There is a joke that circulates among mental health professionals. Why do only 26% of people have a diagnosable mental disorder? Because the other 74% haven’t been diagnosed yet.
We are all psychologically dysfunctional in some way. “Mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life” (Scientific American).
Why do we treat the mentally ill with contempt, trepidation, and ridicule? We are hard-wired to fear and isolate mental illness, and we have been misinformed by history and the disease model of mental health. There are four common misconceptions about psychological dysfunctions. They are (1) abnormal and selective, (2) consequence of behavior, (3) solely mental, and (4) psychotic.
Let us deconstruct these misconceptions, beginning with the latter.
A dysfunctional person is psychotic.
There are two degrees of mental disorder: neuroses and psychoses. When someone sees, hears, or responds to things that are not actual, they are having a psychotic episode. While few persons experience psychosis, everyone has moderate-and-above levels of anxiety, stress, and depression. We are universally neurotic. Since the overwhelming majority of mental disorders are neuroses, we are all dysfunctional to some extent.
A dysfunction is abnormal or selective.
A neurosis is a condition that negatively impacts our emotional wellbeing and quality of life but does not necessarily impair or interfere with normal day-to-day functions. It is a standard part of natural human development. One-in-four individuals have a diagnosable neurosis. According to the World Health Organization, nearly two-thirds of those reject or refuse to disclose their condition. Including those who dispute or chose to remain oblivious to their dysfunction, we can conclude that mental disorders are common, undiscriminating, and impact us all in some fashion or another. Many of us have more than one disorder; depression and anxiety are commonly comorbid, often accompanied by substance abuse.
A dysfunction is the consequence of a person’s behavior.
Combined statistics prove that 89% of neuroses onset at adolescence or earlier. In the rare event conditions like PTSD or clinical narcissism manifest later in life, the susceptibility originates in childhood. Most psychologists agree that they are consequence of childhood physical, emotional, or sexual disturbance. Any number of things can cause this. Perhaps parents are controlling or do not provide emotional validation. Maybe the child is subjected to bullying or from a broken home. Behaviors later in life may impact the severity but are not responsible for the neurosis itself. It is not the fault of the child/adolescent, nor reflective of their behavior. There is the likelihood no one is intentionally responsible. This disputes moral models that we are to blame for our disorder, or it is God’s punishment for sin.
A dysfunction is solely mental.
To early civilizations, mental illness was the domain of supernatural forces and demonic possession. Hippocrates and diagnosticians of the 19th century looked at the relative proportions of bodily fluids. Lunar influence, sorcery, and witchcraft are timeless culprits. In the early 20th century, it was somatogenic. The biological approach argues that dysfunction is related to the brain’s physical functioning, while pharmacology promotes it as a chemical or hormonal imbalance. However, the simultaneous mutual interaction of all human system components—mind, body, spirit, and emotions—is required for sustainability of life and sustainability of dysfunction.
The disease model focuses on the history of deficit behavior. The American Psychiatric Association’s (APA) brief definition of neurosis contains the following words: distressing, irrational, obsessive, compulsive, dissociative, depressive, exaggerated, unconscious, and conflicts. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the APA, uses words like incapable, deceitful, unempathetic, manipulative, difficult, irresponsible, and incompetent.
Moralists and the ignorant assume the ‘mental’ are weak and dishonorable, their behavior bizarre and illogical. The urban dictionary labels us silly or stupid. Adolescents derisively assign the term mental to the unpopular, different, and socially inept. These negative and hostile aspersions on our character are supported by public opinion, media misrepresentation, the mental healthcare industry, and the disease model of mental health.
This ‘defective’ emphasis has been the overriding psychiatric perspective for over a century. The disease model is the chief proponent of the notion that the mentally ill are dangerous and unpredictable. We distance ourselves and deem them socially undesirable. We stigmatize them. The irony is, we are them.
- Over one-third of family members hide their relationship with their dysfunctional child or sibling to avoid bringing shame to the family. They are considered family undesirable, a devaluation potentially more life-limiting and disabling than the neurosis itself.
- The media stereotypes neurotics as homicidal schizophrenics, impassive childlike prodigies, or hair-brained free-spirits. One study evidenced that over half of U.S. news stories involving the dysfunctional allude to violence.
- Psychologists argue that more persons would seek treatment if psychiatric services were less stigmatizing. There are complaints of rude or dismissive staff, coercive measures, excessive wait times, paternalistic or demeaning attitudes, pointless treatment programs, drugs with undesirable side-effects, stigmatizing language, and general therapeutic pessimism.
- The disease model supports doctor-patient power dominance. Clinicians deal with 31 similar and comorbid disorders, 400 plus schools of psychotherapy, multiple treatment programs, and an evolving plethora of medications. They cannot grasp the personal impact of a dysfunction because they are too focused on the diagnosis.
A recent study of 289 clients in 67 clinics found that 76.4% were misdiagnosed. An anxiety clinic reported over 90% of clients with generalized anxiety were incorrectly diagnosed. Experts cite the difficulty in distinguishing different disorders or identifying specific etiological risk factors due to the DSM’s failing reliability statistics. Mainstream medical authorities cite the poor reliability and validity, and inattention to human experience of DSM criteria. The recent head of the National Institute of Mental Health believes traditional psychiatric diagnoses have outlived their usefulness and suggests replacing or augmenting them with easily understandable descriptions of the issues.
Because of the disease model’s emphasis on diagnosis, we focus on the dysfunction rather than the individual. Which disorder do we find most annoying or repulsive? What behaviors contribute to the condition? How progressive is it, and how effective are treatments? Is it contagious? We derisively label the obvious dysfunctional ‘a mental case.’
Realistically, we cannot eliminate the word ‘mental’ from the culture. Unfortunately, its negative perspectives and implications promulgate perceptions of incompetence, ineptitude, and unlovability. Stigma, the hostile expression of someone’s undesirability, is pervasive and destructive. Stigmatization is deliberate, proactive, and distinguishable by pathographic overtones intended to shame and isolate. 90% of persons diagnosed with a mental disorder claim they have been impacted by mental health stigma. Disclosure jeopardizes livelihoods, relationships, social standing, housing, and quality of life.
The disease model assumes that emotional distress is merely symptomatic of biological illness. The Wellness Model focuses on the positive aspects of human functioning that promote our wellbeing and recognize our essential and shared humanity. The Wellness Model emphasizes what is right with us, innately powerful within us, our potential, and determination. Recovery is not achieved by focusing on incompetence and weakness; it is achieved by embracing and utilizing our inherent strengths and abilities.
Benefits of the Wellness Model
- Revising negative and hostile language will encourage new positive perspectives
- The self-denigrating aspects of shame will dissipate, and stigma becomes less threatening.
- Doctor-client knowledge exchange will value the individual experience over the diagnosis.
- Realizing neurosis is a natural part of human development will generate social acceptance and accommodation.
- Recognizing that they bear no responsibility for onset will revise public opinion that an individual’s neurosis is the result of her or his behavior.
- Emphasizing character strengths and virtues will positively impact the self-beliefs and image of the afflicted, leading to more disclosure, discussion, and recovery-remission.
- Realizing proximity and susceptibility of dysfunction will address the desire to distance and isolate.
- Emphasis on an individual’s value and potential will encourage accountability and foster self-reliance.
The impact of neurosis originates in childhood; recovery is a long-term commitment. The Wellness Model creates the blueprint and then guides and supports throughout the recovery process by emphasizing our intrinsic character strengths, virtues, and attributes that generate the motivation, persistence, and perseverance to recover.
The biblical adage treat others as you want to be treated takes on added relevance when we accept that we all experience mental disorders. In fact, dysfunction is evidence of our humanness.
Dr. Robert F. Mullen is the director of ReChanneling Inc, an organization dedicated to the research and development of methods to mitigate symptoms of psychological dysfunction and discomfort.
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