One of the very important disctinctions to peer approaches to mental struggles is that we view problems as temporary and not permanent. It’s a repairable life situation problem, not a lifetime chemical or structural or genetic problem. This is one of the key ideas of the Open Dialogue Model that makes it effective.
Our distress versus disease model is an important paradigm shift to help promote solutions.
I know that in my own personal experience, I wasn’t that ill at the beginning. I became more ill after realizing that I might have these struggles for the rest of my life, that this was the “best” I could get, that my distress versus disease was never going to end. This is what I said in my “Cloudscapes,” poem.
My poem about how the distress versus disease model gave me hope to move forward.
“Through the valley I walked, through the valley where everything was evil
I believed I had no power to choose a challenge, to contribute to the creation on this planet
so in that place I chose the dust, logic of the doom descending as I chose to end my days up this earth….”
I do believe that emotional suffering is real. I know when I was in the depths of the pit, I saw no way out. In my experience in the mental health system, I had five hospitalizations, six suicide attempts, and seven shock treatments. I tried 29 different psychiatric medications before I got off all of them, including using up to six meds at a time. I know how awful emotional distress can feel. In the face of so much suffering, sometimes people’s desperate conclusions feel logical. But it’s important to pull out the difference between distress versus disease.
Me wanting to die because my life was awful didn’t mean I had a disease. It just means I was facing a great deal of emotional distress. One of the late and great leaders of the recovery movement, Judi Chambelin, said, “Mental Illness is just a sign that one’s life has become intolerable. The role of the mental health system is to help you tolerate that life, not to help you resolve what has become intolerable.”
Distress versus disease is hugely important reconceptualization. I’ve explained in a previous blog how emotional distress causes mental health symptoms and not the other way around.
How distress versus disease promotes complete recovery
Looking at things from a distress perspective rather than a disease perspective shows immediate solutions. It shows how we can move through our problems and come out the other side. There isn’t an inherent mixed message like, “Your brain is broken and can never be fixed but we still want you to work on recovery which really means adaptation and not full functioning.” Looking at a distress model points to complete recovery.
I have a folder full of academic research articles on this that I need to work through. If you are interested in taking on this project as a volunteer, please, please sign up. I’ll start off with a quote from Kevin Aho in J Med Humanit (2008) 29:243–259:
To bring the human being back into psychiatric treatment, the hegemony of the
scientific method and technical expertise needs to be challenged. Again, I am not
suggesting that science itself is the problem. The problem, as Heidegger says, is “the
victory of the scientific method over science,” of uncritically applying the fixed rules of the
natural sciences to all things, including the situated finitude of human existence. The strict
emphasis on method that psychiatry must abide by continues to cut the psychiatrist away
from a deeper sense of truth, the truth of the patient’s own lived-experience, an experience
that, as Gadamer reminds us, always “transcends the sphere of the scientific method.” As
a human science, psychiatry would not rule out the use of psychiatric medication or the
DSM, but the first priority would always be to remain attentive to the patient’s life and the
ways in which it is inextricably woven to the world.