Worsening mental health in society

[genop]

I am a healthcare professional, but I’m not in the mental health field. However, I am very passionate about mental health and health in general. I wanted to share some thoughts/questions I’ve had for awhile, and see if others have any opinions about these issues.

1. There are more psych medications, more access to therapy and treatment, and less stigma than there previously was, and yet, the population’s mental health seems to be declining. I understand that access and stigma are still huge issues, but isn’t it strange that with more treatment, mental health is still declining? Could it be that our approach to mental health diagnoses and implementation of treatment are at least partially to blame? (I know correlation does not equal causation)

Don’t you think the DSM is unscientific and lacks validity?

If we do not conceptualize a problem accurately and properly, how can we effectively treat it? Typically, correctly identifying and defining a problem is the first step to adequately solving and addressing it.

So much of these so-called mental illnesses seem to be normal human responses to trauma, excessive life stressors, oppression, systemic issues, societal issues, terrible life circumstances, living in a capitalist society etc. As Krishnamurti said, “It’s no measure of health to be well-adjusted to a profoundly sick society.”

While I don’t promote having a victim mentality, I do think it’s wrong to label someone as mentally ill when there’s actually nothing wrong with them and they are responding in a reasonable and understandable way considering the circumstances. For example, I don’t think it’s right to label someone with PTSD due to gang rape as mentally ill. I’m not saying that person does not need help and support. I’m just saying that person is not diseased or disordered for reacting in a normal way to abnormal circumstances. Their biological, psychological, and physiological response was normal and serves an evolutionary purpose. Going into Fight, flight, freeze mode sometimes is normal. The issue is our modern society. We were not meant to deal with these types of acute and chronic stressors for such long periods of time without adequate rest and safety in between.

2. What percentage of psychologists would you say are competent at assessments and/or therapy? What percentage of therapists (non-psychologists) would you say are competent? Would you trust a majority of psychologists and therapists to assess or treat your loved ones? Is the level of incompetence and harm that is done not concerning, especially since it involves such a vulnerable population? There’s such a lack of accountability. Unless someone does something completely unethical like sleeping with their client, nothing is really done about the harm that mental health professionals inflict on clients/patients. While I don’t think most do it intentionally, it still happens way more than expected, and so many clinicians lack self-awareness about it. People brush it off as it just not being a good fit instead of lack of competence on the professional’s part. I also read that research shows therapists are terrible at judging how well therapy is going. A lot of times they think it’s going well and the client is being helped when that’s not the case. Can you imagine going to a doctor who can’t properly assess how well his treatment is working?

3. I have seen a large number of individuals over identify with their diagnosis as if it’s a core part of their identity. It’s downright harmful in my opinion. Many people are wanting a specific diagnosis and getting angry or upset if the healthcare professional doesn’t give them said diagnosis. So many people seem to want to be autistic, or have ADHD or trauma.

I have more thoughts and could elaborate more on the ones I already wrote, but I don’t want to make this post longer than it already is, and I’m curious to read what others think about these issues.

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[Mama Bear]

1. There are more psych medications, more access to therapy and treatment, and less stigma than there previously was, and yet, the population’s mental health seems to be declining. I understand that access and stigma are still huge issues, but isn’t it strange that with more treatment, mental health is still declining? Could it be that our approach to mental health diagnoses and implementation of treatment are at least partially to blame? (I know correlation does not equal causation)

Another possibility is that increasing attention/awareness in our society creates conditions in which people become more aware of their psychological functioning, thereby leading more people to identify their concerns as mental health-related.

Don’t you think the DSM is unscientific and lacks validity?

The DSM has been developed and updated based on science and clinical utility. No, it is not perfect, but it is not accurate to label it “unscientific.”

So much of these so-called mental illnesses seem to be normal human responses to trauma, excessive life stressors, oppression, systemic issues, societal issues, terrible life circumstances, living in a capitalist society etc. As Krishnamurti said, “It’s no measure of health to be well-adjusted to a profoundly sick society.”

What you describe is a genuine stance people take to describe some psychological reactions. In a perfect world, everyone would clearly understand the difference between an abnormal response (psychopathology) and a normal response to a bad situation. Diagnostic criteria intends to do so, but we will still have people out there who misunderstand or miscategorize. Sometimes my work involves helping my clients/patients understand that they may not actually have a mental health diagnosis but rather a normal reaction.

For example, I don’t think it’s right to label someone with PTSD due to gang rape as mentally ill. I’m not saying that person does not need help and support. I’m just saying that person is not diseased or disordered for reacting in a normal way to abnormal circumstances.

PTSD is by definition a mental illness involving a set of reactions to a traumatic event, but there are a myriad of factors that predict the development of PTSD (I.e., not everyone who experiences a traumatic event develops PTSD, hence the diagnostic label to describe this particular outcome). We can definitely acknowledge that a traumatic situation was a contributing factor. We do not need to label someone negatively, but the reality is that we have diagnoses to help us understand someone’s clinical presentation.

Can you imagine going to a doctor who can’t properly assess how well his treatment is working?

Yes, I can. Quite vividly.

3. I have seen a large number of individuals over identify with their diagnosis as if it’s a core part of their identity. It’s downright harmful in my opinion. Many people are wanting a specific diagnosis and getting angry or upset if the healthcare professional doesn’t give them said diagnosis. So many people seem to want to be autistic, or have ADHD or trauma.

Yes, one outcome of people talking about mental health more in our society is that some people may misunderstand, self diagnose, disagree with professionals by thinking they know better, etc. we are gaining the benefit of people accepting mental health explanations (reduced stigma) at the risk of people overly relying on or self-diagnosing. To your point above, people may overpathologize normal human reactions. We will always be trading one problem for another in our society. I agree that there will be clinicians out there who are bad at their jobs, but make sure not to confound the phenomenon of people self-diagnosing as an error on the clinicians part.

 

[Fan_of_Meehl]

I am a healthcare professional, but I’m not in the mental health field. However, I am very passionate about mental health and health in general. I wanted to share some thoughts/questions I’ve had for awhile, and see if others have any opinions about these issues.

1. There are more psych medications, more access to therapy and treatment, and less stigma than there previously was, and yet, the population’s mental health seems to be declining. I understand that access and stigma are still huge issues, but isn’t it strange that with more treatment, mental health is still declining? Could it be that our approach to mental health diagnoses and implementation of treatment are at least partially to blame? (I know correlation does not equal causation)

Don’t you think the DSM is unscientific and lacks validity?

If we do not conceptualize a problem accurately and properly, how can we effectively treat it? Typically, correctly identifying and defining a problem is the first step to adequately solving and addressing it.

So much of these so-called mental illnesses seem to be normal human responses to trauma, excessive life stressors, oppression, systemic issues, societal issues, terrible life circumstances, living in a capitalist society etc. As Krishnamurti said, “It’s no measure of health to be well-adjusted to a profoundly sick society.”

While I don’t promote having a victim mentality, I do think it’s wrong to label someone as mentally ill when there’s actually nothing wrong with them and they are responding in a reasonable and understandable way considering the circumstances. For example, I don’t think it’s right to label someone with PTSD due to gang rape as mentally ill. I’m not saying that person does not need help and support. I’m just saying that person is not diseased or disordered for reacting in a normal way to abnormal circumstances. Their biological, psychological, and physiological response was normal and serves an evolutionary purpose. Going into Fight, flight, freeze mode sometimes is normal. The issue is our modern society. We were not meant to deal with these types of acute and chronic stressors for such long periods of time without adequate rest and safety in between.

2. What percentage of psychologists would you say are competent at assessments and/or therapy? What percentage of therapists (non-psychologists) would you say are competent? Would you trust a majority of psychologists and therapists to assess or treat your loved ones? Is the level of incompetence and harm that is done not concerning, especially since it involves such a vulnerable population? There’s such a lack of accountability. Unless someone does something completely unethical like sleeping with their client, nothing is really done about the harm that mental health professionals inflict on clients/patients. While I don’t think most do it intentionally, it still happens way more than expected, and so many clinicians lack self-awareness about it. People brush it off as it just not being a good fit instead of lack of competence on the professional’s part. I also read that research shows therapists are terrible at judging how well therapy is going. A lot of times they think it’s going well and the client is being helped when that’s not the case. Can you imagine going to a doctor who can’t properly assess how well his treatment is working?

3. I have seen a large number of individuals over identify with their diagnosis as if it’s a core part of their identity. It’s downright harmful in my opinion. Many people are wanting a specific diagnosis and getting angry or upset if the healthcare professional doesn’t give them said diagnosis. So many people seem to want to be autistic, or have ADHD or trauma.

I have more thoughts and could elaborate more on the ones I already wrote, but I don’t want to make this post longer than it already is, and I’m curious to read what others think about these issues.

I assume you came here for honest opinions.

1. There is a movement afoot to move to more dimensional/ contextual models (on many fronts) and away from categorical (a la DSM nosology) models...but...the classic paradigm has a good deal of utility and validity and it's no easy thing to re-conceptualize mental illness and its treatment.

I saw a newspaper article today bemoaning cognitive-behavioral therapy as wrongheaded and 'unethical' when it comes to helping people who are suffering from clinical anxiety, depression, or trauma and stressor-related disorders if they happen to be a 'marginalized' class or a victim of 'societal' forces...etc. This is going to do a lot of harm to people. We have to be very careful here. Just because someone, say, is African-American and bisexual, it doesn't mean that our scientific models about how to treat depression effectively are invalid or that they don't necessarily apply--at least fundamentally--to these people. I'm all for (quality) scientific and clinical investigations testing hypotheses about how (if at all) our theories and interventions should be modified to be more effective with certain populations, but...these populations can suffer from clinical depression (just like everyone else) and things like behavioral activation or helping them understand that depression does tend to distort one's thinking and emotions in certain ways which can be responsive to therapy are critical to actually helping them vs. feeling smug and good about ourselves and our 'evolved' status. The article completely mischaracterized the cognitive-behavioral approach to helping people understand and respond to horrible treatment or injustices. The article (wrongly) says that a cognitive-behavioral therapist would (necessarily) blame the victim and say they were engaging in cognitive distortions. No decently trained CBT therapist would do that. First, we know that bad things happen to rational people. Not everything is a distortion and it isn't our job to tell patients what or how to think about themselves, their history, or their problems. Second, even in horrible circumstances, it is useful to be supportive in helping a person in their attempts to cope with these circumstances and to make the best of it. Victor Frankl wrote a book on this topic about his experiences in a concentration camp. Psychotherapy is, by definition, focused on self-evaluation and self-change. I work with trauma victims on a daily/hourly basis five days per week. None of that work involves unnecessary 'pathologization' of these people. However, I don't lie to them or myself either. It helps no one. Of COURSE there are pathologies involved. Otherwise, it's not a problem/illness requiring treatment. We do neither ourselves nor our patients any favors by thinking/talking/philosophizing ourselves into circles or trying to practice 'double-think' in the form of simultaneously saying (a) these people are 'normal' and it is the pathology of society that wrongly thinks they have a problem and, simultaneously, saying (b) these people are suffering from dire problems caused by 'society' (or 'the patriarchy' or...you name it) and they are victims and we should feel horrible about it.

Psychotherapists help people examine and--if called for--modify their own beliefs and behaviors.

I don't know who is responsible for 'changing society' itself if that is where we locate the pathology...you? 19 year old dewey-eyed undergrads from Ivy League Universities? Politicians? NGO's? International corporations? Defense contractors? The major news networks or magazines?

2. Competence varies quite a bit. A few are horrible, many are adequate, a few are excellent. In my experience the incidents of truly sadistic/criminal or malevolent acts perpetrated on patients by mental health providers are (thankfully) rare. Far more often people are okay with being mediocre, lazy, avaricious, or cowardly. But a well-trained, earnest, and skilled individual psychotherapist can do an incredible amount of good in the world, one person at a time.

3. I'm not even going to touch this one because I work in the VA system and if I even started typing I wouldn't stop until I was about forty pages into it.

 

[clausewitz2]

The fundamental problem of the DSM is that it is trying to serve many, many masters simultaneously and so is the epitome of the idea that a true compromise means nobody is happy with the outcome. A good article on some of the reasons it was never going to be very conceptually coherent:

https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12075

 

[deleted1038433]

Could it be that our approach to mental health diagnoses and implementation of treatment are at least partially to blame?

Yes

2. What percentage of psychologists would you say are competent at assessments and/or therapy? What percentage of therapists (non-psychologists) would you say are competent? Would you trust a majority of psychologists and therapists to assess or treat your loved ones? Is the level of incompetence and harm that is done not concerning, especially since it involves such a vulnerable population?

It depends on a variety of factors. I'm pretty down about therapy these days. I think therapy can be a helpful tool in mental health recovery. Therapy success is best predicted by patient characteristics coming into treatment and the therapeutic relationship. I think diagnostic assessments serve little therapeutic purpose most of the time. I have told people I have worked with in the past that it doesn't matter to me what their diagnosis is and that I don't necessarily care about their diagnosis. I care about the individual person and how we can work together to help them make change in their life. A lot of the people I try to help would best be helped by an increase in finances, social support, etc. and the problems they present with make perfect sense in relation to their environmental circumstances. I can't help much with the systemic issues. I can do my best to help facilitate change on the things that are within their power to change (how they respond behaviorally, emotionally, cognitively). I believe in functional analysis and addressing the mechanisms that maintain problems (e.g., avoidance, rumination, anhedonia). I don't need the DSM to do the work I do. I don't trust most therapists to do a proper functional analysis or to treat my loved ones.

3. I have seen a large number of individuals over identify with their diagnosis as if it’s a core part of their identity. It’s downright harmful in my opinion.

Yes, it is harmful. A diagnostic label is just a current best guess we use for insurance/billing purposes. Show me the behavior and its antecedents and consequences.

 

[genop]

The fundamental problem of the DSM is that it is trying to serve many, many masters simultaneously and so is the epitome of the idea that a true compromise means nobody is happy with the outcome. A good article on some of the reasons it was never going to be very conceptually coherent:

https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12075

Are you familiar with Dr. Allen Frances and his views on the DSM? He was chair of the DSM IV. Do you agree with him? I’m sure you know of Dr. Thomas Szasz. Do you agree with his views at all?

 

[Sanman]

I am a healthcare professional, but I’m not in the mental health field. However, I am very passionate about mental health and health in general. I wanted to share some thoughts/questions I’ve had for awhile, and see if others have any opinions about these issues.

1. There are more psych medications, more access to therapy and treatment, and less stigma than there previously was, and yet, the population’s mental health seems to be declining. I understand that access and stigma are still huge issues, but isn’t it strange that with more treatment, mental health is still declining? Could it be that our approach to mental health diagnoses and implementation of treatment are at least partially to blame? (I know correlation does not equal causation)

There are more medications, more access to treatments, and less stigma and yet rates of obesity, diabetes, and heart disease continue to increase in the U.S.

Don’t you think the DSM is unscientific and lacks validity?

If we do not conceptualize a problem accurately and properly, how can we effectively treat it? Typically, correctly identifying and defining a problem is the first step to adequately solving and addressing it.

So much of these so-called mental illnesses seem to be normal human responses to trauma, excessive life stressors, oppression, systemic issues, societal issues, terrible life circumstances, living in a capitalist society etc. As Krishnamurti said, “It’s no measure of health to be well-adjusted to a profoundly sick society.”

While I don’t promote having a victim mentality, I do think it’s wrong to label someone as mentally ill when there’s actually nothing wrong with them and they are responding in a reasonable and understandable way considering the circumstances. For example, I don’t think it’s right to label someone with PTSD due to gang rape as mentally ill. I’m not saying that person does not need help and support. I’m just saying that person is not diseased or disordered for reacting in a normal way to abnormal circumstances. Their biological, psychological, and physiological response was normal and serves an evolutionary purpose. Going into Fight, flight, freeze mode sometimes is normal. The issue is our modern society. We were not meant to deal with these types of acute and chronic stressors for such long periods of time without adequate rest and safety in between.

Do you think that we are conceptually treating the problem when we prescribe medications like Ozempic for obesity or drugs for diabetes? Do you think this may have to do with the lifestyle pushed on Americans? Chronic stressors can also contribute to these diseases and lifestyle change is a safer and more permanent solution than medications in many cases. Your beef seems to be with the medical establishment more than mental health. They decided a diagnosis is required for payment...so we diagnose. What good does it do to label people as overweight or obese when there is little that can be done about this in a physician's office?

2. What percentage of psychologists would you say are competent at assessments and/or therapy? What percentage of therapists (non-psychologists) would you say are competent? Would you trust a majority of psychologists and therapists to assess or treat your loved ones? Is the level of incompetence and harm that is done not concerning, especially since it involves such a vulnerable population? There’s such a lack of accountability. Unless someone does something completely unethical like sleeping with their client, nothing is really done about the harm that mental health professionals inflict on clients/patients. While I don’t think most do it intentionally, it still happens way more than expected, and so many clinicians lack self-awareness about it. People brush it off as it just not being a good fit instead of lack of competence on the professional’s part. I also read that research shows therapists are terrible at judging how well therapy is going. A lot of times they think it’s going well and the client is being helped when that’s not the case. Can you imagine going to a doctor who can’t properly assess how well his treatment is working?

What percentage of physicians, NPs, and PAs do you think are incompetent. What percentage can come to a correct diagnosis in 5-10 min. What kind of iatrogenic harm is caused by prescribing the incorrect medications? Medications can cause Cancer and organ failure. What damage does psychotherapy cause?

3. I have seen a large number of individuals over identify with their diagnosis as if it’s a core part of their identity. It’s downright harmful in my opinion. Many people are wanting a specific diagnosis and getting angry or upset if the healthcare professional doesn’t give them said diagnosis. So many people seem to want to be autistic, or have ADHD or trauma.

I have more thoughts and could elaborate more on the ones I already wrote, but I don’t want to make this post longer than it already is, and I’m curious to read what others think about these issues.

I have seen people identify based on their medical disorder as part of a community. Obesity is a lifestyle choice that should not be questioned according to some people. What do you do about that as a healthcare provider?

 

[genop]

There are more medications, more access to treatments, and less stigma and yet rates of obesity, diabetes, and heart disease continue to increase in the U.S.


Do you think that we are conceptually treating the problem when we prescribe medications like Ozempic for obesity or drugs for diabetes? Do you think this may have to do with the lifestyle pushed on Americans? Chronic stressors can also contribute to these diseases and lifestyle change is a safer and more permanent solution than medications in many cases. Your beef seems to be with the medical establishment more than mental health. They decided a diagnosis is required for payment...so we diagnose. What good does it do to label people as overweight or obese when there is little that can be done about this in a physician's office.


What percentage of physicians, NPs, and PAs do you think are incompetent. What percentage can come to a correct diagnosis in 5-10 min. What kind of iatrogenic harm is caused by prescribing the incorrect medications? Medications can cause Cancer and organ failure. What damage does psychotherapy cause?


I have seen people identify based on their medical disorder as part of a community. Obesity is a lifestyle choice that should not be questioned according to some people. What do you do about that ad a healthcare provider?

I actually agree with you on all of it. That’s why I said the problem is with our modern society. It’s not conducive to good health. I just didn’t focus on physical illnesses since this is a psychology forum. I’m all for lifestyle changes.

Furthermore, I still think the DSM is greatly problematic, and psychiatric labels do more harm than good. I understand labels are needed for reimbursement, but why can’t that be changed? When DSM 5 took away the bereavement exclusion to Major Depressive Disorder, that’s when I really couldn’t ignore the problem any longer.

Most medical diseases are understood and defined in a more scientific way. There’s a distinct pathophysiology; there are labs, imaging, biomarkers, findings on physical assessments, etc. The opposite is true of most mental illnesses. One can’t just decide one day that certain behaviors, feelings, and thoughts are pathological and call it an illness or disorder, especially if they are part of the normal human experience. That’s not how science works. Some experts, a majority of whom have ties to the pharmaceutical industry, sat around and decided on what symptoms they want to call a mental illness, completely ignoring etiology and any context in which the symptoms occurred. They do say to rule out medical illness as the cause of symptoms, but that’s about it. A large portion of the population now qualifies as having a mental illness, even though they are just having normal human reactions to life.

I want to emphasize that just because I don’t think of a lot of the mental illnesses in the DSM as diseases or disorders, it doesn’t mean I don’t think people with those symptoms shouldn’t get help. I wish everyone could have access to effective therapy.

There’s not enough focus on prevention whether we are talking about mental or physical illness. I personally don’t like to make a huge distinction between physical and mental because they are interrelated. Proper diet, exercise, sleep, hydration, minimizing stress, spending time in nature, and good social support are key to good health. There’s not enough focus on that because it’s not as profitable as letting someone become obese with multiple health conditions, having to see multiple specialists, having difficulty with their mental health…

Systemic issues play a huge role in causing poor mental and physical health. If we lived in a more just society where profits were not prioritized over people and the environment, we wouldn’t have as big of a problem as we do now. People are lonely and isolated, they’re eating poorly, sleeping poorly, don’t have healthy social connections, spend too much time on social media and electronics, don’t spend enough time outside in nature, don’t exercise, go to stressful jobs and don’t even make a livable wage, medical costs have skyrocketed, so many don’t have access to high quality and affordable medical and mental health care, people are self-treating mental health issues with addictive substances…We prioritize driving cars instead of public transportation and safe bike/walk paths. This leads to death and disability from car accidents, increased stress from sitting in traffic, increased risk for obesity and heart disease from having a sedentary lifestyle…

I wish doctors and psychologists would play a bigger role in effecting positive change in society and advocating for good practices, policies, laws, and regulations with the goal of improving the population’s health since they are the experts (it backfired with the psychiatrists and the DSM). I had so much hope when Dr. Thema became president of APA, but it doesn’t seem like anything really changed much.

To answer your question about incompetence, in my experience, most physicians are competent. I can’t say the same of PAs and NPs. Physicians still make a lot of mistakes, but it’s not due to incompetence or lack of knowledge most of the time. It seems like there are a lot of incompetent therapists doing harm. I wasn’t sure if they are in the minority so I asked the experts here. I’m surprised you asked how psychotherapy can harm. I’m sure you know the answer to that as a psychologist.

Anyway, I think it’s great that some are providing effective therapy. That’s so important, and we need to increase access to affordable and effective therapy. I just don’t think it’s enough to overcome all the systemic issues, and I think psychologists and physicians are respected enough that perhaps lawmakers would listen. As long as we conceptualize mental illness as a problem or disease of the individual, ignoring the root of the problem and systemic factors at play, we cannot effectively address it. The people responsible for a lot of the suffering will continue to evade accountability.

 

[genop]

And thank you guys for doing what you do. I can’t imagine how hard and draining the work must be.

 

[PsyDr]

1) The answer to your leading questions is "no". Don't you think?
2) I read something somewhere that said that you are not in healthcare. You see how these unverifiable arguments go?
3) If you read the DSM cover to cover before you criticized it, you'd know it said, "“An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.”. If you didn't know that, you'd look very foolish.
4) Where is your evidence for any of these positions? Cite the reference to the therapist's perceptions, incidence/prevalence of sexual relationships in psychotherapy, etc.
5) Specifically, which religious figures are correct in their ways to live life?

 

[Fan_of_Meehl]

I actually agree with you on all of it. That’s why I said the problem is with our modern society. It’s not conducive to good health. I just didn’t focus on physical illnesses since this is a psychology forum. I’m all for lifestyle changes.

Furthermore, I still think the DSM is greatly problematic, and psychiatric labels do more harm than good. I understand labels are needed for reimbursement, but why can’t that be changed? When DSM 5 took away the bereavement exclusion to Major Depressive Disorder, that’s when I really couldn’t ignore the problem any longer.

Most medical diseases are understood and defined in a more scientific way. There’s a distinct pathophysiology; there are labs, imaging, biomarkers, findings on physical assessments, etc. The opposite is true of most mental illnesses. One can’t just decide one day that certain behaviors, feelings, and thoughts are pathological and call it an illness or disorder, especially if they are part of the normal human experience. That’s not how science works. Some experts, a majority of whom have ties to the pharmaceutical industry, sat around and decided on what symptoms they want to call a mental illness, completely ignoring etiology and any context in which the symptoms occurred. They do say to rule out medical illness as the cause of symptoms, but that’s about it. A large portion of the population now qualifies as having a mental illness, even though they are just having normal human reactions to life.

I want to emphasize that just because I don’t think of a lot of the mental illnesses in the DSM as diseases or disorders, it doesn’t mean I don’t think people with those symptoms shouldn’t get help. I wish everyone could have access to effective therapy.

There’s not enough focus on prevention whether we are talking about mental or physical illness. I personally don’t like to make a huge distinction between physical and mental because they are interrelated. Proper diet, exercise, sleep, hydration, minimizing stress, spending time in nature, and good social support are key to good health. There’s not enough focus on that because it’s not as profitable as letting someone become obese with multiple health conditions, having to see multiple specialists, having difficulty with their mental health…

Systemic issues play a huge role in causing poor mental and physical health. If we lived in a more just society where profits were not prioritized over people and the environment, we wouldn’t have as big of a problem as we do now. People are lonely and isolated, they’re eating poorly, sleeping poorly, don’t have healthy social connections, spend too much time on social media and electronics, don’t spend enough time outside in nature, don’t exercise, go to stressful jobs and don’t even make a livable wage, medical costs have skyrocketed, so many don’t have access to high quality and affordable medical and mental health care, people are self-treating mental health issues with addictive substances…We prioritize driving cars instead of public transportation and safe bike/walk paths. This leads to death and disability from car accidents, increased stress from sitting in traffic, increased risk for obesity and heart disease from having a sedentary lifestyle…

I wish doctors and psychologists would play a bigger role in effecting positive change in society and advocating for good practices, policies, laws, and regulations with the goal of improving the population’s health since they are the experts (it backfired with the psychiatrists and the DSM). I had so much hope when Dr. Thema became president of APA, but it doesn’t seem like anything really changed much.

To answer your question about incompetence, in my experience, most physicians are competent. I can’t say the same of PAs and NPs. Physicians still make a lot of mistakes, but it’s not due to incompetence or lack of knowledge most of the time. It seems like there are a lot of incompetent therapists doing harm. I wasn’t sure if they are in the minority so I asked the experts here. I’m surprised you asked how psychotherapy can harm. I’m sure you know the answer to that as a psychologist.

Anyway, I think it’s great that some are providing effective therapy. That’s so important, and we need to increase access to affordable and effective therapy. I just don’t think it’s enough to overcome all the systemic issues, and I think psychologists and physicians are respected enough that perhaps lawmakers would listen. As long as we conceptualize mental illness as a problem or disease of the individual, ignoring the root of the problem and systemic factors at play, we cannot effectively address it. The people responsible for a lot of the suffering will continue to evade accountability.

"As long as we conceptualize mental illness as a disease of the individual...and ignore the root of the problem..."

But mental illness IS, fundamentally, individual dysfunction (in terms of disturbed cognitive/emotional/behavioral patterns). If the individual is NOT disturbed, then by definition they don't have a mental illness.

Psychotherapy is all about SELF-evaluation and SELF-change...if it ISN'T, then it isn't PSYCHOTHERAPY, it's something else.

If self-evaluation and self-change aren't the solution (or at least a healthy portion of it) then mental illness, per se, isn't the problem.

If you need to work on yourself, go to therapy.

If you need to 'change the world/ topple the patriarchy / address the wrongs of human history' then..good luck...do anything other than pay for and attend psychotherapy sessions because you will be wasting your time/money.

And if you have considerable personal dysfunction or emotional problems and you're choosing to focus on fixing the world rather than fixing yourself, then I think that is very illogical/unwise. How are you going to fix an entire world filled with billlions of people you don't control when you can't effectively regulate your own thoughts, emotions, and behavior for optimal functioning? And if you're functioning optimally, then why would you need therapy?

If the conceptual model is that your problems are fundamentally being caused by problems EXTERNAL TO YOU and beyond your control/influence then how is psychotherapy going to address this?

 

[Sanman]

I actually agree with you on all of it. That’s why I said the problem is with our modern society. It’s not conducive to good health. I just didn’t focus on physical illnesses since this is a psychology forum. I’m all for lifestyle changes.

Furthermore, I still think the DSM is greatly problematic, and psychiatric labels do more harm than good. I understand labels are needed for reimbursement, but why can’t that be changed? When DSM 5 took away the bereavement exclusion to Major Depressive Disorder, that’s when I really couldn’t ignore the problem any longer.

Most medical diseases are understood and defined in a more scientific way. There’s a distinct pathophysiology; there are labs, imaging, biomarkers, findings on physical assessments, etc. The opposite is true of most mental illnesses. One can’t just decide one day that certain behaviors, feelings, and thoughts are pathological and call it an illness or disorder, especially if they are part of the normal human experience. That’s not how science works. Some experts, a majority of whom have ties to the pharmaceutical industry, sat around and decided on what symptoms they want to call a mental illness, completely ignoring etiology and any context in which the symptoms occurred. They do say to rule out medical illness as the cause of symptoms, but that’s about it. A large portion of the population now qualifies as having a mental illness, even though they are just having normal human reactions to life.

I want to emphasize that just because I don’t think of a lot of the mental illnesses in the DSM as diseases or disorders, it doesn’t mean I don’t think people with those symptoms shouldn’t get help. I wish everyone could have access to effective therapy.

There’s not enough focus on prevention whether we are talking about mental or physical illness. I personally don’t like to make a huge distinction between physical and mental because they are interrelated. Proper diet, exercise, sleep, hydration, minimizing stress, spending time in nature, and good social support are key to good health. There’s not enough focus on that because it’s not as profitable as letting someone become obese with multiple health conditions, having to see multiple specialists, having difficulty with their mental health…

Systemic issues play a huge role in causing poor mental and physical health. If we lived in a more just society where profits were not prioritized over people and the environment, we wouldn’t have as big of a problem as we do now. People are lonely and isolated, they’re eating poorly, sleeping poorly, don’t have healthy social connections, spend too much time on social media and electronics, don’t spend enough time outside in nature, don’t exercise, go to stressful jobs and don’t even make a livable wage, medical costs have skyrocketed, so many don’t have access to high quality and affordable medical and mental health care, people are self-treating mental health issues with addictive substances…We prioritize driving cars instead of public transportation and safe bike/walk paths. This leads to death and disability from car accidents, increased stress from sitting in traffic, increased risk for obesity and heart disease from having a sedentary lifestyle…

I wish doctors and psychologists would play a bigger role in effecting positive change in society and advocating for good practices, policies, laws, and regulations with the goal of improving the population’s health since they are the experts (it backfired with the psychiatrists and the DSM). I had so much hope when Dr. Thema became president of APA, but it doesn’t seem like anything really changed much.

To answer your question about incompetence, in my experience, most physicians are competent. I can’t say the same of PAs and NPs. Physicians still make a lot of mistakes, but it’s not due to incompetence or lack of knowledge most of the time. It seems like there are a lot of incompetent therapists doing harm. I wasn’t sure if they are in the minority so I asked the experts here. I’m surprised you asked how psychotherapy can harm. I’m sure you know the answer to that as a psychologist.

Anyway, I think it’s great that some are providing effective therapy. That’s so important, and we need to increase access to affordable and effective therapy. I just don’t think it’s enough to overcome all the systemic issues, and I think psychologists and physicians are respected enough that perhaps lawmakers would listen. As long as we conceptualize mental illness as a problem or disease of the individual, ignoring the root of the problem and systemic factors at play, we cannot effectively address it. The people responsible for a lot of the suffering will continue to evade accountability.

I don't disagree with you that systemic issues in the U.S. contribute to difficulties. There is an entire field of psychology that addresses these issues (community psychology). However, population health is not the focus of physicians or clinical psychologists. We are there to treat the individual and alleviate suffering. That is why questions of mental health often look at social and occupational impairments. Any class on diagnosis in mental health starts with the idea that mental disorders are on a spectrum and that normal reactions are part of that spectrum. That is why Psych 101 students identify as having xyz disorder. Except that they are functioning perfectly fine. We treat those on the far end of the spectrum.

You criticize the removal of the grief exclusion from depressive disorder but you also acknowledge that people self-medicate. The exclusion was removed because it was perceived to bar those that need help from treatment and there was no definitive research to bar treatment. That does not mean every person experiencing grief has a depressive disorder. However, if you are laying in bed and having 10 cocktails a day after your spouse, child, or parent died maybe you do need some treatment. However, an insurance company would exclude that diagnosis if grief was the trigger.

I never said psychotherapy could not cause harm. I asked you what the harm is caused. Because in comparing the harm between poor psychotherapy and poor prescribing, I think the risks in poor prescribing are worse. With regard to proper treatment and competence of providers, I think this will vary considerably both with education and work expectations. Does a midlevel with less on their plate provide better or worse care than an overworked/overscheduled physician or psychologist?

As for Dr. Thema not making any changes, I mean there was more dancing on the APA main stage this year. What exactly did you expect one person to do?

Overall, there is a sense of idealism in your posts that for the most part in unrealistic without buy in from government, industrialists, etc. I have been watching the Blue Zone docuseries on Netflix recently. One of the things that author/creator discusses is that the people that live long healthy lives did not do it on purpose. They just happened to be in an environment that encouraged longevity. This came down to even the steepest villages in Sardinia have more centenarians than the flat villages. We are not going to turn the U.S. into a seaside village. Maybe though, you want to move to Loma Linda, CA and become a Seventh Day Adventist.

 

[deleted1038433]

"As long as we conceptualize mental illness as a disease of the individual...and ignore the root of the problem..."

But mental illness IS, fundamentally, individual dysfunction (in terms of disturbed cognitive/emotional/behavioral patterns). If the individual is NOT disturbed, then by definition they don't have a mental illness.

Psychotherapy is all about SELF-evaluation and SELF-change...if it ISN'T, then it isn't PSYCHOTHERAPY, it's something else.

If self-evaluation and self-change aren't the solution (or at least a healthy portion of it) then mental illness, per se, isn't the problem.

If you need to work on yourself, go to therapy.

If you need to 'change the world/ topple the patriarchy / address the wrongs of human history' then..good luck...do anything other than pay for and attend psychotherapy sessions because you will be wasting your time/money.

And if you have considerable personal dysfunction or emotional problems and you're choosing to focus on fixing the world rather than fixing yourself, then I think that is very illogical/unwise. How are you going to fix an entire world filled with billlions of people you don't control when you can't effectively regulate your own thoughts, emotions, and behavior for optimal functioning? And if you're functioning optimally, then why would you need therapy?

If the conceptual model is that your problems are fundamentally being caused by problems EXTERNAL TO YOU and beyond your control/influence then how is psychotherapy going to address this?

Psychologists are not social justice warriors. Ours is a business of personal accountability and individual change, which is easier with guidance and support. I liken it to being a personal trainer. I help people build mental discipline and resilience.

 

[Ollie123]

We get posts like this sporadically and I always find it somewhat confusing. I just don't get the profound black and white thinking with regards to these issues. In a rush, but some initial responses:
- Certainly there are many, many problems with DSM diagnoses. I know many people on the DSM committees who will be the first to say this. Some of the people on the DSM committee are literally the same ones arguing we need new models for how we understand psychopathology. I don't really know anyone who thinks its perfect. At the same time, we can recognize pragmatic utility of writing down "The best we've got for now" in such a way that fits into our current insurance system. Even if we need to pinch our nose a bit while doing so. Its better than only being able to treat rich people who can pay out of pocket? The DSM is a book, it isn't "valid" or "invalid." Individual pieces of its content exist along a continuum of validity and we need to work towards improving it over time
- The notion that mental health needs to be ascribed as an individual OR societal issue is a false dichotomy. Its both. Damn near every psychologist worth their salt will tell you it is both. I'm a basic scientist at my core, hang out in biology-heavy circles and nearly all of my colleagues doing neuroimaging, -omics and whatever else would tell you it is both biological and environmental with a "Duh, of course - why are you even asking" look on their face.
- Our society does a lot of things to harm mental health, just as it does a lot of things to harm physical health. Society is getting worse in some ways, better in others and its tough to track the actual change in overall mental health of society over time because of changes in acceptance, etc.
- Related to this, I find people who talk about it as a purely societal problem often have a pretty narrow view of mental health and are really just talking about mild MDD, GAD, etc. Have you ever worked with someone with severe schizophrenia? MDD to the point of catatonia? These are generally not adaptive responses to societal issues and while they may be somewhat more prevalent in certain populations, also cut across all segments of society. This is why most psychologists think it is both. It is a fun philosophical discussion where exactly the line should be drawn between normal response to the death of a loved one and a depressive episode and there are interesting scientific questions about differences in such externally-provoked experiences vs depression that onsets without an obvious cause. That's not fun for the person impacted though, who generally just wants to find a way to feel OK again.
- Medicine does some things better and other things worse. My experience has been that any time a case is not incredibly straightforward, physicians are nearly useless and patients are largely left to figure it out themselves and present the provider with options. There are absolutely A-tier physicians with a functioning prefrontal cortex, but these are definitely not the modal physician. Most are just an algorithmic decision tree that can provide adequate care for the prototypical cases of whatever they do and will "crash" just like a computer as soon as some value arrives that isn't accounted for in whatever algorithm they are using.
- I think psychologists look similar, at least in my experience. Maybe 10-20% excellent, the bulk of the distribution being varying levels of mediocre and probably fine for simple cases and 10-20% utterly terrible/harmful. The nature of the treatment they provide looks different. For better or worse, therapy is still at least partly an "art" and likely always will be as it just inherently cannot be as standardized as something like a medication. We can describe techniques for things like developing rapport (for example), but by its nature the best way to approach this will vary from patient to patient.
- As others have said, we could have a whole other discussion about labels becoming identities. In some cases, it can be helpful when patients use that identity to find support, advocate for others with the same condition, etc. In other cases, it is harmful when people use it as an excuse, structure their entire life around said identity, etc.

 

[genop]

Thanks for the responses. It’s just been heartbreaking for me to see so many patients and people suffer needlessly, and be put on pills or told to go to therapy when that’s not always the answer and it may not be enough. Sometimes, they’re just in really bad financial or otherwise stressful situations, that, unless the situation changes, no amount of effective therapy, meditation, or yoga is going to be able to counteract the negative effects of those circumstances.

Is therapy going to be enough to get rid of a homeless person’s depression and anxiety if they’re still homeless? Are they really mentally ill for being depressed or anxious, or is that an understandable human response to the circumstances? What about a child who is being abused or bullied daily? They’re mentally ill if they become depressed or anxious as a result of horrible abuse? All these people need to do is work on themselves, their cognitive distortions, and what they have control over and then they’ll be fine? Or worse. All they need is a pill or two? Of course I do think these people need and can benefit from therapy, but what they need even more is safety, housing…

Was Dr. Lorna Breen’s suicide really because she was this mentally ill person, or was everything just too much and she reached her breaking point as any human being can?

The prevalence of mental illness is higher in physicians than the general population. Are they really more crazy or is it the job, long hours, lack of sleep, horrible and exploitative employers, excessive stress, trauma, poor work-life balance that eventually takes its toll? They had to be pretty high functioning, not mentally ill and dysfunctional, to get through the grueling education and training to become physicians.

I think a lot of mental illness diagnoses have been a way to blame the individual for normal reactions to systemic problems and toxic and stressful environments. As long as individuals are blamed and given pills, the people responsible can avoid accountability.

I’ve known many patients with chronic health conditions, unable to afford their medications and medical care, and they are understandably anxious about how they’re going to afford meds, rent, food, etc. They get diagnosed with anxiety disorder/depression and get put on more meds!

I’ve known so many healthcare workers get burned out, depressed, and anxious due to toxic work environments and unreasonable workloads, and the hospital sends emails about EAP, wellness, and self care instead. So many healthcare workers are on psych meds, and so many more are scared to even get treatment. There’s no way to be healthy in certain environments.

I definitely think people need to take responsibility for the things they have control over, and get the help that they need. I just don’t think it will be enough if the root cause isn’t addressed.

Most people/patients I’ve known who are depressed, anxious, or have PTSD, are not that way for no reason. Their symptoms make perfect sense considering the trauma and life stressors. In fact, it would be abnormal if they had not been affected.

 

[cara susanna]

PTSD is by definition a mental illness involving a set of reactions to a traumatic event, but there are a myriad of factors that predict the development of PTSD (I.e., not everyone who experiences a traumatic event develops PTSD, hence the diagnostic label to describe this particular outcome). We can definitely acknowledge that a traumatic situation was a contributing factor. We do not need to label someone negatively, but the reality is that we have diagnoses to help us understand someone’s clinical presentation.

The rest of your post is just far, far too complex for me to respond to, but I wanted to address this as someone who treats sexual trauma:

Immediately after a sexual trauma, everyone will look like they have PTSD. But 3-6 months later, many people recover naturally and these symptoms decline over time. The ones that don't develop PTSD. Basically, PTSD is a stalling out of the natural recovery process. Not everyone who gets gang raped goes on to develop it. We think that PTSD is developed when people push away thoughts/feelings about the trauma, don't talk about it with supportive people and hence get a chance to receive corrective feedback about their thoughts regarding the trauma and why it happened. PTSD is diagnosed because the person involves with it usually suffers, in the form of poor sleep, intrusive symptoms, etc, and also is not able to live the life they want to because they feel so terrified in safe situations.

Granted, sexual trauma is very damaging and associated with the highest rates of PTSD, but that is definitely societally impacted (rape culture being a big one).

 

[cara susanna]

Most people/patients I’ve known who are depressed, anxious, or have PTSD, are not that way for no reason. Their symptoms make perfect sense considering the trauma and life stressors. In fact, it would be abnormal if they had not been affected.

It makes sense, but the person is still stuck. There's dialectic we use: "I may not have caused my problems, and I still have to be the one to fix them." No one asks for trauma. It makes sense that they want to avoid and deal with it in ways that are helpful short term but not long term. But, these people usually are suffering because of that. They need to try different things, change those behavioral patterns, and that's where we come in.

If someone doesn't want to deal with their trauma and wants to keep avoiding, because "who wouldn't behave this way if they experienced this thing," by all means. Avoidance or staying miserable is a choice people can make. No one has to get treatment. But generally people come in for PTSD treatment because they reach the point where their current way of coping (read: avoidance) is no longer working.

Again, though, PTSD is NOT the typical response. Look up rates of trauma exposure vs. rates of PTSD. PTSD is the less common outcome. People are remarkably resilient.

 

[oldschooliscool]

Is therapy going to be enough to get rid of a homeless person’s depression and anxiety if they’re still homeless? Are they really mentally ill for being depressed or anxious, or is that an understandable human response to the circumstances? What about a child who is being abused or bullied daily? They’re mentally ill if they become depressed or anxious as a result of horrible abuse? All these people need to do is work on themselves, their cognitive distortions, and what they have control over and then they’ll be fine? Or worse. All they need is a pill or two? Of course I do think these people need and can benefit from therapy, but what they need even more is safety, housing…

See here:

- Related to this, I find people who talk about it as a purely societal problem often have a pretty narrow view of mental health and are really just talking about mild MDD, GAD, etc. Have you ever worked with someone with severe schizophrenia? MDD to the point of catatonia? These are generally not adaptive responses to societal issues and while they may be somewhat more prevalent in certain populations, also cut across all segments of society. This is why most psychologists think it is both. It is a fun philosophical discussion where exactly the line should be drawn between normal response to the death of a loved one and a depressive episode and there are interesting scientific questions about differences in such externally-provoked experiences vs depression that onsets without an obvious cause. That's not fun for the person impacted though, who generally just wants to find a way to feel OK again.

I think a lot of mental illness diagnoses have been a way to blame the individual for normal reactions to systemic problems and toxic and stressful environments. As long as individuals are blamed and given pills, the people responsible can avoid accountability.

I’ve known many patients with chronic health conditions, unable to afford their medications and medical care, and they are understandably anxious about how they’re going to afford meds, rent, food, etc. They get diagnosed with anxiety disorder/depression and get put on more meds!

I’ve known so many healthcare workers get burned out, depressed, and anxious due to toxic work environments and unreasonable workloads, and the hospital sends emails about EAP, wellness, and self care instead. So many healthcare workers are on psych meds, and so many more are scared to even get treatment. There’s no way to be healthy in certain environments.

I definitely think people need to take responsibility for the things they have control over, and get the help that they need. I just don’t think it will be enough if the root cause isn’t addressed.

Most people/patients I’ve known who are depressed, anxious, or have PTSD, are not that way for no reason. Their symptoms make perfect sense considering the trauma and life stressors. In fact, it would be abnormal if they had not been affected.

Seems like you just want a soapbox moment to share your anecdotes / opinions, which is fine for a forum I guess. You're not really responding to what people are telling you in this thread, though. Have you noticed that?

 

[genop]

We get posts like this sporadically and I always find it somewhat confusing. I just don't get the profound black and white thinking with regards to these issues. In a rush, but some initial responses:
- Certainly there are many, many problems with DSM diagnoses. I know many people on the DSM committees who will be the first to say this. Some of the people on the DSM committee are literally the same ones arguing we need new models for how we understand psychopathology. I don't really know anyone who thinks its perfect. At the same time, we can recognize pragmatic utility of writing down "The best we've got for now" in such a way that fits into our current insurance system. Even if we need to pinch our nose a bit while doing so. Its better than only being able to treat rich people who can pay out of pocket? The DSM is a book, it isn't "valid" or "invalid." Individual pieces of its content exist along a continuum of validity and we need to work towards improving it over time
- The notion that mental health needs to be ascribed as an individual OR societal issue is a false dichotomy. Its both. Damn near every psychologist worth their salt will tell you it is both. I'm a basic scientist at my core, hang out in biology-heavy circles and nearly all of my colleagues doing neuroimaging, -omics and whatever else would tell you it is both biological and environmental with a "Duh, of course - why are you even asking" look on their face.
- Our society does a lot of things to harm mental health, just as it does a lot of things to harm physical health. Society is getting worse in some ways, better in others and its tough to track the actual change in overall mental health of society over time because of changes in acceptance, etc.
- Related to this, I find people who talk about it as a purely societal problem often have a pretty narrow view of mental health and are really just talking about mild MDD, GAD, etc. Have you ever worked with someone with severe schizophrenia? MDD to the point of catatonia? These are generally not adaptive responses to societal issues and while they may be somewhat more prevalent in certain populations, also cut across all segments of society. This is why most psychologists think it is both. It is a fun philosophical discussion where exactly the line should be drawn between normal response to the death of a loved one and a depressive episode and there are interesting scientific questions about differences in such externally-provoked experiences vs depression that onsets without an obvious cause. That's not fun for the person impacted though, who generally just wants to find a way to feel OK again.
- Medicine does some things better and other things worse. My experience has been that any time a case is not incredibly straightforward, physicians are nearly useless and patients are largely left to figure it out themselves and present the provider with options. There are absolutely A-tier physicians with a functioning prefrontal cortex, but these are definitely not the modal physician. Most are just an algorithmic decision tree that can provide adequate care for the prototypical cases of whatever they do and will "crash" just like a computer as soon as some value arrives that isn't accounted for in whatever algorithm they are using.
- I think psychologists look similar, at least in my experience. Maybe 10-20% excellent, the bulk of the distribution being varying levels of mediocre and probably fine for simple cases and 10-20% utterly terrible/harmful. The nature of the treatment they provide looks different. For better or worse, therapy is still at least partly an "art" and likely always will be as it just inherently cannot be as standardized as something like a medication. We can describe techniques for things like developing rapport (for example), but by its nature the best way to approach this will vary from patient to patient.
- As others have said, we could have a whole other discussion about labels becoming identities. In some cases, it can be helpful when patients use that identity to find support, advocate for others with the same condition, etc. In other cases, it is harmful when people use it as an excuse, structure their entire life around said identity, etc.

I agree that mental health issues can be due to both individual and societal factors. That’s why I think effective therapy is so important for the individual to work on their issues.

However, there are so many systemic issues at play, and those issues rarely if ever get adequately addressed. Therapy can only do so much. Therapists are not miracle workers.

I’m so sick of toxic organizations telling overworked, burned out healthcare workers to call EAP, and work on their resilience and self-care. I’m also frustrated with people putting patients on psych meds and telling them to go to therapy when they’re struggling financially, as if that’s going to be enough. So they should just take a break from the two full time jobs they have to go talk to a therapist for an hour about how stressed, anxious, and depressed they are that they work two jobs and still don’t make a livable wage, can’t afford their medical care so their health conditions are getting worse, are at risk for being evicted, etc.

 

[oldschooliscool]

I agree that mental health issues can be due to both individual and societal factors. That’s why I think effective therapy is so important for the individual to work on their issues.

However, there are so many systemic issues at play, and those issues rarely if ever get adequately addressed. Therapy can only do so much. Therapists are not miracle workers.

I’m so sick of toxic organizations telling overworked, burned out healthcare workers to call EAP, and work on their resilience and self-care. I’m also frustrated with people putting patients on psych meds and telling them to go to therapy when they’re struggling financially, as if that’s going to be enough. So they should just take a break from the two full time jobs they have to go talk to a therapist for an hour about how stressed, anxious, and depressed they are that they work two jobs and still don’t make a livable wage, can’t afford their medical care so their health conditions are getting worse, are at risk for being evicted, etc.

Sounds like you have a very narrow and inaccurate view of what evidenced based therapy involves or what it is indicated for.

 

[genop]

See here:



Seems like you just want a soapbox moment to share your anecdotes / opinions, which is fine for a forum I guess. You're not really responding to what people are telling you in this thread, though. Have you noticed that?

I agree with most of what people are telling me. You guys seem to take a reasonable approach to mental health issues (that I agree with), and that’s very much needed. I just think systemic issues need to be addressed, too.

 

[Sanman]

Thanks for the responses. It’s just been heartbreaking for me to see so many patients and people suffer needlessly, and be put on pills or told to go to therapy when that’s not always the answer and it may not be enough. Sometimes, they’re just in really bad financial or otherwise stressful situations, that, unless the situation changes, no amount of effective therapy, meditation, or yoga is going to be able to counteract the negative effects of those circumstances.

Is therapy going to be enough to get rid of a homeless person’s depression and anxiety if they’re still homeless? Are they really mentally ill for being depressed or anxious, or is that an understandable human response to the circumstances? What about a child who is being abused or bullied daily? They’re mentally ill if they become depressed or anxious as a result of horrible abuse? All these people need to do is work on themselves, their cognitive distortions, and what they have control over and then they’ll be fine? Or worse. All they need is a pill or two? Of course I do think these people need and can benefit from therapy, but what they need even more is safety, housing…

This is just poor doctoring. They should be referred to the social worker or social services office. Their purpose is literally to address needs such concrete needs as food and shelter. Then send them to me if they require coping skills or emotional support after their concrete needs are met. Giving them an anti-depressant is also bad/lazy doctoring. There is a lot of that. Not sure suggesting yoga for this is anything but idiotic.

Was Dr. Lorna Breen’s suicide really because she was this mentally ill person, or was everything just too much and she reached her breaking point as any human being can?

The prevalence of mental illness is higher in physicians than the general population. Are they really more crazy or is it the job, long hours, lack of sleep, horrible and exploitative employers, excessive stress, trauma, poor work-life balance that eventually takes its toll? They had to be pretty high functioning, not mentally ill and dysfunctional, to get through the grueling education and training to become physicians.

I think a lot of mental illness diagnoses have been a way to blame the individual for normal reactions to systemic problems and toxic and stressful environments. As long as individuals are blamed and given pills, the people responsible can avoid accountability.

I’ve known many patients with chronic health conditions, unable to afford their medications and medical care, and they are understandably anxious about how they’re going to afford meds, rent, food, etc. They get diagnosed with anxiety disorder/depression and get put on more meds!

I’ve known so many healthcare workers get burned out, depressed, and anxious due to toxic work environments and unreasonable workloads, and the hospital sends emails about EAP, wellness, and self care instead. So many healthcare workers are on psych meds, and so many more are scared to even get treatment. There’s no way to be healthy in certain environments.

I definitely think people need to take responsibility for the things they have control over, and get the help that they need. I just don’t think it will be enough if the root cause isn’t addressed.

Most people/patients I’ve known who are depressed, anxious, or have PTSD, are not that way for no reason. Their symptoms make perfect sense considering the trauma and life stressors. In fact, it would be abnormal if they had not been affected.

You are conflating mental illness with the lack of social support in society. There is a reason the DSM-IV had multi-axial categories and one of them was psychosocial and environmental problems (Axis-4) which was distinct from Axis I (mental health and substance abuse). You seem to be conflating the two issues.

 

[deleted1038433]

I agree with most of what people are telling me. You guys seem to take a reasonable approach to mental health issues (that I agree with), and that’s very much needed. I just think systemic issues need to be addressed, too.

Care to share how you are addressing systemic issues as someone in healthcare? I care about the big picture but am at a loss of how to effect change on that scale as a therapist on the frontlines. I can connect folks to resources in the community and validate/ normalize the human experience in modern society. What are you looking for therapists to do that they are not already doing? Do you want more of us to become politicians or otherwise involved in policy?

 

[cara susanna]

Getting caught up on this thread...

I assume you came here for honest opinions.

1. There is a movement afoot to move to more dimensional/ contextual models (on many fronts) and away from categorical (a la DSM nosology) models...but...the classic paradigm has a good deal of utility and validity and it's no easy thing to re-conceptualize mental illness and its treatment.

I saw a newspaper article today bemoaning cognitive-behavioral therapy as wrongheaded and 'unethical' when it comes to helping people who are suffering from clinical anxiety, depression, or trauma and stressor-related disorders if they happen to be a 'marginalized' class or a victim of 'societal' forces...etc. This is going to do a lot of harm to people. We have to be very careful here. Just because someone, say, is African-American and bisexual, it doesn't mean that our scientific models about how to treat depression effectively are invalid or that they don't necessarily apply--at least fundamentally--to these people. I'm all for (quality) scientific and clinical investigations testing hypotheses about how (if at all) our theories and interventions should be modified to be more effective with certain populations, but...these populations can suffer from clinical depression (just like everyone else) and things like behavioral activation or helping them understand that depression does tend to distort one's thinking and emotions in certain ways which can be responsive to therapy are critical to actually helping them vs. feeling smug and good about ourselves and our 'evolved' status. The article completely mischaracterized the cognitive-behavioral approach to helping people understand and respond to horrible treatment or injustices. The article (wrongly) says that a cognitive-behavioral therapist would (necessarily) blame the victim and say they were engaging in cognitive distortions. No decently trained CBT therapist would do that. First, we know that bad things happen to rational people. Not everything is a distortion and it isn't our job to tell patients what or how to think about themselves, their history, or their problems. Second, even in horrible circumstances, it is useful to be supportive in helping a person in their attempts to cope with these circumstances and to make the best of it. Victor Frankl wrote a book on this topic about his experiences in a concentration camp. Psychotherapy is, by definition, focused on self-evaluation and self-change. I work with trauma victims on a daily/hourly basis five days per week. None of that work involves unnecessary 'pathologization' of these people. However, I don't lie to them or myself either. It helps no one. Of COURSE there are pathologies involved. Otherwise, it's not a problem/illness requiring treatment. We do neither ourselves nor our patients any favors by thinking/talking/philosophizing ourselves into circles or trying to practice 'double-think' in the form of simultaneously saying (a) these people are 'normal' and it is the pathology of society that wrongly thinks they have a problem and, simultaneously, saying (b) these people are suffering from dire problems caused by 'society' (or 'the patriarchy' or...you name it) and they are victims and we should feel horrible about it.

Psychotherapists help people examine and--if called for--modify their own beliefs and behaviors.

I don't know who is responsible for 'changing society' itself if that is where we locate the pathology...you? 19 year old dewey-eyed undergrads from Ivy League Universities? Politicians? NGO's? International corporations? Defense contractors? The major news networks or magazines?

2. Competence varies quite a bit. A few are horrible, many are adequate, a few are excellent. In my experience the incidents of truly sadistic/criminal or malevolent acts perpetrated on patients by mental health providers are (thankfully) rare. Far more often people are okay with being mediocre, lazy, avaricious, or cowardly. But a well-trained, earnest, and skilled individual psychotherapist can do an incredible amount of good in the world, one person at a time.

3. I'm not even going to touch this one because I work in the VA system and if I even started typing I wouldn't stop until I was about forty pages into it.

Curious about where that anti-CBT article was. NYT?

Most medical diseases are understood and defined in a more scientific way. There’s a distinct pathophysiology; there are labs, imaging, biomarkers, findings on physical assessments, etc. The opposite is true of most mental illnesses. One can’t just decide one day that certain behaviors, feelings, and thoughts are pathological and call it an illness or disorder, especially if they are part of the normal human experience. That’s not how science works. Some experts, a majority of whom have ties to the pharmaceutical industry, sat around and decided on what symptoms they want to call a mental illness, completely ignoring etiology and any context in which the symptoms occurred. They do say to rule out medical illness as the cause of symptoms, but that’s about it. A large portion of the population now qualifies as having a mental illness, even though they are just having normal human reactions to life.

I'm not sure I would agree with that, actually. Just look into women's health and see how little is known about endometriosis, PCOS, etc. Infertility is another one where we often have zero idea of pathophysiology and assessment markers may be entirely normal.

 

[genop]

This is just poor doctoring. They should be referred to the social worker or social services office. Their purpose is literally to address needs such concrete needs as food and shelter. Then send them to me if they require coping skills or emotional support after their concrete needs are met. Giving them an anti-depressant is also bad/lazy doctoring. There is a lot of that. Not sure suggesting yoga for this is anything but idiotic.



You are conflating mental illness with the lack of social support in society. There is a reason the DSM-IV had multi-axial categories and one of them was psychosocial and environmental problems (Axis-4) which was distinct from Axis I (mental health and substance abuse). You seem to be conflating the two issues.

I agree 100% with your first paragraph. That’s why I’m frustrated.

I’m not conflating mental illness with lack of social support in society. I’m expressing frustration that a lot of Axis 4 problems are incorrectly being treated with pills, and therapy is being recommended for issues that therapy can’t fix. Therapy can be helpful with some aspects that the individual has control over, but it can’t fix psychosocial and environmental problems. I think some people have unreasonable expectations of what therapy can do.

Btw, I’ve known therapists who’ve gone under the bridge to provide psychotherapy to homeless people. Bless them for doing that, but those people need a different kind of support as well.

 

[cara susanna]

I agree 100% with your first paragraph. That’s why I’m frustrated.

I’m not conflating mental illness with lack of social support in society. I’m expressing frustration that a lot of Axis 4 problems are incorrectly being treated with pills, and therapy is being recommended for issues that therapy can’t fix. Therapy can be helpful with some aspects that the individual has control over, but it can’t fix psychosocial and environmental problems. I think some people have unreasonable expectations of what therapy can do.

Btw, I’ve known therapists who’ve gone under the bridge to provide psychotherapy to homeless people. Bless them for doing that, but those people need a different kind of support as well.

Well, yeah, but what should we do? Stop giving people therapy? Or are you just seeking validation?

I have a lot of patients whose problems could be fixed if they had more money or, especially, social support. All I can do is help them make the best of their situation.

 

[Sanman]

I agree 100% with your first paragraph. That’s why I’m frustrated.

I’m not conflating mental illness with lack of social support in society. I’m expressing frustration that a lot of Axis 4 problems are incorrectly being treated with pills, and therapy is being recommended for issues that therapy can’t fix. Therapy can be helpful with some aspects that the individual has control over, but it can’t fix psychosocial and environmental problems. I think some people have unreasonable expectations of what therapy can do.

Btw, I’ve known therapists who’ve gone under the bridge to provide psychotherapy to homeless people. Bless them for doing that, but those people need a different kind of support as well.

Depends on the what they are treating. I've done problem-solving therapy with folks dealing with homelessness in collaboration with the team SW to get these folks to fill out the paperwork to get housing and navigate social services rather than get overwhelmed and just give up. It works.

 

[Sanman]

I agree 100% with your first paragraph. That’s why I’m frustrated.

I’m not conflating mental illness with lack of social support in society. I’m expressing frustration that a lot of Axis 4 problems are incorrectly being treated with pills, and therapy is being recommended for issues that therapy can’t fix. Therapy can be helpful with some aspects that the individual has control over, but it can’t fix psychosocial and environmental problems. I think some people have unreasonable expectations of what therapy can do.

Btw, I’ve known therapists who’ve gone under the bridge to provide psychotherapy to homeless people. Bless them for doing that, but those people need a different kind of support as well.

No, I think people just want to alleviate their guilt rather than admit there is nothing they can do to fix the problem.

 

[genop]

I went to the VA venting thread and saw that you guys are dealing with a lot of ridiculous organizational and systemic problems, too. It’s upsetting. People are getting burned out and stressed out and nothing is being done about it at an organizational or systemic level. 🙁 I was hoping you guys had it better than the rest of us.

 

[genop]

Care to share how you are addressing systemic issues as someone in healthcare? I care about the big picture but am at a loss of how to effect change on that scale as a therapist on the frontlines. I can connect folks to resources in the community and validate/ normalize the human experience in modern society. What are you looking for therapists to do that they are not already doing? Do you want more of us to become politicians or otherwise involved in policy?

I feel powerless to fix systemic problems as an individual. I would love to see people unite and try to effect change. I’ve contacted various professional organizations with possible solutions to specific problems to no avail. I’ve contacted politicians. I’ve contacted licensing boards. I’ve tried to do everything I can to help individual patients through my work. I’ve provided my services in free clinics. I’ve tried to speak up about issues within my organization and came up with tangible and inexpensive, common-sense solutions, only to face retaliation. I’ve tried to mobilize coworkers and others, but people were too scared. I’ve tried to be supportive to other healthcare professionals and friends to try to ease some of their stress. None of it is enough.

 

[AcronymAllergy]

I think it's important to add that just because something is due solely or primarily to a societal issue, at least initially, doesn't mean that it's something therapy can't help at least somewhat. Perhaps part of the reason the person is experiencing those societal problems is based on how they perceive and approach the world, manage problems/themselves/others, etc. Or perhaps they had no role in the societal problems they were dealt, but over time those problems have then created ineffective/problematic ways of managing oneself, others, and/or the world. A causes B, B causes A, and so on. These are things therapy can at least try to help address. Or perhaps the person is so deflated/pathological in their current state that they may need medication so they can get to a place where they can do fundamental work in developing effective strategies.

Agreed that no amount of therapy is going to suddenly give someone a place to stay or a job. Nor will therapy bring back dead loved ones or undo traumatic events. Therapy, as was said above more eloquently than I've done here, helps people manage the after-effects of these types of events (among other things).

 

[genop]

I think it's important to add that just because something is due solely or primarily to a societal issue, at least initially, doesn't mean that it's something therapy can't help at least somewhat. Perhaps part of the reason the person is experiencing those societal problems is based on how they perceive and approach the world, manage problems/themselves/others, etc. Or perhaps they had no role in the societal problems they were dealt, but over time those problems have then created ineffective/problematic ways of managing oneself, others, and/or the world. A causes B, B causes A, and so on. These are things therapy can at least try to help address. Or perhaps the person is so deflated/pathological in their current state that they may need medication so they can get to a place where they can do fundamental work in developing effective strategies.

Agreed that no amount of therapy is going to suddenly give someone a place to stay or a job. Nor will therapy bring back dead loved ones or undo traumatic events. Therapy, as was said above more eloquently than I've done here, helps people manage the after-effects of these types of events (among other things).

I agree with everything you’ve written.

I hope this isn’t a stupid question. Psychologists are experts in all this, but sometimes they end up with anxiety, depression, and PTSD, too. If they know what to do to maintain good mental health and approach the world and problems in a healthy way, why are they affected like this? How can therapy help them if they themselves are the experts?

Isn’t this just another example of it being a normal response to extreme stress or trauma? No one is immune. We need to safeguard people’s mental health. No amount of coping skills will be enough sometimes.

I wish you guys would see some of these suicide attempts coming through the ED. I’m sure you see more than your fair share of suffering, and it takes a toll eventually.

 

[Ollie123]

Couple notes:

I hope this isn’t a stupid question. Psychologists are experts in all this, but sometimes they end up with anxiety, depression, and PTSD, too. If they know what to do to maintain good mental health and approach the world and problems in a healthy way, why are they affected like this? How can therapy help them if they themselves are the experts?

Isn’t this just another example of it being a normal response to extreme stress or trauma? No one is immune. We need to safeguard people’s mental health. No amount of coping skills will be enough sometimes.

I wish you guys would see some of these suicide attempts coming through the ED. I’m sure you see more than your fair share of suffering, and it takes a toll eventually.

I don't think you'll find many arguing against the idea that we should do more to safeguard mental health. I do think you will find varying opinions around exactly where that line should be drawn within the confines of reality. Obviously 16 sessions of CBT can't make poverty go away. When doing therapy, I CAN (and have) worked with people to break out of avoidance cycles keeping them from finding higher paying jobs or otherwise bettering their life circumstances. Some people aren't able to do that for any of a number of reasons. More systemic support would be great, but where exactly should the line be drawn. Everyone gets basic living expenses covered? Rice and beans basic or do they get to eat meat and fresh veggies? Studio apartment? 1 bedroom? What if they have kids? Do the kids have to share a bedroom?

I think we need a much stronger social safety net, but we can recognize it is a complicated issue. Its very easy to say "We need to change society to better support good mental health" but it is extremely hard to come up with an actionable plan for doing so that is effective, feasible and economically sustainable.

With regards to psychologists a couple points:
- I think expecting 100% success rate for anything is a bit much. An oncologist with late-stage pancreatic cancer is still in a heap of trouble.
- Doing things is hard. Most nutritionists don't eat a perfect diet. Most personal trainers will skip a workout now and then. Some struggle to a point they develop more serious issues (obesity, cardiovascular disease). That isn't a fundamental failure of the nutrition model or a condemnation of exercise.

 

[cara susanna]

I agree with everything you’ve written.

I hope this isn’t a stupid question. Psychologists are experts in all this, but sometimes they end up with anxiety, depression, and PTSD, too. If they know what to do to maintain good mental health and approach the world and problems in a healthy way, why are they affected like this? How can therapy help them if they themselves are the experts?

Isn’t this just another example of it being a normal response to extreme stress or trauma? No one is immune. We need to safeguard people’s mental health. No amount of coping skills will be enough sometimes.

I wish you guys would see some of these suicide attempts coming through the ED. I’m sure you see more than your fair share of suffering, and it takes a toll eventually.

Because therapists are human and may not practice what they preach. I imagine you find the same in any healthcare field. It's FAR easier to tell others what to do and view them with compassion. You are always going to be hardest on yourself. In fact, this is a tool we use in therapy: would you say this to your partner/child/parent/loved one?

Therapy is about the process, not the outcome. If you have a therapist engaging in therapy, they can't go in with the attitude that they know it all and have nothing to learn. Someone I know put it this way: even if you know how the movie's gonna end, you still have to invest in it when you watch it. I've seen (treated) therapists who do well in therapy and others who can't let go of their own expertise enough to engage with good faith in the process.

 

[Ollie123]

Because therapists are human and may not practice what they preach. I imagine you find the same in any healthcare field.

There are even jokes about doctors being terrible patients. They cancel appointments because they're busy, eat crap from a vending machine instead of lunch while running between clinics, don't adhere to the treatments, randomly stop the treatment because they think they know better, etc. If you know physicians you have seen this play out

 

[genop]

There are even jokes about doctors being terrible patients. They cancel appointments because they're busy, eat crap from a vending machine instead of lunch while running between clinics, don't adhere to the treatments, randomly stop the treatment because they think they know better, etc. If you know physicians you have seen this play out

Yes. This made me chuckle because of how true it is.

 

[futureapppsy2]

I agree with everything you’ve written.

I hope this isn’t a stupid question. Psychologists are experts in all this, but sometimes they end up with anxiety, depression, and PTSD, too. If they know what to do to maintain good mental health and approach the world and problems in a healthy way, why are they affected like this? How can therapy help them if they themselves are the experts?

Isn’t this just another example of it being a normal response to extreme stress or trauma? No one is immune. We need to safeguard people’s mental health. No amount of coping skills will be enough sometimes.

I wish you guys would see some of these suicide attempts coming through the ED. I’m sure you see more than your fair share of suffering, and it takes a toll eventually.

Sometimes, people just get sick--either they just have the genes for it (e.g., endogenous depression or anxiety) or they just get deeply affected by a traumatic event and go onto develop PTSD or there's just the right brew of stressors and biological disposition, and it leads to diagnosable mental illness, etc. I was talking about the general concept with a PCP friend/colleague of mine, and she used the comparison of hypertension. Someone can do all the right behavioral things to decrease their risk of hypertension and still develop it anyway because of genetics or lifestyle things they can't entirely control, etc. It doesn't mean that behavioral prevention is bunk or that hypertension isn't an illness--it just means that, for that particular person, behavioral prevention didn't stop the illness from developing. The nasty secret of all preventative medicine is that no prevention is 100%. If you don't smoke, you have a much lower risk of getting lung cancer but you can still get it (there's even a decent handful of documented SCLC in never smokers). If you follow every pregnancy guideline, there's a lower chance you'll have a disabled kid but there's still a chance. We run into this logical fallacy a lot in suicide prevention--just because something doesn't work 100% time doesn't mean that it's worthless.

 

[AcronymAllergy]

I agree with everything you’ve written.

I hope this isn’t a stupid question. Psychologists are experts in all this, but sometimes they end up with anxiety, depression, and PTSD, too. If they know what to do to maintain good mental health and approach the world and problems in a healthy way, why are they affected like this? How can therapy help them if they themselves are the experts?

Isn’t this just another example of it being a normal response to extreme stress or trauma? No one is immune. We need to safeguard people’s mental health. No amount of coping skills will be enough sometimes.

I wish you guys would see some of these suicide attempts coming through the ED. I’m sure you see more than your fair share of suffering, and it takes a toll eventually.

The only thing I'd add to what's already been said (and someone else might've said this as well) is that sometimes, even if you know what the problem is, you can get mired within it, and it then takes an outside person/perspective to guide you through. It's not the best analogy, but as another example, knowing why smoking is harmful and how to stop smoking doesn't prevent the actual mechanisms of nicotine addiction, nor does it always make stopping much easier when you're going through it yourself. But the other analogies with healthy eating, exercise, etc., were better.

 

[clausewitz2]

Couple notes:


I don't think you'll find many arguing against the idea that we should do more to safeguard mental health. I do think you will find varying opinions around exactly where that line should be drawn within the confines of reality. Obviously 16 sessions of CBT can't make poverty go away. When doing therapy, I CAN (and have) worked with people to break out of avoidance cycles keeping them from finding higher paying jobs or otherwise bettering their life circumstances. Some people aren't able to do that for any of a number of reasons. More systemic support would be great, but where exactly should the line be drawn. Everyone gets basic living expenses covered? Rice and beans basic or do they get to eat meat and fresh veggies? Studio apartment? 1 bedroom? What if they have kids? Do the kids have to share a bedroom?

I think we need a much stronger social safety net, but we can recognize it is a complicated issue. Its very easy to say "We need to change society to better support good mental health" but it is extremely hard to come up with an actionable plan for doing so that is effective, feasible and economically sustainable.

With regards to psychologists a couple points:
- I think expecting 100% success rate for anything is a bit much. An oncologist with late-stage pancreatic cancer is still in a heap of trouble.
- Doing things is hard. Most nutritionists don't eat a perfect diet. Most personal trainers will skip a workout now and then. Some struggle to a point they develop more serious issues (obesity, cardiovascular disease). That isn't a fundamental failure of the nutrition model or a condemnation of exercise.

It's helpful to imagine that you're going to your PCP and they discover that you have developed diabetes. But your PCP says, 'Well, there are medications that might be helpful in making you less negatively affected by diabetes. But I'm not going to prescribe any of them because what we really need to do is change our society's approach to eating, industrial agriculture, and food insecurity. "

Mutatis mutandis for mental healthcare.

 

[Fan_of_Meehl]

And your health psychologist says that if you (as the patient) agree that your own dietary and lifestyle choices are at least, in principle, within your ability to alter or influence...there are behavioral change methods that could be beneficial as well.

No one is saying it is easy, or that you should be blamed/shamed for it, or that there aren't other factors in play, but...in most cases of diabetes there is some degree of impact of dietary and lifestyle choices on the problem.

 

[PsychPhDone]

I agree that mental health issues can be due to both individual and societal factors. That’s why I think effective therapy is so important for the individual to work on their issues.

However, there are so many systemic issues at play, and those issues rarely if ever get adequately addressed. Therapy can only do so much. Therapists are not miracle workers.

I’m so sick of toxic organizations telling overworked, burned out healthcare workers to call EAP, and work on their resilience and self-care. I’m also frustrated with people putting patients on psych meds and telling them to go to therapy when they’re struggling financially, as if that’s going to be enough. So they should just take a break from the two full time jobs they have to go talk to a therapist for an hour about how stressed, anxious, and depressed they are that they work two jobs and still don’t make a livable wage, can’t afford their medical care so their health conditions are getting worse, are at risk for being evicted, etc.

Ok cool
Go fix it then
🤷‍♀️

I'll be helping people with the aspects of their lives they can control.

 

[PsychPhDone]

I agree with everything you’ve written.

I hope this isn’t a stupid question. Psychologists are experts in all this, but sometimes they end up with anxiety, depression, and PTSD, too. If they know what to do to maintain good mental health and approach the world and problems in a healthy way, why are they affected like this? How can therapy help them if they themselves are the experts?

Isn’t this just another example of it being a normal response to extreme stress or trauma? No one is immune. We need to safeguard people’s mental health. No amount of coping skills will be enough sometimes.

I wish you guys would see some of these suicide attempts coming through the ED. I’m sure you see more than your fair share of suffering, and it takes a toll eventually.

Do oncologists not get cancer?

 

[futureapppsy2]

but...in most cases of diabetes there is some degree of impact of dietary and lifestyle choices on the problem.

Type 2 diabetes, that is.

 

[Fan_of_Meehl]

Type 2 diabetes, that is.

Good point.

 

[MCParent]

1) The answer to your leading questions is "no". Don't you think?
2) I read something somewhere that said that you are not in healthcare. You see how these unverifiable arguments go?
3) If you read the DSM cover to cover before you criticized it, you'd know it said, "“An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.”. If you didn't know that, you'd look very foolish.
4) Where is your evidence for any of these positions? Cite the reference to the therapist's perceptions, incidence/prevalence of sexual relationships in psychotherapy, etc.
5) Specifically, which religious figures are correct in their ways to live life?

I have an intense dislike of people saying “don’t you think…” when they mean “I think…”

 

[genop]

It's helpful to imagine that you're going to your PCP and they discover that you have developed diabetes. But your PCP says, 'Well, there are medications that might be helpful in making you less negatively affected by diabetes. But I'm not going to prescribe any of them because what we really need to do is change our society's approach to eating, industrial agriculture, and food insecurity. "

Mutatis mutandis for mental healthcare.

Except no one is saying we should do that. We need to do both.

We need to focus more on prevention than we currently do. “An ounce of prevention is worth a pound of cure.”

 

[PsyDr]

I have an intense dislike of people saying “don’t you think…” when they mean “I think…”

Forensics 102: the answer is “no” to any question that starts with “Don’t you think…” or “Wouldn’t you agree that…”

It’s a leading question format that attorneys use. It allows the attorney to testify through questions. And it requires you to accept the initial proposition of the question.

I guess it’s the same for clinical interactions with patients. But I’ll defer to my clinical colleagues on that.

 

[Fan_of_Meehl]

Forensics 102: the answer is “no” to any question that starts with “Don’t you think…” or “Wouldn’t you agree that…”

It’s a leading question format that attorneys use. It allows the attorney to testify through questions. And it requires you to accept the initial proposition of the question.

I guess it’s the same for clinical interactions with patients. But I’ll defer to my clinical colleagues on that.

Exactly. It's 'begging the question' (the real definition of the logical fallacy). Trapping you to agree with their conclusion before any examination of their premises, logical analysis, or evidence.

It's an intellectual 'fools mate' attempt.

 

[MCParent]

Exactly. It's 'begging the question' (the real definition of the logical fallacy). Trapping you to agree with their conclusion before any examination of their premises, logical analysis, or evidence.

It's an intellectual 'fools mate' attempt.

In normal discussion it means a person is trying to make a claim and then shift the onus onto the other person to defend their position instead of explaining their own. Lazy, sloppy debate method.

 

[Fan_of_Meehl]

In normal discussion it means a person is trying to make a claim and then shift the onus onto the other person to defend their position instead of explaining their own. Lazy, sloppy debate method.

'Cleverness is not wisdom.'

- Euripides