In this series I am going to attempt to build on the past two series of Enviraikido and Terroir. We all tend to feel initial relief when we get a diagnosis and are given a label. We can feel vindicated—that despite all those who minimized or brushed aside our challenges and struggles—what we were experiencing was “real.” We can also experience grief and loss that the diagnosis or label removes both possibility and hope.
Flickr.com: Ivo Dimitrov
But everything in our modern medical industrial complex reinforces that beyond a diagnosis and a label lies deficits. And only deficits. The focus, whether this is a medical or mental health diagnosis, is on (primarily) the treatments and drugs to help minimize, suppress, and generally cope with those deficits.
In this series we are going to play around with first the diagnoses and labels, and then ultimately reject the deficit/strength model as just another binary human-derived framework that does not capture the complexity of self and others.
Neurodiversity as a Compass Point
Neurodiverse communities (those with autism) have taught me much in how they grapple with the otherness without othering. Most within neurodiverse communities have been ruthlessly othered, bullied and discriminated against by the dominant “normal” of our societies. But rather than passing as normal or seeking retribution from the neurotypical world for the painful experiences of exclusion and harm; they would prefer to have a bit of help in interfacing with the neurotypical world. However, and this is critical, they insist they should direct and define how that might transpire. They do not want to be cured or to have accommodations; they want inclusion.
In this multi-part series, I am going to look at several different facets of inclusion in the hopes that it may help some of you on whatever journey you are on with chronic illness.
Ah, the DSM
It would be easier to list things that are not included in the Diagnostic and Statistical Manual (DSM) as mental disorders these days. I know that is a pretty flippant remark, but at 947 pages it is not too far off the mark.
Feeding and eating disorders have their own category and exist alongside all these other categories [thank you Wikipedia]:
Neurodevelopmental disorders
Schizophrenia spectrum and other psychotic disorders
Bipolar and related disorders
Depressive disorders
Anxiety disorder
Obsessive-compulsive and related disorders
Trauma- and stressor-related disorders
Dissociative disorders
Somatic symptom and related disorders
Elimination disorders
Sleep–wake disorders
Sexual dysfunctions
Gender dysphoria
Disruptive, impulse-control, and conduct disorder
Substance-related and addictive disorders
Neurocognitive disorders
Personality disorder
Paraphilic disorders
There is most certainly a mental health industrial complex now where there is pressure both on and by patients to seek out and receive a diagnosis in many of our countries as a way to ensure access to some treatment and services.
There are some hard lines between all these categories that I have witnessed in my work, but like all human beings I may love categories and that can compress and eradicate very important subtleties and complexities.
I have already written quite a bit in the past on this site on depression and anxiety as well as obsessive compulsive and related conditions. I will likely do quite a bit more material on trauma, substance use and psychosis-spectrum conditions coming up in the next few months.
Re-Grouping
Today, I wanted to first set the stage for a new lens on all things “mental disorders and illnesses.” The reason I want to do this is that I think there may be value in changing up how we group the conditions (to recognize significant overlaps) and, more importantly, how anyone with any of these diagnoses (one or more) might develop a consciously-developed story, well beyond a label, that puts them at the centre of what they want for their lives.
Coping Continuum
Feeding and Eating Disorders
Depressive disorders
Anxiety disorders
Obsessive-compulsive and related disorders
Trauma- and stressor-related disorders
Dissociative disorders
Somatic symptom and related disorders
Substance-related and addictive disorders
Sexual dysfunctions
Sleep–wake disorders
Schizophrenia spectrum and other psychotic disorders
Bipolar and related disorders
Childhood Conglomerations
Feeding and Eating Disorders
Disruptive, impulse-control, and conduct disorders
Gender dysphoria
Elimination disorders
Neurodevelopmental disorders
Brain Body Bits
Neurocognitive disorders
Sexual dysfunctions
Sleep–wake disorders
Epigenetic Entanglements
Personality disorders
Explanation of Exceptions
And for paraphilic disorders it is everything from the range of sexual interests that consenting adults may share but can be classified as a disorder when someone finds it personally distressing to have the interest, to the stuff that involves definitely not consenting adults but lives in the world of fantasy and then the dark stuff. There will be way more useful sites to go to on this topic than EDI in any case, so I will just mark it here as a standalone: Paraphilic disorders
I have placed sleep-wake disorders and sexual dysfunctions in two categories because some have physical underpinnings and some may be more coping continuum challenges.
You will also notice that I have placed feeding and eating disorders in both Coping Continuum and Childhood Conglomerations as there are some elements of restrictive feeding in early childhood that may have more neurodevelopmental sensory elements to their appearance.
Coping Continuum
I expect many would dispute what I have chosen to bundle together in this category. There has been a significant emphasis within the psychiatric space, which can be heavily attributed to the creation and marketing of psychoactive drugs, to medicalize all of these conditions and to suggest that there is an inherent brain chemistry gone awry. Furthermore, the dominant established position is that these brain chemistry aberrations are distinct for each condition.
However, the way in which all the psychoactive drugs are prescribed confirm that there is no distinct brain chemistry associated with depression when compared to schizophrenia or substance use disorders. Rather than reference all the studies on that fact, I will simply refer you to any work by Dr. Joanna Moncreiff including her books The Myth of the Chemical Cure and The Bitterest Pills.
I refer to it all as the Coping Continuum because their symptoms tend to arise from adaptive responses to various environments and circumstances and then they basically get a bit ratcheted, stuck and may start to impair the person’s quality of life. And it must be emphasized that quality-of-life impairment is also culturally determined and not purely individually created. Furthermore, both expectations and experience will influence how any one person defines their quality of life.
The WEIRD of Quality of Life
I have mentioned the WEIRD study in a couple of past entries such in Remission Accomplished: What Does it Signify? WEIRD is the acronym for White, Educated subjects from Industrialized Rich Democracies and it was coined by UBC researchers identifying that most studies on the human mind are not representative of the majority of the world’s human experience as we disproportionately use white university students in industrialized rich democracies in our studies.
I believe I have also mentioned another study that identifies being poor and experiencing all the negative health outcomes of poverty appears in Americans who are not objectively poor but are not as wealthy as their neighbours. There is being poor or feeling poor (inequality) and they have similar impacts on health. Dr. Keith Payne has written a book (referencing all the studies they have conducted) on the topic: The Broken Ladder: How Inequality Affects How We Think, Live, and Die.
In the book, Happiness Across Cultures: Views of Happiness and Quality of Life in Non-Western Cultures, the editors lay out in the introduction to this textbook that the following themes show up on this topic:
In general cultures with a wider gap between rich and poor experience lower levels of happiness. Quality and fairness are qualities that almost uniformly contribute to a better society…lack of comparison figures significantly in many of the chapters—people report that their lives are good if they are about the same as their friends and relatives.
Folks in most unequal western societies navigating various coping continuum conditions have a very clear sense that they do not match their neighbours and that there are few options on the cultural landscape to find room for being okay while navigating being less than okay.
Across this broad array of conditions there are commonalities:
Each condition tends to have a wide spectrum of symptoms, severity and also very non-linear trajectories.
Each condition has symptoms that under the right circumstances, or perhaps even for a period of time, are adaptive and can be found in individuals in the population that do not meet the criteria of having the disorder.
In the next entry in this series I will touch on some of the other grouped categories I have concocted but then we will return to the Coping Continuum in more detail.