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.

Where Do We Fit?

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I’ve been thinking a lot about the middle man lately, us “moderates”.

In the current system of mental health, there are three labels which determine the level of “care” you receive: “Mild”, “Moderate”, and “Severe”.

There’s no doubt that some people face deeper challenges than some of us, someone always will. But have these organizational categories really organized the system into something that’s useful?

Mild

Alright, the milds. I was in this category for a brief period when the only diagnosis I held was Social Anxiety. First I was told I’d grow out of it. Secondly, I was told I’d grow out of it. Thirdly, again, GROW OUT OF IT.

I was called shy, told to “speak up” so frequently the phrase has become something I despise. The worst thing I think, though, was when people walked up to me and said “you’re so quiet”. I–I’m aware I am, I’m glad you’ve realized it as well. That too, I began regarding as an insult. I’m still highly sensitive to these words.

Because no one really saw the level of distress I held on my shoulders, and because I couldn’t properly express that distress because I didn’t understand it, I was told by therapists that I just needed to get out there and expose myself to social crowds. I did. It didn’t help much. And when I said that, well, it’s because things take time and I wasn’t trying hard enough.

The mild category is where those of us with anxieties, sometimes depression, and other experiences like phobias are tossed away. We’re taken serious, but often not serious enough.

Severe

This is where you want to land in the world of mental health IF you want serious care. This isn’t where you want to land in the world of mental health if you want to maintain dignity and independence, because sometimes the “Care” that’s provided steals those right from under your feet. You won’t even see it coming. Like a snake in the grass. Wear high, rubber boots if you’re wading in this swamp.

Damn, my jokes are lame.

This is often where you’re placed briefly if you’re being hospitalized. It’s also where you hear of the “severe mental illnesses”, people labeled with schizophrenia or bipolar 1, schizoaffective, DID, sometimes OCD, and so on.

Of course there are different layers to this thing we call diagnosis because it’s SO scientific, and someone labeled severe can eventually jump down to Moderate and even mild depending on what kind of treatment they receive, what they are told about themselves, and what they choose to believe about themselves and their life.

With my most recent hospitalization, all previous diagnoses were thrown out the window. Four options were put under a microscope: Bipolar 1, Depression with Psychotic Features, Psychosis NOS, and Schizoaffective, and there’s still no consensus as different opinions yield different results. Psychiatry is very scientific, I’m telling you.

I’m not one to chase a diganosis, but what they put on that little piece of paper will determine, in combination with my experiences, the level of “care” I’m given (with insurance limitations), regardless of what I feel I really need. Complicated.

Those with the “severe” label often are those who are homeless, who can’t have a “coherent” conversation (to the outside observer), who can’t take care of personal hygiene, and who can’t work. Disability benefits is often one of their life lines.

Moderate

I think this category wasn’t created intentionally, but as a result of people who were a combination of both of the above. For myself, there are times when I am what they call functional, and times where I am what they call not functional. Where do I go? In the moderate pile. What do I get in the moderate pile? Well . . . not much.

Therapy every couple of weeks is nice I guess.

Often, those of us who have been neglected and/or abused in some way in the past, whether that abuse was intentional or not, have trouble speaking up for ourselves. We’re trapped in that victim mentality, and that can render therapy useless at times. It also means we need a little more guidance and help understanding what is healthy and what isn’t–because we never learned. This means: what is a healthy way to treat ourselves? What is a healthy way to treat others? When do we know our relationships and friendships aren’t healthy?

Therapy can help with that. Support from multiple outlets can help with that. Moderates don’t always have the option of intensive support because we’re decently functional: we shower most of the time, we have a place to live even if that place isn’t healthy, and most of the time we have some source of income, whether it’s part time work, freelance work, or full time work.

The problem with this category is often it can lead to “severe states”. And you have to wait until that point before you’re really serviced.

What Can We Do?

It’s time this “moderate” category get taken serious as a category. Attenuated Psychosis Syndrome, the DSM board’s attempt at bridging the gap between “moderate” care and “severe” care, their attempt at launching a preemptive strike on psychosis, failed majorly.

We don’t need more diagnosis to bridge that gap. In fact, that’s the last thing we need. We just need more of a focus on the moderates. We need programs dedicated towards us. We need care specialized towards us. It’s not that difficult: if we can do it for the “severe”, we can do it for the “moderates”.

This also requires us moderates to really vouch for ourselves. It requires us to step outside of what we’ve been taught and really express the struggle we face. Because what we stuff down has to come out eventually, and that’s what launches those of us in the moderate category into the severe.

“A closed mouth don’t get fed”. Yet another saying jammed down my throat I’ve learned to hate, regardless of how truthful it is.

If you’re a moderate, get involved in something. If therapy is the only thing you receive, and you feel it isn’t helping, reach out your fingers into other options, I know I’ve been trying to. Support groups, peer mentors, community groups, retreats (if you’ve got that kind of money), anything that will support you.

You are your biggest support, until the system catches up.