The Future of Preventive Care

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In the last post, I mentioned the DSM board’s attempt at preemptively striking against textbook psychosis. There’s a whole other world out there in the mental health field dedicated, and quite passionately might I add, to prevention psychiatry: stopping the progression of certain experiences, mainly psychosis, before they turn into something they can label as schizophrenia.

I have nothing against their passion. But I would like one of the members to explain how creating several new disorders like attenuated psychosis syndrome would do anything other than create a new label multitudes of teenagers would be diagnosed with, fed medications that aren’t researched on teenagers, and make them fear their future more than they should.

So, where do we start?

If you ask me (no one did), preventive care, if that’s what it’s to be called, includes family dynamics, relationship dynamics, and self-dynamics, not only diagnosis and medications.

Family Dynamics

This is an important but difficult portion for me to write. I find myself grappling with words that sound rehearsed and disingenuous, because I’m not quite sure what a healthy family dynamic would be. But I understand that what you are taught, what you see, what you experience as a child heavily influences what you teach, what you see, and what you experience as an adult. This includes behaviors and thought patterns that may be seen in the world of psychology as abnormal.

The family as a whole must be looked at in preventive care because it may very well be that the problem starts somewhere in the family, perhaps in the history of the family. Substance use, abuse, neglect, perfectionism, other illnesses of family members that fall on the responsibility of the child. Every moment of life becomes a little more traumatic, and the brain is our rock, it must do what it must to protect us from processing emotions we don’t fully understand. As helpful as that can be in the moment, it becomes something to wrestle with for many years in the long run.

As a child, I never spoke my insecurities, my emotions, or opinions. I didn’t feel safe physically or emotionally. I didn’t learn healthy outlets for anger, and I didn’t learn healthy outlets for sadness. I didn’t know my pain was worth mentioning, so all of it meshed together somewhere in the back of my mind, and eventually came out as panic attacks, depression, psychosis, and self-harm.

Does this mean my family is to blame? No. What it means is that the dynamics were not healthy. It means when looking at preventing further development of experiences like psychosis and depression and self harm, regardless of whether a diagnosis is the main goal, we have to look at how the family functions/functioned as a whole.

Relationship Dynamics

What’s been learned in childhood and adolescence inevitably bridges into the relationships we have throughout life, and if there is a pattern of bumpy relationships–friendships, romantic relationships, acquaintanceship– then it’s time to also take a look at why. Everyone, even the most introverted person, needs a close friend once in a while. The inability to have an open, comfortable, a mutual connection with another person may force a person inward.

It may also signify an inability to understand what healthy relationships look like, another one of my own personal weak points. Part of preventive care should be focused heavily on providing a person resources on how to learn to have these healthy relationships, even if it’s just one person. And I’m not talking about just therapy, I’m talking about workshops and intensive analysis. Having someone in your corner makes all the difference when you feel lost or disregarded or confused.

Self-Dynamics

How does the person regard themselves? How does the person treat themselves? This is the most important aspect of preventive care, because in the end you really only have yourself as your largest support force; if you’re not on your side, who is? This is why I believe adding another diagnostic label telling someone they’re developing a life-long “illness” that they will need long-term medication as treatment doesn’t really empower them to look at their life with healthy vision.

Is the person stuck inward? Do they value themselves? Do they value others? Do they have painful outbursts? I point out these behaviors for a reason: they are most often questions asked and behaviors people want to change. I don’t believe preventive care should be about changing anyone, but rather giving the person a chance to see a different perspective and a different side of things. The personal transformation which transpires from that will help the person loosen up in the way they are meant to loosen up, rather than forcing a way of being on them. We’ve seen that force isn’t a healthy dynamic between “patient/client” and doctor many times.

Where Does This Leave Us?

If you are a provider, take into account everything. I’m sure that’s something that’s taught over and over again, in fact I know it is because I’ve heard it in every psychology class I’ve ever taken. But sometimes we forget. And sometimes we don’t mean to forget. Sometimes we get wrapped up in what our job is versus what our job could be. And that’s when it’s important to take a step back and really engage with people, understanding them on a personal level. It’s a two way street here: while it’s up to us consumers to take our health into our own hands, it’s also up to providers to guide us appropriately when we might not be able to take our health into our own hands.

There’s a notable difference between doctor’s who are genuinely curious about what’s ailing you and those who want to help, but come equipped only with the DSM.

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