Mental Disorders and Illnesses: Part Two
In this series we are looking at how “mental illness and disorder” classifications and diagnoses may need to be filtered through various lenses and that we should work beyond the labels when it comes to how to live with these conditions. In the first part of this series, I chose to re-group the mental disorders from how they are classified within the Diagnostic and Statistical Manual (DSM-5).
I will return to the Coping Continuum classification in much more detail in a moment, but first a bit of an overview on the other categories I have dreamed up:
Childhood Conglomerations
The biggest chunk in this category is the neurodevelopmental spectra and they encompass everything from autism to cerebral palsy to vision and hearing impairments to ADHD, FASD and learning and intellectual challenges.
Brain Body Bits
A neurocognitive disorder is decreased mental function due to a medical disease other than a psychiatric illness. Within this category are many of the physical brain deterioration illnesses that impair neurocognition.
Not all sleep-wake and sexual dysfunctions have medical underpinnings, but some do and that is why we find these conditions both here and in the coping continuum.
Epigenetic Entanglements
These are the personality disorders and they are broken out into three clusters: A (odd/eccentric), B (dramatic, erratic), and C (anxious/fearful). In the DSM there are three disorders in cluster A, four disorders in cluster B and another three disorders in cluster C.
The word “pervasive” is a specific marker for all these disorders in the DSM descriptions and that is because they are trying to delineate between personality traits and states. An obsessive-compulsive personality disorder (Cluster C) does not have much in common with someone dealing with an obsessive-compulsive disorder. Why? The subjective experience is very different.
The best way to describe a personality disorder is that it is the person’s set point. The epigenetic explanation is one that is gathering support within research circles. Basically, enough of a genetic pre-disposition coupled with a pretty unpleasant childhood development environment and you activate and influence the genetic landscape such that behaviours become personality traits and it is what one researcher called a maladaptive syndrome. You can look out the work of Dr. Dragan M. Svrakic MD if you are interested in learning more.
The final sentence from the paper Personality disorders: A burden in the community, neglected in the clinic zeros in on the essential subjective difference for these epigenetic entanglements:
“Personality disorders cause significant problems for those who have them. Persons with personality pathology often suffer, and their relationships with others are typically problematic. They have difficulty responding flexibly and adaptively to the changes and demands of life, and they lack resilience under stress. Instead, their usual ways of responding perpetuate and intensify their difficulties. However, individuals with personality disorders often blame others for their difficulties or deny that they have any problems at all.”
Again, I will be focusing more on the coping continuum conditions here, but the epigenetic entanglements are something that may co-present with the mood disorders found in the coping continuum.
Maladaptive Syndrome vs. Maladaptive Coping
Someone with an eating disorder or perhaps a substance use disorder certainly experiences far reaching impacts in their lives from the maladaptive coping behaviours that are present as part of their condition, but many facets of their lives can also remain quite intact.
For those with personality disorders, the syndromic nature of their condition creates a type of one-note-ish-ness wherein no part of the lives is untouched by the rigidity and brittleness of their personality-driven behaviours and responses.
There are always going to be exceptions in all of these categories and conditions, but in general terms those on the coping continuum tend to wish for less brittleness and more flexibility in themselves, whereas those with the epigenetic entanglements predominantly wish that others would be less problematic and more supportive and flexible.
Pandemic Mental Health Narrative
If you are in the working world in any capacity at all, you will have noticed the flood of media attention, and also human resources attention, on “taking care of your employees’ mental health” during these times. The rollout of corporate initiatives to tackle employee mental health has been significant across many industries and tends towards what I have always called the meditation-and-veggies approach to care (meaning all mental health crises are resolved through practicing meditation and eating your veggies). At its core, employers are just reinforcing with employees that it is their individual responsibility to attend to their own mental health.
The mental health narrative closely aligns with the public health narrative across all western countries right now – namely it is an individual choice and responsibility to attend to mental health as much as it is a personal choice to wear a mask or take a vaccine.
There is no community narrative to be had and no shared responsibility or recognition of influences beyond your locus of control.
I will address this pervasive individualistic focus in another piece in more depth, but for now I bring it up because this narrative did not really arise out of the pandemic; it predates the pandemic by a good long while.
However, I do believe that we are seeing a fascinating passive resistance in many western nations at present by huge swaths of workers in all ranks of industries, as they recognize that they have little interest in racing back to pre-pandemic normal. There has been much hype in the press on the “Great Resignation” or “the Big Quit” — here is just one such article in the BBC — where employees are simply choosing to resign rather than be ordered back to the physical office space, or to return to in-person services that were unrelenting and unsupportive of their employees through several serious outbreaks of the virus in the communities in which they work.
There is so much capitalist focus in the media on “post-pandemic” life and racing back to our usual lives now that vaccines have solved it all, that I have not seen too much reflection yet on how humans living and dying through significant events tend to drastically shift their trajectories (often not permanently, but certainly for a good while) to reflect a rather unceremonious and stark reminder of the finiteness of their lives and the lives of their loved ones.
As we all grind our way through yet another fire and brimstone season (I am writing this in the middle of yet another heat warning in August that essentially covers North America while the monstrous wildfires create their own cataclysmic weather systems); navigate our days and nights alongside variants of concern and variants of interest; witness exhausted healthcare workers and the dependably greedy Leaders of Industry anxiously pressuring everyone to sign up for some unspoken Allowable Death Rate, opportunities for new narratives are nonetheless there for the taking these days.
Anger and Righteous Indignation
Those with disabilities and those who have navigated debilitating chronic conditions for years were understandably horrified at the speed with which our society, that had been loathe to so much as provide even marginal accessibility pre-pandemic, ramped up telemedicine, remote work, and all kinds of virtual access within weeks.
And while it was painful for them to instantly have the kind of access that they had been requesting for years, just because the abled masses had a sudden need for that kind of access, it is far more painful to have the narrative shift to blaming the unvaccinated for the pandemic ruining our race back to normality, rather than us pledging to maintain all the many ways in which we can protect the vulnerable and include them in our society from this point forward.
It is a “have we learned nothing?” moment.
This piece from the New York Times I found particularly useful in encapsulating many of the amorphous and unclear thoughts I have had on these topics:
I am going to leave it here for this week as next week in Part Three we are going to delve into this opinion piece in much more detail.
Skodol AE. Personality disorders: a burden in the community, neglected in the clinic?. The Journal of clinical psychiatry. 2015 Nov 25;76(11):14168.
