Psychological distress versus mental illness

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Bela
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Psychological distress versus mental illness

Post by Bela » Fri Sep 23, 2016 11:46 am

This blog popped up on my twitter today

http://blogs.bmj.com/bmj/2016/09/19/mar ... l-illness/

It made me seethe silently to myself so though I would post it here - part rant, part genuine request for people's ideas on how they challenge this discourse.

As a trainee, I've found these conversations really tricky to navigate. Clients can find their diagnosis so confusing - is it an 'illness' that I'll have for the rest of my life and if it is what is the point in being here? Or is it something that I can change/ no longer have in the future. Depending on which staff group your working with, the same can be true. Or, like this person, they might devalue psychology, believing that certain people are 'untreatable' and therefore talk about them in terms of their diagnosis rather than as an actual human being.

Depending on the situation I've tried sitting with that confusion and questioning these ideas to prompt formulation of the person and promote empathy, but sometimes it is just really difficult and can result in being swiftly dismissed by people who hold the opposing view. This is particularly hard when you are the only psychologist at a meeting full of nurses and a psychiatrist. :roll:

Like I say, part rant, part request for support, reflections and advice! :lol:

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lingua_franca
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Re: Psychological distress versus mental illness

Post by lingua_franca » Fri Sep 23, 2016 4:15 pm

Bela wrote:As a trainee, I've found these conversations really tricky to navigate. Clients can find their diagnosis so confusing - is it an 'illness' that I'll have for the rest of my life and if it is what is the point in being here? Or is it something that I can change/ no longer have in the future. Depending on which staff group your working with, the same can be true. Or, like this person, they might devalue psychology, believing that certain people are 'untreatable' and therefore talk about them in terms of their diagnosis rather than as an actual human being.
I don't think this blogger is calling anyone 'untreatable' or talking about them in terms of their diagnosis. I think you're perhaps reading what she's written through the lens of previous bad experiences with teams that use a constraining medical model, and this is leading you to infer things from the article that aren't there. She writes: "I am annoyed to see the umpteenth book published on how to cure your depression through mindfulness, sports, or improved diet. Someone with major depressive disorder or psychosis is not going to get better simply by meditating or going for a brisk walk...Why am I so adamant? Because I feel that many people who are truly mentally ill suffer not only from their symptoms and associated stigma, but also from the patronizing attitudes of those who believe they should just 'get on with their lives'." Now, personally I don't see why she's bothering to write this - there's hardly anything original or groundbreaking in the idea that people with depression can't just snap out of it, and as she's writing for the BMJ readership, she's probably preaching to the converted - but I don't see anything offensive there. She isn't saying that psychology is all about curing depression through diet and sports either, so I don't think she's devaluing CPs. I do think her apparent conflation of 'counselling', 'psychotherapy', 'words', and 'behavioural advice' suggests that she's not very clued up about evidence-based therapies and their scope, but as she's neither a psychiatrist nor a psychologist herself, I wouldn't expect her to be. It's basically just a personal vent about the way that mental health difficulties are underestimated by the general public.

I also think that she's sloppy with terminology in other ways. I don't see psychological distress and mental illness as two discrete categories, for example, and I would use whichever term the client found most helpful. Someone who sets punishingly high standards for themselves and who struggles to accept care might find that viewing their difficulties as a mental illness gives them the impetus they need to take care of themselves - "I'm ill, I deserve treatment, and I must look after myself" - while referring to it as the more nebulous 'distress' might not be so helpful. On the other hand, a person whose difficulties stem from being abused and who has a tendency to blame themselves and view their entire situation as hopeless might respond better to 'distress', because it shifts the focus from them onto the things that caused the distress.

I think you've set up a second dichotomy with this: "Clients can find their diagnosis so confusing - is it an 'illness' that I'll have for the rest of my life and if it is what is the point in being here? Or is it something that I can change/ no longer have in the future." Even if you do conceptualise a set of difficulties as mental illness, that doesn't mean you're viewing it as lifelong and it doesn't mean no change is possible. Equally, even if the difficulties really do recur for a very long time, maybe even for life, it doesn't mean that there's no point in treatment and that no valuable changes can be made. It's not a zero-sum game.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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miriam
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Re: Psychological distress versus mental illness

Post by miriam » Sat Sep 24, 2016 1:41 am

I think it is a silly, naive and non-evidence based article. As I said on twitter:

Psychosis & bipolar are definitely helped by therapy, RCTs show improved outcomes, even those who aren't helped by medication! See Kuiper's meta analyses which shows CBT and family interventions are effective for psychosis. And the evidence is clear that psychological therapy also helps people with bipolar diagnoses, eg http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536930/

More importantly, these diagnoses are labels put on clusters of similar presentations, rather than discrete organic conditions. The author of that blog would do well to read recent DCP publications such as this guide for service users and this special issue of the psychologist. The author would also do well to read the open letters from Richard Bentall and Peter Kinderman on the false assumption that disorders like psychosis and bipolar are organic and genetic in origin, when the evidence instead suggests a very large role for experience.
Miriam

See my blog at http://clinpsyeye.wordpress.com

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