What is recovery? Recovery in mental illnesses can mean living a meaningful and productive life despite a disability. It can also refer to a reduction or complete remission of symptoms and a healing transformation of the self. For most people, it refers to the power of hope in healing disorders that were once thought to be hopeless. As Henry Ford once said, "Whether you think you can, or you think you can't, you're right."

Tuesday, August 28, 2012

Apples and disorders

Can we define psychological disorders? Should we try?

We can never really truly define what constitutes a psychological disorder, but this hasn’t stopped us from trying. I think the trend away from categories and toward dimensions will further our understanding, but it doesn’t and cannot eliminate all barriers to clarity because a psychological disorder can never be as easily pinpointed as say, an apple. This is in part because there is not as much at stake in the definition of an apple. As David Patrick concluded, “the concept of mental disorder is of dubious scientific value but it has substantial political utility for several groups who are sane by mutual consent” (qtd. in Maddux & Winstead, 2012, p. 15). Every single person on the DSM-IV workgroups responsible for the definition of mood and psychotic disorders received funding from pharmaceutical companies (Maddux & Winstead, 2012). Although most of those people may truly believe that psychological disorders are caused by (yet to be discovered) chemical or genetic imbalances that can only be corrected with medication, this, too, is a problem, because disorders are being defined based on the limited views of one profession, with less consideration to the views and experiences of counselors, psychologists, and particularly consumers. This is by design, because “the purpose of DSM-III... was to allow psychiatry a means of marking out its professional territory” (Maddux & Winstead, 2012, p. 15). When people define disorders so that they can get in or remain in power and/or profit, our understanding remains clouded. Other obstacles to definition include vast differences in disorders between different cultures and individuals. Yet we can do our best to define psychological disorders by continuing to revisit the issue and looking at various perspectives, rather than remaining frozen in one viewpoint. We need more thinking, for example, about why third world countries have much higher rates of recovery from schizophrenia than first world countries. What can we learn that will help us better define psychotic disorders and improve worldwide rates of recovery? The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is another step toward a deeper understanding, offering a complementary (or alternative) perspective to the DSM.

A related question tugs at my mind. While we are defining disorders, why are we choosing to define them as disorders? Why must we see people with mental health challenges as broken? I see people with mental illnesses as coping as best they can with psychological, social, spiritual and biological challenges. Evidence of post-traumatic growth (Woodward & Joseph, 2010) and post-psychotic growth (Williams, 2012) indicates that what we view as disorders are often healing in and of themselves. The mere idea of disorders assumes a mechanistic rather than naturalistic viewpoint. I see therapists not as mechanics but as guides and supporters along a challenging path of healing. 

Maddux, J. & Winstead, B. (2012). Psychopathology: Foundations for a contemporary understanding (3rd ed.). New York: Routledge, Taylor & Francis Group. 

PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations. 

Williams, P. (2012). Rethinking madness: Towards a paradigm shift in our understanding and treatment of psychosis. San Rafael, CA: Sky’s Edge Publishing. 

Woodward, C. & Joseph, S. (2003, September). Positive changes and post-traumatic growth in people who have experienced childhood abuse: Understanding vehicles of change. Psychology and Psychotherapy: Theory, Research and Practice, 76(3): 267-283. doi: 10.1348/147608303322362497. Abstract retrieved from http://onlinelibrary.wiley.com

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