The theme is that there are very few drug treatment innovations coming for mental disorders. He said that this is due to changes in focus and funding at the big drug makers. He also adds that there are very few new “targets” (areas of the brain for drugs to influence) for drug researchers to explore.

When I read this I couldn’t help but think back to something Dr. Morgan Sammons (Aliant University) describes as the “paradoxes” of drug treatment for psychiatric disorders.

The first paradox is that the drugs are not “curative”. They reduce symptoms while someone is taking them, but the symptoms often return after the person stops. Second, most of the reasons the drugs actually work for mental disorders are not understood. Third, and perhaps most importantly, is that the newer drugs are not any more effective than the older ones. They are less toxic, but their effectiveness is essentially the same.

Putting this together, if history repeats itself, we would expect new drugs to have about the same effectiveness as those we have now (and maybe be a bit safer).

I think this offers an opportunity to people studying and practicing psychotherapy. With the landscape of medications likely staying constant for awhile, this is a great time for innovation, as well as communication about how effective psychotherapy can be, when practiced well.

I’m also hopeful that more work on how psychotherapy changes brain processes will emerge during this time. Either way, just because there are few drugs on the way does not mean that the innovation won’t emerge somewhere else, and I think psychotherapy is the right thing at the right time.

The biggest complaint here is that the DSM-5 development committee appears to have departed from the “atheoretical” approach that the past two version of have taken, in favor of a clear biomedical approach. The DSM-5 also seems to be changing the very definition of mental disorder by adding the criterion: ‘[A behavioral or psychological syndrome] that reflects an underlying psychobiological dysfunction.’

The APA divisions, and this author, are most concerned about this because it minimizes the importance of sociocultural variation; and this combined with other moves the DSM-5 is making in lowering the threshold to be diagnosed with some disorders (ADHD, GAD, MDD), means that even more of the normal human condition will be pathologized. In plain words, more stuff that is a normal part of human life is turned into a disorder/disease. The more suspicious can see how this dovetails with the pharmaceutical industry’s efforts to do the same.

The bottom line is that big changes are coming in how we all discuss, treat, and understand what it means to have a mental disorder. Anyone who knows the long history of doing this may see the potential blunders ahead, and this letter could be an interesting historical artifact someday. I’ll stay with the woo-woo side that all of these things are combinations of nature and nurture that don’t always have an underlying biological dysfunction, and will wait for research and history to continue proving us, and that crazy idea, right.

_{Will Meek PhD is a psychologist in Vancouver, Washington, and writes weekly at his blog: Vancouver Psychology.}

The DSM takes a medical approach to diagnosis. In short, this means that a ‘patient’ is assumed to have an underlying ‘pathology’ that manifests as various ‘symptoms’ that are assessed to make a ‘diagnosis’ and then apply a ‘treatment’ to said diagnosis. This approach basically makes various human conditions into ‘illnesses’ that need ‘interventions’ like medication or cognitive behavioral therapy. In a recent paper, BPS has criticized this framework as harmful to individuals and the public.

“The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation. (p.1)”

“We believe that classifying these problems as ‘illnesses’ misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our well-being and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the experiences and learning through our lives. (p.4)”

As a practicing psychologist who also teaches a class on diagnosis for master’s level therapists, I could not be more excited reading this paper. BPS essentially takes a more humanistic and social constructivist approach to the problems of living. The benefits of this include reducing stigma, a larger focus on the interpersonal dimensions of mental health, and normalizing the experience of having problems during life. Cheers to you BPS, now if only your American counterparts would get the message…

_{Dr Will Meek is a psychologist practicing in Vancouver, WA. He writes regularly about mental health on his blog: Vancouver Psychologist}

The article essentially made the case that if fewer men go into counseling professions, then fewer men may want to attend because they feel more comfortable talking about certain topics with other men. Dr. Grohol wrote a fabulous piece on this blog yesterday making the counter-point that there is no research evidence to support that view. While I also understand this to be true, I still have some concerns about the trend.

For me, the most important thing is that unique concerns related to male psychology and the lives of men will be devalued. Each time I teach a class on the psychology of men, there is almost instantaneous push-back and reactivity. The arguments are generally that “all psychology is the psychology of men”, that most of the theorists in the textbooks are males, and that focusing uniquely on the psychological experience of male counseling clients (gender role issues, fragile nature of masculinity, power/sex dynamics, aggression, incorporating emotions into male identity, boyhood and socialization trauma, homophobia, etc) is not a credible topic and may even aid maintenance of a perceived patriarchal structure in the profession. I often make a statement up front that there is usually minimal compassion for the male experience, or interest in male psychology, and the level of agreement from the students is striking to me.

The ironic part is that in my training to be a psychologist, I became very skilled at working with female clients. Most of those accessing services were female, all of my supervisors and professors (with two exceptions) were female, and I got specialized coursework on the psychology of women. Not once was there even a 10 minute part of a lecture on the psychology of men. Sadly (but in hindsight not surprisingly), despite being male, when male clients came to my office, I felt lost amidst a complex picture of gender role expectations and pressures, internal conflicts, and distaste for the type of feeling based interventions that I was trained to do. In short, it was a mess, and later in my training I became compelled to be a voice for the importance of understanding male psychology.

Another important aspect of male therapists is in modeling alternate ways of being for both male and female clients. The experience of a client working with a male therapist who is healthy, attuned to his feelings, attentive, well-boundaried, and compassionate can be enriching by itself. I often hear my clients tell me that I am the only man they have ever met who is comfortable with emotions or who can communicate differences in non-aggressive way. For my female clients, the only man who they have had deep discussions and a connection with that doesn’t include a sexual motive. For adolescent males, I’m the one that models a healthy and mature way to be a man in contrast to what is seen on TV, or valued by an equally confused peer group or by a distant father. These things have intrinsic value above and beyond the content of the counseling sessions, and opportunities for these experiences are becoming more scarce.

Ultimately, the concern with these changes in the field is that the male psychological experience will be further devalued and ultimately obscured, and that this is what will cause fewer men to attend counseling sessions. There will also be fewer opportunities for people to develop healthy therapeutic relationships with men, and the unique benefits that come from them. Unfortunately there is no data on this stuff yet, but the writing is on the wall.

_{Will Meek, PhD is a licensed psychologist in the state of Washington where he provides counseling for adults, couples, and teens. He writes regularly on his blog: The Vancouver Counselor. He also writes about male psychology at Psychology of Men.}

I have a lot of people come into my office at various stages of explaining what is happening with them. Some people will say “I don’t know” straight away, whereas others have created a complex narrative. But we can have a tendency in our search for explanations to latch onto things that we read online or heard about on a TV show that have very little probability of being accurate. That is looking for zebras before horses.

Sometimes the zebra explanations can be comforting because we can put a name to something, or they can be a way of going into denial about what else may be happening. A medical example would be having a cough, and being convinced you have lung cancer before you consider, or rule out, having a cold.

Horses are a lot less fun to consider because they are usually more common and have the tendency to make us face basic truths that may be impacting our lives. The best thing about horses is that they also lead us to what will actually help us.

A routine example in my practice is an adult coming in, convinced he has ADHD. He had no problems with attention as a child, and excelled throughout most of his life in a detail oriented field. The part that was missing was that he had not been sleeping well for a month, had stopped going to the gym, was drinking much more caffeine to compensate, and his 10yr relationship was on the verge of collapse. The hoofprint was the attention problem. The zebra is ADHD. The horse is stress and anxiety related to his relationship.

So next time you are looking for an explanation for what is happening, start simple and look for the horses first.

_{Will Meek is a licensed psychologist in Washington state and writes regularly on his blog at Vancouver WA Counseling Psychology.}

I have heard that quote in my clinical practice so many times in the past year that I decided I have to write about it. Somehow this definition has become part of the collective understanding of abnormal psychology and has been terribly misapplied. I don’t know much more about the context of the quote but I am guessing that it was a bit of a humorous comment on science.

First, to critique the quote. If we are going to take this definition seriously to start, then everyone, yes everyone, is insane. Behavioral research in the early part of the twentieth century taught the world about how human beings learn: through long processes of conditioning based on pairings and reinforcement.

Consider this, let’s say someone was taught from a very early age that if you are not getting your way, then you should become a bully. And let’s say that doing so actually produced some big results in many situations. Then let’s say after 20 years of doing this and always having it work out, the person confronts an airline over a flight delay, and the person is not rewarded with a free ticket, instead they are thrown off the flight.

What is the likelihood of the person stopping years of reinforced behavior after that this one trial? Probably very small. The same process would happen again and again, and unless the consequences were too great, the person built some awareness of the process, and had access to other models. This is all called “extinction,” and it is a basic human learning process, not “insanity.”

Another example of this is less clear and involves things like choosing romantic partners. Most of us have some “type” of person that we gravitate toward, and if that person has some unhealthy characteristics (e.g. is an alcoholic, is prone to relationship violence, etc), a person could find him/herself in the same style of dysfunctional relationship over and over again. Often, a link can be made to childhood trauma or family dynamics.

Freud called this “repetition compulsion,” and it later became a big part of “Control Mastery Theory,” a newer school of psychotherapy. The theory is that traumatic events, painful dynamics, or unfinished processes from the past remain in the unconscious and part of our decision making, and we look for opportunities to finally “master” or resolve them in the present time. This again is a very basic human process, and although it can be painful, it is not “insanity.”

So what is insanity? Well there is still a lot of disagreement about it. Legal definitions include someone who is not able to tell the difference between right and wrong. Clinical psychologists would rarely use a word like that, and focus more on psychotic symptoms like delusions and hallucinations. Either way, Einstein, as brilliant as he was, is off on this one. And I’d guess he was just poking some fun at us all anyway.

-Will Meek, PhD
I also write weekly at my blog: Vancouver Counseling

Our culture does a pretty terrible job educating us about normal human functioning. In fact, after 12 years of school, and then 10 more years of college and graduate school, I never once had a single full lecture on “normal” or “healthy” functioning. That fact alone helps me understand some of the questions or fears my clients have.

Before we go any further, one thing I want to note is that all of the experiences below can still be unpleasant, and we can benefit from learning new perspectives and approaches. Additionally, if the things below are

a) severe
b) endure over long periods of time
c) are difficult to cope with

then they may start to exceed normal/healthy functioning, and can benefit from counseling. Otherwise, the following are normal experiences that people often see as signs that “something is wrong” with them.

1. Inner Voices: Due to media portrayals of people with Dissociative Identity Disorder (multiple personality disorder) and Schizophrenia, a lot of my clients are afraid to tell me that they have internal voices guiding their decision-making and behavior. The fact is that we all have internal “voices” or motivations, and it is completely normal to experience this.

2. Internal Conflicts: I wrote about “Resolving Cognitive Dissonance” previously, but another worry many clients have is inconsistency in their behavior or personality. We actually know very little about how the mind works at this point in history, but current belief is that we have two somewhat distinct personalities within the same case that operate in different ways. To put it simply, we have a dual-processing system with one part processing information on a conscious, logical, and deliberate level, and a second part processing the same information at the same time on an unconscious, emotional, and automatic level. This gives rise to all sorts of hilarious (and agonizing) internal conflicts and impulsive behavior that is very normal.

3. Relationship Anxiety: My clients that are forming new romantic relationships often express anxiety in the first few days to months about what is happening. They experience some worry about being liked and accepted for who they are (including their flaws and shortcomings) by their new partner, and often assume that “no one else” including the new partner worries about this stuff. That would be wrong, this type of anxiety is 100% normal (and even helpful).

4. Attention Problems: A lot of people worry about whether they have ADHD when they have problems focusing on concentrating on something. Certainly attention issues can be a marker of something that does need more intensive care, but in the vast majority of these situations, the material the person is struggling to focus on is often seen as “boring”, “exhausting”, or “grueling”. In these situations, who would NOT have a problem sustaining their attention?

5. Responses to Loss: Our culture has so pathologized negative emotional states that even normal grieving processes or other responses to loss are seen as disordered. Going through a period of sadness, anger, fear, anxiety, or guilt in response to a disruption of your life or a major loss (person, job, relationship, identity, status, home, health, etc) is completely normal. The key difference here is that more harmful states emerge when the coping with these things is unhealthy (substance use, dissociation, escapism, etc) or they become very severe and prolonged.

6. Social Anxiety: Another collective myth is that “everyone should be able to just walk into a party where they don’t know anyone and be relaxed”. This, along with some others about public speaking or performance situations are just not true. Almost everyone, unless they have substantial experience in doing so, would have some kind of anxiety in these situations. Even the most extroverted and socially confident people have some experience of anxiety in novel social situations, and current thought is that this may even be a part of us at biological/instinctual level.

In conclusion, if you are experiencing any of these things, hang in there, it is a normal part of the human experience. If these things become more severe or difficult to cope with, or you want to learn how to master your individual experience with them, then counseling can be a great help.

PS: I am back!

- Will Meek, PhD

This statistic is not something that is brand new, and most professionals are aware that having a close friend or family members that has even attempted suicide can increase the risk for someone, particularly if they are struggling with a serious mental illness. Hopefully this type of study will educate people about this fact and increases the likelihood of people seeking treatment or emergency services if they have this type of pattern in their family.

_{Dr Will Meek is a psychologist practicing in Vancouver, WA. He writes regularly about mental health on his blog: Vancouver Counseling}

This is a nice representation of the oldest debate in all of psychology: nature v. nurture. Based on what we are learning about evolution, my view is that our biology allows us to have the skills to learn social behavior as early as these ages, and that the life experience of the child up to that point would be a large reason for their choosing the helpful other.

I always think it is interesting to see these types of reports since job stress can certainly contribute to depression. However, I think the results give more indication about the types of people that go into those jobs than those jobs actually creating people who experience depression. Meaning, that people choose certain areas of work for reason that may be reflective of their already formed personality, and that these traits are what makes the difference in depression levels rather than job stress or income levels.

If any of this is interesting to you, then take a look at this recent piece from CBS news on the advances in aging research. If some sort of procedure ever actually makes living indefinitely possible, it will be quite interesting to see how people make decisions regarding it.

According to a recent report on teenagers and domestic violence, approximately 1/3 of teenagers report fearing for their safety in romantic relationships, and 20% have actually experienced abuse. Experts note that some teenagers mistake possessiveness as a sign of love, when in fact it can be an element leading to abuse. If you’re a parent, it may be important to check in with your teen on how their love life is going and ensuring they are making safe decisions.

Overall, it is great to have parents interested in their children’s education and college life. However, the shadow side of this is that many kids will over-rely on their parents to solve problems and will struggle to ever become autonomous adults. It is left to be seen what other effects this may have culturally.

It would be expected that in an organization as large as the military that this level of people have been identified and discharged with these problems, but the rest of the issue does seem questionable. I hope that somehow there is not an abuse of mental health diagnoses for some secondary gain, and possible avoidance of paying for continued health care for these personnel.

Many of the students have nightmares, are hyper-vigilant, easily startled, irritable, depressed or want to avoid things that remind them of the trauma, which can include the loss of family, pets and their homes, the study reported in the Psychiatric Services.

“Mental health responses were good during the early part of the crisis, but most schools were not able to sustain their efforts,” Jaycox said in a statement.

Although it is great to see that the initial push of services for kids affected by the hurricane was successful at getting people back to their lives, it is troubling to think that a generation of children will have lingering psychological problems due to the disaster. Perhaps some of that is inevitable, and the same could be said for the staff burnout and difficulty accessing services, but there must be some solutions. Any ideas out there?