On This Day … 26 July [2022]

Events

  • 1990 – The Americans with Disabilities Act of 1990 is signed into law by President George H.W. Bush.

People (Births)

Americans with Disabilities Act of 1990

The Americans with Disabilities Act of 1990 or ADA (42 U.S.C. § 12101) is a civil rights law that prohibits discrimination based on disability.

It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964, which made discrimination based on race, religion, sex, national origin, and other characteristics illegal, and later sexual orientation and gender identity. In addition, unlike the Civil Rights Act, the ADA also requires covered employers to provide reasonable accommodations to employees with disabilities, and imposes accessibility requirements on public accommodations.

In 1986, the National Council on Disability had recommended the enactment of an Americans with Disabilities Act (ADA) and drafted the first version of the bill which was introduced in the House and Senate in 1988. The final version of the bill was signed into law on 26 July 1990, by President George H.W. Bush. It was later amended in 2008 and signed by President George W. Bush with changes effective as of 01 January 2009.

Disabilities Included

ADA disabilities include both mental and physical medical conditions. A condition does not need to be severe or permanent to be a disability. Equal Employment Opportunity Commission regulations provide a list of conditions that should easily be concluded to be disabilities:

Other mental or physical health conditions also may be disabilities, depending on what the individual’s symptoms would be in the absence of “mitigating measures” (medication, therapy, assistive devices, or other means of restoring function), during an “active episode” of the condition (if the condition is episodic).

Certain specific conditions that are widely considered anti-social, or tend to result in illegal activity, such as kleptomania, paedophilia, exhibitionism, voyeurism, etc. are excluded under the definition of “disability” in order to prevent abuse of the statute’s purpose. Additionally, gender identity or orientation is no longer considered a disorder and is also excluded under the definition of “disability”.

Carl Jung

Carl Gustav Jung (26 July 1875 to 06 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung’s work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philosophy, psychology, and religious studies.

Jung worked as a research scientist at the famous Burghölzli hospital, under Eugen Bleuler. During this time, he came to the attention of Sigmund Freud, the founder of psychoanalysis. The two men conducted a lengthy correspondence and collaborated, for a while, on a joint vision of human psychology.

Freud saw the younger Jung as the heir he had been seeking to take forward his “new science” of psychoanalysis and to this end secured his appointment as president of his newly founded International Psychoanalytical Association. Jung’s research and personal vision, however, made it impossible for him to follow his older colleague’s doctrine and a schism became inevitable. This division was personally painful for Jung and resulted in the establishment of Jung’s analytical psychology as a comprehensive system separate from psychoanalysis.

Among the central concepts of analytical psychology is individuation – the lifelong psychological process of differentiation of the self out of each individual’s conscious and unconscious elements. Jung considered it to be the main task of human development. He created some of the best known psychological concepts, including synchronicity, archetypal phenomena, the collective unconscious, the psychological complex and extraversion and introversion.

Jung was also an artist, craftsman, builder and a prolific writer. Many of his works were not published until after his death and some are still awaiting publication.

Glynis Breakwell

Dame Glynis Marie Breakwell DBE DL FRSA FAcSS (born West Bromwich, 26 July 1952) is a social psychologist and an active public policy adviser and researcher specialising in leadership, identity process and risk management. In January 2014 she was listed in the Science Council’s list of ‘100 leading UK practising scientists’. Her achievements as Vice-Chancellor of the University of Bath in Bath were marred by controversy culminating in her dismissal in a dispute regarding her remuneration.

Breakwell has been a Fellow of the British Psychological Society since 1987 and an Honorary Fellow since 2006. She is a chartered health psychologist and in 2002 was elected an Academician of the Academy of Social Sciences.

Breakwell was appointed Dame Commander of the Order of the British Empire in the 2012 New Year Honours for services to higher education. She is also a Deputy Lieutenant of the County of Somerset.

Mysteries of Mental Illness (2021): S01E04 – The New Frontiers

Introduction

Mysteries of Mental Illness explores the story of mental illness in science and society. The four-part series traces the evolution of this complex topic from its earliest days to present times. It explores dramatic attempts across generations to unravel the mysteries of mental illness and gives voice to contemporary Americans across a spectrum of experiences.

Outline

Cutting-edge treatments for mental illness; profiles of patients undergoing deep brain stimulation surgery, infusions of ketamine and modern electro-convulsive therapy.

Mysteries of Mental Illness Series

You can find a full index and overview of Mysteries of Mental Illness here.

Production & Filming Details

  • Release Date: 23 June 2021.
  • Running Time: 60 minutes (per episode).
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Mysteries of Mental Illness (2021): S01E03 – The Rise and Fall of the Asylum

Introduction

Mysteries of Mental Illness explores the story of mental illness in science and society. The four-part series traces the evolution of this complex topic from its earliest days to present times. It explores dramatic attempts across generations to unravel the mysteries of mental illness and gives voice to contemporary Americans across a spectrum of experiences.

Outline

The rise and fall of mental asylums in the US; the largest de-facto mental health facility in the US, its detainees and the realities of care both inside and outside.

Mysteries of Mental Illness Series

You can find a full index and overview of Mysteries of Mental Illness here.

Production & Filming Details

  • Release Date: 23 June 2021.
  • Running Time: 60 minutes (per episode).
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Mysteries of Mental Illness (2021): S01E02 – Who’s Normal?

Introduction

Mysteries of Mental Illness explores the story of mental illness in science and society. The four-part series traces the evolution of this complex topic from its earliest days to present times. It explores dramatic attempts across generations to unravel the mysteries of mental illness and gives voice to contemporary Americans across a spectrum of experiences.

Outline

The fight to develop mental illness standards rooted in empirical science rather than dogma; how science and societal factors mix with the ever-shifting definitions and diagnoses of mental health and illness.

Mysteries of Mental Illness Series

You can find a full index and overview of Mysteries of Mental Illness here.

Production & Filming Details

  • Release Date: 22 June 2021.
  • Running Time: 60 minutes (per episode).
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Mysteries of Mental Illness (2021): S01E01 – Evil or Illness?

Introduction

Mysteries of Mental Illness explores the story of mental illness in science and society. The four-part series traces the evolution of this complex topic from its earliest days to present times. It explores dramatic attempts across generations to unravel the mysteries of mental illness and gives voice to contemporary Americans across a spectrum of experiences.

Outline

Ancient conceptions of mental illness and the establishment of psychiatry; modern-day stories of mental illness, including an aspiring astrophysicist with schizophrenia a d a boxer with obsessive compulsive disorder (OCD).

Mysteries of Mental Illness Series

You can find a full index and overview of Mysteries of Mental Illness here.

Production & Filming Details

  • Release Date: 22 June 2021.
  • Running Time: 60 minutes (per episode).
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Mysteries of Mental Illness Documentary Series Overview (2021)

Introduction

Mysteries of Mental Illness explores the story of mental illness in science and society. The four-part series traces the evolution of this complex topic from its earliest days to present times. It explores dramatic attempts across generations to unravel the mysteries of mental illness and gives voice to contemporary Americans across a spectrum of experiences.

Outline

The attempts across generations to unravel the mysteries of mental illness, including its causes and treatments.

Throughout history to today, we have continued to grapple with deceptively simple questions about mental health: what is mental illness? From where does it come? And how can it be treated?

Around one in four people suffer from mental illness; an American is more likely to need services from psychiatry than from any other medical specialty. Yet a diagnosis of a mental disorder still carries a stigma that a heart condition or other physical ailment does not, largely because mental illness has been so poorly understood for so long.

Many Americans’ diagnoses have grown more acute during the coronavirus pandemic, and people who had been previously undiagnosed – including many who remain so – are now suffering for the first time from depression and other illnesses that have been exacerbated by the present-day crises. One of the most critical barriers to treatment is the stigma of mental illness.

Mysteries of Mental Illness Series

Production & Filming Details

  • Director(s):
    • Peter Yost … (4 episodes, 2021).
  • Producer(s):
    • Alex T. Ostroff … associate producer (4 episodes, 2021).
    • Peter Yost … producer (4 episodes, 2021).
    • Anna Auster … co-producer (2 episodes, 2021).
  • Writer(s):
    • Peter Yost … (4 episodes, 2021).
  • Music:
  • Cinematography:
    • Tom Bergmann … (4 episodes, 2021).
  • Editor(s):
    • Anna Auster … (4 episodes, 2021).
  • Production:
    • GBH.
  • Distributor(s):
    • Public Broadcasting Service (PBS) (2021) (USA) (TV).
  • Release Date: 22 June 2021 to 23 June 2022.
  • Running Time: 60 minutes (per episode).
  • Rating: Unknown.
  • Country: US.
  • Language: English.

What is Positive Disintegration?

Introduction

The theory of positive disintegration (TPD) by Kazimierz Dąbrowski is a theory of personality development.

Unlike some other theories of development such as Erikson’s stages of psychosocial development, it is not assumed that even a majority of people progress through all levels. TPD is not a theory of stages, and levels do not correlate with age.

Unlike mainstream psychology, Dąbrowski’s theoretical framework views psychological tension and anxiety as necessary for growth. These “disintegrative” processes are therefore seen as “positive”, whereas people who fail to go through positive disintegration may remain for their entire lives in a state of “primary integration”, lacking true individuality. Advancing into disintegration and into the higher levels of development is predicated on having developmental potential, including overexcitabilities, above-average reactions to stimuli.

Dąbrowski’s Theory

Kazimierz Dąbrowski (1902-1980), a Polish psychiatrist and psychologist, developed the Theory of Positive Disintegration which led to the 1964 publication of the eponymous book, Positive Disintegration. He believed that the key to the treatment of mental illness was intense personal suffering and hence singled out the self-infliction of suffering as essential to personal development.

Dąbrowski’s theory of personality development emphasised several major features including:

  • Personality is not a given universal trait, it must be created – shaped – by the individual to reflect his or her own unique character (personality shaping)
  • Personality develops as a result of the action of developmental potential (DP) (overexcitability and the autonomous factor), not everyone displays sufficient DP to create a unique personality.
  • Developmental potential is represented in the population by a normal (bell) curve. Dąbrowski used a multilevel approach to describe the continuum of developmental levels seen in the population.
  • Developmental potential creates crises characterized by strong anxieties and depressions – psychoneurosis – that precipitate disintegration
  • for personality to develop, initial integrations based on instinct and socialisation must disintegrate – a process Dąbrowski called positive disintegration
  • The development of a hierarchy of individual values – emotional reactions – is a critical component in developing one’s personality and one’s autonomy, thus, in contrast to most psychological theories, emotions play a major role in this approach
  • Emotional reactions guide the individual in creating his or her individual personality ideal, an autonomous standard that acts as the goal of individual development
  • The individual must examine his or her essence and subsequently make existential choices that emphasize those aspects of essence that are higher and “more myself” and inhibit those aspects that are lower or “less myself” based upon his or her own personality ideal
  • Critical components of individual development include autoeducation and autopsychotherapy

Factors in Personality Development

Dąbrowski observed that most people live their lives in a state of “primary or primitive integration” largely guided by biological impulses (“first factor”) and/or by uncritical endorsement and adherence to social conventions (“second factor”). He called this initial integration Level I. Dąbrowski observed that at this level there is no true individual expression of the autonomous human self. Individual expression at Level I is influenced and constrained by the first two factors.

The first factor channels energy and talents toward accomplishing self-serving goals that reflect the “lower instincts” and biological ego – its primary focus is on survival and self-advancement. Often talents are used in antisocial or asocial ways. For example, at the lowest edge of Level I many criminals display this type of selfish behaviour. They tend to advance their own goals at the expense of others.

The second factor, the social environment (milieu) and peer pressure, constrains individual expression and creativity by encouraging a group view of life and discouraging individual thought and expression. The second factor externalises values and morals, thereby externalising conscience. Social forces shape expectations. Behaviour and one’s talents and creativity are funnelled into forms that follow and support the existing social milieu. “My mom says we should always be aware of what our lawn looks like because we want other people to think well of us when they drive by.” Because conscience is derived from an external social context, so long as society holds ethical standards, people influenced by the second factor will behave ethically. However, if a society becomes corrupt, people strongly influenced by second factor will not dissent. Socialisation without individual examination leads to a rote and robotic existence (the “robopath” described by Ludwig von Bertalanffy). Individual reactions are not unique, they are based upon social contexts (“I cry at funerals and laugh at weddings—everyone does”). According to Dąbrowski, people primarily motivated by second factor represent a significant majority of the general population.

Dąbrowski felt that society was largely influenced by the two lower factors and could be characterised as operating at Level I. For example, society’s emphasis on corporate success (“a dog eat dog mentality”) means that many CEOs operate on the basis of first factor – they will quickly sacrifice another to enhance their own advancement. As well, society’s educational, political, corporate, and media systems are self-promoting and discourage real examination or individual autonomy – the second factor. Alternatively, social justifications are often used: “Of course I break the speed limit, everyone does.” Or a soldier may explain that he or she was simply “following orders”. Thus, this external value system absolves the individual of any individual responsibility.

Dąbrowski also described a group of people who display a different course: an individualised developmental pathway. Such people break away from an automatic, rote, socialised view of life (which Dąbrowski called negative adjustment) and are said to move into and through a series of personal disintegrations. Dąbrowski saw these disintegrations as a key element in the overall developmental process. Crises challenge the status quo and cause people to review the self, ideas, values, thoughts, ideals, etc. If development continues, one goes on to develop an individualised, conscious and critically evaluated hierarchical value structure (called positive adjustment). This hierarchy of values acts as a benchmark by which all things are now seen, and the higher values in society’s internal hierarchy come to direct behaviour (no longer based on external social mores). These higher, individual values characterise an eventual second integration reflecting individual autonomy and for Dąbrowski, mark the arrival of true human personality. At this level, each person develops his or her own vision of how life ought to be and lives it. This higher level is associated with strong individual approaches to problem solving and creativity. One’s talents and creativity are applied in the service of these higher individual values and visions of how life could be – how the world ought to be. The person expresses his or her “new” autonomous personality energetically through action, art, social change, and so on.

Development Potential

Advanced development is often seen in people who exhibit strong developmental potential (“DP”). Developmental potential represents a constellation of genetic features, expressed and mediated through environmental interaction. Many factors are incorporated in developmental potential but three major aspects are highlighted: overexcitability (OE), specific abilities and talents, and a strong drive toward autonomous growth, a feature Dąbrowski called the “third factor”.

Overexcitability

The most evident aspect of developmental potential is overexcitability (OE), a heightened physiological experience of stimuli resulting from increased neuronal sensitivities. The greater the OE, the more intense are the day-to-day experiences of life. Dąbrowski outlined five forms of OE:

  • Psychomotor;
  • Sensual;
  • Imaginational;
  • Intellectual; and
  • Emotional.

These overexcitabilities, especially the latter three, often cause a person to experience daily life more intensely and to feel the extremes of the joys and sorrows of life profoundly. Dąbrowski studied human exemplars and found that heightened overexcitability was a key part of their developmental and life experience. These people are steered and driven by their value “rudder”, their sense of emotional OE. Combined with imaginational and intellectual OE, these people have a powerful perception of the world.

Although based in the nervous system, overexcitabilities come to be expressed psychologically through the development of structures that reflect the emerging autonomous self. The most important of these conceptualisations are dynamisms: biological or mental forces that control behaviour and its development. Instincts, drives, and intellectual processes combined with emotions are dynamisms. With advanced development, dynamisms increasingly reflect movement toward autonomy.

Abilities and Talents

The second aspect of developmental potential, specific abilities, and talents tends to serve the person’s developmental level. As outlined, people at lower levels use talents to support egocentric goals or to climb the social and corporate ladders. At higher levels, specific talents and abilities become an important force as they are channelled by the person’s value hierarchy into expressing and achieving the person’s vision of his or her ideal personality and his or her view of how the world ought to be.

The Third Factor

The third aspect of developmental potential (DP), which is simply referred to as ‘the third factor’, is a drive toward individual growth and autonomy. The third factor is critical as it applies one’s talents and creativity toward autonomous expression, and second, it provides motivation to strive for more and to try to imagine and achieve goals currently beyond one’s grasp. Dąbrowski was clear to differentiate third factor from free will. He felt that free will did not go far enough in capturing the motivating aspects that he attributed to third factor. For example, an individual can exercise free will and show little motivation to grow or change as an individual. Third factor specifically describes a motivation – a motivation to become one’s self. This motivation is often so strong that, in some situations, one can observe that one needs to develop oneself and that in so doing, it places one at great peril. This feeling of “I’ve gotta be me” especially when it is “at any cost” and especially when it is expressed as a strong motivator for self-growth is beyond the usual conceptualization ascribed to free will.

A person whose DP is high enough will generally undergo disintegration, despite any external social or family efforts to prevent it. A person whose DP is low will generally not undergo disintegration (or positive personality growth) even in a conducive environment.

The notion that some people have an innate potential for development that is determined by a higher sensitivity or overexcitability (analogous to the first aspect of DP) and by a related tendency to develop individual differences and autonomy from the group (analogous to the third aspect of DP) was independently developed by Elaine Aron (see Highly sensitive person) (although Aron’s approach is substantially different from Dąbrowski’s).

Developmental Obstacles

Dąbrowski called OE “a tragic gift” to reflect that the road of the person with strong OE is not a smooth or easy one. Potentials to experience great highs are also potentials to experience great lows. Similarly, potentials to express great creativity hold the likelihood of experiencing a great deal of personal conflict and stress. This stress both drives development and is a result of developmental conflicts, both intrapsychic and social. Suicide is a significant risk in the acute phases of this stress. The isolation often experienced by these people heightens the risk of self-harm.

Dąbrowski advocated autopsychotherapy, educating the person about OEs and the disintegrative process to give him or her a context within which to understand intense feelings and needs. Dąbrowski suggested giving people support in their efforts to develop and find their own self-expression. Children and adults with high DP have to find and walk their own path, often at the expense of fitting in with their social peers and even with their families. At the core of autopsychotherapy is the awareness that no one can show anyone else the “right” path. Everyone has to find their own path for themselves. Alluding to the knights on the Grail Quest, the Jungian analyst, Joseph Campbell allegedly said: “If a path exists in the forest, don’t follow it, for though it took someone else to the Grail, it will not take you there, because it is not your path”.

The Levels

The first and fifth levels are characterised by psychological integration, harmony, and little inner conflict. There is little internal conflict at Level I because just about every behaviour is justified – it is either good for the individual and is therefore “right”, or the individual’s society endorses it and it is therefore “right”. In either case, with a high level of confidence the individual acts as he or she perceives anyone else would, and does what anyone is “supposed to do”. At Level V there is no internal conflict because what a person does is always in accord with their own internal sense of values. Of course, there is often external conflict at both Levels I and V.

Levels II, III, and IV describe various degrees and types of disintegration and literal disease.

Dąbrowski was very clear that the levels he presents “represent a heuristic device”. In the process of development the structures of two or even three contiguous levels may exist side by side, although it must be understood that they exist in conflict. The conflict is resolved when one of the structures is eliminated, or at least comes under complete control of another structure.

Level I: Primary Integration

As outlined above, the first level is called primitive or primary integration. People at this level are often influenced primarily by either prominent first factor (heredity/impulse) and/or second factor (social environment) forces. The majority of people at Level I are integrated at the environmental or social level (Dąbrowski called them average people); however, many also exhibit shades of both impulse and socialization. Dąbrowski distinguished the two subgroups of Level I by degree: “the state of primary integration is a state contrary to mental health. A fairly high degree of primary integration is present in the average person; a very high degree of primary integration is present in the psychopath”.[9] Marked by selfishness and egocentrism (both reticent and explicit), those at level one development generally seek self-fulfilment above all, justifying their pursuits through a sort of “it’s all about me” thinking; or, more simply put, they adhere strongly to the phrase “the end justifies the means”, sometimes disregarding the severity of the “means”. Many people who are considered “leaders” often fall into this category.

A vast majority of people either do not break down their primitive integration at all or after a relatively short period of disintegration, usually experienced at the time of adolescence and early youth, end in a reintegration at the former level or in partial integration of some of the functions at slightly higher levels, without a transformation of the whole mental structure. Primary integration in the average person was proposed to be of a certain value due to its stability and predictability, and when accompanied by kindness and good-will, could represent persons who can provide support and stability to those experiencing disintegration.

Level II: Unilevel Disintegration

The prominent feature of this level is an initial, brief and often intense crisis or series of crises. Crises are spontaneous and occur on only one level. These crises involve alternatives that may appear to be different but ultimately are on the same level.

Unilevel disintegration occurs during developmental crises such as puberty or menopause, in periods of difficulty in handling some stressful external event, or under psychological and psychopathological conditions such as nervousness and psychoneurosis. Unilevel disintegration consists of processes on a single structural and emotional level; there is a prevalence of automatic dynamisms with only slight self-consciousness and self-control.

Conflicts on the same level (horizontal) produce ambitendencies and ambivalences: the person is equally attracted by different but equivalent choices on the same level (ambitendencies) and is not able to decide what to do because he or she has no real preference between the choices (ambivalences). If developmental forces are strong enough, ultimately, the person is thrust into an existential crisis: one’s social rationales no longer account for one’s experiences and there are no alternative explanations. During this phase, existential despair is the predominant emotion. The resolution of this phase begins as individually chosen values begin to replace social mores that have been ingrained by rote and are integrated into a new hierarchy of personal values. These new values often conflict with the person’s previous social values. Many of the status quo explanations for the “way things are,” learned through education and from the social order, collapse under conscious, individual scrutiny. This causes more conflicts focused on the person’s analysis of his or her own reactions to the world at large and of the behaviour of self and others. Common behaviours and the ethics of the prevailing social order come to be seen as inadequate, wrong or hypocritical. Positive maladjustment prevails. For Dąbrowski, these crises represent a strong potential for development toward personal growth and mental health. Using a positive definition, mental health reflects more than social conformity: it involves a careful, personal examination of the world and of one’s values, leading to the development of an individual personality.

Level II is a transitional period. Dąbrowski said you either fall back (reintegration on a lower level), end negatively, in suicide or psychosis or move ahead to Level III.

The transition from Level II to Level III involves a fundamental shift that requires a phenomenal amount of energy. This period is the crossroads of development: from here one must either progress or regress. The struggle between Dąbrowski’s three factors reflects this transitional crisis: “Do I follow my instincts (first factor), my teachings (second factor) or my heart (third factor)?” The developmental answer is to transform one’s lower instincts (automatic reactions like anger) into positive motivation, to resist rote and social answers, and to listen to one’s inner sense of what one ought to do.

Level III: Spontaneous Multilevel Disintegration

Level III describes a new type of conflict: a vertical conflict between two alternatives that are not simply different, but that exist on different levels. One is genuinely higher and the other is lower in comparison. These vertical conflicts initially arise from involuntary perceptions of higher versus lower choices in life.

“You just look at something, maybe for the 1000th time (to use the words of G. K. Chesterton), and it strikes you—you see this one thing differently and once you do, it changes things. You can no longer ‘go back and see it the way you did before.'”

Dąbrowski called this vertical dimension multilevelness. Multilevelness is a gradual realisation of the “possibility of the higher” (a phrase Dąbrowski used frequently) and of the subsequent contrasts between the higher and the lower in life. These vertical comparisons often illustrate the lower, actual behaviour of a person in contrast to higher, imagined ideals and alternative idealised choices. Dąbrowski believed that the authentic individual would choose the higher path as the clear and obvious one to follow (erasing the ambivalences and ambitendencies of unilevel conflicts). If the person’s actual behaviour subsequently falls short of the ideal, internal disharmony and a drive to review and reconstruct one’s life often follow. Multilevelness thus represents a new and powerful type of conflict, a conflict that is developmental in Dąbrowski’s approach.

Vertical conflicts are critical in leading to autonomy and advanced personality growth. If the person is to achieve higher levels, the shift to multilevelness must occur. If a person does not have the developmental potential to move into a multilevel view, then he or she will fall back from the crises of Level II to reintegrate at Level I. In the shift to multilevelness, the horizontal (unilevel), stimulus-response model of life is replaced by a vertical and hierarchical analysis. This vertical view becomes anchored by one’s emerging individual value structure, and all events are seen in relation to personal ideals. These personal value ideals become the personality ideal: how the person wants to live his or her life. As events in life are seen in relation to this multilevel, vertical view, it becomes impossible to support positions that favour the lower course when higher goals can be identified (or imagined).

Level IV: Directed Multilevel Disintegration

In Level IV the person takes full control of their development. The involuntary spontaneous development of Level III is replaced by a deliberate, conscious and self-directed review of life from the multilevel perspective. This level marks the real emergence of the third factor, described by Dąbrowski as an autonomous factor “of conscious choice (valuation) by which one affirms or rejects certain qualities in oneself and in one’s environment”. The person consciously reviews his or her existing belief system and tries to replace lower, automatic views and reactions with carefully thought out, examined and chosen ideals. These new values will increasingly be reflected in the person’s behaviour. Behaviour becomes less reactive, less automatic and more deliberate as behavioural choices fall under the influence of the person’s higher, chosen ideals.

Social mores are reviewed and re-accepted by a conscious internalisation when the individual feels it is appropriate. Likewise, when the person feels it is proper, a social value is reviewed and may be rejected to be replaced by a self-perceived higher alternative value. One’s social orientation comes to reflect a deep responsibility based on both intellectual and emotional factors. At the highest levels “individuals of this kind feel responsible for the realization of justice and for the protection of others against harm and injustice. Their feelings of responsibility extend almost to everything.”

This perspective results from seeing life in relation to one’s hierarchy of values (the multilevel view) and the subsequent appreciation of the potential of how life could be, and ought to be, lived. One’s disagreements with the (lower level) world are expressed compassionately in doing what one can to help achieve the “ought”.

Given their genuine (authentic) prosocial outlook, people achieving higher development also raise the level of their society. Prosocial here is not just support of the existing social order. If the social order is lower and you are adjusted to it, then you also reflect the lower (negative adjustment in Dąbrowski’s terms, a Level I feature). Here, prosocial is a genuine cultivation of social interactions based on higher values. These positions often conflict with the status quo of a lower society (positive maladjustment). In other words, to be maladjusted to a low-level society is a positive feature.

Level V: Secondary Integration

The fifth level displays an integrated and harmonious character, but one vastly different from that at the first level. At this highest level, one’s behaviour is guided by conscious, carefully weighed decisions based on an individualised and chosen hierarchy of personal values. Behaviour conforms to this inner standard of how life ought to be lived, and thus little inner conflict arises.

Level V is often marked by creative expression. Especially at Level V, problem solving and art represent the highest and noblest features of human life. Art captures the innermost emotional states and is based on a deep empathy and understanding of the subject. Often, human suffering and sacrifice are the subjects of these works. Truly visionary works, works that are unique and novel, are created by people expressing a vision unrestrained by convention. Advances in society, through politics, philosophy and religion, are therefore commonly associated with strong individual creativity or accomplishments.

Applications

Therapy

The theory of positive disintegration has an extremely broad scope and has implications for many areas. One central application applies to psychological and psychiatric diagnosis and treatment. Dąbrowski advocated a comprehensive, multidimensional diagnosis of the person’s situation, including symptoms and developmental potentials.

Symptoms and Developmental Potential

If the disintegration appears to fit into a developmental context, then the person is educated in the theory and encouraged to take a developmental view of his or her situation and experiences. Rather than being eliminated, symptoms are reframed to yield insight and understanding into life and the person’s unique situation.

The Importance of Narratives

Dąbrowski illustrated his theory through autobiographies of and biographies about those who have experienced positive disintegration. The gifted child, the suicidal teen or the troubled artist is often experiencing the features of TPD, and if they accept and understand the meaning of their intense feelings and crises, they can move ahead, not fall apart. The completion of an extensive autobiography to help the individual gain perspective on his or her past and present is an important component in the autopsychotherapy process. In this process, the therapist plays a very small role and acts more as an initial stimulus than an ongoing therapist. Dąbrowski asked clients to read his books and to see how his ideas might relate to their lives.

Autopsychotherapy

For Dąbrowski, the goal of therapy is to eliminate the therapist by providing a context within which a person can understand and help oneself, an approach to therapy that he called autopsychotherapy. The client is encouraged to embark on a journey of self-discovery with an emphasis on looking for the contrast between what is higher versus what is lower within his or her personality and value structure. The person is encouraged to further explore his or her value structure especially as it relates to the rationale and justification of positions. Discrepancies between values and behaviour are highlighted. The approach is called autopsychotherapy to emphasize the important role that the individual must play in his or her own therapy process and in the larger process of personality development. The individual must come to see that he or she is in charge of determining or creating his or her own unique personality ideal and value structure. This includes a critical review of social mores and values that have been learned.

Dąbrowski was very concerned about what he called one-sided development, in which people display significant advanced development in only one aspect of life, usually intellectual. He believed that it is crucial to balance one’s development.

Overexcitability

Dąbrowski also encouraged people to see their reactions (overexcitabilities) and their phenomenological view of the world in the context of their developmental potential. The experience of, and reaction to, crises are a very important aspect of this approach and people are encouraged to experience personal crises with a positive and developmental view.

Dąbrowski reminds clients that without internal disease there is little stimulus for change or growth. Rather than trying to rapidly ameliorate symptoms, this approach encourages individuals to fully experience their feelings and to try to maintain a positive and developmental orientation to what they may perceive as strong depression or anxiety. Of course, this is a unique approach in today’s world of seeking immediate and total relief of any unpleasant psychological experience (although it can be compared to Aron’s to some extent).

Dąbrowski and the Gifted Individual

In an appendix to Dąbrowski (1967), results of investigations done in 1962 with Polish youth are reported. Specifically, “a group of gifted children and young people aged 8 to 23” were examined (p.251). Of the 80 youth studied, 30 were “intellectually gifted” and 50 were from “drama, ballet, and plastic art schools” (p.251). Dąbrowski found that every one of the children displayed overexcitability, “which constituted the foundation for the emergence of neurotic and psychoneurotic sets. Moreover it turned out that these children also showed sets of nervousness, neurosis, and psychoneurosis of various kinds and intensities, from light vegetative symptoms, or anxiety symptoms, to distinctly and highly intensive psychasthenic or hysterical sets” (p.253). Dąbrowski asked why these children should display such “states of nervousness or psychoneurosis” and suggested that it was due to the presence of OE (p.255). “Probably the cause is more than average sensitivity which not only permits one to achieve outstanding results in learning and work, but at the same time increases the number of points sensitive to all experiences that may accelerate anomalous reactions revealing themselves in psychoneurotic sets” (p.255).

The association between OE and giftedness appears to be borne out in the research (Lysy and Piechowski 1983; Piechowski 1986; Piechowski and Miller 1995). It appears that at the least OE is a marker of potential for giftedness/creativity. Dąbrowski’s basic message is that the gifted will disproportionately display this process of positive disintegration and personality growth.

Key Ideas

The theory is based on key ideas that may be listed as follows:

  • That lower animal instincts (first factor) must be inhibited and transformed into “higher” forces for people to be Human (this ability to transform instincts is what separates people from other animals).
  • That the common initial personality integration, based upon socialisation (second factor), does not reflect true personality.
  • At the initial level of integration, there is little internal conflict as when one “goes along with the group”, there is little sense of individual wrongdoing. External conflicts often relate to the blockage of social goals – career frustrations for example. The social mores and values prevail with little question or conscious examination.
  • True personality must be based upon a system of values that are consciously and volitionally chosen by the person to reflect their own individual sense of “how life ought to be” and their “personality ideal” – the ideal person they feel they “ought to be”.
  • The lower animal instincts and the forces of peer groups and socialisation are inferior to the autonomous self (personality) constructed by the conscious person.
  • To break down the initial integration, crises and disintegrations are needed, usually provided by life experience.
  • These disintegrations are positive if the person can achieve positive and developmental solutions to the situation.
  • “Unilevel crises” are not developmental as the person can only choose between equal alternatives (go left or go right?).
  • A new type of perception involves “multilevelness”, a vertical view of life that compares lower versus higher alternatives and now allows the individual to choose a higher resolution to a crisis over other available, but lower, alternatives – the developmental solution.
  • “Positive disintegration” is a vital developmental process.
  • Dąbrowski developed the idea of “developmental potential” to describe the forces needed to achieve autonomous personality development.
  • Developmental potential includes several factors including innate abilities and talents, “overexcitability” and the “third factor”.
  • Overexcitability is a measure of an individual’s level of nervous response. Dąbrowski found that the exemplars he studied all displayed an overly sensitive nervous system, also making them prone to angst, depression and anxiety – psychoneuroses in Dąbrowski’s terms, a very positive and developmental feature.
  • The third factor is a measure of an individual’s drive toward autonomy.
  • Dąbrowski’s approach is very interesting philosophically as it is Platonic, reflecting the bias of Plato toward essence – an individual’s essence is a critical determinant of his or her developmental course in life. However, Dąbrowski also added a major existential aspect as well, what one depends upon the anxieties felt and on how one resolves the day to day challenges one faces. Essence must be realised through an existential and experiential process of development. The characterisation advanced by Kierkegaard of “Knights of faith” may be compared to Dąbrowski’s autonomous individual.
  • Reviewed the role of logic and reasoning in development and concludes that intellect alone does not fully help people know what to do in life. Incorporates Jean Piaget’s views of development into a broader scheme guided by emotion. Emotion (how one feels about something) is the more accurate guide to life’s major decisions.
  • When multilevel and autonomous development is achieved, a secondary integration is seen reflecting the mature personality state. The individual has no inner conflict; they are in internal harmony as their actions reflect their deeply felt hierarchy of values.
  • Rejected Abraham Maslow’s description of self-actualisation (Dąbrowski was a personal friend and correspondent of Maslow’s). Actualisation of an undifferentiated human self is not a developmental outcome in Dąbrowski’s terms. Dąbrowski applied a multilevel (vertical) approach to self and saw the need to become aware of and to inhibit and reject the lower instinctual aspects of the intrinsic human self (aspects that Maslow would have people “embrace without guilt”) and to actively choose and assemble higher elements into a new unique self. Dąbrowski would have people differentiate the initial self into higher and lower aspects and to reject the lower and actualise the higher in creating unique personalities.

Secondary Integration versus Self-Actualisation

People have often equated Maslow’s concept of self-actualisation with Dąbrowski’s level of secondary integration. There are some major differences between these two ideas. Fundamentally, Maslow described self-actualisation as a process where the self is accepted “as is”, so both higher and lower aspects of the self are actualised. Dąbrowski introduces the notion that although the lower aspects may initially be intrinsic to the self, as human beings we are able to become aware of their lower nature. People are able to develop self-awareness as to how they feel about these low levels – if they feel badly about behaving in these lower ways, then they are able to cognitively and volitionally decide to inhibit and eliminate these behaviours. In this way, the higher aspects of the self are actualized while the lower aspects are inhibited and, for Dąbrowski, this is what is unique about humans and sets people apart from other animals – no other animal is able to differentiate their lower instincts and therefore can not inhibit their animalistic impulses, an idea also expressed in Plessner’s eccentricity.

Controversy

Few psychological tests exist that measure Dąbrowskian constructs. The most widely known instrument is the Overexcitability Questionnaire – Two.

According to some, Dąbrowski was influenced by his Catholic upbringing and pursued a lifelong obsession with self-mutilation resulting in his semi-autobiographical 1937 work, Psychological Basis of Self Mutilation. It is claimed by Majorie Battaglia that his personal experience as a victim of medical torture by Nazis for several months as a member of the Polish resistance, being only one of the 38 surviving psychiatrists in Poland out of the 400 practicing at the beginning of World War II, almost definitely informed his world view.

What is the Myth of Mental Illness (Book)

Introduction

The Myth of Mental Illness 1961
The Myth of Mental Illness 1961.

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticises psychiatry and argues against the concept of mental illness.

It received much publicity, and has become a classic, well known as an argument that “mentally ill” is a label which psychiatrists have used against people “disabled by living” rather than truly having a disease.

Refer to:

  • Game theory: For Szasz, mental illness is best understood through the lens of game theory
  • Neurodiversity: A belief of promoting the acceptance of numerous different brain types typically considered to be mental disorders or illnesses by the scientific community

Background

Szasz writes that he became interested in writing The Myth of Mental Illness in approximately 1950, when, having become established as a psychiatrist, he became convinced that the concept of mental illness was vague and unsatisfactory. He began work on the book in 1954, when he was relieved of the burdens of a full-time psychiatric practice by being called to active duty in the navy. Later in the 1950s, it was rejected by the first publisher to whom Szasz submitted the manuscript. Szasz next sent the manuscript to Paul Hoeber, director of the medical division of Harper & Brothers, who arranged for it to be published.

Summary

Szasz argues that it does not make sense to classify psychological problems as diseases or illnesses, and that speaking of “mental illness” involves a logical or conceptual error. In his view, the term “mental illness” is an inappropriate metaphor and there are no true illnesses of the mind. His position has been characterised as involving a rigid distinction between the physical and the mental.

The legitimacy of psychiatry is questioned by Szasz, who compares it to alchemy and astrology, and argues that it offends the values of autonomy and liberty. Szasz believes that the concept of mental illness is not only logically absurd but has harmful consequences: instead of treating cases of ethical or legal deviation as occasions when a person should be taught personal responsibility, attempts are made to “cure” the deviants, for example by giving them tranquilisers. Psychotherapy is regarded by Szasz as useful not to help people recover from illnesses, but to help them “learn about themselves, others, and life.” Discussing Jean-Martin Charcot and hysteria, Szasz argues that hysteria is an emotional problem and that Charcot’s patients were not really ill.

Reception

The Myth of Mental Illness received much publicity, quickly became a classic, and made Szasz a prominent figure. The book was reviewed in the American Journal of Psychiatry, Journal of Nervous and Mental Disease, Psychosomatic Medicine, Archives of General Psychiatry, Clinical Psychology Review, and Psychologies. Published at a vulnerable moment for psychiatry, when Freudian theorizing was just beginning to fall out of favour and the field was trying to become more medically oriented and empirically based, the book provided an intellectual foundation for mental patient advocates and anti-psychiatry activists. It became well known in the mental health professions and was favourably received by those sceptical of modern psychiatry, but placed Szasz in conflict with many doctors. Soon after The Myth of Mental Illness was published, the Commissioner of the New York State Department of Mental Hygiene demanded, in a letter citing the book, that Szasz be dismissed from his university position because he did not accept the concept of mental illness.

The philosopher Karl Popper, in a 1961 letter to Szasz, called the book admirable and fascinating, adding that, “It is a most important book, and it marks a real revolution.” The psychiatrist David Cooper wrote that The Myth of Mental Illness, like the psychiatrist R.D. Laing’s The Divided Self (1960), proved stimulating in the development of anti-psychiatry, though he noted that neither book is itself an anti-psychiatric work. He described Szasz’s work as “a decisive, carefully documented demystification of psychiatric diagnostic labelling in general.” Socialist author Peter Sedgwick, writing in 1982, commented that in The Myth of Mental Illness, Szasz expounded a “game-playing model of social interaction” which is “zestful and insightful” but “neither particularly uncommon nor particularly iconoclastic by the standards of recent social-psychological theorising.” Sedgwick argued that many of Szasz’s observations are valuable regardless of the validity of Szasz’s rejection of the concept of mental illness, and could easily be accepted by psychotherapists. Although agreeing with Szasz that the assignation of mental illness could undermine individual responsibility, he noted that this did not constitute an objection to the concept itself.

The philosopher Michael Ruse called Szasz the most forceful proponent of the thesis that mental illness is a myth. However, while sympathetic to Szasz, he considered his case over-stated. Ruse criticized Szasz’s arguments on several grounds, maintaining that while the concepts of disease and illness were originally applied only to the physiological realm, they can properly be extended to the mind, and there is no logical absurdity involved in doing so. Kenneth Lewes wrote that The Myth of Mental Illness is the most notable example of the “critique of the institutions of psychiatry and psychoanalysis” that occurred as part of the “general upheaval of values in the 1960s”, though he saw the work as less profound than Michel Foucault’s Madness and Civilization (1961).

The psychiatrist Peter Breggin called The Myth of Mental Illness a seminal work. The author Richard Webster described the book as a well known argument against the tendency of psychiatrists to label people who are “disabled by living” as mentally ill. He observed that while some of Szasz’s arguments are similar to his, he disagreed with Szasz’s view that hysteria was an emotional problem and that Charcot’s patients were not genuinely mentally ill. The lawyer Linda Hirshman wrote that while few psychiatrists adopted the views Szasz expounded in The Myth of Mental Illness, the book helped to encourage a revision of their diagnostic and therapeutic claims. The historian Lillian Faderman called the book the most notable attack on psychiatry published in the 1960s, adding that “Szasz’s insights and critiques would prove invaluable to the homophile movement.”

What is Repression (Psychoanalysis)?

Introduction

Repression is a key concept of psychoanalysis, where it is understood as a defence mechanism that “ensures that what is unacceptable to the conscious mind, and would if recalled arouse anxiety, is prevented from entering into it.”

According to psychoanalytic theory, repression plays a major role in many mental illnesses, and in the psyche of the average person.

There has been debate as to whether (or how often) memory repression really occurs and mainstream psychology holds that true memory repression occurs only very rarely. American psychologists began to attempt to study repression in the experimental laboratory around 1930. However, psychoanalysts were at first uninterested in attempts to study repression in laboratory settings, and later came to reject them. Most psychoanalysts concluded that such attempts misrepresented the psychoanalytic concept of repression.

Sigmund Freud’s Theory

As Sigmund Freud moved away from hypnosis, and towards urging his patients to remember the past in a conscious state, ‘the very difficulty and laboriousness of the process led Freud to a crucial insight’. The intensity of his struggles to get his patients to recall past memories led him to conclude that ‘there was some force that prevented them from becoming conscious and compelled them to remain unconscious … pushed the pathogenetic experiences in question out of consciousness. I gave the name of repression to this hypothetical process’.

Freud would later call the theory of repression “the corner-stone on which the whole structure of psychoanalysis rests” (“On the History of the Psycho-Analytic Movement”).

Freud developed many of his early concepts with his mentor, Josef Breuer. Moreover, while Freud himself noted that the philosopher Arthur Schopenhauer in 1884 had hinted at a notion of repression (but he had only read him in later life), he did not mention that Johann Friedrich Herbart, psychologist and founder of pedagogy whose ideas were very influential in Freud’s environment and in particular with Freud’s psychiatry teacher Theodor Meynert, had used the term in 1824 in his discussion of unconscious ideas competing to get into consciousness.

Stages

Freud considered that there was ‘reason to assume that there is a primal repression, a first phase of repression, which consists in the psychical (ideational) representative of the instinct being denied entrance into the conscious’, as well as a ‘second stage of repression, repression proper, which affects mental derivatives of the repressed representative: distinguished what he called a first stage of ‘primal repression’ from ‘the case of repression proper (“after-pressure”).’

In the primary repression phase, ‘it is highly probable that the immediate precipitating causes of primal repressions are quantitative factors such as … the earliest outbreaks of anxiety, which are of a very intense kind’. The child realises that acting on some desires may bring anxiety. This anxiety leads to repression of the desire.

When it is internalised, the threat of punishment related to this form of anxiety becomes the superego, which intercedes against the desires of the id (which works on the basis of the pleasure principle). Freud speculated that ‘it is perhaps the emergence of the super-ego which provides the line of demarcation between primal repression and after-pressure

Therapy

Abnormal repression, as defined by Freud, or neurotic behaviour occurs when repression develops under the influence of the superego and the internalised feelings of anxiety, in ways leading to behaviour that is illogical, self-destructive, or antisocial.

A psychotherapist may try to ameliorate this behaviour by revealing and reintroducing the repressed aspects of the patient’s mental processes to their conscious awareness – ‘assuming the role of mediator and peacemaker … to lift the repression’. In favourable circumstances, ‘Repression is replaced by a condemning judgement carried out along the best lines’, thereby reducing anxiety over the impulses involved.

Reactions

The philosopher Jean-Paul Sartre challenged Freud’s theory by maintaining that there is no “mechanism” that represses unwanted thoughts. Since “all consciousness is conscious of itself” we will be aware of the process of repression, even if skilfully dodging an issue. The philosopher Thomas Baldwin stated in The Oxford Companion to Philosophy (1995) that Sartre’s argument that Freud’s theory of repression is internally flawed is based on a misunderstanding of Freud. The philosopher Roger Scruton argued in Sexual Desire (1986) that Freud’s theory of repression disproves the claim, made by Karl Popper and Ernest Nagel, that Freudian theory implies no testable observation and therefore does not have genuine predictive power, since the theory has “strong empirical content” and implies testable consequences.

Later Developments

The psychoanalyst Otto Fenichel stressed that ‘if the disappearance of the original aim from consciousness is called repression, every sublimation is a repression (a “successful” one: through the new type of discharge, the old one has become superfluous)’.

The psychoanalyst Jacques Lacan stressed the role of the signifier in repression – ‘the primal repressed is a signifier’ – examining how the symptom is ‘constituted on the basis of primal repression, of the fall, of the Unterdrückung, of the binary signifier … the necessary fall of this first signifier’.

Family therapy has explored how familial taboos lead to ‘this screening-off that Freud called “repression”‘, emphasising the way that ‘keeping part of ourselves out of our awareness is a very active process … a deliberate hiding of some feeling from our family’.

Experimental Attempts to Study Repression

According to the psychologist Donald W. MacKinnon and his co-author William F. Dukes, American psychologists began to attempt to study repression in the experimental laboratory around 1930. These psychologists were influenced by an exposition of the concept of repression published by the psychoanalyst Ernest Jones in the American Journal of Psychology in 1911. Like other psychologists who attempted to submit the claims of psychoanalysis to experimental test, they did not immediately try to develop new techniques for that purpose, instead conducting surveys of the psychological literature to see whether “experiments undertaken to test other theoretical assertions” had produced results relevant to assessing psychoanalysis. In 1930, H. Meltzer published a survey of experimental literature on “the relationships between feeling and memory” in an attempt to determine the relevance of laboratory findings to “that aspect of the theory of repression which posits a relationship between hedonic tone and conscious memory.” However, according to MacKinnon and Dukes, because Meltzer had an inadequate grasp of psychoanalytic writing he misinterpreted Freud’s view that the purpose of repression is to avoid “unpleasure”, taking the term to mean simply something unpleasant, whereas for Freud it actually meant deep-rooted anxiety. Nevertheless, Meltzer pointed out shortcomings in the studies he reviewed, and in MacKinnon and Dukes’s view he also “recognized that most of the investigations which he reviewed had not been designed specifically to test the Freudian theory of repression.”

In 1934, the psychologist Saul Rosenzweig and his co-author G. Mason criticized Meltzer, concluding that the studies he reviewed suffered from two basic problems: that the studies “worked with hedonic tone associated with sensory stimuli unrelated to the theory of repression rather than with conative hedonic tone associated with frustrated striving, which is the only kind of ‘unpleasantnesss’ which, according to the Freudian theory, leads to repression” and that they “failed to develop under laboratory control the experiences which are subsequently to be tested for recall”. In MacKinnon and Dukes’s view, psychologists who wanted to study repression in the laboratory “faced the necessity of becoming clear about the details of the psychoanalytic formulation of repression if their researches were to be adequate tests of the theory” but soon discovered that “to grasp clearly even a single psychoanalytic concept was an almost insurmountable task.” MacKinnon and Dukes attribute this situation to the way in which Freud repeatedly modified his theory “without ever stating clearly just which of his earlier formulations were to be completely discarded, or if not discarded, how they were to be understood in the light of his more recent assertions.”

MacKinnon and Dukes write that, while psychoanalysts were at first only disinterested in attempts to study repression in laboratory settings, they later came to reject them. They comment that while

“the psychologists had criticized each other’s researches largely on the grounds that their experimental techniques and laboratory controls had not been fully adequate, the psychoanalysts rejected them on the more sweeping grounds that whatever else these researches might be they simply were not investigations of repression.”

They relate that in 1934, when Freud was sent reprints of Rosenzweig’s attempts to study repression, he responded with a dismissive letter stating that “the wealth of reliable observations” on which psychoanalytic assertions were based made them “independent of experimental verification.” In the same letter, Freud concluded that Rosenzweig’s studies “can do no harm.” MacKinnon and Dukes describe Freud’s conclusion as a “first rather casual opinion”, and state that most psychoanalysts eventually adopted a contrary view, becoming convinced that “such studies could indeed be harmful since they misrepresented what psychoanalysts conceived repression to be.”

Writing in 1962, MacKinnon and Dukes state that experimental studies “conducted during the last decade” have largely abandoned the term “repression”, choosing instead to refer to the phenomenon as “perceptual defence”. They argue that this change of terminology has had a major effect on how the phenomenon is understood, and that psychoanalysts, who had attacked earlier studies of repression, did not criticise studies of perceptual defence in a similar fashion, instead neglecting them. They concluded by noting that psychologists remained divided in their view of repression, some regarding it as well-established, others as needing further evidence to support it, and still others finding it indefensible.

A 2020 meta-analysis of 25 studies examined the evidence that active memory suppression actually leads to decreased memory. It was found that in people with a repressive coping strategy, the wilful avoidance of remembering certain memory contents leads to a significant reduction in memory performance for these contents. In addition, healthy people were better able to do this than anxious or depressed people. These results indicate that forgetting induced by suppression is a hallmark of mental wellbeing.

Repressed Memories

One of the issues Freud struggled with was the status of the childhood “memories” recovered from repression in his therapy. He concluded that “these scenes from infancy are not always true. Indeed, they are not true in the majority of cases, and in a few of them they are the direct opposite of the historical truth”. Controversy arose in the late 20th century about the status of such “recovered memories”, particularly of child abuse, with many claiming that Freud had been wrong to ignore the reality of such recovered memories.

While accepting “the realities of child abuse”, the feminist Elaine Showalter considered it important that one “distinguishes between abuse remembered all along, abuse spontaneously remembered, abuse recovered in therapy, and abuse suggested in therapy”. Memory researcher Elizabeth Loftus has shown that it is possible to implant false memories in individuals and that it is possible to “come to doubt the validity of therapeutically recovered memories of sexual abuse … [as] confabulations”. However, criminal prosecutors continue to present them as evidence in legal cases.

There is debate about the possibility of the repression of psychological trauma. While some evidence suggests that “adults who have been through overwhelming trauma can suffer a psychic numbing, blocking out memory of or feeling about the catastrophe”, it appears that the trauma more often strengthens memories due to heightened emotional or physical sensations (However these sensations may also cause distortions, as human memory in general is filtered both by layers of perception, and by “appropriate mental schema … spatio-temporal schemata”).

What is a Mental Health Consumer?

Introduction

A mental health consumer (or mental health patient) is a person who is obtaining treatment or support for a mental disorder, also known as psychiatric or mental illness.

The term was coined by people who use mental health services in an attempt to empower those with mental health issues, historically considered a marginalised segment of society. The term suggests that there is a reciprocal contract between those who provide a service and those who use a service and that individuals have a choice in their treatment and that without them there could not exist mental health providers.

Brief History

In the 1970s the term “patient” was most commonly used. Mental Health activists of the civil rights times recognised, as did many other groups seeking self-definition, that such labels are metaphors that reflect how identities are perceived and constructed. In particular, in the mental health field they shape the nature of the relationship between the giver and receiver of psychiatric services, be it one with an emphasis on reciprocity or hierarchy. Users of psychiatric services repulsed the efforts of experts to define them and sought to develop ways to define themselves. In Australia, informal support groups of people who had recovered from episodes of mental ill health were formed during the first wave of moving patients out of psychiatric hospitals into the community in the 1960s. In the USA and other countries, radical movements to change service delivery and legislation began to be driven by consumers during the 1980s. Activists, such as Judi Chamberlain, pressed for alternatives to psychiatrist dominated and controlled systems of mental health provision. Chamberlain’s On Our Own: Patient Controlled Alternatives to the Mental Health System helped guide others intent on a more collaborative form of mental health healing.

In the 1980s with some funding from NIMH, small experimental groups flourished. In 1985 at the First Alternatives Conference attendees agreed upon the term “consumer” reflecting the patients’ choice of services. The term also implied assumptions of rationality and ability to make choices in one’s own best interests rather than be a passive incapacitated recipient of “expert” attention. In the 1990s many consumer groups were formed, such as Self Help Clearing House and the National Empowerment Centre. They continued to press for more peer involvement in alternatives treatments, pointing out that peers support and comfort, which may be in contrast to some therapists who just attempt to change the behaviour and thinking patterns.

Contemporary Usage

Today, the word mental health consumer has expanded in the popular usage of consumers themselves to include anyone who has received mental health services in the past, anyone who has a behavioural health diagnosis, or simply anyone who has experienced a mental or behavioural disorder. Other terms sometimes used by members of this community for empowerment through positive self-identification include “peers,” “people with mental health disabilities,” “psychiatric survivors,” “users,” individuals with “lived experience” and “ex-patients.” The term “service users,” is commonly used in the UK. In the US “consumer” is most frequently used by ex-patients and users of psychiatric and alternative services.

One can view this term, “consumer,” neutrally as a person who receives psychological services, perhaps from a psychologist, a psychiatrist or a social worker. It can be impersonal term relating to the use in the health sector of a large economy. It suggests that the consumer expects to have some influence on service delivery and provides feedback to the provider. Used in its more activist sense, consumer groups aim to correct perceived problems in mental health services and to promote consultation with consumers. Consumer theory was devised to interpret the special relationship between a service provider and service user in the context of mental health. Consumer theory examines the consequences and sociological meaning of the relationship.