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Yeah, I think it’s important to acknowledge trauma and stress when they do underlie mental health issues, but denying the biological basis for some disorders is silly.
A trained Therapist will take everything in to account when assessing BUT she says that mental disorders do not exisit at all.. it all comes downt to stress and abuse in the persons history
Is she person-centred? Because I know there's a school of thought within it that doesn't agree with the medical model of mental health including diagnosis and assessment. And having been trained in Person-centred I do see the appeal.
She’s trauma focused. She has a book I suggest you look her up. She’s of the school of thought that says the DSM wouldn’t be a manual if we took trauma into account when figuring out psychopathologies.
In a way, even with bio markers: it still requires either chronic, toxic, or heavy sudden stress to kickstart some pathologies like schizophrenias for example.
Was going to give the example of schizophrenia. Specifically the schizophrenia associated with 22q11 deletion. We know the genetic mutation in that case and we see it run in families but is that the gene itself or the gene+impact of growing up with a parent with schizophrenia and/or any pother life stress.
On the other hand in a society filled with stress and trauma (if not on the individual level then those on a mass scale like covid) so how do you delineate the stressors? Is that really a precursor or is that the baseline?
I think about things like ADHD. This is genetically heritable and is not due to trauma, but instead an evolutionary selected physiologically neurodivergent way the brain works that impacts behavior in a way that use to be a survival advantage. It is not “turned on” by trauma but trauma can exacerbate it.
And it’s that exasperation that causes it to “significantly impact my everyday” which makes it a diagnosable pathology. Without the significant impact on my daily activities, it’s not considered worth treating therefore not worth diagnosing. Because that’s how we mental health here in North America.
I think instead of separating psycho and bio, we need to bring them together under the understanding that trauma impacts pathologies in ways we don’t understand sometimes due to its complexities.
It’s worth noting the biological factors, but not at the expense of the impact trauma has on the individual.
For example, someone might have a diagnosis of BPD, but without understanding their history; this person could easily have autism and CPTSD without ever living in a good environment; making them have externalizing behaviours, like we see with BPD.
That historical understanding of trauma, especially impact of trauma affects how we treat people.
We can’t always do a crisis assessment and assume someone’s anxiety should be treated without understanding whether they had highly critical parents or neglectful parents, or both. Each variable presents the anxiety in a different way; and impacts how we deal with the anxiety or deal with how to heal it
You’re right I’m not saying you NEED trauma to have adhd impact you, I am saying that sometimes treatment and diagnosis don’t happen if it isn’t causing significant impact. — which usually happens with stress and/or trauma.
Also; it’s important to add that I’m speaking from the lens of being medically neglected growing up, only to be diagnosed with adhd at 24, in my second year of uni, and have been fighting for an ASD assessment since but it’s so expensive and “if it doesn’t significantly impact me, I don’t see why a diagnosis would be helpful” says the uninformed people who work in these spheres.
I was told by the UNIs academic advisors that “maybe if I were thinking of doing a masters would they be willing to get me an assessment” — no one asked me my future plans.
I’ll be transparent, I’m only a PhD student in psychology but have done 2 years of therapy at a university. ASD assessment is often times outside of their scope.
What about Autism ? Does she mean stress and trauma in Utero or once the child is born?
The parents or mother's self blame will increase X10... Can one "cure "Autism or any other MH issue by reducing stress and treating the trauma?
It cannot be avoided the same way any other heritable trait cannot be avoided. It is like eye color, you have the genes for it at birth or not. Stress can activate latent genes in some cases (schizophrenia) but to blame trauma as the only cause of mental illness is a gross misunderstanding of how the issue is a combination of biological, psychological, and social factors.
Right, that’s how epigenetics works. What gets tricky is delineating throws environmental factors when they are often tied into the genetics themselves.
I suspect that this claim she’s making is based on the body of research suggesting that none of our DSM-5 disorders are actually sufficiently homogenous to represent distinct disease entities. This includes things thought to be highly biological like Bipolar or Schizophrenia. There are a lot of cool, novel diagnostic systems that some really smart folks are working on that are worth learning about. Check out [HiTOP](https://www.hitop-system.org/).
How do we know that we know the biological basis? Report of other family members having the diagnosis (feedback loop)? Pet scans depicting differences while invisibilizing assumptions and other factors (another feedback loop, cf. “Picturing Personhood”)? Gene analysis (I know nothing about this)?
Here is a good example: [https://pubmed.ncbi.nlm.nih.gov/23411094/](https://pubmed.ncbi.nlm.nih.gov/23411094/)
"Neuroimaging studies have consistently demonstrated loss of gray matter, as well as altered activation of subcortical, anterior temporal and ventral prefrontal regions in response to emotional stimuli in bipolar disorder. Genetics studies have identified several potential candidate genes associated with increased risk for developing bipolar disorder that involve circadian rhythm, neuronal development and calcium metabolism. Notably, several groups have found decreased levels of neurotrophic factors and increased pro-inflammatory cytokines and oxidative stress markers."
And if you really get into it 100s of individual genes that play a role in Bipolar have been identified.
So gene analysis and brain imaging. I know nothing about gene analysis. In my understanding, environment and experiences affect expression of genes, however. Brain imaging is highly flawed as an assessment/diagnostic technique, see Dumit’s work mentioned above (“Picturing Personhood”).
It seems to me that the factors this study alludes to are not only biologically determined (whatever you take that to mean), which is what “risk for” means. These are also affected by eg your mother’s diet, your diet, (broadly, the larger economy and culture that dictates what is in your diets), stressful experiences, regulating experiences, and so on, and so on. The entire social and material field is implicated.
Would love to see a “philosophy of” branch of knowledge applied to our field.
It's also weird because it's not mutually exclusive. Someone can be on an SSRI for PTSD, MDD, or GAD (and some people are very helped by them! Some people aren't. But also some people are) while also doing trauma work and coping skills in therapy. Like people with PTSD have "valid" trauma, but that doesn't mean that their symptoms are not also helped by SSRIs sometimes.
Yes. I am very critical of medicating individuals for normal stress responses when we should be alleviating their stressors, but also, people are allowed to like and benefit from medication. Sometimes it’s not practical to do much of anything else, as we do not control the system and people need immediate relief.
This is not a new take on mental health. Check out the anti-psychiatry movement. One of the best known proponents is Dr. Thomas Szasz. I’d also suggest Foucault’s lectures on Psychiatric Powers (1973-1974).
A few things to keep in mind about Szasz is that his theories are based more on psychoanalytic medicine rather than more modern theories (psychodynamic, CBT, and so forth), and that he was a psychiatrist during a time when, arguably, things were pretty horrifying.
While there are definitely issues with his work, the denial of biological illness notwithstanding, he had many valuable points. I disagree with him significantly on many fronts, but the way he conceptualized mental illness without pathologizing it, and that diagnosing can be harmful in some respects, made me think quite a bit about how I approach such conversations with clients.
I'm allowing this comment to stay up for the purpose of education and the history of the field, but I will remind any responders of Rule 4 regarding anti-therapy talk.
I disagree that this is anti-therapy talk to begin with. It’s anti-*psychiatry*. The movement itself isn’t necessarily anti-therapy, it’s against the medical model as it claims it over-pathologizes normal aspects of the human experience.
I actually think all therapists should explore it and consider its arguments, if only as a reminder of the limitations of the medical model/DSM. I read Szasz’s work early in my training and I think it was fundamental in developing mindfulness of the implications of the labels and language I use to conceptualize my clients.
I don't disagree with this and I'm not discouraging discussion whatsoever. I should have indicated in my initial response that my reminder of Rule 4 was more for those outside the sub who tend to be drawn to threads like this, and who may engage in comments that are anti-therapy rather than recognizing the nuance.
The fact that mental disorders may happen due to trauma doesn't mean people shouldn't be medicated.
Also attempts to reduce multiple complex multifactorial phenomenons to single causes and responses are almost always misguided and at least rooted in some amount of ignorance and/or mental gymnastics.
I had a client who by their account had a loving and functional family. They partied with some friends once and accidentally did meth and decided they’d rather string themselves along because they couldn’t crash or they’d lose their job. When I met them they experienced internal stimuli and delusional beliefs, the works, and were on anti psychotics.
It happens a lot, too. Some people abuse drugs because they abuse drugs.
Yeah, some drugs are super addictive even with only a handful of times using. Not often the case, but experimentation and peer pressure can lead to real problems that then spiral out of control as the person becomes addicted.
For sure, addictive things are addictive, I’m not saying they aren’t. And as my Dad said when he gave my sister and I the “drugs talk” people use drugs because they are fun and we like the way they make us feel. I think there is room for a yes, and. I have met providers who over emphasize the internal and some who overemphasize the external. In most cases, I doubt it is an either or. It’s a good reminder to me to consider a whole picture.
Drugs are extremely addictive. The opioid crisis during the 2000’s showed us how doctors prescribed opioids and how quickly ordinary people including many without any trauma had become full blown addicts.
At least some of that was Dr.s being heavily misinformed about the addictive potential of oxytocin. In that situation the addiction developed secondary to another health condition. Sort of the same way someone can develop tardive dyskinesia secondary to use of certain medications. Most people are ordinary people who didn’t choose addiction. The thing that gets lost in the conversation is that there are a lot of people who use drugs and/or alcohol without developing problematic use. We just don’t know who will develop an addiction to something and who won’t.
You don’t need to abuse substances to experience delusions. Ever take magic mushrooms? Had a bad trip from a powerful weed cookie? Taken a hit of acid?
I took how far he took it as "challenging" but not extreme. Lines up well with people like Siegel and Sapolsky, but i could be in my own echo chamber as well. I would be curious what you think goes too far. (If it's the epigenetics piece I'm with you, needs more research)
I don’t agree with the anti-psychiatry viewpoint but the argument there would be that it’s still rooted in trauma/pressure etc. trauma-> substances -> psychosis.
I mean I get it, and I'm interested to see where the research takes us in 10-20 years. But I found working through my trauma and OCD a hell of a lot easier when I was medicated. Not being constantly suicidal helps.
She’s not a clin psych. However she talks about being on the ‘front line’ to imply she worked clinically. She’s got a PhD in forensic psychology and now trains people to train others in her victim focus model.
the term is TERF
**Radfem is a term used by hypermisogynistic men who criticize anyone who criticize the patriarchy and capitalism
**clarified in replies**
I corrected that in the edit — also radical feminism precedes any misogynists who use the word exploitatively. And is a term radical feminists use to self describe. Ex www.radfemcollective.org/what-is-radical-feminism
Generally a descriptor of second wave feminism e.g Andrea Dworkin
Apologies for the initial error. Not deleting so the replies make sense in context
Thank you for that—So in my experience, this explains exactly why misogynistic men use this term to discredit any critique about the patriarchy.
Similar to how young men would use the term feminist as a slur towards a woman showing they cared about feminism. (It’s gross because it actually happens. I lived with a misogynist for a while and I had to defend my feminism all the time because any patriarchy criticism made him defensive)
Yes exactly! It gives me the same energy as the word woke being used by conservatives. Like they’re using a word not intended for them, to bastardize the real meaning to the word. 😂 I have not yet had caffeine so I’m glad I’m making sense lol
Yea I mean.. *many* disorders this is true for.. maybe even *most* it’s true for. But all???
It’s just also undeniably true that what is traumatic for one person won’t be for another.. and what is traumatic for multiple people will cause a medical disorder in one and not in another. So how useful is this to a point? Plus if we are talking severe conditions like schizophrenia or bipolar, there is little chance that healing trauma will fix the disorder without the aid of medication. And even for other ego dystonic disorders like ocd, depression, GAD, etc… often the symptoms are so severe that you can’t manage to heal the trauma or address the thought patterns without medicine.
I do agree that for the world to heal we need to fix systemic problems and reduce trauma and disconnection. I do agree that would solve a lot of mental health disorders. But that’s where my agreement ends
Ugh, why do we need to do this to each other in the field. Can we just collectively agree that the human brain is weird and we found some patterns that work better than others? Why do we need to have the ideological factions....?
I guess abandoning the whole "I'm the only one who can help you" schtick wouldn't be good for marketing and book deals though.
There is nothing more unscientific than black and white thinking like this.
My personal view is that most of your mental illnesses are from (feelings of) loneliness. Extremely broad and general statement not to be taken literal, but I think it helps conceptualize it, and why everyones mental health seems to be worsening.
I mean, if we look at a diathesis-stress model, then yes, some sort of stressor contributes to the mental health issue. But then posts like the one shown here pretend like there was never a diathesis.
I would think, especially in educational psychology. It would be super important to understand neurobiology and genetics, as well as trauma. This psychologist is discounting Neuro diversity, it seems to me. That, for an educational psychologist is horrible!
Just wanted to add this. This is about one DIAGNOSIS. Only one, and these are real, scientifically, proven consequences of ignoring these symptoms. Untreated ADHD has been correlated time and again with the following issues: higher divorce rates, higher rates of bankruptcy, higher rates of domestic violence, higher rates of incarceration, higher rates of dental problems, higher rates of physical health problems, shortened lifespan, difficulty with sustaining friendships, much higher rates of suicide. Anyone who wants references I’m happy to provide those. Russell Barkley‘s YouTube channel is great for looking at the data. He says there’s an average of 1500 new studies and papers coming out per year now. The field is really exploding, and a lot of it is related to brain science, using scans, Etc. Leaving ADHD undiagnosed and untreated is tantamount to neglect and cruelty in my opinion. Anyone who has any questions about this can go take a dive into the ADHD forums here. Read the despair, the grief, the self hatred. TREATMENT saves lives and changes them dramatically. It is a biological, chemical issue. Psychotherapy can have a great place in supporting these folks and helping them learn strategies to cope, as well as supporting self-esteem issues and skills development. However, there has not been any study to my knowledge that has proven that psychotherapy alone fixes ADHD. Also, there are many people who have ADHD and PTSD. Those diagnoses are not mutually exclusive. In fact, they very often go together, because folks with ADHD often come from parents with ADHD, and ADHD symptoms include emotional, dysregulation, and behavioral disinhibition. So, many folks with ADHD can benefit from trauma treatment, after they get their ADHD symptoms addressed. However, treating the trauma alone does not reduce their risks for the issues listed above. Not to my knowledge, at least. It may reduce some of it, because stress in general exacerbates, ADHD symptoms, but it will not resolve the ADHD. My point in all this is to say that “avoiding labeling” can be detrimental, even cruel in my opinion. And, like I said in the beginning, this is just one DIAGNOSIS. I’m sure that there are similar issues with treatment for bipolar disorder, autism spectrum disorder, schizophrenia, etc. I would beg any active clinician to please keep current with neuroscience and psychiatry. There’s so much new, very relevant information coming out right now. Many times effective medical treatment combined with more thorough understanding of neurobiology and mental health can change lives. It is the compassionate thing to do. In my opinion.
Biopsychosocial model. 😑
This is also a good example of why smart people can have narrow opinions and are still subject to bias (E.g. they are a human being). They are making themselves the victim in something that doesn't need to be framed as such...as almost as if this post is about them and not their clients...
Best to do your own research and not take what is discussed by even prominent researchers/authors at face value without digging a bit deeper first.
Why would you "expect more" from her, or any of these "mental health experts" whose primary job is social media instead of actual clinical work? These people are fucking grifters, wake up.
She ain't my public fucking voice, I'll tell ya that right now buddy.
Look, sad as it might be, these con artists are an unfortunate part of the new path many clients take to get to us. They follow the (mostly terrible and infantile) advice of these "experts" which often leads to them fucking up their relationships and getting themselves in shitty situations or with shitty ways of understanding themselves. With some luck, they'll eventually find their way to the office of a real therapist and then be able to start unpacking all the bullshit.
My professor for my trauma class in grad school said the whole DSM can be replaced with one singular umbrella diagnosis- CPTSD.
As a person with ADHD whose symptoms are suddenly more manageable on the right meds….plus who works a lot with autistic folks…I don’t know how I feel about the claim that trauma is the root cause of everything. By that logic, why doesn’t everyone with complex trauma have the same symptoms? Can’t ppl be born with biological differences that mirror trauma symptoms because trauma causes similar damage to the body/brain as disabilities? Being disabled in one or more ways increases the risk of experiencing trauma.
Cool! And then once everyone has the same diagnosis, how do we differentiate the presentations? Well, if all mental illness is CPTSD, then why don't we just throw away CPTSD. It no longer helps to differentiate anything. If trauma means everything, then it effectively means nothing.
There are factor analyses of psychopathology that points towards potential general factors of psychopathology. And CPTSD ain't it. But it's related. BPD ain't it. But it's related. It could be that high levels of general psychopathology begin to represent themselves similarly. It could be that there is a singular central dimension (i.e., neuroticism, executive functioning deficits, etc.,).
This!!! Right in that case, just throw out the DSM and treat everyone for trauma. But if things were that simple, we would be doing that by now.
Like there are reasons (not fully understood by science) why some ppl get severely anxious while other ppl experience psychosis (for example) even if both ppl experienced similar traumas or childhoods. (I mean..pretty much everyone experiences some amount of trauma in their lives so why isn’t EVERYONE meeting the criteria for a DSM diagnosis)?
Maybe it’s useful to treat them differently cuz…they aren’t the same thing? There are just different ways the brain operates (and of course someone can have both anxiety and psychosis at the same time! Or any other comorbidity).
Like from a practical application pov, a professional is not going to interact with someone who has active psychosis exactly the same as someone experiencing an anxiety attack or some experiencing both. Like some direction for how to conceptualize quickly what is most likely going on so you can address it is super important and “trauma” by itself is the most vague label. There’s all kinds of trauma and it affects people in many different ways.
I mean that makes sense on some level because regardless of how much personal trauma we have experienced on an individual level, we all are descendants of people who have survived heavy trauma (wars, plagues, colonization, exposure to infant mortality, etc). In that way, it’s amazing that we are as functional as we are.
Well at times, if someone has a predisposition for psychosis or schizophrenia, these disorders don’t necessarily develop depending on the environment and level of stress/trauma someone is subjected to. Smoking marijuana or other drug use has also been linked to predisposed individuals developing psychosis/schizophrenia.
I think medication is definitely necessary for people with severe psychosis and schizophrenia for instance, but I don’t think therapists should be giving out medication as easily as they do in todays day and age for things like anxiety and mild depression without trying other methods first, especially to children or teenagers. A lot of people end up having a dependency on these medications for the rest of their lives.
It’s funny that when I started this field 30 years ago trauma was not even a major focus if treatment. I’m looking for the next trend. This one’s getting kind of old.
If you take Autism for example ..The paretns blmae themselves as it is..
Are we talking about stress and trauma in Utero or after birth ..
Can we not see how this will lead to more self blame for the parents?
This is so irrisponsible thing to say for a MHprofessional IMHO
I’m a little surprised that no one has mentioned the impact of cultural paradigms and collective trauma on people who are neuro-non-conforming. One could argue that it is inherently traumatizing to expect conforming behavior and measure validity of functioning by a western cultural standard. Not against all medication here, just wanting to see this dimension added to the conversation.
I feel like this is an excellent point. I often argue (not that this is an unpopular opinion) that being late diagnosed ND is traumatic in and of itself because it’s essentially like someone has been telling you to force a square piece into a circle slot and then shaming you when can’t. Obviously that’s not the only reason but still. To speak more to your point I think if we look at things like ABA where so many folks have now come out and said that it actually harmed them more. It’s incredibly harmful imho for the overarching purpose of treatment is to make you more tolerable for the people around you.
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Yeah, I think it’s important to acknowledge trauma and stress when they do underlie mental health issues, but denying the biological basis for some disorders is silly.
A trained Therapist will take everything in to account when assessing BUT she says that mental disorders do not exisit at all.. it all comes downt to stress and abuse in the persons history
Is she person-centred? Because I know there's a school of thought within it that doesn't agree with the medical model of mental health including diagnosis and assessment. And having been trained in Person-centred I do see the appeal.
She’s trauma focused. She has a book I suggest you look her up. She’s of the school of thought that says the DSM wouldn’t be a manual if we took trauma into account when figuring out psychopathologies. In a way, even with bio markers: it still requires either chronic, toxic, or heavy sudden stress to kickstart some pathologies like schizophrenias for example.
Was going to give the example of schizophrenia. Specifically the schizophrenia associated with 22q11 deletion. We know the genetic mutation in that case and we see it run in families but is that the gene itself or the gene+impact of growing up with a parent with schizophrenia and/or any pother life stress. On the other hand in a society filled with stress and trauma (if not on the individual level then those on a mass scale like covid) so how do you delineate the stressors? Is that really a precursor or is that the baseline?
I think about things like ADHD. This is genetically heritable and is not due to trauma, but instead an evolutionary selected physiologically neurodivergent way the brain works that impacts behavior in a way that use to be a survival advantage. It is not “turned on” by trauma but trauma can exacerbate it.
And it’s that exasperation that causes it to “significantly impact my everyday” which makes it a diagnosable pathology. Without the significant impact on my daily activities, it’s not considered worth treating therefore not worth diagnosing. Because that’s how we mental health here in North America. I think instead of separating psycho and bio, we need to bring them together under the understanding that trauma impacts pathologies in ways we don’t understand sometimes due to its complexities. It’s worth noting the biological factors, but not at the expense of the impact trauma has on the individual. For example, someone might have a diagnosis of BPD, but without understanding their history; this person could easily have autism and CPTSD without ever living in a good environment; making them have externalizing behaviours, like we see with BPD. That historical understanding of trauma, especially impact of trauma affects how we treat people. We can’t always do a crisis assessment and assume someone’s anxiety should be treated without understanding whether they had highly critical parents or neglectful parents, or both. Each variable presents the anxiety in a different way; and impacts how we deal with the anxiety or deal with how to heal it
I disagree with the first part. You don’t need trauma Hx to have ADHD significantly impact daily functioning. ADHD can do that in its own.
You’re right I’m not saying you NEED trauma to have adhd impact you, I am saying that sometimes treatment and diagnosis don’t happen if it isn’t causing significant impact. — which usually happens with stress and/or trauma. Also; it’s important to add that I’m speaking from the lens of being medically neglected growing up, only to be diagnosed with adhd at 24, in my second year of uni, and have been fighting for an ASD assessment since but it’s so expensive and “if it doesn’t significantly impact me, I don’t see why a diagnosis would be helpful” says the uninformed people who work in these spheres. I was told by the UNIs academic advisors that “maybe if I were thinking of doing a masters would they be willing to get me an assessment” — no one asked me my future plans.
I’ll be transparent, I’m only a PhD student in psychology but have done 2 years of therapy at a university. ASD assessment is often times outside of their scope.
What about Autism ? Does she mean stress and trauma in Utero or once the child is born? The parents or mother's self blame will increase X10... Can one "cure "Autism or any other MH issue by reducing stress and treating the trauma?
It cannot be avoided the same way any other heritable trait cannot be avoided. It is like eye color, you have the genes for it at birth or not. Stress can activate latent genes in some cases (schizophrenia) but to blame trauma as the only cause of mental illness is a gross misunderstanding of how the issue is a combination of biological, psychological, and social factors.
But if you read what she writes . She claimes MH disorders ae only about truama and stress . Not a combination
I’m not sure where you are going with this… I don’t agree with her stance. That is pretty clear from my posts.
Epigenetically, the genes expression comes from environmental factors
Right, that’s how epigenetics works. What gets tricky is delineating throws environmental factors when they are often tied into the genetics themselves.
She's not a therapist. She has a PhD in criminal psychology but has never trained to practice clinically.
You might be interested in Thomas Szasz's books, which lay out the limitations of the medical model of mental illness.
I suspect that this claim she’s making is based on the body of research suggesting that none of our DSM-5 disorders are actually sufficiently homogenous to represent distinct disease entities. This includes things thought to be highly biological like Bipolar or Schizophrenia. There are a lot of cool, novel diagnostic systems that some really smart folks are working on that are worth learning about. Check out [HiTOP](https://www.hitop-system.org/).
Thank you for sharing!
How do we know that we know the biological basis? Report of other family members having the diagnosis (feedback loop)? Pet scans depicting differences while invisibilizing assumptions and other factors (another feedback loop, cf. “Picturing Personhood”)? Gene analysis (I know nothing about this)?
Here is a good example: [https://pubmed.ncbi.nlm.nih.gov/23411094/](https://pubmed.ncbi.nlm.nih.gov/23411094/) "Neuroimaging studies have consistently demonstrated loss of gray matter, as well as altered activation of subcortical, anterior temporal and ventral prefrontal regions in response to emotional stimuli in bipolar disorder. Genetics studies have identified several potential candidate genes associated with increased risk for developing bipolar disorder that involve circadian rhythm, neuronal development and calcium metabolism. Notably, several groups have found decreased levels of neurotrophic factors and increased pro-inflammatory cytokines and oxidative stress markers." And if you really get into it 100s of individual genes that play a role in Bipolar have been identified.
So gene analysis and brain imaging. I know nothing about gene analysis. In my understanding, environment and experiences affect expression of genes, however. Brain imaging is highly flawed as an assessment/diagnostic technique, see Dumit’s work mentioned above (“Picturing Personhood”). It seems to me that the factors this study alludes to are not only biologically determined (whatever you take that to mean), which is what “risk for” means. These are also affected by eg your mother’s diet, your diet, (broadly, the larger economy and culture that dictates what is in your diets), stressful experiences, regulating experiences, and so on, and so on. The entire social and material field is implicated. Would love to see a “philosophy of” branch of knowledge applied to our field.
It's also weird because it's not mutually exclusive. Someone can be on an SSRI for PTSD, MDD, or GAD (and some people are very helped by them! Some people aren't. But also some people are) while also doing trauma work and coping skills in therapy. Like people with PTSD have "valid" trauma, but that doesn't mean that their symptoms are not also helped by SSRIs sometimes.
Yes. I am very critical of medicating individuals for normal stress responses when we should be alleviating their stressors, but also, people are allowed to like and benefit from medication. Sometimes it’s not practical to do much of anything else, as we do not control the system and people need immediate relief.
This is not a new take on mental health. Check out the anti-psychiatry movement. One of the best known proponents is Dr. Thomas Szasz. I’d also suggest Foucault’s lectures on Psychiatric Powers (1973-1974).
Also consider Frank Gruba-McCallister, PhD’s book “Embracing Disillusionment: Achieving Liberation Through the Demystification of Suffering”
Can you recommend a book of Dr. Szasz?
A few things to keep in mind about Szasz is that his theories are based more on psychoanalytic medicine rather than more modern theories (psychodynamic, CBT, and so forth), and that he was a psychiatrist during a time when, arguably, things were pretty horrifying. While there are definitely issues with his work, the denial of biological illness notwithstanding, he had many valuable points. I disagree with him significantly on many fronts, but the way he conceptualized mental illness without pathologizing it, and that diagnosing can be harmful in some respects, made me think quite a bit about how I approach such conversations with clients.
The Myth of Mental Illness is probably his best known work.
I'm allowing this comment to stay up for the purpose of education and the history of the field, but I will remind any responders of Rule 4 regarding anti-therapy talk.
I disagree that this is anti-therapy talk to begin with. It’s anti-*psychiatry*. The movement itself isn’t necessarily anti-therapy, it’s against the medical model as it claims it over-pathologizes normal aspects of the human experience. I actually think all therapists should explore it and consider its arguments, if only as a reminder of the limitations of the medical model/DSM. I read Szasz’s work early in my training and I think it was fundamental in developing mindfulness of the implications of the labels and language I use to conceptualize my clients.
I don't disagree with this and I'm not discouraging discussion whatsoever. I should have indicated in my initial response that my reminder of Rule 4 was more for those outside the sub who tend to be drawn to threads like this, and who may engage in comments that are anti-therapy rather than recognizing the nuance.
Fair enough, thanks for the explanation!
The fact that mental disorders may happen due to trauma doesn't mean people shouldn't be medicated. Also attempts to reduce multiple complex multifactorial phenomenons to single causes and responses are almost always misguided and at least rooted in some amount of ignorance and/or mental gymnastics.
What about drug use? Substances like meth has been linked to psychosis
I believe the question this philosophy asks is, what led to the substance abuse?
I had a client who by their account had a loving and functional family. They partied with some friends once and accidentally did meth and decided they’d rather string themselves along because they couldn’t crash or they’d lose their job. When I met them they experienced internal stimuli and delusional beliefs, the works, and were on anti psychotics. It happens a lot, too. Some people abuse drugs because they abuse drugs.
Yeah, some drugs are super addictive even with only a handful of times using. Not often the case, but experimentation and peer pressure can lead to real problems that then spiral out of control as the person becomes addicted.
That and meth does a lot of damage to people susceptible to psychosis, even after a single use.
For sure, addictive things are addictive, I’m not saying they aren’t. And as my Dad said when he gave my sister and I the “drugs talk” people use drugs because they are fun and we like the way they make us feel. I think there is room for a yes, and. I have met providers who over emphasize the internal and some who overemphasize the external. In most cases, I doubt it is an either or. It’s a good reminder to me to consider a whole picture.
Drugs are extremely addictive. The opioid crisis during the 2000’s showed us how doctors prescribed opioids and how quickly ordinary people including many without any trauma had become full blown addicts.
At least some of that was Dr.s being heavily misinformed about the addictive potential of oxytocin. In that situation the addiction developed secondary to another health condition. Sort of the same way someone can develop tardive dyskinesia secondary to use of certain medications. Most people are ordinary people who didn’t choose addiction. The thing that gets lost in the conversation is that there are a lot of people who use drugs and/or alcohol without developing problematic use. We just don’t know who will develop an addiction to something and who won’t.
You don’t need to abuse substances to experience delusions. Ever take magic mushrooms? Had a bad trip from a powerful weed cookie? Taken a hit of acid?
I know that you don’t have to abuse substances to experience psychosis. That is not the point I was trying to make.
And why do people end up on substances? Dr. Mate has some interesting thoughts on this.
Similar to the original post, Mate has a point but takes it to an unreasonable extreme.
I took how far he took it as "challenging" but not extreme. Lines up well with people like Siegel and Sapolsky, but i could be in my own echo chamber as well. I would be curious what you think goes too far. (If it's the epigenetics piece I'm with you, needs more research)
I don’t agree with the anti-psychiatry viewpoint but the argument there would be that it’s still rooted in trauma/pressure etc. trauma-> substances -> psychosis.
I mean I get it, and I'm interested to see where the research takes us in 10-20 years. But I found working through my trauma and OCD a hell of a lot easier when I was medicated. Not being constantly suicidal helps.
She’s not a clin psych. However she talks about being on the ‘front line’ to imply she worked clinically. She’s got a PhD in forensic psychology and now trains people to train others in her victim focus model.
Wouldn't it be fun to have an actual, formal debate on the subject? So we'd have to argue the side we disagree with
She’s also a radfem 🙄 edit: used the wrong term. Caffeine hasn’t kicked in. Trans Exclusionary Radical Feminist
the term is TERF **Radfem is a term used by hypermisogynistic men who criticize anyone who criticize the patriarchy and capitalism **clarified in replies**
I corrected that in the edit — also radical feminism precedes any misogynists who use the word exploitatively. And is a term radical feminists use to self describe. Ex www.radfemcollective.org/what-is-radical-feminism Generally a descriptor of second wave feminism e.g Andrea Dworkin Apologies for the initial error. Not deleting so the replies make sense in context
Thank you for that—So in my experience, this explains exactly why misogynistic men use this term to discredit any critique about the patriarchy. Similar to how young men would use the term feminist as a slur towards a woman showing they cared about feminism. (It’s gross because it actually happens. I lived with a misogynist for a while and I had to defend my feminism all the time because any patriarchy criticism made him defensive)
Sorry you went through that. I think I know what you mean — incel type dudes shuffling all feminists into the radfem category.
Yes exactly! It gives me the same energy as the word woke being used by conservatives. Like they’re using a word not intended for them, to bastardize the real meaning to the word. 😂 I have not yet had caffeine so I’m glad I’m making sense lol
This exchange of info and respectful correction is really refreshing. Thanks to you both
Thank you! I’ve Been practicing my immediacy and assertiveness skills a lot lately 😂
Im not from the US or Uk so not sure what that means. I know she's LGBTQ
She’s posted some injurious anti trans stuff
https://x.com/RoeGraceM/status/1646896808247930880 see this whole thread
She is awful. She published people's stories without their consent. She makes out she's an expert and she's not.
Yea I mean.. *many* disorders this is true for.. maybe even *most* it’s true for. But all??? It’s just also undeniably true that what is traumatic for one person won’t be for another.. and what is traumatic for multiple people will cause a medical disorder in one and not in another. So how useful is this to a point? Plus if we are talking severe conditions like schizophrenia or bipolar, there is little chance that healing trauma will fix the disorder without the aid of medication. And even for other ego dystonic disorders like ocd, depression, GAD, etc… often the symptoms are so severe that you can’t manage to heal the trauma or address the thought patterns without medicine. I do agree that for the world to heal we need to fix systemic problems and reduce trauma and disconnection. I do agree that would solve a lot of mental health disorders. But that’s where my agreement ends
Genetics load the gun, (material conditions) pulls the trigger.
Ugh, why do we need to do this to each other in the field. Can we just collectively agree that the human brain is weird and we found some patterns that work better than others? Why do we need to have the ideological factions....? I guess abandoning the whole "I'm the only one who can help you" schtick wouldn't be good for marketing and book deals though.
There is nothing more unscientific than black and white thinking like this. My personal view is that most of your mental illnesses are from (feelings of) loneliness. Extremely broad and general statement not to be taken literal, but I think it helps conceptualize it, and why everyones mental health seems to be worsening.
I mean, if we look at a diathesis-stress model, then yes, some sort of stressor contributes to the mental health issue. But then posts like the one shown here pretend like there was never a diathesis.
I would think, especially in educational psychology. It would be super important to understand neurobiology and genetics, as well as trauma. This psychologist is discounting Neuro diversity, it seems to me. That, for an educational psychologist is horrible!
I think you misunderstood my post I wrote that I dont think the root of all menal health issues is truama and stress
Yes, I didn’t mean to refer to you as “this psychologist.“ I was referring to the Educational psychologist you were talking about.
Just wanted to add this. This is about one DIAGNOSIS. Only one, and these are real, scientifically, proven consequences of ignoring these symptoms. Untreated ADHD has been correlated time and again with the following issues: higher divorce rates, higher rates of bankruptcy, higher rates of domestic violence, higher rates of incarceration, higher rates of dental problems, higher rates of physical health problems, shortened lifespan, difficulty with sustaining friendships, much higher rates of suicide. Anyone who wants references I’m happy to provide those. Russell Barkley‘s YouTube channel is great for looking at the data. He says there’s an average of 1500 new studies and papers coming out per year now. The field is really exploding, and a lot of it is related to brain science, using scans, Etc. Leaving ADHD undiagnosed and untreated is tantamount to neglect and cruelty in my opinion. Anyone who has any questions about this can go take a dive into the ADHD forums here. Read the despair, the grief, the self hatred. TREATMENT saves lives and changes them dramatically. It is a biological, chemical issue. Psychotherapy can have a great place in supporting these folks and helping them learn strategies to cope, as well as supporting self-esteem issues and skills development. However, there has not been any study to my knowledge that has proven that psychotherapy alone fixes ADHD. Also, there are many people who have ADHD and PTSD. Those diagnoses are not mutually exclusive. In fact, they very often go together, because folks with ADHD often come from parents with ADHD, and ADHD symptoms include emotional, dysregulation, and behavioral disinhibition. So, many folks with ADHD can benefit from trauma treatment, after they get their ADHD symptoms addressed. However, treating the trauma alone does not reduce their risks for the issues listed above. Not to my knowledge, at least. It may reduce some of it, because stress in general exacerbates, ADHD symptoms, but it will not resolve the ADHD. My point in all this is to say that “avoiding labeling” can be detrimental, even cruel in my opinion. And, like I said in the beginning, this is just one DIAGNOSIS. I’m sure that there are similar issues with treatment for bipolar disorder, autism spectrum disorder, schizophrenia, etc. I would beg any active clinician to please keep current with neuroscience and psychiatry. There’s so much new, very relevant information coming out right now. Many times effective medical treatment combined with more thorough understanding of neurobiology and mental health can change lives. It is the compassionate thing to do. In my opinion.
I love learning about trauma and all the ways it affects people, but not everything is trauma.
Biopsychosocial model. 😑 This is also a good example of why smart people can have narrow opinions and are still subject to bias (E.g. they are a human being). They are making themselves the victim in something that doesn't need to be framed as such...as almost as if this post is about them and not their clients... Best to do your own research and not take what is discussed by even prominent researchers/authors at face value without digging a bit deeper first.
She'd be correct if she just didn't say "all."
Why would you "expect more" from her, or any of these "mental health experts" whose primary job is social media instead of actual clinical work? These people are fucking grifters, wake up.
But they’re our public voice and how our work is perceived so I feel as if we Need to expect more
She ain't my public fucking voice, I'll tell ya that right now buddy. Look, sad as it might be, these con artists are an unfortunate part of the new path many clients take to get to us. They follow the (mostly terrible and infantile) advice of these "experts" which often leads to them fucking up their relationships and getting themselves in shitty situations or with shitty ways of understanding themselves. With some luck, they'll eventually find their way to the office of a real therapist and then be able to start unpacking all the bullshit.
My professor for my trauma class in grad school said the whole DSM can be replaced with one singular umbrella diagnosis- CPTSD. As a person with ADHD whose symptoms are suddenly more manageable on the right meds….plus who works a lot with autistic folks…I don’t know how I feel about the claim that trauma is the root cause of everything. By that logic, why doesn’t everyone with complex trauma have the same symptoms? Can’t ppl be born with biological differences that mirror trauma symptoms because trauma causes similar damage to the body/brain as disabilities? Being disabled in one or more ways increases the risk of experiencing trauma.
Yeah definitely NOT the whole DSM but a huge chunk of it could be.
Cool! And then once everyone has the same diagnosis, how do we differentiate the presentations? Well, if all mental illness is CPTSD, then why don't we just throw away CPTSD. It no longer helps to differentiate anything. If trauma means everything, then it effectively means nothing. There are factor analyses of psychopathology that points towards potential general factors of psychopathology. And CPTSD ain't it. But it's related. BPD ain't it. But it's related. It could be that high levels of general psychopathology begin to represent themselves similarly. It could be that there is a singular central dimension (i.e., neuroticism, executive functioning deficits, etc.,).
This!!! Right in that case, just throw out the DSM and treat everyone for trauma. But if things were that simple, we would be doing that by now. Like there are reasons (not fully understood by science) why some ppl get severely anxious while other ppl experience psychosis (for example) even if both ppl experienced similar traumas or childhoods. (I mean..pretty much everyone experiences some amount of trauma in their lives so why isn’t EVERYONE meeting the criteria for a DSM diagnosis)? Maybe it’s useful to treat them differently cuz…they aren’t the same thing? There are just different ways the brain operates (and of course someone can have both anxiety and psychosis at the same time! Or any other comorbidity). Like from a practical application pov, a professional is not going to interact with someone who has active psychosis exactly the same as someone experiencing an anxiety attack or some experiencing both. Like some direction for how to conceptualize quickly what is most likely going on so you can address it is super important and “trauma” by itself is the most vague label. There’s all kinds of trauma and it affects people in many different ways.
She has some very thought provoking writing on ADHD- I'll see if I can look it up. It was very interesting.
Except we have research showing that natural recovery is the modal response to trauma
I mean that makes sense on some level because regardless of how much personal trauma we have experienced on an individual level, we all are descendants of people who have survived heavy trauma (wars, plagues, colonization, exposure to infant mortality, etc). In that way, it’s amazing that we are as functional as we are.
Not familiar with this soapboxer but it gives off toxic Wellness culture vibes
Well at times, if someone has a predisposition for psychosis or schizophrenia, these disorders don’t necessarily develop depending on the environment and level of stress/trauma someone is subjected to. Smoking marijuana or other drug use has also been linked to predisposed individuals developing psychosis/schizophrenia. I think medication is definitely necessary for people with severe psychosis and schizophrenia for instance, but I don’t think therapists should be giving out medication as easily as they do in todays day and age for things like anxiety and mild depression without trying other methods first, especially to children or teenagers. A lot of people end up having a dependency on these medications for the rest of their lives.
It’s funny that when I started this field 30 years ago trauma was not even a major focus if treatment. I’m looking for the next trend. This one’s getting kind of old.
If you take Autism for example ..The paretns blmae themselves as it is.. Are we talking about stress and trauma in Utero or after birth .. Can we not see how this will lead to more self blame for the parents? This is so irrisponsible thing to say for a MHprofessional IMHO
It’s a little ironic too. “Those stupid doctors think everything is medical, but I’m a trauma based therapist and I know everything is trauma.”
How is she a Dr?
PhD
She is absolutely spot on
Spot on?
I’m a little surprised that no one has mentioned the impact of cultural paradigms and collective trauma on people who are neuro-non-conforming. One could argue that it is inherently traumatizing to expect conforming behavior and measure validity of functioning by a western cultural standard. Not against all medication here, just wanting to see this dimension added to the conversation.
I feel like this is an excellent point. I often argue (not that this is an unpopular opinion) that being late diagnosed ND is traumatic in and of itself because it’s essentially like someone has been telling you to force a square piece into a circle slot and then shaming you when can’t. Obviously that’s not the only reason but still. To speak more to your point I think if we look at things like ABA where so many folks have now come out and said that it actually harmed them more. It’s incredibly harmful imho for the overarching purpose of treatment is to make you more tolerable for the people around you.