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  • Amina Aitsi-Selmi

The problem with the current mental health paradigm [Wise Wednesdays]

OK, it’s a long one. A lifetime’s worth of exploration in a page. The first time I met a psychotic patient, I was a medical student. He’d been diagnosed years before and was in hospital after a relapse. With the risk of suicide and violence looming, he was admitted to adjust his treatment. The medication helped but he was burned out. Schizophrenia used to be seen as a behavioural disorder (the behaviour is the illness) then as a family disorder. By the time I was a student it was seen as a neurochemical disorder of the brain summarised as: “a white-matter neurodevelopmental encephalopathy affecting the interconnections of the associated centres of the brain”. If that doesn’t mean anything to you, it’s because it doesn’t. It means: it’s in the brain but we can’t quite find it. What struck me was a sense that this man wasn’t quite present. I couldn’t connect with him in any way. It’s as though he were absent from the reality I was in, and our minds couldn’t meet anywhere. What could cause a person to be so disconnected from (a shared) reality? ================================== Beyond the individual: civilisation and its discontents ==================================

If you go to a doctor, you’ll get an opinion.

But it’s not the opinion that heals you, right?

It’s the disruption to a disease process, no?

How is that process disrupted? Well, in my experience, empathy and kindness cut right through the psychic pain.

Most doctors can prescribe a pill or an intervention for the biological problem.

But that’s not all.

Illness is the result of psychological and social factors, too. Social isolation, loss of a job or loved one, pollution, discrimination. These can all take a toll on your physiological capacity through stress and direct physical harm. How do you disrupt those?

The mental health system is still mostly focused on symptom management. What can it possibly do about the wider factors?!

Even Freud lamented the fact that the best therapy was limited. It couldn’t contend with the tragic controls and existential angst experienced by individuals in a civilisation built on fear and anxiety…

But let’s stay on the bright side.

There are community interventions, policy solutions, even social prescribing. And that’s great.

The medical establishment is slowly recognising that your past experience, your social environment and wider economic and political factors have a role.

================================== Confirmation bias: the real disease

================================== Getting a doctor’s opinion on a spell of anxiety, taking some medication and seeing a counsellor while you find a new job may alleviate some of the problem but it won’t cure it. Why? Because it accidentally reinforces an unhealthy, underlying narrative – a toxic story you may be telling yourself. It’s something like:

  1. There’s something wrong with you

  2. The solution is external to you

  3. You can only access it if you abide by some rules i.e. play an agreed role

You arrive with a story in your head that says: “there’s something wrong with me. I feel scared and alone”. You hear: “Yes, there might be something wrong with you and you need fixing”. This is confirmation bias. If instead you heard: “Tell me everything, my friend. You’re not alone. You’ve got help.” This might be healing. Excellent doctors are good at the medical mechanics as well as the healing. But the system squeezes them to the point of moral injury (aka burnout). In summary, it’s the disruption to the illness on a physical, psychological and social level that heals. Not the opinion. Sure, the drugs and interventions can help. But they help best if they disrupt the patient’s underlying illness narrative as well. ================================== Live without the toxic narrative

================================== Can you be healthy all the time? The World Health Organisation defines mental health as: “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Needless to say, we’re quite far from this. By this definition, you may not have mental health. But what can you do immediately? Health Realisation is a coaching school of thought that sees our default state of mind as healthy. What’s more: that you can access it any time. The principle is at the heart of mindfulness, of the most effective therapies and of ancient spiritual traditions. We have powerful tools and techniques for this. Essentially: “You” minus “limiting/toxic narrative and beliefs” = healthy state of mind. The most painful narratives, repeated over time result in thought and behaviour patterns we call mental illness:

  • Depression: life is so sad, there’s no point. - I feel crushed and helpless.

  • Anxiety: the future is so uncertain, I must try to keep everything under control. - I can’t relax.

  • Schizophrenia: reality is so painful, I’m leaving it and creating my own. - I’m not here and neither are you.

I don’t know what happened to my first psychotic patient. But I know that when I met others subsequently, they seemed equally lost, absent and distressed. Like many of us are even though we try and hide it. There’s a way out. With deep empathy and sustained attention which are so rare these days, we can examine and release the underlying toxic narratives. We can disrupt the harmful processes and find health in this very moment. While medicines and other clinical interventions are vital and you might need a medical expert to give you their opinion as to which to choose, remember this: it’s in the space between the opinions that the healing happens. Have a good week, Amina

p.s. The Leaders Circle on the 24th of October is overbooked. If you’re interested in hearing about the next one enter your email here. If you want to explore personal coaching to break out of what’s holding you back from your deepest potential contact me here. Liked it? Subscribe to the Wise Wednesdays community – wisdom straight to your inbox.

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