What if the way we think about mental disorders is upside down?

Current Ideas about Mental Disorders

At the moment there are three prongs to our thinking about mental disorders. Social, psychological and medical. 

In social model terms we see the predisposing, triggering or maintaining factors of a particular person's mental state as being a function of a person's position in and relationship to society as a whole. Treatments are therefore aimed at improving the social position and opportunities for the person to engage in a more self-reinforcing way with their social milieu, for example by ensuring they have somewhere safe to live, or the benefits they are entitled to. Or in fact changing their social milieu to an easier one for them to negotiate, for example by moving them into residential care.

In medical model terms we generally think about mental syndromes as analogous to physical syndromes as being symptomatic expressions of a mis-functioning of the brain and therefore the way we go about treating them is to either attempt to rebalance the neurotransmitters or empirically give them medical treatments which are proven to help in the majority of people with similar symptoms.

Or alternatively and increasingly, a diagnosis of abnormal brain functioning autistic spectrum or ADHD, with associated medical treatments.

In psychological terms we generally think about mental disorders as being driven by traumatic experiences in early life and therefore the way we go about treating them is to either talk about the traumatic experiences in a safe relationship or work in a systematic way to influence the unproductive core beliefs that we think the experiences led to. 

Our explanatory concept, coming from all three at once, is something like this:

 Complex combined genetic predispositions and abnormalities

and/or

Something happened in early life (or something really extreme in adult life) 

and/or 

Current Social Circumstances or Relationship Problems or Physical Health are conspiring to make life too difficult/ stressful for normal functioning

and/or

Self-limiting beliefs or Inaccurate schema OR abnormal brain physiology

leading to 

Understandable or somewhat bizarre counterproductive behaviour

Other possible conceptual frameworks:

This model is the result of lots of different blind men describing an elephant. What happens if we take a step back and rethink this thing from a distance?

What I see when I do that is that there are some other alternative ways of thinking about mental distress and it's life consequences. One is that we're missing out the obvious. Another that there is a step missing. And another is that maybe we've got it upside down. 

1. Stating the obvious

It's not just that many people have what might be called trumatic experiences but don't present in distress later in life. It's also that which experiences appear to be traumatic, and are dwelt on with anger or self-pity by a person, are dictated not by the experineces themselves but by the perspective of the person having them. 

So for me the problem with my childhood was that I was neglected. But for my sister it might be the lack of standards. And for my brother perhaps a lack of love. And perhaps for another sibling it was a very happy childhood.

There are three possible explanations for this: 

• Either we were actually treated so differently from each other that our early life experiences can be as different as this suggests. 
• Or as genetically different individuals we are built to filter the world differently from each other, so that our experiences, while essentially similar, are perceived and interpreted differently through our differently organised brains. 
• Or it could be some combination of the two. 

There is evidence for the genetic filter idea in the obvious fact that each human being does, in our everyday lives, evidently experience the world differently from us. And in the prevalence and repeated reinvention of personality typing schemes despite the intrinsic difficulty of proving them through scientific method. And in the way that the people we know well are so very predictable about what they will remember and report about certain events or encounters in their lives even now in adulthood. 

For example, for one friend the subject of her conversation will always be a list of who has treated her unfairly, and for another will be a series of tangentially connected new sensory experiences and for the third will be a list of times when the system failed to provide the certainty it should have provided. Try it for yourself. Next time you are going to speak to someone you know well, predict what type of complaint they will have once the preliminaries are over. See how you do.

I would argue that this reliable selectiveness in the perceptions of our friends colleagues and family members supports the idea of genetically coded filtering as a much more important factor in our mental health than is generally understood. 

2. There's a step missing 

Something traumatic happening in early life and/or something stressful happening in our current circumstances doesn't automatically result in the experience of mental ill-health or distress. There is another step missing in the model, one which modulates the effect of the perceived experiences on the person's current emotional experiences and behaviour. Let us call this the Personal Filter. 

So if we put the Personal Filter into the model it initially looks like this:

 Complex combined genetic predispositions and abnormalities

and/or

Experiences in life, including early experiences, current social, health or relationship experiences

and/or 

A Personal Filter that Perceives and Labels these particular Experiences as Significant

and then 

We believe that what our Personal Filter is telling us is the whole of reality (rather than the highly selective lowlights)

leading to

Self-limiting beliefs, and/or inaccurate schema and/or Chronic arousal of the sympathetic nervous system 

leading to 

Counterproductive behaviour of various kinds

leading to 

Formal or Informal Diagnoses of various kinds

3. Maybe we've got it upside down

You will have spotted that I said 'initially' there. As in 'When we put the Personal Filter into the model it initially looks like this.' That is because when we've done that and given it time to percolate through into our own inner model, we start to see that perhaps the Personal Filter overlaps with or even is the same as the 'complex combined genetic abnormalities'. 

And that perhaps the personal filter is what leads to the idea that those early experiences were malign influences. 

And that perhaps it's not so much the Personal Filter that's the problem but the BELIEF that what we experience is independent of our Personal Filter. 

I should mention at this point that yes of course there are experiences that are so bad that anyone would have emotional troubles afterwards. And that people who have experienced these should have our sympathy, not be blamed for their reactions. 

You will notice that there is no blame here for the fact that we all have our Personal Filter. We all have them. It's a matter of human nature, like we all have a gut. However, wouldn't you like to know that even for traumatic bereavements and actual bodily harm for example, seeing our relationship to our Personal Filter differently has the potential to change the way experiences affect us now, in the present and future. Surely that's worth a try?

So now the model looks more like this:

 Our Personal Filter

alerts us to

Particular kinds of experiences in life, including early experiences, current social, health or relationship experiences

and by its very nature

Labels these particular Experiences as Significant

and then

We mistakenly believe that what our filter is telling us is the whole of reality

which leads to

Counterproductive ideas and behaviour of various kinds

See what I mean about upside down? The Personal Filter is the cause of us being alerted to and experiencing certain things as significant. The fact of the experiences is not the cause. It is the effect of us believing what our filter is telling us. 

I saw this all the time as a psychiatrist. Someone would believe that something was significant eg a rustle in the bushes, or the changing of a traffic-light to red, and that would alert them even more to other signs that there was something fishy going on, right up to and including barricading themselves into their home or tragically missing the fact that they were surrounded by people who cared deeply about their wellbeing. 

So the problem is not that we have this filter, or that it gives us a different experience of life than anyone else, but that we believe that it is telling us the whole truth about reality and act accordingly.