Relationships with disability and distress

I seem to have tears in my eyes at the moment. Not sure why.

Anyway, so far I've written about psychopathology, distress and a personal scale of wellness. Now I want to explore two other concepts and I want to consider them with respect to the first three spectrums I've described.

In my descriptions of psychopathology I may have made it sound like a terrible thing which enforces a system of judgement about people using doctors and the paradigm of illness. In part it is but it also also something else.

The fundamental biomedical paradigm involves two things: a biological difference and a prognosis, I.e. a predictable set of negative outcomes. This is the fundamental Kraeplinan ostenstive prototype of mental illness. (Emil Kraeplin was a pre-eminient early psychiatrist)

Mental illness is not an illness without this Kraeplinian model. This is why the brain studies exist as well as stuff like genetic studies. It's all primarily about proving the biological nature of mental illness. This is why some people and psychiatry in general used to (and still do) consider personality disorders as non-mental illnesses (as well as the idea that they're percieved as extremes of normal traits whereas mental illnesses are considered abnormal).

This model of mental illness brings with it the "privilege of the invalid". I'll use Thomas Szasz's term. This concept is part of what mental illness means in socioeconomic and political cicrles. The extension of the privilege of compassion and support through things like the welfare system is done because of the biomedical model, the model which says mental illnesses are real illnesses (something I disagree with in the main).

The biological evidence is one part of this strict definition of mental illness as is the prognosis. The prognosis is the worse life outcomes on the clinical and social outcomes. The latter outcome is where the disability component exists.

Let me explain. It's horrible to think it but a mental health diagnosis is sort of a way of saying your life is going to get worse. The negative social outcomes - the prognosis - is a scientific description of a life less lived.

This is the brutality I have to live with when understanding the mental health theory and living it. I'm sitting here drinking wine alone in a country park typing this on my smartphone. I'm unemployed, alone and very unhappy. My life has gotten a lot worse than it used to be and my outcomes are much worse than the people I grew up with.

I've had many psychiatric labels applied to me and they predicted where I am now but there are times I've beaten the negative predicted outcomes and excelled when I couldn't or shouldnt. But overall and at this moment my life is a total wreck and so am I.

In human terms I'm discussing the outcome or the disability. I've been untreated now for a few years and some might say this is part or all of the problem.

there's a bit of my life and I'll chose to reveal other parts as I go on. It isn't for sympathy. It's so you know that I'm not writing just theorectical bullshit even though I've read so many papers and other sources to understand the theory. I want to convey some of what living it is like.

The disability causes distress and in a sense distress can be a disability. I say in a sense because the research into outcomes uses complex measures and distrss is usually a small part. The evidence isn't really there in a scientific sense to say that distress alone is associated with disability - though it's usually associated with a poorer quality of life - but psychiatric science is very good at showing diagnosis is a predictor of much worse outcomes in life. (Give or take....the last statement is caveated by the information in Bentall's book Madness Explained and the problem of how much of the science is lost when it's used in clinical practice.)

I should segue into a bit about how psychiatric science, while reasonably good at predicting outcomes, is poor at affecting them but instead I'll move to explore this idea of distress versus psychopathology when predicting prognosis.

This is perhaps a bit overly complicated and perhaps I don't fully understand it myself but its worth considering here.

Remember I've explained that distress isn't required for depression and subjective unwellness is diagnostically irrelevant as well as being different from distress. Subjective unwellness is a complex and discrete concept which can relate to distress and psychopathology just as those two can also involve the other but are not the same thing.

Resilience is the concept which...well...it relates to many things. I think it is aligned with the concept of distress more than psychopathology though it's involved in this too.

Let me switch to my examples to help crystalise my own thinking as well as yours.

Let's imagine a person has a high level of distress. They feel sad and low and other things associated with misery. Now let's imagine they're used to it.

My example in an example is how I extinguish a cigarette...specifically the hand rolled cigarettes I smoke as well as the occasional manufactered one. I stub then out between my pointing finger and my thumb.

If you try it it will hurt. It probably did when I first started and it can still hurt sometimes. Now the pain has lessened and when I feel it I'm tolerant to the pain.

This is resilience. Two people can feel the same level of emotional distress. They can feel all sorts of different pain. They can externalise it in different ways but they can also be resilient to it, to displaying it or to it not even affecting their internal reality, or they can not be.

This is confusing or not well explain, perhaps, so let me try another way. When I was a child I played rugby. I had a cracked tendon and a lot of physical pain as well as an assortment of other injuries. I'll tell you how I got the cracked tendon.

We played rugby once or twice a week at my school. Everyone had to do it. It was a pretty posh school. This wasn't touch rugby. It was full contact and we all played it from the age of 11.

It was great. At first I hated it. All that damn exercise. Running around in the cold English winter in shorts. I was a fat geeky kid who wore glasses. I couldn't even wear my glasses on the field so everyone was a blur.

Our school was split into houses and you join on the very first day. I was in Rowan House if I remember right. This was assigned by the schoool and it was an integral part of the experience.

Once or twice a year all the houses would get together to play against each other. We'd all have to get a team together of our best players.

I was rubbish but I was fat. I made a good prop. Outside these house competitions they split us up according to level and I spent most of my time with the bottom level.

I made it into the house team though and one day we played against our arch rivals. It was a cold, wet dark day much like today but I was playing for Rowan house....

...hmmm....let's hurry up what I'm trying to say....

At one point I got my foot stamped on. It hurt like hell. The pain seared down my foot and it hurt to walk. I carried on playing. For a couple of minutes at least. My team mates looked at me. I wasn't sobbing but there tears streaming down my eyes. I wasn't angry or scarred. I was in intense pain but it wouldn't stop me playing rugby for my house. They took me off the field and the nurse got me sorted. Not sure if I even went to hospital but my memory isn't great.

It hurt but I tried not to feel it. I tried not to let it change my performance but other people saw the pain I was trying to hide.

I was in pain but I wouldn't take myself off the field. I think this is resilience.

This example may not sit comfortably with those who suffer but it is an important concept. I extend my compassion to both those with and without resilience. My compassion I hope, or perhaps at least in theory, extends to anyone who suffers and to those who don't.

This is what the mental health system, in some respects, asks a person to do: have some compassion. This is what the privilege of the invalid is all about. This is about the providence of welfare benefits and alternatives to the criminal justice system for those who have committed serious crimes but are diagnosed as mentally ill. Compassion is the given reason why the mental health system exists. It is a post-Industrial Age system initated because the political systems wanted a compassionate way to help those worse off.

It was legal instruments such as the Poor Law (as well as other less politically correct acts) which made society responsible for the mentally disadvantaged and destitute of the time, those ejected from society for whatever reason. These people would have been doomed without the inception of psychiatry and the biomedical model.

It is fascinating to note the psychological distress model was accepted as a main stream construct much later on and only officially recognised in the mainstream of politics in the UK in the New Horizons stratgy. (LOL. Thanks to me and a lot of other people.) It was the mental hygiene movement in the early 20th century which pushed distress and the dual continua model in the UK and eventually Mind got it recognised in the early 21st century. It is noteworthy that Mind used to be called the National Association for Mental Distress and one of their original founding organisations which came together after the second world war was the National Association for Mental Hygiene.

Resilience is an important associated concept. It may not be liked by those who promote the mental distress continuum. Now let me try and finesse it a bit. How does it relate to psychopathology?

In my rugby example, I played on regardless of the pain but if I felt my performance was a compromise to the team I would have left the field. I was trying to overcome the injury and would have kept on playing. Though internally I overcame the pain there was one part I couldn't control: the tears streaming down. Someone made a judgement and took me off the field. They recognised I was in pain and they were right to do so in that instance but I wouldn't have been able to play on much longer anyway and I would have taken myself off.

Psychopathology judgements are like the judgement of my physical injury. Reread the last paragraph and consider my personal valuation of resilience, in this example. If I had kept playing and not removed myself from the field then the results would have been worse, but I can take pain or I can not. The measure of this is my internal resilience.

I believe this is a question of epistomology but if you knew what the word meant then you'd already be understanding this is a theme in what I write about.

I don't really know what the word means but to me it means how do you know what you know?

Distress or lack of distress can be called the female or feminie epistomology of mental health. The male or masculine epistomology is resilience. I admit my bias. Resilience has value. Can you admit yours?

These are concepts which are dressed in subjective judgements people use as if they're objective. They can be objective but we have to strip our bias and if we can't then I hope we can strip our bias naked before we make judgements we consider are objective truths.

When I asked the question of what is m,ental health I wanted truth, objective truth rather than subjective or simply supposition and hypotheisis.

There is a truth behind mental health. It is neither a good truth nor a bad one. It might be but we don't know enough to know, to be truthful in our subjective valuations.

What is true is suffering exists. I'l be blunt and truthful and confusing. I would cease suffering and yet I see it may have value. My understanding of suffering is not a truth, not when I place value judgements upon it.

When I talk about resilience and distress I would like to be talking about protons and neutrons. They're just subatomic particles. So are electrons. Protons. Neutrons and Electrons are all essential to the universe. Their mixture creates the diversity of existence and more. There's the value.

When I talk about psychopathology and disability it is all to seek those underlying truths, those things which are still beyond any analyisis. Essentially only history will tell any truth about what mental health is or isn't. I just want to try and explore the objective definition. I mean seriously....if what I've written thus far isn't enough to make you, in your heart, ask what mental health is then I'm not doing my job properly.

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