There are alternatives to psychiatric diagnosis which can help people to make sense of experiences of distress.
Some remarkable changes are happening in mental health theory and practice, and yet most professionals, let alone service users, have hardly heard of them. ‘A disorder for everyone!’ is the title of a movement making its way round the major cities of the UK as an event, with the aim of bringing these new ideas to everyone.
"A trauma-informed understanding of someone’s distress is likely to focus on the impact of difficult events. What we call ‘symptoms’ are better seen as ‘survival strategies’ – creative ways of coping with emotionally overwhelming events and situations, which helped at the time, but may become a problem in their own right."
At each event, organiser Jo Watson, psychotherapist, and Lucy Johnstone, clinical psychologist, are joined by speakers and workshop leaders from a range of backgrounds, both professional and lived experience. The day usually starts with performance poetry and ends with a lively panel discussion. In between, attendees are invited to question everything they have been told about psychological and emotional distress, and to come to their own conclusions about what they learn.
The central message of the day is that there are alternatives to psychiatric diagnosis which can help people to make sense of experiences of distress, however extreme, and which are based on working together to explore personal meaning.
These are sensitive issues, and it is important to emphasise that no one is doubting people’s very real distress and desperation, such as suicidal feelings, panic, hopelessness, urges to self-harm, struggles with eating, and in some cases, terrifying mood swings or hearing hostile voices. But the core question posed by the event is whether these awful experiences are always best understood as a form of illness which needs diagnosing. The distress is all too real – but is the widely-accepted explanation correct?
Few people will be aware that even senior figures in psychiatry have described the current system for describing people’s difficulties in terms like ‘schizophrenia’, ‘bipolar disorder’ and ‘personality disorder’ - the Diagnostic and Statistical Manual for Mental Disorders - as ‘totally wrong, an absolute scientific nightmare’. Nor is it widely appreciated that there is no evidence for the ‘chemical imbalance’ theory of depression – or of any other mental health condition.
Forming a story rather than a diagnosis
In this context, a range of emerging alternatives to diagnosis has emerged. One which is slowly growing in popularity within services is formulation, which is an individual summary or story developed jointly with the service user over a period of weeks or months. Formulations draw on psychological evidence about the possible causes of someone’s distress in their lives and social circumstances. These personal narratives help to suggest interventions that are not based on the idea that someone is suffering from an ‘illness’ of some kind.
Trauma informed approach
We also have emerging alternatives to the ‘illness’ model of distress. One of the most important is known as the Trauma-Informed Approach, a radically different perspective which is summarised in the slogan ‘Instead of asking “What’s wrong with you?” ask “What’s happened to you?”’ It is based on the large and growing amount of research demonstrating that difficulties and adversities of all kinds, especially in childhood, greatly increase the likelihood that people will experience mental health problems (along with many other difficulties) later on in their lives.
A trauma-informed understanding of someone’s distress is likely to focus on the impact of difficult events such as bullying, abuse or bereavement, or social stresses such as living in poverty or experiencing racial discrimination. From this perspective, what we call ‘symptoms’ are better seen as ‘survival strategies’ – creative ways of coping with emotionally overwhelming events and situations, which helped at the time, but may become a problem in their own right.
Are we ready to move away from a diagnostic model which too often traps people into a patient role without addressing their real difficulties? Professionals, service users, carers and anyone else who is ready to explore this question will find plenty of food for thought at the ‘A disorder for everyone’ events. Follow the link for our forthcoming events in Brighton, Birmingham and London, take a look at the reviews and resources on the website, and prepare to be challenged.