Poem by Carly Sheehan, daughter of Cindy Sheehan. Cindy credited this poem with pushing her into action after her son’s death, resulting in her becoming a national leader. You may or may not agree with the politics, but the poem illustrates the important social role of “emotional upset.”

Have you ever heard the sound of a mother screaming for her son?The torrential rains of a mother’s weeping will never be doneThey call him a hero, you should be glad that he’s one, butHave you ever heard the sound of a mother screaming for her son?

Have you ever heard the sound of a father holding back his cries? He must be brave because his boy died for another man’s liesThe only grief he allows himself are long, deep sighsHave you ever heard the sound of a father holding back his cries?

Have you ever heard the sound of taps played at your brother’s grave?They say he died so that the flag will continue to waveBut I believe he died because they had oil to saveHave you ever heard the sound of taps played at your brother’s grave?

Have you ever heard the sound of a nation being rocked to sleep? The leaders want to keep you numb so the pain won’t be so deepBut if we the people let them continue another mother will weepHave you ever heard the sound of a nation being rocked to sleep?

Traumatized, or “mentally ill?”

• How trauma can lead to experiences and mental states that get psychiatric labels

• Problems when after-effects of trauma get identified as “mental illness”

• A better alternative

What’s normal after trauma

• Disturbed, and disturbing, emotions and thoughts

• A process of making sense of the experience– That may take some “wrong turns” before

getting to a healthy resolution

Diagnosis after trauma: it’s not just PTSD

• PTSD diagnosis is made only when symptoms revolve around the trauma in an identifiable way

• If you are too successful in avoiding thinking about the trauma (but you haven’t resolved it) then you will likely end up with a different diagnosis

Which diagnoses are more likely after trauma:

• Disorders involving panic, anxiety, depression, substance abuse, eating problems, obsessive compulsive, even personality disorders

• Bipolar disorders can also probably be caused by trauma

• “Experts” say psychotic disorders like schizophrenia are not caused by trauma, but evidence says they often are

What constitutes a traumatic event?

• For physical trauma, we are more willing to define a traumatic event as one where someone gets hurt– whatever the type of incident

• Mental/Emotional trauma likewise depends on the specific details of events, and also on interpretations of events

But isn’t “mental illness” genetic?

• Many genetic studies are flawed, and their results exagerated– though there probably are some genetic

differences in vulnerability

• Differences in vulnerability should not be interpreted as genetic defect

• Creativity itself likely leads to greater vulnerability to “mental illness”

When emotional upset leads to diagnosis

• There are some benefits to diagnosis– less catastrophic than some interpretations– commonalties with others with same diagnosis– hope for treatments known to work with that

diagnosis– Most importantly, the mental health system

requires the diagnosis before being willing to offer assistance

Problems resulting from “mental illness” diagnosis

• I’ll outline 10 of them

Focus on the person’s story is often lost

• Story includes:– what happened, when– how did the individual, and others, respond– when did efforts intended to improve things

actually make things worse– now that we know all of the above, how can we

turn it around so that a story of personal triumph emerges?

Seeing labels as real things

• Instead of looking for the cause of the person’s experience in their life and in their attempts to makes sense of their life, we look for it in a “disease” process

• The diagnosis is imagined to be a real entity that causes things– But this has no more scientific validity than saying

that an evil spirit or demon is causing the problem

Client: What'scausing theseweirdexperiences?

Therapist: Theseweird experiences arebeing caused by yourillness, which isschizophrenia

Client: How do youknow that I have anillness calledschizophrenia?

Therapist: We candiagnose you with theillness calledschizophrenia becauseyou have weirdexperiences.

Increases Stigma

• Research shows that when the public believes behavior is caused by “mental illness” they are– more likely to fear the person– more likely to take a punitive attitude– more likely to want “social distance” from the

person

Induces passivity

• People convinced they have a medical illness are less likely to work on changing their own thoughts and behavior

• The public withdraws, feeling only “experts” can really help

• Professionals also frequently give up on many forms of help when they believe the problem is “medical” or “biological”

Induces excess reliance on medications

• Often the medications don’t work, but person has become convinced only a biochemical solution could address their biochemical problem– so they don’t try much else

• Even when medication does “work” person is often stuck with medication dependence and/or destructive “side effects”

The diagnosis itself can increase trauma

• This happens especially with the more “severe” diagnoses

• By – inducing hopelessness– causing others to withdraw support in ways

that are traumatizing

“Abnormalizes” a person’s experience

• This has also been called “exaggerated otherness”– All “mental disorders” can be seen as just more

extreme versions of everyday human problems and distress

• By putting experiences in completely different categories, it makes them harder to understand and to relate to

“Black and White” view of certain thoughts & emotions

• Anxiety and depression become seen as sicknesses

• Alternative view: anxiety and depression can be either helpful or unhelpful, – depending on many factors– people can develop wisdom around evaluating

these emotions related to specific situations

Increases focus on “getting rid of” unwanted thoughts &

emotions

• Then when these thoughts & emotions won’t leave, people feel more helpless and traumatized

• The alternative: accept the thoughts & emotions but learn how to cope with and overcome them

Loss of contact with the healthy self underneath the trauma

• Think of three layers– outer layer is observed troubles, or “diagnosis”

– next layer is the unresolved trauma

– deepest layer is one’s healthy potential, the healthy self that lies deeper than any trauma or “disorder”

• To recover, learn to see through both the “disorder” and the trauma, to the healthy self

What would work better?

• A better system would recognize that we all have psychological distress and problems– Sometimes and for some people these problems

become more severe• More severe does not mean categorically different

– Society or insurance could decide whether to pay or not, based on current severity of problems, not “diagnosis”

Recognizing that problems have a story

• Seek out the story of how problems developed

• Acknowledge that recovery is also about a unique personal journey or story

– Lots of ways people work on recovery

Frame ongoing distress as possibly related to a mistake in

coping, not an “illness”

• A difference is that if a person’s coping is mistaken, that person can learn to cope differently

• Also, recognize the uncertainty in our attempts to decide what is healthy or unhealthy coping– are we always more healthy when we allow

ourselves to be “rocked to sleep?”

Recognize that medications are just one possible approach

• Alternatives should always be made available– For those who choose to not tolerate negative

“side effects” or dependence– For those who find medications to be only

partly effective or not effective at all

Redefine health

• not as the absence of negative emotions and thoughts and problems

• but as the coexistence with them of life and joy and triumph

Normalize difference and be open to Ambiguity

• It is “normal to be different”– this attitude is the key to overcoming stigma

• Stay open to the ambiguity of difference– support individual self determination and

dialogue regarding what is healthy and what is not

Recovery is a community issue

• Mutual relationship is the real healer– Those who are more stable can offer support to

those who are disturbed– Those who are disturbed or in extreme states

also have gifts for the community• canary in a coal mine

• new ways of seeing and being, new sense of meaning

Questions for the Panel• In what ways, if any, was getting a psychiatric diagnosis helpful

to you?

• Did getting a psychiatric diagnosis ever interfere with you or others being able to see the connection between the problems you were having and the traumas that you suffered? If so, how?

• Did getting a diagnosis make it harder for you or for others to connect with your positive potential, with the healthy and resilient center of yourself? If so, how?

• What have you found to be the most helpful way for you and others to understand the mental and emotional difficulties that you have had?"

Discussion questions• How does thinking of people as mentally "sick" make it easier to ignore

their feelings, their perceptions, and their truths, compared to viewing the same people as simply responding to confusing and upsetting events?

• What do you think are the most important changes our families, schools, mental health workers, businesses, and community groups should make in how they view and respond to the after-effects of trauma in people? What are your dreams for change?

• What doable steps can you think of that could be done now in the community with available resources, that will take us closer to your dreams for change? What steps will take us closer to a time when where people and communities willingly interact with, support, and learn from distressed or "different" individuals, rather than label them and create distance?

Discussion question

• How does thinking of people as mentally "sick" make it easier to ignore their feelings, their perceptions, and their truths, compared to viewing the same people as simply responding to confusing and upsetting events?

Discussion question

• What do you think are the most important changes our families, schools, mental health workers, businesses, and community groups should make in how they view and respond to the after-effects of trauma in people? What are your dreams for change?

Discussion question

• What doable steps can you think of that could be done now in the community with available resources, that will take us closer to your dreams for change? What steps will take us closer to a time when where people and communities willingly interact with, support, and learn from distressed or "different" individuals, rather than label them and create distance?