Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (14)
Similar to Person centered diagnosis and treatment
Similar to Person centered diagnosis and treatment (20)
Recently uploaded
Recently uploaded (20)
Person centered diagnosis and treatment
- 5. Pros • Effectively Categorizes Mental Disorders • Moderately Effective in Reducing Symptoms • Highly Efficient Standardized Format • Based on Statistical Probability Cons • Considers Only Client Symptoms • No Framework for Client’s Experience • Less Effective in Symptoms Maintenance • Over-Identification with Labels • Semantically Unsophisticated • Human Experience Limited to what is in the DSM
- 8. • “The potential for finding meaning in suffering.” • “Despair = Suffering – Meaning” • Resiliency Found in Necessary Suffering
- 10. • Diagnosis Forms Through Personal Discovery • Therapeutic Alliance between Client and Practitioner • Being an Expert vs. Being a Collaborator & Critical Thinker
- 12. • Whole Person vs. Symptoms • The Experience is the Problem • Holistic Health and Wellness Program
- 14. Pros • Clients as Unrecognized Experts • Meaning Attached to Experience • Considers the Whole Person • Treats the Whole Experience • Allows for Growth and Change Cons • Lack of Statistical Reliability and Validity • Less Able in Establishing Standardized Practices • Less Orderly • Less Efficient • Inability to Make a Quick Diagnosis of the Problem.
- 15. • Empirical • Precise • Statistical • Symptomatic
- 16. In a sense, a medical model of diagnosis flattens human complexity for the sake of diagnosis and shows indifference to the humanistic, holistic, and nuanced perspective of the client. Danielle Egan, 2011
- 17. Experiential, Comprehensive, Meaningful, Holistic Empirical, Precise, Statistical, Symptomatic
- 18. Client’s Experience Environment Emotions Behavior Thoughts Beliefs Neuroscience • Dysfunctional Patterns • All areas are inter- connected • Diagnose the Whole Person • Holistic View of Treatment (Ex. Diabetes) • Mental Illness vs. Terminal Illness
- 19. • Clients have Experiences that Share Common Characteristics (Ex. Clients with PTSD) • Phenomenological Frameworks (Shared Client Experiences have a Unique Structure and Meaning) • Learned Schemata (Such Experiences Create Learned Patterns in the Client’s Memory) • Personal Constructs (These Schemata or Constructs Affect the Future Experiences of Clients) • Neurological-Pathways (Changing Client Experience Creates New Pathways in the Brain. Maurice Merleau-Ponty Daniel Siegel Jean Piaget George Kelly
- 21. GAD Uncertainty Over- focusing Excessive Worry Developing Symptoms Underlying Crisis Accumulation • Identify Uncertainty (Beliefs/ Environment) • Expand Client Focus (Thoughts) • Change Worry to Concern (Thoughts/Emotions) • Reduce Symptoms (Biology) • Control Impulses (Behavior) • Identity Issues (Beliefs/Environment)
- 22. • Meaning in Pleasure (Biology/Environment) • Change Worthlessness to Loss (Emotions) • Depression vs. Apathy (Biology/Beliefs) • Returning to Normal (Thoughts) • Resiliency (Behavior) • Personal Empowerment (Beliefs/Environment) Depression Lack of Pleasure Worthless Feelings Overly Sensitive Obsessive Internalizing Feeling Trapped Defeatist Attitude
- 23. • Isolation is not Biological (Environment) • Rejection vs. Acceptance (Thoughts) • Working Through vs. Getting Rid of Pain (Emotions) • Being Aware vs. Distractions (Behavior) • Necessary Risk and Resiliency (Beliefs) • Reconnection is Interpersonal (Environment) Loneliness Isolation Rejection Pain Awareness Risk Reconnection
- 24. • Mental Disorder or Addiction? (Not Only Mental and Not a Disorder) • Study of Neuroscience and Human Experience (Phenomenology) • Reciprocal Relationship between the Brain and Client Experience. • One Reinforces the Other: More in Line with Addiction • Efficacy vs. Effectiveness (Ottawa University) • Personal Point of View: (Ex. Canton-Potsdam Hospital)
- 25. If this theory is correct, then the use of drugs, so often prescribed in mental health treatment, cannot take sole responsibility for changing these addictive patterns in your brain. More correctly, they may only help you tolerate them. A more person-centered, holistic perspective helps in the development of new patterns of experience, along with new neurological pathways. In other words, help clients find new meaning in their lives that do not use drugs to reinforce old addictive patterns through symptoms reduction and symptoms maintenance. Peter Ladd, 2008
- 27. • Do We Want Human Experience Pathologized by the Continued Use of Statistics and Drugs? • Should We Consider a Bio/Psych/Soc/Spiritual Model of Diagnosis and Treatment? • With the Release of the DSM 5, is this the Right Time for Change?
- 28. • Bastine, M. & Winfield, M (2011) Iroquois Supernatural: Talking Animals and Medicine People. Bear & Company Publishers • Frankl, V. (1971) Man’s Search for Meaning. New York: Pocket Books. • Kelly, G. (1955) Psychology of Personal Constructs. London, UK: Routledge. • Ladd, P. D. & Churchill, A. C (2012) Person-Centered Diagnosis and Treatment in Mental Health: A Model for Empowering Clients. London, UK: Jessica Kingsley Publishers • Merleau-Ponty, M. (1970) Phenomenology of Perception. New York, NY: Routledge and Kegan Paul. • Piaget, J. & Elder, B. (1972) The Psychology of the Child. New York, NY: Basic Books. • Potter, J & Jacob, T. (2011) Picture of Tewakierakwa (Clan Mother). Akwesasne Mohawk Nation: Holistic Health and Wellness Program. • Rogers, C. (1978) Carl Rogers and Personal Power: Inner Strength and its Revolutionary Impact. Philadelphia, PA: Transatlantic Publications. • Siegel, D. J. (2010) The Mindful Therapist: A Clinician's Guide to Mindsight and Neural Integration. New York, NY: W. W. Norton and Company. • Shapiro, D. (2012) AHC Gives Feedback on Proposed DSM Changes. Counseling Today. 55, 5, 69-70.
Editor's Notes
- Our thinking is changing as we move from a 20th Century Industrial Age into a 21st Century Information Age. The dissemination of information through such phenomena as the Internet and other information sharing devices has changed our methods for perceiving and resolving problems. (I first saw this when writing the book, Mediation, Conciliation and Emotions. The Information Age was calling for a new paradigm in Education and the Legal System.) In an Information Age, there may be an emerging paradigm shift from a traditionally rules based format to a more problem solving format where individuals have increasing input into decision making processes that affect their lives. In mental health, the traditional approach has been a symptoms based (rules based) approach where mental health professionals (experts) perceive and make decisions on the mental health problems of their clients or patients. This is an age that calls for a more modern format that empowers clients to be a part of a process that has significant consequences for their health and futures. Keeping this in mind, we have written a client empowerment, problem solving based diagnosis and treatment manual. Our intention was to empower clients to participate in a collaborative effort in solving their mental health problems
- Let me start this presentation with making an analogy. There is a difference between writing a book and the “book writing business” as much as there is a difference in making a mental health diagnosis for the client and the “mental health diagnosis business”. Regardless of its original intentions, the DSM assessment has become the diagnostic instrument for the “mental health diagnosis business” with categories and labels used as the language for insurance reimbursement, pharmaceutical treatment and collaboration between experts. However, it is my belief that it has lost perspective therapeutically when making a mental health diagnosis that helps clients grow and change. When the “business” of mental health diagnosis becomes more important than making an accurate mental health diagnosis for the client, questions need to be considered regarding this practice in mental health. Just as the book writing business is different than writing a book, making and accurate mental health diagnosis for the client is different than diagnosing for the mental health business. Here is another analogy. In education, there is a difference between grades and evaluations. Grades are connected to the “education business” for example, where an accumulation of grades, commonly called a transcript is used in the “education business” for getting into college or graduate school or for getting a job. However, grades are not true evaluations but are scores. True evaluations are what you receive, for example, on a paper that describes what worked, what did not work, what was valuable or what needs to be changed etc. Evaluations are not necessarily connected to the education business” but to a students individual learning. Grades are not accurate predictors of what was learned. At most, they are predictors of future grades. It may be fair to say that professional knowledge based on a medical model of diagnosis expresses certain knowledge to insurance companies, managed care agencies, drug companies, and other professionals in the health care system, but is this knowledge imparting a specific message that is therapeutic to the clients receiving the diagnosis?
- Just a note: The DSM 5 will make a concerted effort to define mental disorders as primarily biological. It will also lessens, the diagnostic thresholds of many mental disorders. For example, it will remove the exclusion of bereavement from major depressive disorder, and it will lessen the number of criteria for Attention Deficit Hyperactive Disorder. In this manner, it will continue to pathologize expected natural human responses to typical occurrences (Shapiro, 2012). While questioning the rules of the DSM 5 professionals also may want to question whether diagnosing a client should be solely based on rules. I have struggled with this narrow minded perspective for over 30 years in teaching graduate classes in mental health and in actual practice as a mental health clinical supervisor who overseas diagnosis for insurance reimbursement and pharmaceutical treatment. For me, the art of mental health diagnosis and complying with the mental health diagnosis business can be, at times, a pseudo-schizophrenic experience. Ethically, I find it troubling that DSM IV diagnoses submitted to insurance companies by most medical model practitioners, fail to capture the client/practitioner’s actual experience. For example, I understand that in medicine, being diagnosed with a brain tumor does not require the patient to advise the surgeon when making a medical diagnosis or when performing medical treatment. However in mental health, a diagnosis excluding input from the client seems counter-productive and should not imitate the same process as found in medicine, In other words, a DSM diagnosis should not automatically lead to bio-chemical treatment through psychotropic drugs, especially when most of the treatment based on the diagnosis should be carried out by the mental health client — not by the mental health practitioner. Keeping this in mind, here is the question I ask myself, “Why is an expert-centered, medical model diagnosis such a big problem for me?” They have been going on for years and they happen routinely with little apparent threat to the nature of mental health diagnosis or treatment. Yet, this apparently benign reality may reveal a subtle yet insidious problem for the future identity of many mental health clients. Using only the experience and knowledge of experts to make a diagnosis without considering someone who lives their suffering 24/7, sends the message that, “I know more about your experience than you do.” At best, again in my opinion, an expert can add up mental health symptoms based on statistical probability and give a diagnostic label without actually knowing the client, but it baffles me how an expert can describe, understand or live through the nuances of any client’s treatment without asking them.
- Another problem with the DSM IV is its lack of sophistication regarding how it speaks about people. In my opinion, it indirectly de-personalizes them. For example, the DSM IV has such labels as Bi-Polar Disorder or Obsessive/Compulsive Disorder. Semantically, a person may incorrectly say, “I am bi-polar or I am obsessive/compulsive.” Even from a strictly medical model, such semantics do not make sense. In medicine one does not say, “I am cancer or I am stroke.” However, with mental disorders one can personalize them as though they were connected to one’s identity. In some respects, a medical model treats mental illness in the same manner as they treat terminal illness with little emphasis on growth and change. The model does this by emphasizing symptoms reduction and symptoms maintenance. Is this not the same view of treatment that is practiced for the terminally ill?
- Flyer on the Back of the Book: Clients with mental health conditions are often diagnosed and treated using a strictly medical model of diagnosis, with little input from the client themselves. This reference manual takes a person-centered, holistic approach to diagnosis and treatment, seeing the client as the unrecognized expert on their condition and encouraging their collaboration. Designed to complement the DSM-IV, the manual covers several different conditions including ADHD, depression, bulimia, and OCD, as well as mental health 'patterns' such as abuse, bullying, violence and loss. In each case, the client is involved in the diagnosis and treatment plan. The book features extended case studies, sample questions and treatment plans throughout. This will be an essential reference book for all those involved in mental health diagnosis and treatment, including psychologists, psychiatrists, mental health counselors, clinical social workers, school counselors and therapists.
- Forty years ago, I was assigned to assist Frankl for about 12 months, just before writing my doctoral dissertation on “Resentment of Authority: A Phenomenological Approach”. I was very lucky because he resented authoritarian behavior and oppression and understood phenomenology. His influence on my writing still prevails to this day. However, what I most remember about him was his dry sense of humor. From his past experiences, he had little logical reason to be that humorous. He taught me that humor and wisdom are intricately connected. He said that “Humor expands our potential for wisdom. Being too serious shrinks the boundaries of what is possible.”
- Not all negative experiences presented to mental health professionals are negative in the lives of clients. In painful experiences much can be learned by managing suffering rather than eliminating it. The idea that someone can get through life without moments of suffering or more specifically “pain free” seems an unreasonable assumption. Mental health professionals may need to remind themselves that reduction of client symptoms is not always the most appropriate approach for the mental health patterns presented for treatment. It may be that constantly reducing symptoms can lessen the resiliency found in working through suffering.
- Another major influence was Carl Rogers who 30 years ago came to St. Lawrence University for a week in the early 80’s to study our person-centered counselor and teacher education programs. He was extremely generous when later on, he asked me and others to be contributing authors and write about both programs in one of his books Freedom to Learn for the Eighties (Rogers, 1983). Of course, I can remember this being a “big deal”, with thoughts of how it would affect my career and other self-centered thinking. Yet, Rogers demonstrated first-hand the importance of empowerment and person-centered thinking. I found him to be an unassuming and humble person. Actually, his humility was very surprising but it eventually taught me the value of focusing on others. He seemed to stay in the moment and showed little interest in emphasizing his expertise.
- Rogers would probably say that any specific expertise should not be used unless it is relevant to empowering a client’s personal discovery and personal identity. He understood the difference between creating a therapeutic climate that advocated for human potential than in creating a competing school of therapy A therapist is working from a “disciplined naivete” and is open to the moment, using their professional discipline only when necessary (Merleau-Ponty,1970). Usually, if the client and I try certain psychological techniques such as, CBT or Mindfulness Training, it is because both parties in the therapeutic alliance have discovered its usefulness, together.
- For the past 35 years, I have worked closely with Native Healers from the Akwesasne Mohawk Reservation, and what has most impressed me about them is the honor and respect they give to authentic people. They taught me the difference between being honored and being rewarded which has helped define my understanding of humanism. In my culture at the University, we are rewarded for following the rules. In Native culture a person is not rewarded but is honored and respected for showing personal balance and authenticity. They show a unique ability to balance the harmony found in the human spirit. (Bastine & Winfield, 2011)
- The model believes that it is important to diagnose and treat the whole person not just client symptoms. Such a model goes beyond a medical model diagnosis of “I am the problem” and offers a new approach where the “The experience is the problem”. It empowers the client to understand experiences in everyday life by externalizing the experience where it is better understood and treated, and where it finds new meaning beyond being strictly a mental disorder. In the Holistic Health and Wellness Program on the Akwesasne Mohawk Reservation, we have been using this model for the past twenty years. It includes diagnosing and treating everyday patterns that combine; neuroscience, beliefs, cognitions, emotions, behaviors, and social experiences of clients. We treat clients holistically through mental health, addictions, medicine, traditional medicine, consultations with an on site pharmacist and social services. I have been involved in setting up two different mental health clinics on the Akwesasne Reservation (which spans both Canada and the United States and is inhabited by 20,000 people). In 1985, I helped create a medical model mental health clinic on the U.S. side of the Reservation. In 1990, I was involved in setting up a community model mental health clinic on the Canadian side of the Reservation. I have been involved with the Canadian mental health clinic ever since. The Canadian clinic sees more types of problems, has far more clients, and is more community oriented. (Note: For you hard core pragmatists, it is also more successful with insurance reimbursement). Of course, we are talking about serving a group of people who have viewed the world holistically for many generations, and maybe that is why it seems more effective. Or, it may be that psychiatry and the business model can learn something from this ancient culture.
- The nature of the client’s suffering becomes clear to the client only in the course of therapy, that ‘diagnosis’ cannot be made prior to the client’s own formulation of his or her suffering, which takes place during the relationship between client and therapist Purton, 2004). Only in this process can be found the wisdom in making a mental health diagnosis at least for the client. However, in the “mental health diagnosis business” there is a mandate to make the diagnosis before you get started or at the beginning of counseling or shortly thereafter, again imitating the field of medicine more than mental health. After establishing a therapeutic alliance is where a mental health diagnosis becomes valid and where the wisdom of making a diagnosis becomes more collaborative and person-centered rather than expert-centered. In some respects, a person-centered diagnosis is a mediated agreement based on two crucial points of view between the client and the practitioner, and this agreement is discovered in the common ground that emerges after creating a therapeutic alliance. It also establishes an opportunity to collaborate on an effective treatment plan.
- In a more person-centered approach based on teamwork, clients may be utilized as the unrecognized experts in diagnosing problems. Unlike the empirical model used in mental health to uncover specific facts or statistics, the client empowerment model is used to uncover meaningful experiences associated with the whole person. It assumes that in order to find meaning in the experiences of clients, it is important to treat the whole person not just one facet of the person
- The rats, cats and stats form of diagnosis leads to a distortions In an effective diagnosis the whole is more meaningful than a sum of its part. Only diagnosing symptoms requires only diagnosis parts at the expense of the whole.
- Perspective on a phenomenon is best achieved when an observation is made from an optimal standpoint. Stand too close and the image becomes narrow and over focused, with details emphasized at the exclusion of the complete picture. Only using DSM criteria to diagnose human functioning is similar to focusing on details, while missing the larger picture. A client empowerment model for diagnosis and treatment offers a more optimal standpoint where details or symptoms are observed at a distance, bringing into focus patterns and human meaning related to the symptoms. This distance viewing on the part of mental health practitioners, allows for integration of information into a comprehensive picture of the client’s issues without becoming immersed in details. From a distance, patterns are detected and person-centered understanding is achieved. It may be this person-centered perspective that entails meaning making, offering a more helpful approach in facilitating human growth and change.
- Person is not viewed as the problem, his or her dysfunctional patterns become the problem. Makes the assumption that all areas of a client’s experience are inter-connected For example, even when clients begin talking to a mental health practitioner about how depression feels or how it has changed specific behaviors or how the social environment has affected their depression, clients still are talking about themselves as a whole person and through the therapeutic alliance between practitioner and client, the meaning of depression is found for that specific client. Regardless of the initial focus, all other areas contribute to this person-centered perspective as mental health services progress.
- Diagnosis and Treatment in Mental Health is a synthesis of theories by; The concepts found in the book Person-Centered Diagnosis and treatment. Maurice Merleau-Ponty (French Phenomenologist). His work convinced me that you could capture the basic structure of any given phenomenon (Merleau-Ponty, 2012). Jean Piaget (Swiss Developmental Psychologist) convinced me that we rely on specific schemata to identify meaningful experiences (Piaget, & Endler, 1972). George Kelly (American Personality Theorist) is AnnMarie Churchill’s input based on developing personal constructs where some of these personal constructs cause us conflict (Kelly, 1955). Mostly recently, I have been influenced by Daniel Siegel (Neuroscience Researcher) who points out the flexibility of the brain and how it can develop neurological pathways based on human experience (Siegal, 2010). I have thought for some time that certain patterns in human experience have common characteristics. In other words, each person has their unique experiences in life; however, we have in common certain phenomena or patterns that are recognizable to many different people going through these experiences. For example, each person may have their unique experience with anger but most of us recognize a pattern of anger in ourselves and in others that is vaguely familiar. In psychology, Jean Piaget would call these vaguely familiar experiences, schemata which are based on what we have learned and remember. Maurice Merleau-Ponty would call them experiential frameworks based on our perceptions of the world. George Kelly would call them personal constructs through decisions made in life, and Daniel Siegel would call them neurological pathways based on how the brain responds to human experience. From their unique theoretical perspectives, they would say that such experiences help us efficiently organize information as we go through life Yet, sometimes these schemata, personal constructs, experiential frameworks or neurological pathways may hinder us from other meaningful experiences. Human experience is filled with recognizable patterns that may influence us on a daily basis both positively and negatively (Ryan, 2006). The bulk of the work on this book was in identifying and modifying these recognizable patterns of experience in the field of mental health. I believe that some people experience everyday patterns in living that are too narrow and inflexible, such as found in mental disorders. By expanding these patterns or adapting to new patterns, people can discover their freedom. This premise is far from the medical model of symptoms reduction and symptoms maintenance. These patterns include neuroscience, beliefs, thoughts, emotions, behaviors and the environment. In this regard, the book Person-Centered Diagnosis and Treatment in Mental Health includes a more bio/psycho/social/spiritual model that relies on human experience.
- Person-Centered Diagnosis (Phenomenological Research) : A Person-Centered Model for mental health diagnosis is formed by an understanding of phenomenological research , that creates structure in the form of patterns for specific life experiences. In this example, during our research, we empowered clients to develop a pattern of experience for General Anxiety Disorder. It was our belief that clients understand this experience if empowered to express themselves. Here is the pattern that emerged from the research: The pattern begins by having clients feel uncertain about meaningful experiences in their lives. They become so meaningful or disruptive that clients begin to over-focus in order to change uncertainty into certainty. When they cannot accomplish this, they tend to excessively worry about their problem or problems. Excessive worry leads to developing symptoms. However, even when symptoms are reduced, they still have a low level of underlying crisis. Ironically, it becomes the accumulation of underlying crisis that causes people to experience more uncertainty and the cycle begins again. Over time, I believe, a client is experiencing an addictive pattern of experience called General Anxiety Disorder. Drugs help in gaining control but do not help clients work through uncertainty. Help through Existential or Person-Centered therapy. Based on beliefs and feelings Drugs may help clients expand their focus (may numb focus) Exercise, Mindfulness Training, Meditation more helpful. Drugs do not help with excessive worry Help through Rational-Emotive Therapy Drugs can help reduce symptoms. Help through pharmacological consult Effective for about 8 weeks Drugs help less in reducing underlying crisis Help through Dialectical Behavioral therapy (DBT) (Behavior and beliefs) DSM Diagnosis may cause accumulation of uncertainty (Issue of identity) Holistic Treatments (Participatory Action Research): Based on this view of General Anxiety Disorder, a mental health practitioner can view this pattern holistically, and discuss with the client how to change it anywhere along the cycle. For example: Discuss whether your client’s anxiety is based on issues that have personal meaning. This may call for some form of existential therapy or person-centered counseling (Uncertainty based on beliefs and feelings.) Discuss the use of cognitive behavioral therapy and how it may demonstrate the connection between thoughts, feelings and behaviors. It may also help clients assess and challenge chronic negative thought patterns. (Over-focusing through thoughts) Sometimes it is thoughts and feelings that cause anxiety. Discuss some form of rational emotive therapy especially with excessive worry. (Excessive worry based on thoughts and emotions) Discuss clients changing their worry to concern. Discuss whether they would be open to cognitive therapy to achieve this goal. (Excessive worry based on thoughts) Ask your client how unstable the anxiety feels? If they want some form of psychotropic drug to stabilize their feelings, make a referral for a pharmacological consult. (Controlling symptoms based on psychotropic drugs) Dialectical Behavioral therapy (DBT) is a more structured process that you may want to discuss, with your client. (It seems to be effective for underlying crisis.) Some clients are open to forms of relaxation skills. EMDR (eye movement desensitization and reprocessing) skills may work for these clients or exercise programs to control an accumulation of anxiety.
- Drugs do not help client gain pleasure. Drugs may reduce libido or pleasure Help through Existential Therapy or Narrative Therapy Drugs may inhibit grieving Help through grieving loss of self Drugs can work for over-sensitivity however not for under-sensitivity (Ex. Children diagnosed with depression who have experienced trauma from apathy) Drugs can give minimal relief to obsessive internalizing but not with returning to normal Help through person-Centered Therapy Help through developing resiliency Do right thing or wrong thing but do something Drugs do not help with a deafest attitude (Second Problem with Depression) Help through personal empowerment Person-centered or existential counseling (isolation) Rational Emotive Therapy (rejection) Pain Management (pain) Focusing Training (awareness) Person-centered Counseling (Necessary Risk) Relationship Counseling (Re-Connection) Comparison between depression and apathy. Apathy is misdiagnosed as depression. Give drugs to apathetic clients and they get worse.
- Confused with depression (pain relievers for the pain of loneliness) Drugs can help with socialization but also cause isolation Person-centered or existential counseling (isolation) Drugs do not help relieve feelings of rejection Rational Emotive Therapy (rejection) Drugs may be counterproductive. Pain Management (pain) (Billion dollar industry) Drugs do not stop distracting behavior and may allow it to happen. Focusing Training (assertiveness) Drugs may help relieve un-necessary risk but inhibit necessary risk Person-centered Counseling (Necessary Risk) Again Drugs can help socialize but not re-connect. Relationship Counseling (Re-Connection)
- I first would like to mention that I do not agree with the term mental disorders. First, they are not specifically mental. As I have mentioned previously, they are a combination of neuro-science, beliefs, thoughts, emotions, behaviors and the social environment. Secondly, they are not disorders. They cause disorder in a person’s life or they represent some so called “chemical imbalance”, but more accurately, the term “disorder” is used by psychiatrists as a substitute for the term, disease. Personally, I believe the term “addiction” should replace “disorder’ and “pattern of experience” should replace “mental” in other words “addictive patterns of experience.” Let me try to explain this theory. Modern day neuroscience discusses the reciprocal relationship between neuro-science and phenomenology. In other words, how life experiences impact on the brain and how the brain impacts on life experiences. In the book, Emotional Addictions I worked from that premise, leading me to conclude that most mental disorders are best described as addictions. From a neuroscience point of view, neuro-pathways that are repeatedly used grow stronger. From a phenomenological point of view, the more you believe a certain way, think a certain way, feel in a certain way, behave in a certain way and live in your social environment in a certain way, the stronger the possibility of repeating that “certain way”, again. For example, a person with a pattern of General Anxiety Disorder who believes they are an anxious person, has thoughts that cause anxiety, has feelings of anxiousness, behaves in anxious ways and lives in a social environment that causes anxiety, will reinforce anxiety pathways in his or her brain. Furthermore reinforced anxiety pathways in the brain will reinforce the everyday experience of General Anxiety Disorder. From my point of view, this seems more like an addiction than a disorder. If this theory is correct, then the use of drugs so often prescribed in a medical model will not change these addictive patterns of experience in your brain. They will only help you tolerate them. A more person-centered, holistic perspective will help people develop new patterns of experience along with new neurological pathways. In other words, help people find new meaning in their lives through developing new patterns of experience rather than reinforcing old addictive patterns of experience by reducing symptoms and symptoms maintenance. Note: I probably would not had the confidence to write the book, Person-Centered Diagnosis and Treatment in Mental Health with my co-author Ann Marie Churchill, if it were not for the book written in 2009 called Emotional Addictions. For most of my career, taking a phenomenological approach to research has been a disadvantage, especially in getting research published. Fortunately, this changed about fifteen years ago when the field of neuroscience acknowledged phenomenological research or the study of human experience as an important part of researching the human condition. Even still, publishing a book that dares to criticize the “Bible of Mental Health” the DSM IV with its 1,300 contributors, may be an example, of a shift in the thinking of many mental health practitioners. One only has to witness the criticism waged against the soon to be released DSM 5 to realize that making judgments about people’s lives based only on statistical probability or consensus by a committee of experts, has its limitations in an Information Age.
- Pathologizing Human Experience
- Neuroscience has stirred up a renewed interest in phenomenology or the study of experience (Siegel, 2010). In other words, human experience causes neurological changes, and neurological changes are best understood through studying human experience. Such a notion takes mental health diagnosis in a different direction than the DSM IV that adds up symptoms in order to give a diagnosis based on statistical probability. The question to ask is whether, “Should mental health diagnosis and treatment rely only on a statistical probability of symptoms, leading to a diagnosis? Or, should we rely on neuroscience research and combine it with phenomenological experience in developing a more bio/psycho/social/spiritual (Holistic and Person-Centered) model of diagnosis? This may be the moment to consider a different model of diagnosis leading to a different perspective on treatment with the ultimate release of the DSM 5, and the book, Person-Centered Diagnosis and Treatment in Mental Health: A Model for Empowering Clients is one attempt at presenting a different model. One only has to witness the criticism waged against the soon to be released DSM 5 to realize that making judgments about people’s lives based only on statistical probability or consensus by a committee of experts, or for the sake of big business, has its limitations in an Information Age.