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  • Writer's pictureDouglas Pfeifer

Changing the Mental Health Lens: Rethinking the Mental Health System

By: Douglas Pfeifer MA, LPC, ALPS

“Why do we keep calling it PTSD? Why do we keep calling it a disorder? If you are going to turnaround to someone and label them a disorder, that’s them screwed for the rest of their life.” Says Prince Harry in an interview with Harpaars Bazaar. He goes on to say, “Why are we not calling it PTSI? It should be an injury. If you are telling someone they’ve got an injury, then guess what they’re going to do? They’re going to try and get better.” This quote really resonated with me and the mission we have of reducing stigma and helping people make a proactive commitment to taking care of their mental health. The term mental health is almost looked at as a curse word. Something we should not say, a bad thing. But in reality, mental health is not good or bad. This term is defined as a person’s condition with regard to their psychological and emotional well being. Basically, what is our current psychological and emotional state and how does this state impact the way we function in our life. Similarly, what state is our physical health in and how does it impact our ability to function in our life. If we are physically injured, for the most part, we go to the doctor and get checked out. We don’t have the same belief’s about ourself when we go to the doctor for a physical ailment like the flu or a torn ACL. But if we have experienced a really painful life event that has created sadness and grief, we don’t think it’s okay to reach out for help and support. At least not until it gets really, really bad. Often times, in the mental health field, people are reaching out in considerable crisis. It would be like an athlete straining his ACL in his knee and continuing to play and play despite this injury. As a result, the ACL progresses from strain, to sprain to complete tear and likely injury of other ligaments in the knee. Now, instead of rest and ice, the athlete is requiring reconstructive surgery and months of rehabilitation. This typically doesn’t happen. Treatment gets addressed quickly. But not in the mental health world. We have to wait till things gets really bad.

50 million people in the United States suffer from a diagnosable mental health condition and 27 million of that 50 million have not received any treatment. Most barriers have resources available to overcome so someone can access services. Financial resources are more available through grants and local governmental support. The number of mental health agencies around the country is rivaling the number of Starbucks. And now, we don’t even have to leave our house to get therapy as we can access services through telehealth. Despite all of these resources, we still have over half of those suffering not seeking out or accessing mental health services. Our mental health system is not set up to inspire hope and optimism about our ability to create positive change. What is the first thing that you have to do when you seek mental health services? Get assessed by a licensed clinician to find out what lucky disorder you might have from the DSM 5 (Diagnostic and Statistical Manual-5th Edition). An approximately 1000 page book full of disorders that we will have to make sense of before we can even try to help the person heal.

When you hear the word disorder, what comes to mind? You might be thinking of words like broken, damaged, or words like hopeless and helpless. Ultimately, it likely describes something inherently wrong with you. I remember often working with kids, diagnosed with things like ADHD, Bipolar, Depression and often telling me, “I can’t help it, I have Bipolar.” This illustrates the struggle in mental health treatment to keep these labels from becoming the client’s identity. You would often see mental health experts and academics encourage clinicians to say, “this person suffers from Bipolar or suffers from depression versus this person is bipolar of is depressed. It doesn’t matter how you say it, people suffering are more likely to become their label and disorder. To make matters worse, there are significant criticisms about the DSM-5 specifically related to the fact that they DSM is reliable, meaning that multiple clinicians assessing the same individual will come to the same diagnostic conclusion. However, the DSM-5 is not valid, meaning that the diagnosis is not accurate. Take ADHD for example. A child can meet criteria for Attention Deficit Hyperactivity Disorder because they have inattention and hyperactivity issues that meet the symptom criteria. However, there are many reasons why someone would have problems with paying attention and controlling our arousal levels. Depressed feelings, intrusive thoughts and images from past traumas, living in a toxic stress environment, learning problems, lack of opportunity for movement and physical activity and having to behave in a developmentally misinformed environment. The point is that we spend too much time focusing on a diagnosis that is often not accurate instead of truly trying to understand the experience of the person seeking treatment This leads me to my next point into shifting our focus from disorder to injury.

In 1995-1997, Kaiser Permanente and Dr. Fellini developed a study that looked at the impact of childhood adversity on our health. This was a groundbreaking study that really highlighted that impact of adverse childhood experiences on our physical and mental health. That the more adversity a person experiences in their childhood, the more likely the person will experience poor health outcomes such as diseases like cancer and also be at risk for behavioral health issues like addiction and suicide. This, along with the trauma informed movement in our field has rightfully shifted the critical diagnostic question from What is Wrong with You (not trauma informed) to What has happened to You? (Trauma and Developmentally Informed). This question is of critical importance because we are our experiences and we function as a result of those experiences. We are impacted by our adversities and our relational health. Dr. Bruce Perry, in his newest book What Happened to You? describes a relationship between adversity and relational health. If we have high adversity and low relational health, we are at high developmental risk. Meaning we are risk for a variety of physical and behavioral health problems. Conversely, if we have high relational health and low adversity, we are at low developmental risk. Relational health can act as a buffer to adversity and prevent these poor health outcomes. This understanding falls in line with injury. We experience an adverse life experience which creates a mental health injury. In the same way running and rolling our ankle creates a physical injury. No one seeks out mental health treatment when everything in their world is going great. Depression, anxiety, mood problems and trauma stems from life experiences that impact our ability to cope. Nothing comes from nothing. Our coping style to these life experiences is what brings about the labels and diagnosis. However, our ability to create positive change lies in working through the painful experiences and not found in the label.

Circling back to Prince Harry’s quote, mental health injury does not become our identity. Those who have experienced a torn ACL are not referred to as Torn ACLers. They have an ACL injury and they are going to physical therapy to rehabilitate. In fact, Torn ACL gives you a source of the problem and a clear direction on how to heal. ADHD or Depression, does not give you a clear source of the problem. It gives you a list of symptoms but not what drives those symptoms. Clinicians and clients typically find themselves at a loss and frustrated on how to help those in need. Interestingly, good therapy clinicians, by pass the importance of the disorder and instead, take a developmental approach to assessment and treatment by asking What has happened to you instead of what is wrong with you. This leads to finding the sources of the symptomology that creates the DSM labels. Therefore, providing clinicians and clients a good direction to move in when try to create positive change.

Treatment is comparable to treatment of a physical injury like a torn ACL. Like building up the muscles that support the Knee and it’s ligaments, therapy will focus on building up regulation skills to help manage difficulty and challenging emotional states that leads to the maladaptive coping. Unfortunately, we can’t take away the painful traumas. However, we can build resilience. This maybe going to the source of the injury or building up internal strengths but likely both. Injury indicates opportunity. Injury gives us hope. Injury much like adversity provides the opportunity to build resilience. Becoming strong despite our adversities!

An additional issue around the unintended consequences of disorder and diagnosis of mental health symptomology that is based on what has happened to us is that non-mental health professionals are often at a loss on how to support and help our friends, peers and family. The key to healing is community and connection and yet we are often isolated when suffering from a mental health condition and push the people away. Would we push people away and disconnect if we didn’t look through the lens of disorder or disease. Would we push people away or hide our mental health struggles it we understood mental health through the lens of injury? To me, injury normalizes mental health. It is something that we all experience and at varying degrees. Just like a physical injury, such as a sprained ankle, our injury requires healing. For an injury like a twisted ankle, we might only need to employ RICE-Rest, Ice, Compression, and Evaluation. But with a more severe ankle injury, we might require treatment like physical therapy or at the most intense level of intervention require surgery. With a mental health injury like experiencing grief symptoms as a result of losing a loved one, all that might be required is spending time with family and having ceremony and ritual to mourn the loss. However, if the injury of grief is more severe, longer lasting, it might require some mental health intervention like therapy and if more intense of an injury, possibly require an intensive mental health program to effectively heal the injury. We can assess the intensity of the injury and implement a treatment protocol based on that intensity. Whereas my disorder becomes my identity which impacts my sense of recovery and healing. Some injuries are certainly more severe than others and we might be more vulnerable to certain types of mental health injuries. There might be injuries we experience that require longer term attention. However, I believe that even changing the lens to injury will help us be more successful at treatment of mental health problems and reduce the amount of people requiring long term intervention. Much like improvements in cancer research leads to less long term treatments of cancer.

Physical injury and mental health injuries might require a different style of intervention but the framework about how we view the problem is the same. And how we view the problem greatly determines how we intervene. Although the system won’t change because I wrote this blog, your framework can move from “I have a disorder and something is inherently wrong and therefore a flaw,” to “I have suffered a mental health injury that requires healing.” Healing that focuses on connection and building a resilient stress response system and build skills to better face the problems in our world. Just like you build muscles to support the injured joint in your body, we have to support the muscles of our mind to heal our emotional injuries.

A2R Counseling and Consulting focuses on mental health as an injury that needs heaingl. Through breathing, laughter, movement. Through connection and self-reflection. We have the ability to be resilient and overcome our adversities. I leave you with this quote from Bruce Lee that illustrates the capability we have to heal and overcome our adversities. “The medicine for my suffering I had within me from the very beginning but I did not take it. My ailment came from within myself but I did not observe it until this moment. Now I see I will never find the light unless, like a candle, I am my own fuel.”

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