Throughout the years I've agonized when working with dual diagnosis clients who attend Alcoholics Anonymous (AA) or any of their sister programs. Too often there are well-meaning people in the groups who take it upon themselves to give psychological or medical advice. All too often, this results in tremendous damage. One of the major offenders is the idea that any member of AA, CA or NA who is taking psychiatric medications is not "clean and sober". Not only is this bad advice it's not the official policy of AA.
While watching The Caine Mutiny* this weekend I realized that this classic movie has a powerful portrayal of the Scapegoat role playing out in a military crew.
This statement was made byBritish psychologist Oliver James in a recent article by The Guardian.
I hope James is right. I fear he is not.
James is referring to new research which suggests major psychiatric disorders are not biological but situational - a response to a childhood trauma. Why is this going to set the psychiatric community on its ear?
A recent story in U.S. News and World Report states, "The Diagnostic and Statistical Manual of Mental Disorders, as it is known, is hugely influential because it determines what is and is not a mental disorder. In turn, it is responsible for much of the sales growth in prescription drugs." In a recent article in Psychiatric Times Dr. Allen Frances discusses his concerns about the way the next version of the DSM is being formulatedand the possibility that formerly normal human behaviors will be become "medicalized".
I read an interesting article by the same name, "Trauma and Schizophrenia" (Karon 2007). In it Karon states,
"Schizophrenia is a chronic terror syndrome. In World War II there were battlefield traums that always produced classic schizophrenic symptoms. However, if the patients were healthy before the trauma, they spontaneously recovered. The myth of the incurability of schizophrenia led to the belief that these individuals could not be schizophrenic if they recovered. But all schizophrenics are the victims of lives filled with trauma, sometimes subtle but usually obvious. Professionals have tried not to listen. But if one investigates, most of the bad things patients talk about or symbolize in their symtpoms are not delusional, but real traumas. It helps to face the truth."
When considering the most important elements for mental health, a really basic one is often overlooked. It's not stress reduction, a healthy diet, exercise, healthy relationships, or taking your medications. What is it?
When I began working in the mental health field I began as a caseworker for the county mental health authority. This essentially involved working under psychiatrists as a caseworker. The system being utilized to diagnose and treat mental health "disorders" was, and still is, referred to as "the medical model". What is the "medical model" and why is it important for the general public to understand it?
Years ago I worked in a county mental health clinic that treated serious mental health issues utilizing the "medical model". (For more information on this model see my article, "The Medical Model for Treating Mental 'Disorders'".) I worked with a client who was diagnosed with Schizophrenia. I always remember his story when I hear of clients being "noncompliant" and refusing their psychiatric medications.
"Thor Nystrom was diagnosed with Attention Deficit Hyperactivity Disorder his sophomore year of high school in Minnesota and prescribed the drug Adderall. When he developed anxiety, a side effect of Adderall, he was prescribed Paxil. The two drugs, mixed with the beer he consumed as a KU freshman, led to behavior that culminated in a fight in a Lawrence parking lot, his arrest and his entry into the mental health system. Using his own medical records, police records, his own diaries, interviews with family and his own recollections, he wrote this account of what he calls his descent into the 'depths of hell,' a journey with an ending that neither he nor his parents saw coming. This is his graduation story."
