Monday, September 28, 2015

Reason # 2 to Grow Beyond the Medical Mindset of DSM Diagnosis (Essay Series on Mental Diversity vs. Mental Illness)

Trauma is Pervasive - and That Explains A Lot

In 2011, the National Council for Behavioral Health ‘broke the silence’ on the impact of trauma in behavioral healthcare. It devoted a special publication - nearly 100 pages in all - entirely to the issue of trauma in behavioral health. You can read it here:  Breaking the Silence: Trauma-Informed Behavioral Healthcare (National Council Magazine: 2011:2),

In this publication, National Council leadership called on behavioral health providers in mental health, substance use, criminal justice and public housing settings to recognize and respond to role of trauma in behavioral health. It called attention to the fact that ninety (90!) percent of clients across these public service domains are trauma survivors. Notably, A. Kathryn Power, then-Director of the Center for Mental Health Services (a division of SAMHSA) wrote: “Interpersonal violence … is widely accepted to be a near universal experience of individuals with mental and substance use disorders and those involved in the criminal justice system.” Many also have suffered serious neglect and deprivation related to basic human needs like food, shelter and protection from the elements.

The National Council is not a fringe organization. It is the premier representative of behavioral health organizations nationwide. It supports mainstream mental health providers nationwide and lobbies Congress for their interests. In calling attention to the importance of trauma, the National Council was taking an important leadership role. It was sending a message to providers nationwide: Do not ignore this issue. It is far too important to public health. We must get with the times and face these facts. We ignore them at our peril.

We Must Get With the Times

Sadly, providers overall have been slow to make the shift to a trauma-informed approach. That is not ok.

In the first place, the implications of this are vast. The emerging statistics on trauma raise a lot of questions about the the conventional 'medical illness' model of mental health. They suggest modern psychiatry could be entirely wrong. According to psychiatry, people have a pre-existing genetic or biochemical abnormality. But, in actuality, we could be seeing the after-effects of social and environmental trauma.

The treatment implications of these difference are urgent. If psychiatrist are correct - and people actually do have genetic or biochemical abnormalities - then medication and surgical treatments may make sense. In theory, such responses could actually correct something that is structurally wrong in the brain and make it better.

But, what if that is not the case? What if - as the trauma statistics suggest - many people (up to 90! percent) are actually just scared and overwhelmed? That requires a very different response.

When we are afraid and overwhelmed (not defective), we need responses that help us get out of fear. For most people, that does not mean high tech responses that involve complicated instruments or heavy duty chemicals. In the first place, we don't understand them. They act on our minds and bodies in unpredictable ways. They take us away from familiar environments and require us to navigate strange ones. They require us to put a high level of trust in people with white coats who seem very busy, and typically talk way over our heads. Such things tend to scare us more.

Secondly, a lot of current treatments may actually damage brain pathways, not help heal them. There is a lot of evidence that this is true of neuroleptics and electroshock, especially if we use them a lot over long periods of time. It may also be true of other treatments, like SSRIs, anxiolytics and psychostimulants. Whitaker, R. (2010), Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Random House.

Finally, we should not overlook the demands that medical treatments place on our brains and bodies. Every new medication is asking our body to make an adjustment.  Sometimes this adjustment may help.  But for many people, it just adds a new stress on top of the ones that already exist.  This is bad news!  We were already having trouble coping.  Now it's even worse, because the 'treatment' made it even harder.  Romme M. Escher S. Dillon J. Corstens D. Morris M. (2009) Living with Voices: 50 Stories of Recovery, PCCS Books/Birmingham City University. 

Given the high prevalence of trauma, the safest course to start with is probably kind, caring human beings.   What if - before diagnosing people - and before prescribing medications - we simply offered someone to listen?  This person could try to understand, help us make sense of what we are experiencing and maybe offer a bit of support in getting our basic needs met. This is the approach of the peer respite movement and it's getting some good results. Evidence for Peer-Run Crisis Alternatives

At the very least, this way of starting out does no harm.  Practically no one says they were hurt because of kindness or caring.  To the contrary, many people report that this made a big difference in their healing.  Some people even say that this was main thing - or the only thing - that made a difference. 

Given the prevalence of trauma, it's a much better bet than the high tech medications and hospital-based treatments. There's no sense in our government is paying out public billions for 'treatments' that can't possibly work. It's hardly a surprise that conventional treatments have such low success rates. What person with real life problems would get better from someone telling them to take a pill, sit around and accept their illness? How can people overcome their challenges in a system that won't acknowledge them?

Trauma Survivor Bill of Rights

If you're a trauma survivor and no one is listening, we'd like to hear from you. Please complete our Trauma Report, which is available here: Human Rights/ Trauma Report,

We'd also like you to know that you have rights. You can read about those in other sections of this blog. In addition, your rights are recognized by the National Council for Behavioral Health and published on their website. You can get a copy here:

The Time for Change is NOW

There is no longer any excuse anything less than complete, competent trauma-informed responses to behavioral health needs. According to the National Council, universal trauma-informed care is a do-able, effective, cost-saving response. Providers can and should uniformly screen for trauma. They should also offer services that respect the rights of trauma survivors and address their needs.


The premiere organization representing behavioral health providers nationwide has spoken. Trauma-informed care is the most effective standard of care. It is the 'best buy' both monetarily and in terms of human suffering. There is no reason not to offer it. Supporting trauma recovery benefits everyone!

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