Part of the challenge in welcoming people
with diverse mental health experiences, lies in
understanding that there is more than one point
of view. In part, different perspectives have
emerged because of uncertainty regarding the
science underpinning mental health conditions.
Recently, there has been controversy about
the validity of the Diagnostic and Statistical
Manual of Mental Disorders (DSM; American
Psychological Association, 2013). This manual
presents a taxonomy of disorders designed to
be reliable rather than valid (Cuthbert and Insel,
2013). Challenges to the disorders’ validity have
recently led to the National Institute of Mental
Health’s call for a new framework for classifying
mental health problems based on dimensions
instead of syndromes and spectrums instead
of categorical labels.
From this unsure foundation springs a world of choices facing
people living with mental health conditions, their supporters, and
their clinicians. Individual differences spring forth from values,
beliefs, experiences, terminologies, roles, cultures, and abilities.
The personal decisions people make may lead them to different
philosophies about what’s causing their instability, how to label
it, and what strategies to use in addressing it. This may mean
choosing different clinicians, different treatments, and different
advocacy communities.
Perspectives in the world of mental health continue to differ across a variety of dimensions including role in the system,
views about the nature of the problem, views about rights,
and views about appropriate treatment. For example, some
organizations, such as the National Alliance on Mental were
forged primarily from a family member perspective, while others, such as the Depression and Bipolar Support Alliance, were
born out of the peer perspective. Still others, such as the Icarus Project, have emphasized departing from the mainstream
to advocate for their beliefs in radical mental health definitions
and treatments.
We must embrace the conflict resolution technique of validation to ensure all perspectives feel welcome in discourse. While
some may find it difficult to validate alternative approaches,
there are indeed sound reasons that people choose them.
Many mental health consumers depart from mainstream medicine’s best practices, citing concerns like side effects and high
rates of treatment resistance. For example, from 30 to 60%
of schizophrenia cases and 12 to 20% of depression cases
are treatment resistant. Meanwhile, alternative treatments
that were once relegated to the fringes have since become
embraced by mainstream mental health professionals. Take
mindfulness meditation, which is now frequently used to prevent depression relapse and in many other contexts. Before
mindfulness was mainstreamed as an evidence-based practice,
it was approached with skepticism similar to some of the pater-nalistic attitudes toward modern-day alternative approaches.
Our mental health discourse must welcome participants from
every viewpoint. To do so, we start by staying mindful of the
complexities of mental health and standing ready to entertain all
perspectives that come to the table. But we have to go further
– we have to make our events accessible to the full spectrum of
constituents. We can do this by placing our invitation announcements in communities outside of our mainstream bubbles, and
by stressing a welcoming message throughout our events.
That message must openly recognize that there are varying
viewpoints, and it must emphasize that all are welcome. This
accessibility to alternative views is why our first National Dialogue event was successful in making all attendees feel like they
belonged in the conversation.
2: BE CAREFUL WITH TERMS
Is the correct term for mental instability “mental illness,”
“mental disorder,” “mental health condition” or something else
entirely? Is it offensive to call someone a “patient” or “
consumer”? Are they actually a “survivor” or “user” or another
term? There are no simple answers when it comes to terminology in mental health, as every word has the potential to offend
some constituent. Mental health stakeholders have many language disagreements, differing in their view of the appropriate
way to denote a mental health problem or describe someone’s
lived experience, and that makes conversations especially
challenging.
The biomedical model, supported by the DSM, has dominated
the way many stakeholders conceptualize mental health problems in large part due to the heavy influence of pharmaceutical
companies in shaping the national conversation about mental health. This dynamic has spawned the language of “mental
disorder” and the specific DSM conditions, but there are many
other possible word choices. When referring to individuals experiencing these problems, the vernacular ranges from
“patient,” amongst many medical professionals, to “consumer,”
“peer,” “survivor,” “user of services,” “person with a psychiatric
history,” and many other terms.
