Most of us have heard that “mental illnesses” are biological diseases or brain abnormalities of some kind, with a handful of exceptions, such as PTSD. Even when someone has experienced extreme trauma, many mental health professionals refuse to acknowledge emotional distress as a reaction to trauma, rather than the result of a defective brain. Other than the factual inaccuracy of the “biological brain disease” theory, it is extremely problematic for victims for the following reasons:
Pathologizing blames the victim and offers little hope for healing and a better future. When someone recounts an extremely traumatic event and the effects of that event to a mental health professional, and that professional simply checks off which criteria are met for a given diagnosis, this is, essentially, telling a victim that perhaps he really was abused, but he is also mentally ill. His abuser may have had her own issues, but he is emotionally disturbed to the point that his brain is defective, and he needs his symptoms controlled, rather than help healing the horrors he suffered at the hands of someone he should have been able to trust. If it is a “serious” mental illness, he likely has few prospects for the future because of his brain disease. This is, most often, a subconscious message sent solely by the process of diagnosing a survivor with a mental illness, but, all too often, it is quite explicitly stated by mental health professionals.
Pathologizing denies the value of the survival skills that helped abuse survivors to live through their torment. Much of what is typically referred to as “mental illness” is truly just a manifestation of very necessary, creative survival skills. We all, generally, accept that PTSD “symptoms” are purely the understandable effects of trauma that no longer serve a purpose once that trauma has ended. Individuals who are diagnosed with other “mental illnesses” rarely seem to find the same understanding. Dissociation is a normal part of the human experience, and more extreme forms of dissociation are simply a brilliant, creative way to survive overwhelming trauma. If you are physically trapped and unable to escape from horrifying abuse, you might mentally “escape” and watch the events unfolding from the safety of the other side of the room, the ceiling, or a picture on the wall. You might insist that it’s not happening to you, but to someone else, or that someone else is helping you deal with the traumas as they unfold when such a person does not truly exist, until this really is your reality and that “someone else” manifests into a separate personality state. However, these understandable, adaptive experiences are quickly labeled as dissociative disorders in a psychiatric setting- that is, when survivors are lucky enough to even find a clinician who has some understanding of dissociation. Even “mental illnesses” that are not commonly thought to result directly from trauma, quite often, can be seen in that context simply by asking questions about an individual’s experiences and what they mean to that person rather than an individual’s symptoms and diagnoses. I once knew someone who was diagnosed with various forms of psychosis and told that she had “delusions of grandeur.” She was on a cocktail of psychotropic drugs that produced no apparent benefit, while just talking to her for a brief time led to a fascinating discussion about how she could only function in the context of these “delusions” because she had been severely, repeatedly abused by a very powerful, influential individual. She felt like less of a victim within the confines of these “delusions” about her own success and power.
Pathologizing compromises the ability of victims to get help from the criminal justice system and leads to misdiagnosis of medical illnesses. The criminal justice system is widely ill-informed about the effects of profound trauma on survivors. All too often, a panicked, seemingly unstable victim recounts a story that sounds too horrific to be true to officers with little empathy and inadequate training and when they speak to the perpetrator, he is calm, poised, respectful, and able to give what sounds like a more plausible version of events. This can lead officers to assume that the victim is, simply, mentally ill and imagining the abuse. When the victim has already been labeled as mentally ill, the chance of officers seeing the truth in such a situation moves from “unlikely” to “not a chance in hell.” While there are certainly exceptions to this rule, they are, unfortunately, quite rare. Trauma also tends to cause or, at least, worsen many physical illnesses. Some can directly result from the trauma, such as broken bones or other bodily injuries, in the case of physical abuse, or STDs or physical damage to the sexual organs, in the case of sexual abuse. However, the constant stress of living in an abusive environment can often lead to other important bodily functions, essentially, shutting down, making abuse survivors more susceptible to illness (particularly, to autoimmune diseases). Patients with autoimmune diseases often face misdiagnosis and assertions that their complaints are purely psychological under the best of circumstances- once you add in a diagnosed “mental illness,” the odds of a patient receiving accurate medical treatment plummets even further.
Pathologizing leads to survivors taking psychotropic drugs that are often counterproductive or ineffective for anything other than numbing them to the horrors of their experiences, and often have serious medical consequences. Given that many trauma survivors already have health issues, throwing in a bunch of pills that notoriously cause toxic, sometimes permanent damage to the brain and body, blown off as “possible side effects,” is often a recipe for disaster. While there could be some value in prescribing a psychotropic drug to an individual who is in extreme distress and needs a way to find a bit of relief for a short period of time, or so that individual can feel as though he can control his emotions a bit better while working through extreme difficulties, the endless years that many people spend on “medication management” clearly indicates that psychotropic drugs do not produce the immediate, positive benefits that would make them worthwhile and can, instead, lead to lifetimes of drug dependence, emotional numbness that effectively prevents healing from trauma, and serious medical or psychological consequences, such as tardive dyskinesia and suicidal thoughts or actions. If someone knows that a particular psychotropic drug benefits him when he is truly overwhelmed, I can certainly see the value in taking it when such an individual feels that the benefits outweigh the risks, but it should be far from the knee-jerk response to emotional distress that it currently is, especially when there is a multitude of extremely effective, low or no-risk herbs and natural supplements that can signficantly benefit those in emotional distress who feel they need more help than just emotional support and counseling can provide.
Pathologizing can lead to further trauma from forced psychiatric treatments. Many survivors talk about being forced into psychiatric hospitals or forced to take psychiatric medications, and how this is akin to government-sanctioned sexual assault, as they are being told that they have no rights over their own bodies and their own lives. Individuals who have been committed to psychiatric hospitals retain very few rights, and there is virtually no oversight to prevent violations of the few rights they maintain. While hospitalized, they are expected not to show any emotion that could be interpreted as anger or distress- this runs the risk of having hospital staff forcibly remove their clothing in order to inject them with psychotropic drugs, tie them to a bed, or place them in solitary confinement until they “calm down.” Imagine how traumatizing these “interventions” can be for someone who has already been traumatized by having their rights to own their own bodies stripped away, not to mention, how extremely triggering it can be to forcibly remove the clothing of a sexual abuse survivor, or tie someone who has been sexually assaulted to a bed. Often, a far worse consequence can take place- further abuse while survivors are in locked psychiatric hospitals. Not only are physical and sexual assaults horrifyingly common in this setting, but survivors have little recourse if they are attacked because they’ve already been deemed “mentally ill” by the hospital staff- the thought is, it’s just a crazy person making things up. Survivors can even be punished by hospital staff if they show any visible injuries from such assaults, as they are assumed to have been self-inflicted. This system, set up for those who are a “danger to themselves or others,” actually causes quite a bit of violence (self-inflicted and otherwise) due to these massive human rights violations and lack of actual support and compassion for survivors, as specifically evidenced by the sheer numbers of individuals who choose to end their lives while hospitalized or immediately after being discharged. According to Mike J. Crawford, author of the study, “Suicide following discharge from inpatient psychiatric care,” “The risk of suicide is higher during the period immediately following discharge from in-patient psychiatric care than at any other time in a service user’s life.” Clearly, this system does not work and simply leads to more trauma and quite tragic endings for many survivors.
It is very possible to discuss specific issues that survivors may have without the stigmatizing labels. We truly have no need for these arbitrarily-defined labels of what is normal and what is pathological. Abuse is not normal, and, quite often, its consequences on victims can make them appear to also not be normal while they are really just reacting to the horrors they experienced. The key is moving from a culture of diagnosing and medicating to a culture of healing, of not asking, “What’s wrong with you?” but, “What terrible things have you been through and how did those experiences affect you?” I know many survivors who were diagnosed with dissociative disorders, but choose to use a term such as “dissociative survivor” rather than “DID patient.” Others choose the word, “traumatized,” over “mentally ill.” These distinctions may seem insignificant, but the difference is in interpretation, both on the part of the survivor and those around him. One says to the world, “I’ve survived things that most people couldn’t even imagine, and am struggling as a result,” while the other says, “I have a malfunctioning brain.” It also reframes their prospects for getting help, and puts the focus on helping them heal from their troubled pasts, rather than controlling their “symptoms.” After all, psychiatrists cannot cure anyone, and don’t pretend that they can- they simply focus on medication management and symptom control. In contrast, effective trauma therapists and other supportive individuals can help someone to truly heal by addressing the traumas that caused their distress.
Here’s the bottom line: there’s no such thing as a “wrong” or “pathological” reaction to abuse. Quite honestly, I question the sanity of anyone who talks to a victim of child abuse, sexual assault, domestic violence, or any other trauma and responds with nothing more than a list of diagnoses. No matter how a survivor reacts to the horrors she has experienced, she deserves to be treated as an equal, competent, sane human being who is dealing with the effects of overwhelming trauma, and she deserves safety, support, and opportunities to talk about her experiences.
Special thanks to Hope for reminding me of the importance of including a discussion about the perils of forced psychiatry in this article.
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