The most interesting part of this very interesting post is the topic of self- stigmatization. It permeates so many experiences, "good" and "bad". I want to 'noodle' on this for a bit!
I wanna listen to the whole article, but I had to stop when you stated the two myths. It burns my a** what psychiatry has done to people. I experienced it firsthand when there was a hormone issue and I was being diagnosed with anxiety, panic attack attacks and depression, but I was too young to be checked for hormones so from age 30 to 40 I suffered immensely. As a nurse, I have worked mental health for a short period of time and even got people discharged from facilities that did not belong there. I could write a book so I'm just gonna stop but just those first few sentences really sparked my interest because I know how the system is and it's not for us. Thank you, Sarah for shining the light and I'm back to listen to the whole article 🙏
I'm so sorry you had to go through this, Kathleen. Your experiences are fascinating. How amazing that you've helped get people discharged who didn't belong there. Such good work you're doing.
Sarah, it's just a part of my journey, and I was meant to go through it for a reason. I used to be so angry about it, but I turned that anger into helping others, which is so rewarding. I don't work in the system anymore, not for the past three years. I actually do it mainly online. I like to do it with my writing, which I'm just learning about writing since July of last year. My grandmother was a published writer. She would be so proud of me. She said I should be a writer when I was a teenager. I think I wrote a few poems. I said I'm not a writer. She saw something in me that I didn't. I had a comment from someone and actually just recommended your book to them. I think it will help them. Thank you for everything that you do. It does not go unnoticed 🙏🙏🙏
this is so good! Back in the day I went to "counseling" over my diagnosis of general anxiety disorder. I said to the therapist "this is not who I am and I'm not gonna accept it as my identity. I will be healed of it."
He said to me well if you don't have this, you would have something else and since you know how to deal with this, it's better just to have this. That is the day I got up and walked out and never returned to "counseling". It's bullshit. I'm not saying all counseling, but that was bullshit.
It's like you stated we take on this identity and it's like well. Who would I be without this and the uncertainty and the unknown can be scary .... until it's not.
I have strength that's for sure. My mom's side of the family are all northerners- my grandmother from Leominster, Massachusetts. She went to some of the best writing schools back in the day. My grandfather from Westchester County in New York. I don't recall the exact name of the city I do know mom grew up and they were members of the Westchester country club. Not meaning to go into a story about them, but grandmother worked for Fred Astaire as his PR agent. Mom knew Jimmy Stewart, and Roy Rogers actually sat on his horses. Walt Disney was gonna be her godfather, but something changed because of the kidnapping of I can't remember the name of the child back then. They were part of the motion picture business out in Hollywood as well and worked with RKO radio. One of mothers I don't know if he wasn't uncle or a great uncle he actually was an associate producer. She has so many stories. I wish she didn't have the stroke and she could write a book 😉
But yeah, my strength comes from them and also from my life experiences . I'm not wanting to water anything down. I speak what I say and sometimes people don't like it, but I don't really give a damn. They either like me or they don't. I will not only stand up for myself. I will stand up for anybody who cannot stand up for themselves. It's a calling.
Anyway, didn't mean to give you a dissertation, but just some cool facts.
The only bummer about this post is that it is evident that one very important model has been excluded - the trauma model. A comprehensively trained trauma therapist will not fall inside of what has been presented here but turn the whole post on its head. It's a good and fair view (this post) of the traditional clinical mental health model. But many of us in the field left that behind long ago.
Such a good point, Winden, and I agree. I actually don't talk about trauma in any of my work, not because it isn't important--it is!--but because I know so many people who grapple with trauma and know it's a very singular experience and treatment and not one I've been through.
After publishing Pathological, I found that many, many mental health professionals (though not PCPs, who are doing the lion's share of the diagnosing) know the limitations of the traditional biomedical model and treat patients according to a more enlightened view of diagnoses.
The majority of the public, however, firmly believes in the biomedical model and it's spread on social media as if it's the gospel truth. Very unfortunate.
I agree with you, and as someone with a serious mental illness, I find it really depressing that society has such a black-and-white view of the causes. Even in my (very good) healthcare system locally there is still a tendency to mega-label disorders first before saying “oh shit, they also have this crappy situation, family history, and unstable people around them.” I even forget that the people around me affect me just as much as whether I take my meds. It’s an ongoing struggle for so many of us - thanks for bringing it up, and I hope you’re well!
We both published posts today about correlation vs. causation!
It makes me wonder if thinking that an SSRI is helping explains a great deal of the moderate efficacy SSRIs have been shown to have. Or whether someone taking an SSRI may get better because they are combining it with other treatments such as changing behaviors and modes of thought.
This paragraph of yours below makes a crucial point.
"A vocal minority of psychiatrists and researchers pushed the biomedical model. That isn’t a crime; the crime is that they campaigned for hypothesized neurological explanations at the expense of other factors, such as environment, personality, trauma, and economic and social injustices. Doing so allowed them—and us—to shirk responsibility. If it’s all biology and genetics, then we can ignore everything else that contributes to mental distress: racial inequality, racism, economic inequality, transphobia, homophobia, misogyny, violence."
I was thinking that we both posted on this. Medication gets tricky because our bodies become dependent on them and withdrawal can feel like we're getting worse when really it's the withdrawal.
Ms. Fay, if I may say so, excellent reading, I listened rather than read.
I’m not going to justify my thesis by telling you my life experiences, my education, my story.
My thesis is that everything you say essentially aligns with my opinion, recognizing opinions are just opinions: I believe that the thought and analysis you apply to the biomedical field, can be applied to almost all areas of life. Recognizing that, for me, helped me see that almost everything I was taught in life was either incomplete or skewed in some manner, at best or just damned lies at almost worst.
Realizing this, and stopping, seeing the world through anyone else’s eyes is finally giving me some peace, even though finding peace was not the goal.
Since models are mentioned by other responders above:;
The quote "All models are wrong, but some are useful" is widely attributed to the British statistician George E.P. Box, according to lacan upc. He often used this statement to emphasize that while all models are simplifications of reality and therefore inherently imperfect, they can still be valuable tools for understanding complex systems and making predictions.
We could spend many metaphysical and epistemological days, months, years or lifetimes digging into that quote.
Very true, Jim. And when we get granular like that, it does get to this point: "that almost everything I was taught in life was either incomplete or skewed in some manner, at best or just damned lies at almost worst."
I guess the question is if there are ever facts of negation, i.e., little can be proven true but much can be shown to be false.
I’m guessing you already know the answer to this. I’m very familiar with this idea of negation as a way to define science by Carl Popper, physicist/philosopher.
It seems some, don’t ask me who as I do not remember, are starting to take issue with this way to define science.
Things are easier for me. I do not need to find “The Truth” since I look at every thing through the lens of probability.
I’ll spare your readers the dense science, math and philosophical reasons for doing so.
I believe Sigmond Freud stated his concerns that once psychotherapy became a professional career path the potential value to individuals and society would be lost. I could be wrong but as the father of it, I'm pretty sure it was him. If he could speak now, I'm sure he'd have some opinions about the state of things in his School of the Study of Thought
I have a subtle yet unique take on the theory that mental health,( or shall we call it mental balance?) is affected by our body chemistry, and vice versa.
Everything about how our body works is affected by how we maintain it in all ways.. the food we put in it (or don’t), how we exercise (or don’t) what we think (or don’t think). Of course it is, since food is what makes the fuel in our physical system for us to function. We can live on water alone for a couple of months (but we won’t be functioning well). Without water, we can only survive about three days (according to the medical texts.. I’ve not tested this out 🤣)
I’m not attempting to link major issues like schizophrenia to the food we eat, yet I do know that when my oldest daughter doesn’t eat something for four hours, her body reacts with feeling crappy, having a grouchy temper and getting depressed. I use the word depressed in this instance to represent the “I don’t care” lack of feelings. She has hypoglycemia. Depression is a flat kind of feeling, where nothing matters. If she eats within a routine pattern/number of hours/ healthy balance of protein and carbs, she doesn’t enter the “I don’t care” phase.
I’m not saying that food and water are responsible for all emotional responses of course not. Yet maintaining our body’s chemical balance does affect our ability to process information and our environment. And we are all different in our physical needs.
While it takes a bit of time to reverse the effects of poor nutrition (and thus mood and mental processes) many things can be rebalanced by attending to this first.
Sometimes it amazes me that science still doesn’t know why SSRIs help some bodies improve yet others not. I don’t think I’ve ever told a client that their imbalance was permanent. I do know that some people’s bodies have tendencies to get unbalanced chemically in one direction or another, and that tendency does seem to run in some gene pools.
Similarly, two brothers (out of my three siblings) have gut issues we need to pay attention to, as do I. My Mom had very similar bad gut issues, as did her Mom. One of my brothers inherited dark hair from my Dad, the other three of us lean towards blondes (like my mom). Two of my brothers, my Dad, myself and both my daughters have had a type of depression. My Mom, myself and both my daughters get anxiety.
I wasn’t very adept at “handling” either depression or anxiety in my thirties and early forties, but I’ve got both settled down now. Food (paying attention to what my body requires), exercise, water, and vitamins have “cured” about 85% of what was off before.
I’m not a scientist, nor an MD.. and? I have helped many regain their balance.
Your points here are very valid Sarah. I’m so sorry you had such terrible medical care when you were younger
Such good points. What we eat, what we do, and genetics are such a huge part of mental balance. I have a post coming about what a huge influence diet had on my recovery like you!
Are you familiar with Dr. Caroline Leaf, @Sarah Fay? Her book, Who Switched Off My Brain, changed my life in 2010. It was actually the impetus for “How Hard is Love?” the project I am sharing via Substack. I have subscribed to you, and would love if you would reciprocate. We probably have much in common. :)
That is awesome! I will have to look for the podcast. That would be great, thank you! I am newish to Substack and will only be posting once a week at this point.
So the fMRI studies and neurotransmitter imbalances is this more a chicken or egg debate? Like we do see differences in those with mental health issues but it’s unclear if it’s the cause or just an effect? Or is it that we really don’t see any significant changes from a “normal” individual.
Thanks for the clarification, just trying to understand better.
Very interesting article with lots to think about. Self-stigmatizing is something I feel I have been struggling with since my diagnosed personality disorders and have been exploring thoughts far too deeply in my mind. I am compelled to read this again. Thank you for your words.
The most interesting part of this very interesting post is the topic of self- stigmatization. It permeates so many experiences, "good" and "bad". I want to 'noodle' on this for a bit!
Thank you so much for reading, Pat. Self-stigmatization is such a not-talked-about-enough part of the mental health conversation.
I wanna listen to the whole article, but I had to stop when you stated the two myths. It burns my a** what psychiatry has done to people. I experienced it firsthand when there was a hormone issue and I was being diagnosed with anxiety, panic attack attacks and depression, but I was too young to be checked for hormones so from age 30 to 40 I suffered immensely. As a nurse, I have worked mental health for a short period of time and even got people discharged from facilities that did not belong there. I could write a book so I'm just gonna stop but just those first few sentences really sparked my interest because I know how the system is and it's not for us. Thank you, Sarah for shining the light and I'm back to listen to the whole article 🙏
I'm so sorry you had to go through this, Kathleen. Your experiences are fascinating. How amazing that you've helped get people discharged who didn't belong there. Such good work you're doing.
Sarah, it's just a part of my journey, and I was meant to go through it for a reason. I used to be so angry about it, but I turned that anger into helping others, which is so rewarding. I don't work in the system anymore, not for the past three years. I actually do it mainly online. I like to do it with my writing, which I'm just learning about writing since July of last year. My grandmother was a published writer. She would be so proud of me. She said I should be a writer when I was a teenager. I think I wrote a few poems. I said I'm not a writer. She saw something in me that I didn't. I had a comment from someone and actually just recommended your book to them. I think it will help them. Thank you for everything that you do. It does not go unnoticed 🙏🙏🙏
this is so good! Back in the day I went to "counseling" over my diagnosis of general anxiety disorder. I said to the therapist "this is not who I am and I'm not gonna accept it as my identity. I will be healed of it."
He said to me well if you don't have this, you would have something else and since you know how to deal with this, it's better just to have this. That is the day I got up and walked out and never returned to "counseling". It's bullshit. I'm not saying all counseling, but that was bullshit.
It's like you stated we take on this identity and it's like well. Who would I be without this and the uncertainty and the unknown can be scary .... until it's not.
I'm so impressed you were able to say that to your therapist. It shows your strength.
I have strength that's for sure. My mom's side of the family are all northerners- my grandmother from Leominster, Massachusetts. She went to some of the best writing schools back in the day. My grandfather from Westchester County in New York. I don't recall the exact name of the city I do know mom grew up and they were members of the Westchester country club. Not meaning to go into a story about them, but grandmother worked for Fred Astaire as his PR agent. Mom knew Jimmy Stewart, and Roy Rogers actually sat on his horses. Walt Disney was gonna be her godfather, but something changed because of the kidnapping of I can't remember the name of the child back then. They were part of the motion picture business out in Hollywood as well and worked with RKO radio. One of mothers I don't know if he wasn't uncle or a great uncle he actually was an associate producer. She has so many stories. I wish she didn't have the stroke and she could write a book 😉
But yeah, my strength comes from them and also from my life experiences . I'm not wanting to water anything down. I speak what I say and sometimes people don't like it, but I don't really give a damn. They either like me or they don't. I will not only stand up for myself. I will stand up for anybody who cannot stand up for themselves. It's a calling.
Anyway, didn't mean to give you a dissertation, but just some cool facts.
Thanks, Sarah 🙏
Excellent post! I am convinced we need to talk more about mental health.
Indeed! We'll keep talking.
As a kid, I saw mental health as a simple binary. You were either sane or insane. It was black and white. That sure made life simpler. Then I grew up.
I thought that too. And then I grew up too.
The only bummer about this post is that it is evident that one very important model has been excluded - the trauma model. A comprehensively trained trauma therapist will not fall inside of what has been presented here but turn the whole post on its head. It's a good and fair view (this post) of the traditional clinical mental health model. But many of us in the field left that behind long ago.
Such a good point, Winden, and I agree. I actually don't talk about trauma in any of my work, not because it isn't important--it is!--but because I know so many people who grapple with trauma and know it's a very singular experience and treatment and not one I've been through.
After publishing Pathological, I found that many, many mental health professionals (though not PCPs, who are doing the lion's share of the diagnosing) know the limitations of the traditional biomedical model and treat patients according to a more enlightened view of diagnoses.
The majority of the public, however, firmly believes in the biomedical model and it's spread on social media as if it's the gospel truth. Very unfortunate.
I agree with you, and as someone with a serious mental illness, I find it really depressing that society has such a black-and-white view of the causes. Even in my (very good) healthcare system locally there is still a tendency to mega-label disorders first before saying “oh shit, they also have this crappy situation, family history, and unstable people around them.” I even forget that the people around me affect me just as much as whether I take my meds. It’s an ongoing struggle for so many of us - thanks for bringing it up, and I hope you’re well!
Amen. I so agree.
Sarah,
We both published posts today about correlation vs. causation!
It makes me wonder if thinking that an SSRI is helping explains a great deal of the moderate efficacy SSRIs have been shown to have. Or whether someone taking an SSRI may get better because they are combining it with other treatments such as changing behaviors and modes of thought.
This paragraph of yours below makes a crucial point.
"A vocal minority of psychiatrists and researchers pushed the biomedical model. That isn’t a crime; the crime is that they campaigned for hypothesized neurological explanations at the expense of other factors, such as environment, personality, trauma, and economic and social injustices. Doing so allowed them—and us—to shirk responsibility. If it’s all biology and genetics, then we can ignore everything else that contributes to mental distress: racial inequality, racism, economic inequality, transphobia, homophobia, misogyny, violence."
I was thinking that we both posted on this. Medication gets tricky because our bodies become dependent on them and withdrawal can feel like we're getting worse when really it's the withdrawal.
But you're right.
Ms. Fay, if I may say so, excellent reading, I listened rather than read.
I’m not going to justify my thesis by telling you my life experiences, my education, my story.
My thesis is that everything you say essentially aligns with my opinion, recognizing opinions are just opinions: I believe that the thought and analysis you apply to the biomedical field, can be applied to almost all areas of life. Recognizing that, for me, helped me see that almost everything I was taught in life was either incomplete or skewed in some manner, at best or just damned lies at almost worst.
Realizing this, and stopping, seeing the world through anyone else’s eyes is finally giving me some peace, even though finding peace was not the goal.
Again, good reading and I thank you.
Just a small P.S.—
Since models are mentioned by other responders above:;
The quote "All models are wrong, but some are useful" is widely attributed to the British statistician George E.P. Box, according to lacan upc. He often used this statement to emphasize that while all models are simplifications of reality and therefore inherently imperfect, they can still be valuable tools for understanding complex systems and making predictions.
We could spend many metaphysical and epistemological days, months, years or lifetimes digging into that quote.
Very true, Jim. And when we get granular like that, it does get to this point: "that almost everything I was taught in life was either incomplete or skewed in some manner, at best or just damned lies at almost worst."
I guess the question is if there are ever facts of negation, i.e., little can be proven true but much can be shown to be false.
I’m guessing you already know the answer to this. I’m very familiar with this idea of negation as a way to define science by Carl Popper, physicist/philosopher.
It seems some, don’t ask me who as I do not remember, are starting to take issue with this way to define science.
Things are easier for me. I do not need to find “The Truth” since I look at every thing through the lens of probability.
I’ll spare your readers the dense science, math and philosophical reasons for doing so.
I believe Sigmond Freud stated his concerns that once psychotherapy became a professional career path the potential value to individuals and society would be lost. I could be wrong but as the father of it, I'm pretty sure it was him. If he could speak now, I'm sure he'd have some opinions about the state of things in his School of the Study of Thought
Good point.
“The medical model saved my life; the recovery model gave me my life.” - well summed up
Isn't it? It's such a nuanced way to look at it instead of opting for anti- or pro- biological psychiatry.
I have a subtle yet unique take on the theory that mental health,( or shall we call it mental balance?) is affected by our body chemistry, and vice versa.
Everything about how our body works is affected by how we maintain it in all ways.. the food we put in it (or don’t), how we exercise (or don’t) what we think (or don’t think). Of course it is, since food is what makes the fuel in our physical system for us to function. We can live on water alone for a couple of months (but we won’t be functioning well). Without water, we can only survive about three days (according to the medical texts.. I’ve not tested this out 🤣)
I’m not attempting to link major issues like schizophrenia to the food we eat, yet I do know that when my oldest daughter doesn’t eat something for four hours, her body reacts with feeling crappy, having a grouchy temper and getting depressed. I use the word depressed in this instance to represent the “I don’t care” lack of feelings. She has hypoglycemia. Depression is a flat kind of feeling, where nothing matters. If she eats within a routine pattern/number of hours/ healthy balance of protein and carbs, she doesn’t enter the “I don’t care” phase.
I’m not saying that food and water are responsible for all emotional responses of course not. Yet maintaining our body’s chemical balance does affect our ability to process information and our environment. And we are all different in our physical needs.
While it takes a bit of time to reverse the effects of poor nutrition (and thus mood and mental processes) many things can be rebalanced by attending to this first.
Sometimes it amazes me that science still doesn’t know why SSRIs help some bodies improve yet others not. I don’t think I’ve ever told a client that their imbalance was permanent. I do know that some people’s bodies have tendencies to get unbalanced chemically in one direction or another, and that tendency does seem to run in some gene pools.
Similarly, two brothers (out of my three siblings) have gut issues we need to pay attention to, as do I. My Mom had very similar bad gut issues, as did her Mom. One of my brothers inherited dark hair from my Dad, the other three of us lean towards blondes (like my mom). Two of my brothers, my Dad, myself and both my daughters have had a type of depression. My Mom, myself and both my daughters get anxiety.
I wasn’t very adept at “handling” either depression or anxiety in my thirties and early forties, but I’ve got both settled down now. Food (paying attention to what my body requires), exercise, water, and vitamins have “cured” about 85% of what was off before.
I’m not a scientist, nor an MD.. and? I have helped many regain their balance.
Your points here are very valid Sarah. I’m so sorry you had such terrible medical care when you were younger
I love the term mental balance!
Such good points. What we eat, what we do, and genetics are such a huge part of mental balance. I have a post coming about what a huge influence diet had on my recovery like you!
Thank you for understanding my comment as I intended it. You rock! 💞
Are you familiar with Dr. Caroline Leaf, @Sarah Fay? Her book, Who Switched Off My Brain, changed my life in 2010. It was actually the impetus for “How Hard is Love?” the project I am sharing via Substack. I have subscribed to you, and would love if you would reciprocate. We probably have much in common. :)
I do know her! I was on her podcast when Pathological first came out. I'll check out your Substack when I have the time.
That is awesome! I will have to look for the podcast. That would be great, thank you! I am newish to Substack and will only be posting once a week at this point.
So the fMRI studies and neurotransmitter imbalances is this more a chicken or egg debate? Like we do see differences in those with mental health issues but it’s unclear if it’s the cause or just an effect? Or is it that we really don’t see any significant changes from a “normal” individual.
Thanks for the clarification, just trying to understand better.
Very interesting article with lots to think about. Self-stigmatizing is something I feel I have been struggling with since my diagnosed personality disorders and have been exploring thoughts far too deeply in my mind. I am compelled to read this again. Thank you for your words.