. I have never really managed that when met with self-less-ness. 

The Logic of Nice gets in the way and hears "You are a horrible person" when I say "Please to remove posterior from the breathing". (Brownie points if you know where this quote comes from.)

But I'd rather be seen as Bad than have someone’s posterior in my breathing. 

I prefer to breathe freely. 

Related post: 

Wednesday, 12 February 2014

Claire Hummel on apologizing

The Logic of Nice

Paper on the connection between
childhood harm and mental problems

Via the blog of the Norwegian organization We Shall Overcome and @Sigrun_ 

This is so important that I am posting it in both my blogs. Links to any research that debunks these findings are very welcome, please post them in the comments section.

I do have a question about this point:
▪ Clinical implications include the need to routinely take trauma/neglect/loss histories from all users of mental health services.
How does one "routinely take" trauma histories? I hope they don't ask: "How badly were you neglected on a scale from 1 to 10?"

Full Text
February 2014, Vol. 4, No. 1, Pages 65-79 , DOI 10.2217/npy.13.89

John Read*1Roar Fosse2Andrew Moskowitz3 & Bruce Perry4
* Author for correspondence

Next section
SUMMARY Evidence that childhood adversities are risk factors for psychosis has accumulated rapidly. Research into the mechanisms underlying these relationships has focused, productively, on psychological processes, including cognition, attachment and dissociation. In 2001, the traumagenic neurodevelopmental model sought to integrate biological and psychological research by highlighting the similarities between the structural and functional abnormalities in the brains of abused children and adults diagnosed with ‘schizophrenia’. No review of relevant literature has subsequently been published. The aim of this paper, therefore, is to summarize the literature on biological mechanisms underlying the relationship between childhood trauma and psychosis published since 2001. A comprehensive search for relevant papers was undertaken via Medline, PubMed and psycINFO. In total, 125 papers were identified, with a range of methodologies, and provided both indirect support for and direct confirmation of the traumagenic neurodevelopmental model. Integrating our growing understanding of the biological sequelae of early adversity with our knowledge of the psychological processes linking early adversity to psychosis is valuable both theoretically and clinically.
Practice points
▪ Multiple studies and reviews have found a causal relationship between childhood trauma/adversity and psychosis.
▪ The 2001 traumagenic neurodevelopmental model of psychosis identified similarities in the brains of traumatized children and adults diagnosed with schizophrenia.
▪ Subsequently, 125 publications have provided indirect support for, or direct confirmation of, the traumagenic neurodevelopmental model.
▪ Many studies have now demonstrated the relationship between psychosis and over-reactivity to stress of the hypothalamic–pituitary–adrenal axis and the dopaminergic system.
▪ Studies of the frontal lobes and hippocampus also support the traumagenic neurodevelopmental model.
▪ Two lines of evidence link prior stress and brain alterations to cognitive deficits in individuals diagnosed with psychotic disorders.
▪ Clinical implications include the need to routinely take trauma/neglect/loss histories from all users of mental health services.
▪ The primary prevention implications are profound.

Tuesday, 11 February 2014

Winning back the right
to say my word to name the world

The thought is from Paolo Freire's "Pedagogy of the oppressed". I'll get back to that soon, after a detour to the word "recovery":

I was enchanted with the concept of recovery when I first read about it. And now that I have read a lot more, it seems to be moving from “helping with” towards something that looks like this definition that I found in a «Guide to Government health and social care jargon»:

Recovery: Persuade GPs and psychiatrists to tell everyone they are now well and don't need help - cut services. 

In Googling “recovery health”, I no longer get this Wikipedia article on the first page, I get links to what looks like a thriving recovery industry based on the good oldfashioned principle of "helping at".

And now "Psychiatry Embraces Patient-Centered Care" in a manner that seems aimed at medication compliance.

So I’ll be using the words “detangling” and “liberation” instead of "recovery". That fits into the story that I have never been “mentally ill”: I have reacted with natural defenses against societal harm, and I am liberating myself from both the harm and the defenses, mainly by working the words ... because  words are what I am best at. 

And in encounters with toxic psychiatry and psychology, working the words was seen as a defense against The Current Truth (it did keep changing) about me and my life and my problems. And I found this in my notes from way back then: 

"The help you offer I do not need. I do not need to be invaded by yet another story. I need to use my words to free myself from stories that others have brainwashed into me, so that my own story can emerge." 

Many years later I found a description of this process of liberation in Richard Shaull's foreword to the 1996 edition of Paolo Freire's "Pedagogy of the oppressed":
... every human being, no matter how "ignorant" or submerged in the "culture of silence" he or she may be, is capable of looking critically at the world in a dialogical encounter with others. Provided with the proper tools for such encounter, the individual can gradually perceive personal and social reality as well as the contradictions in it, become conscious of his or her own perception of that reality and deal critically with it. In this process, the old, paternalistic teacher-student relationship is overcome. A peasant can facilitate this process for a neighbour more effectively than a "teacher" brought in from outside. "People educate each other through the mediation of the world."

As this happens, the word takes on a new power. It is no longer an abstraction or magic but a means by which people discover themselves and their potential as they give names to things around them. As Freire puts it, each individual wins back the right to say his or her word to name the world.

And that brings me back to a definiton of recovery that has traction in my life:  "The regaining of what has been lost or taken away."

Sunday, 9 February 2014

More on responsibility

With the author's permission, I am posting a long excerpt - her description of a discussion on responsibility. I am ingridjoanne*:

PhebeAnn Wolframe, page 157 -159:

I picked up this sense of a coexisting individuality and collectivity again in a conversation generated by ingridjoanne’s post about the impact of science fiction author David Gerrold’s work on their life. Like Anne, ingridjoanne explains their use of terminology: “this series [Gerrold’s “War Against the Chtorr” novels] works as self-help literature for people with societal damage (my way of saying ‘dysfunction’ or ‘personality disorder’).” By connecting the commonly understood language of psychiatry (dysfunction, disorder) to their own way of understanding their experiences, ingridjoanne borrows the legitimacy of psychiatric discourse in order to make their own perceptions intelligible. The juxtaposition of their own terminology with the language of disease positions their terminology as equal to but different from psychiatric language, and in doing so, maddens psychiatric discourse, calling into question its primacy. Furthermore, their use of the first person (“my way of saying”) makes clear that their perspective is their own, and exists alongside others, including, but not necessarily limited to, the medical model. Their perspective––the idea that madness is a sign of having been damaged by society––while proclaimed as an individual standpoint, opens up a space for thinking about madness collectively, rather than as an individual problem. This interplay of individuality and collectivity continues in the comment thread for the entry. Several of the participants who followed the link that ingridjoanne posted to a sample of David Gerrold’s work went on to read it, and, like  ingridjoanne, a number of them identified strongly with what he had to say. In Gerrold’s linked chapter, which belongs to his novel A Matter for Men, a teacher, Whitlaw, asks a group of students to define responsibility. He rejects various definitions that tie responsibility to accountability, blame, shame, burden and guilt (Gerrold 404). Eventually one student suggests, borrowing from the dictionary, that “being responsible is being the source” or cause of something (405). As Whitlaw elaborates:

It’s not just source we’re talking about here, Jim. We’re talking about ownership. The word source sometimes confuses people; because source isn’t something you do—it’s something you are. So, the way we ease people into the concept and the experience of source is to talk about ownership. Not ownership as in property, but ownership as in command—as in, ‘When I teach this class, I own this room.’…

You are the source for your life, for everything that happens in it, for the effect you have on the people around you. You can create it for yourself, or you can pass that responsibility on to someone else—say, like the universe at large—and then you can pretend to be satisfied with the results, a life out of control. (406)

After considering this take on responsibility, I felt somewhat sceptical, particularly when reading it through the context of the treatment of mad people, who are often told (for example, by family members) that their problems would go away if they simply “took charge” of their lives, that is, if they were to make better decisions instead of “hiding from responsibility” behind their “symptoms” and/or their diagnoses. Calling upon the mad person to “take responsibility” can, furthermore, be a way of deflecting responsibility onto the mad person (the “failure”) and away from family, institutions, and broader social issues.  I wrote about my concerns in a comment on ingridjoanne’s entry: “I do like the idea of being ‘the source’ for your life – but I also wonder where community and social support fit into this equation? To what extent does society (or should it) also have responsibility? I think that this is an important question when we think about how mad people are treated.” Ingridjoanne responded to my comment with their reading of Gerrold’s notion of responsibility, which differed from my own. They explain:

For me, responsibility has been a key to healing: GIVING responsibility to those who have harmed me, and TAKING responsibility for my own actions. And it was this chapter of Gerrold’s that pointed me in the direction of ‘who owns what?’ I discovered that it was easier to TAKE responsibility after I had GIVEN what didn’t belong to me. (Not ‘given’ in a confrontational sense, just knowing in myself that this was not mine, this was X’s) And that leads to a reply to your question about society, I think: We cannot demand that society accept responsibility for its harmful actions, but we can refuse to carry it, and place it where it belongs. (emphasis in original)

This idea of a necessarily dual giving and taking of responsibility was a crucial distinction, one that read beyond the surface of Gerrold’s text, maddening it through experience. *** Ingridjoanne’s reading of Gerrold was one with which several blog participants identified. For example, winningpaththinking commented that it resonated with their own understanding:

This short piece was one of comfort and pain and great insight for me.

Over the numerous years of tyranny and injustice done to me, my family and others in many forms as we are seeing and hearing here I come to this belief I am the source...

Being responsible gives me integrity, reliability and ownership, thus reinforcing my right to be treated and seen as [a] unique individual who is one and all a part of society. This truth empowers me giving me the inner courage, strength and perseverance to take action, giving me the privilege and my God-given right to demand accountability from those I feel have been a part in any way of these perceived injustices. This will allow the seeds of willingness and interest to blossom as stated in the article... I will definitely read more of his works

For winningpaththinking, Gerrold’s idea of being the source is empowering because it speaks to their experiences (“over the numerous years... I come to this belief”) and provides them with an imperative to take charge of their life. It also, however, provokes them to make others accountable for the harm they have done, and for their impact on winningpaththinking’s ability to be the source, to “allow the seeds of willingness and interest to blossom” in their life. This moment of connection between ingridjoanne and winningpaththinking through Gerrold’s idea of the source is one of the relatively rare moments where a strong sense of community seemed to be present in MadArtReview.

Link to the first post on responsibility:

* I wanted to use my full name, but that was not allowed: 
The ethics advisor explained that people who have experience of the mental health system are a “vulnerable population” and that, as a researcher, I am ethically obligated to protect “their” identities. This framing of people who have mental health system experience as a group that needs to be pinned down to an identity (“vulnerable”) and regulated (via consent forms, discouragements about “outing” oneself, and management on the part of the reasoned researcher: ironically, me) reveals the university’s institutional and epistemological investment in fixing identity according to a liberal humanist framework, for the purposes of biopolitical governance. 

** PhebeAnn Wolframe on "madding": 

In the research blog, participants continually challenged the fixing of mad experience as either mental illness or a reified mad identity. Drawing on McRuer’s concept of cripping–– transforming “the substantive, material uses to which queer/disabled existence has been put by a system of compulsory able-bodiedness”––I propose the term maddening for the way in which mad communities make visible and redefine the ways in which bodies deemed mad are used discursively and materially.
*** I'm glad PhebeAnn pointed out this, as the context of the novel is post-cataclysmic: The problems facing the protagonists come from outside forces, so there is nothing to give responsibility to. Everyone knows that "X caused Y". 

In my context of societal harm, "everyone" knows that people are mentally ill or just need to to pull themselves together.