[Mental health treatment ] was so re-traumatizing. It was so similar to the original trauma; people who do things to you and deny that they did it. They deny that they had any responsibility and put it all back on you and just, it reinforces how evil you must be for that to happen. P13
While the news and other media outlets regularly report advancements in mental health treatment and discoveries, rates of diagnosable mental illness have increased across the globe, disability rates have skyrocketed, and advocacy movements led by ex-patients and dissident mental health professionals have grown. Suicide is now the second leading cause of death among individuals aged 15–34 years (Centers for Disease Control and Prevention (CDC), 2013/2011), and almost a quarter of individuals who suicide were on antidepressants at the time of death (Parks, Johnson, McDaniel, & Gladden, 2010). Perhaps more disturbingly, recent evidence has demonstrated that as contact with psychiatric intervention increases, so too does completed suicide, suggesting the possibility that the current mental health system may be creating the very problems it purports to aid, at least for some (Hjorthoj, Madsen, Agerbo, & Nordentoft, 2014; Large & Ryan, 2014). And, although suicide rates and disability due to mental health continue to rise, so too does spending on traditional mental health care (e.g., Druss, 2006). Are we continuing to funnel money into a fundamentally broken system? Is it possible that the biomedical paradigm under which all of mental health care operates is actually creating circumstances that are making people worse? Evidence from across cultures appears to point in this direction.1
Although the public is led to believe in the foregone conclusion that what is called mental illness is biological and genetic in nature and that medical advancements have led to new discoveries and improved treatments, this is not actually so certain. In fact, much of the scientific literature tends to dispute these assertions while instead demonstrating the extensive effects that adversity has on biology and overall mental health (Chap. 6). Adverse experiences, particularly in childhood (such as physical and sexual abuse, parental separation, bullying, parental death, foster care, neighborhood violence, poverty , racism, etc.), have been demonstrated to have a direct and dose-response relationship (meaning the more adversity, the greater the risk) with adult mental health issues like hearing voices, suicidality, drug abuse, experiencing altered states of consciousness, extreme and intense emotions, fragmented sense of self, obesity, depression, paranoia, beliefs in conflict with consensus reality, anxiety, and more (see, e.g., Bentall, Wickham, Shevlin, & Varese, 2012; Felitti et al., 1998; Janssen et al., 2004; Read, van Os, Morrison, & Ross, 2005). There is also some evidence indicating specificity, wherein certain adverse experiences appear to be related to specific psychic phenomena. For instance, being bullied as a child is closely related to intense paranoia, while sexual abuse is more closely related to hearing voices (Bentall et al., 2012). Yet, most research and treatment continues to focus on individual internal defects (i.e., “illness”) that exist separate from one’s developmental context or life circumstances, and a search for the ever-elusive genetic basis for these purported defects.
In 1980, posttraumatic stress disorder (PTSD) was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) as a diagnosis that recognized the traumatic nature of one very specific way that some express their emotional distress, namely, by experiencing flashbacks directly and obviously related to an original traumatic event, excessive arousal and alertness, fear, and avoiding reminders of the trauma. This inclusion was largely the result of political efforts on the part of American veterans of war, as opposed to the discovery of a new disease that exists in nature. During this period, women also increasingly had political power and a voice in the greater public discourse, and brought to public awareness the common experiences of childhood sexual abuse, rape, and domestic violence. This was the first time since that of Pierre Janet, in the late nineteenth century, and the early works of Sigmund Freud that the impact of trauma was recognized on a broad level (Chap. 2).
Since then, the field of trauma studies has continued to expand and the findings consistently support instinctual wisdom: people go mad, become aggressive, and are fearful because they have been profoundly hurt. Despite these findings, the biomedical paradigm continues to reign, treatment continues to be centered on a coercive and paternalistic framework, and “mental illness” is still asserted by many to be a real disease that is based in genetics and brain dysfunction. The trauma field at times perpetuates this both by separating out disorders based in trauma from what is believed to be more genetically determined illness, and by implying that trauma causes brain dysfunction that is permanent. Yet, brain difference does not equal disease, what is maladaptive in one context is actually highly adaptive in another, and the brain is constantly changing—nothing is necessarily permanent.
The harm done by excluding certain disorders from those based in trauma is particularly evident for categories such as schizophrenia and bipolar disorders. In this, an apparent conceptual separation exists that deems experiences like hearing voices or paranoia as “psychotic-like” in those individuals (usually White women) whose trauma is easily recognized as being associated with such experiences, while others (usually Black men) are designated as having a brain disease (i.e., schizophrenia ) and truly psychotic for expressing these same internal experiences in a more confusing or symbolic manner (Chap. 3). Perhaps more troubling are those individuals whose trauma is recognized but whose responses to this trauma are dismissed as a personality defect, manipulative, fake, and/or representative of a multitude of different diseases (i.e., comorbidity; Chaps. 2 and 4).
There is much debate within the mental health field as to how useful, if at all, these diagnoses are and if they actually inform or improve professional interventions. The central purpose of diagnosing and distinguishing alleged disorders is to provide specific treatment recommendations that predictably will help increase positive outcomes and understanding of their etiology (cause); if what is helpful, then, across categories is the same, or if diagnoses actually tell us little beyond the description upon which they are based, are these constructs really doing what they are supposed to do? Is it possible that they are actually preventing us from developing a greater understanding of human behavior?
Often, the classification of a person’s suffering has more to do with how well a mental health professional can relate to any particular individual’s experiences rather than an objective differentiation of underlying internal processes (e.g., Morrison, 2001). Some practitioners may offer an open and empathic lens to most, yet nonetheless inadvertently ostracize those they do not understand in the process. The concept of dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is a categorical area in which this segregation and, at times, political discord arise. It is often confused with schizophrenia and/or borderline personality disorder (BPD), due to the fact that they are all describing similar behaviors and experiences, with bitter debates arising both in and out of professional circles on the topic. Are they different? Which ones are real diseases in need of intrusive and coercive biological interventions and which are reactions to trauma? Are some individuals just faking it for attention? What do we really know? And how much do we still not know?
One inadvertent consequence of labeling emotional distress as illness and categorizing different ways of reacting to life as disease is marginalizing p...