Anonymous – My epiphany on DBT, Trauma, and Undiagnosing Emotional Distress

Undiagnosing Emotional Distress as an alternative approach for mental illness seems to be the issue.

I attended a presention by the DBT guru at my local community mental health center. DBT stands for Dialectical Behavioral Therapy, a type of mental health talk therapy treatment that focuses on mindfulness or being in the moment, tolerating distress, and developing people skills. The founder of DBT, Marsha Linehan, is a person who is herself in recovery from mental health diagnoses. She recently shared her story for the first time in the New York Times.

The pillowcase project from Fulton State Hospital in Missouri where some people drew dreams along the lines of UnDiagnosing Emotional Distress

The pillowcase project from Fulton State Hospital in Missouri where some people drew dreams along the lines of UnDiagnosing Emotional Distress

The title of the presentation I went to was “Creating a life worth living: all about the results.” As an empiricist, I value results. She spoke on behaviors to increase: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Some behaviors to decrease are emptiness, scattered and obsessive thoughts, confusion about self, fear of abandonment or rejection, hot and cold feelings, up and down mood swings driven by choices and behavior, desperation, and impulsivity.

The discussion of emotion regulation and distress tolerance brought about some discussion of dignity, integrity and self respect. Several comments were made about not being validated in ones youth leading to the development of a tendency to exaggerate emotion to make contact with others to gain validation.  I think this is sometimes called ‘acting out’ or ‘throwing a fit’.

How UnDiagnosing Emotional Distress becomes important:

I can see that if a young person adopts such a behavior pattern, it can result in being marginalized and this can lead to furthering the need for validation and more extreme attempts to be noticed and…a sort of positive feedback loop develops.

At some point I can see this resulting in the crossing of some threshold into ‘trouble’.  Few parents are equipped to deal withsuch a situation effectively to de-escalate and stabilize a child.  So it just gets worse and some one says ‘get treatment’ or ‘you are under arrest’ or ‘you’re fired’ or ‘sign this divorce decree’ or…

Then I thought back to what I’ve learned about trauma informed care. This is a program that teaches that our past overwhelming experiences might be worsening our current emotional issues.  This program is often directed at clinicians dealing with patients who have been so marginalized as to now be drawn into institutionalization. Perhaps as an outpatient or in lock down with one-on-one in a hospital ward. They teach staff to at least not make the patient’s distress worse,

When I reflected on the notion of mental illness being a response to emotional distress, the whole thing began to take shape in my mind. If it weren’t about emotional distress, then trauma informed care wouldn’t make sense. and frankly, trauma informed care makes sense. I have seen people responding to insensitive clinicians become much more agitated, and, as am empiricist, this is significant.

Undiagnosing Emotional Distress T-shirts modeled at Alternatives 2011

Undiagnosing Emotional Distress T-shirts modeled at Alternatives 2011

Further, I see nothing in the concept that is inconsistent with the current allopathic paradigm of genetic involvement. Ultimately, I guess it comes back to how to deal with people who display some rather extreme behavior in our conformist oriented culture.  From my studies in anthropology, it seems few societies embrace outliers, by which I mean people whose behavior is sometimes very different than what is normally seen in the community.

Whether the approach is to cast out perceived demons, chain up and imprison the beasts, drug a person into submission or sit down and talk and mostly listen and patiently embrace a person who has an unusually strong response to some situation, the goal needs to be “don’t make it worse unless there is a clear path to a better outcome”.

Let’s face it, cleaning the gravel out of a skinned elbow hurts like the devil but not doing it can easily result in a nasty infection. Sometimes helping hurts. On the other hand, we no longer amputate limbs when a bullet enters. Perhaps this is a bit more of a ramble than I want to think but I do feel that it represents some of my increased understanding of the need for “UnDiagnosing Emotional Distress.”

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