The Medical Model and Diagnosis
By now I think it should be clear that I have serious reservations about the medical model and that includes diagnoses. As I’ve said, granted ,taking people out of the realm of possession by demons was a distinct move forward. But now it is time to reevaluate a great deal about what we call mental illness.. Once we have a diagnosis then we are supposed to have a clear course forward. As a psychologist I must say I do not agree with that viewpoint. I’ve seen psychiatrists recommending long term intensive psychotherapy for heroin addicts. I prefer to think of long term guidance and support to gain a viable life course. The difference is notable. Such can be said in many other places.
A Lifetime Issue
Now we have what is called PTSD or post traumatic stress disorder. It seems to have arisen as a recognized disorder during the Vietnam War. Actually it was discussed at least as far back as World War II and possibly World War I as such things as shell shock. Probably though we have always recognized forms of battle fatigue etc. The problem now is that the disorder often gets in the way of people getting help. The military is struggling with simply adopting post traumatic stress and dropping the word disorder. And we need a clear view that reacting to living months in an environment where you are trying to kill people or be killed may overwhelm people. In fact many don’t seem overwhelmed but some simply shut down and close themselves off. I’ve met such cold and distant people.
What’s The Point?
The point is that we have yet to come to terms with the reality of human existence. It is not an indication of mental illness if a person is reacting to a high stress environment or sudden trauma. It is much more reassuring to tell someone they are having a normal and understandable reaction. Granted reactions can vary from person to person but that is to be expected.
We still seem to not have clarity about these facts. There have been several times when I discussed such a reaction with a veteran in a social occasion and they were then in tears. Often they would express relief that they weren’t pathological and that a burden had been lifted.
And just recently we seem to have jumped a barrier. Particularly after the mass murder in a school in Florida the students began to speak about PTSD. Yes! Of course! You go to school on a quiet day and suddenly someone is running through the halls killing your fellow students and friends. What would be wrong is if the other students didn’t have a reaction. They need to accept feelings and work to deal with them either personally or with others. But a reaction is to be expected and may be variable but above all it should be accepted as reality. Life delivers blows to us and we have to respond and cope.
Can we now take a different approach to trauma. Diagnosis really doesn’t show us the way forward. Each person may well have a different reaction or way of handling it. They may need to discuss tactics but need to accept that a reaction is understandable and is not pathological.
A Personal Story
I can share a personal story. In 1984 I had a catastrophic auto accident when someone drove in my driver’s door at high speed. I went through years of surgery and recovery. Then ten years later I was waiting at a traffic light when a man turned a corner at high speed, spilled his coffee on himself and totaled my car. I got off with a light blow to my head. But within twenty-four hours I recognized that I had been hurled back to the other accident. I called a colleague and we spent three sessions discussing it and my reaction. I was then able to put away my experience with PTS.
The Bottom Line
Life can be difficult, dangerous and terrifying. We need not deal with such events and our reaction with a diagnosis and a declaration of mental illness. And we need to deal with insurance companies and their practices. If it is not pathology then they won’t pay for someone getting help with management of a reaction. But help is often essential. The bottom line here is that there is such a thing as life management which is crucial. And life management often requires help with understanding, restructuring and engagement of coping tactics. Its time to reframe mental illness and life management.
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