Physical attributes

An integral part of the DSM IV TR states that before you give a psychiatric diagnosis, the diagnostician rules out the possibility of alternate causes of psychiatric disorder. For example, a damaged thyroid gland may create mood instability. This doesn’t mean the person can be diagnosed with a mood disorder, but rather the diagnosis should be some kind of thyroid related diagnosis.

Socioeconomics and lifestyle can lead to three common activities that lead toward behaviours that can be confused for psychiatric symptoms: Sleep deprivation, mal-nutrition and drugs misuse.

Sufficient sleep deprivation can lead to hallucinations, low concentration, confused diet, micro-sleeps and many other symptoms. Sleep deprivation can be caused by many factors, some of which can be psychiatric disorder, some can be drug induced, some can be poor diet and there are a host of living situations, stress, and biological sources. However, if you find that sleep deprivation is a significant part of your current situation, consider what may be contributing to your sleep deprivation, rectify that and see if some of your more concerning symptoms clear up.

Mal-nutrition is far more common in the Western world than many people think. If your diet does not consistently contain a variety for fruit, vegetables, grains and occasional meat, then your diet may be significantly out of balance. Consider this analogy to understand why a varied, nutritious diet is important to mental health. If you consider that your body is a complex biological machine, made of many small machines (cells), which build and maintain your body. If important nutrients are not regularly supplied to your body, then your cells cannot maintain necessarily health. It’s like the car repair shop running out of welding rods and not being able to weld new pieces of metal to your rusted out car door. It just doesn’t work. Or another thing to consider is how well will your engine run if it runs out of oil and you don’t add more? Your mind is a finely tuned engine which needs a variety of vitamins, nutrients and proteins to work properly.

Drugs change the functioning of how your cells work. Sometimes we want this change, such as when we are trying to help our white cells identify foreign inimical biology to kill. When the function is how you think, you want to be very careful about what changes in function you are introducing. Most illegal drugs create unwanted long term changes in cell functioning, leading to mental processes that are not what you had hoped for when you took the drug. Drugs that many don’t consider seriously include nicotine, caffeine and alcohol. All three directly change your behaviour. For example, caffeine changes your mood, alters your concentration (increased to begin with, then decreased after a few hours for many hours).

Society does not help us to recognise when we are abusing these drugs. Nicotine is currently in the bad books, so most people believe any nicotine consumption is bad. On average, that is true, however for altering blood pressure and a few other conditions, nicotine is quite useful. I highly recommend that you check with a health professional rather than take my word for it, however. If you are drinking more than 4 cups of coffee a day, then you are probably abusing it. Similarly, if you drink more than 1 standard drink of alcohol a day, then you are probably abusing alcohol as well. I would suggest that the best way you can test yourself for drug addiction is to consider how much your current life would be inconvenienced if you were to stop right now and not use any of the substance for 30 days. If your response includes an expletive or serious consideration of how hard that is going to be, then you are probably addicted and abusing the substance.

Consider that 20% of the population of Australia who smoke cigarettes are people diagnosed with a psychiatric condition. Those 20% of the population consume almost half of the nicotine, which is a disproportionate amount. Again, people with a psychiatric diagnosis consumer approximately five times more caffeine than people without. One of the reasons considered for this is that both caffeine and nicotine have short term benefits to concentration, and nicotine has short term calmative effects, which can often combat the negative effects of medication or stress.

If you find that your life is out of control, by all means get some help as soon as possible, which may include a prescription of medication. Be wary of just ignoring medical advice, however feel free to question your practitioner. If your diagnostician does not consider physical causes to your experience, then perhaps remind them or consider controlling and compensating for these, or other, physical factors.

Therapeutic Focus

Once upon a time, I was speaking to a counselor. He uncovered that I would not take medication for cyclothymia, anxiety or anything else because I classed them as mind altering. As I pointed out to him, this is my issue, and it is a phobia. He seemed to have some significant issues accepting that I had this phobia since it was unusual. I suspect, although I am quite willing to be wrong, that he believed I was just being difficult. After all, the perfect solution for him was probably for me to take medication rather than work through the issues of discomfort that I was experiencing.

I asked him if he had any phobias and he said that his experiences were irrelevant to this conversation and that we should just focus on me. Strangely enough, I really didn’t like him. The reason that I asked him was to point out to him, through his example, that phobia doesn’t make sense. It just is and is something you either work through or around, but you don’t just say “my goodness, this phobia makes no sense so now it is gone”. He really didn’t understand that.

Two issues were raised for me in this. The first is that the therapist didn’t want to work on my discomforts in a way that was compatible to my beliefs. The other was to do with his cold inhuman clinical detachment.

This first issue is fairly common in the therapeutic industry, but it is not universal. Professionals need to remember that people are not universally the same, but are unique and different to each other. If we humans were all the same, then we would not need professionals, we would only need technicians, ticking a box as we progress, working on all of us in the same way as we all respond exactly the same. Clearly we don’t, so it is up to the professional to demonstrate the artistry behind their profession and adjust to the situation in front of them. Those who use professionals who will not budge should find those who are willing to compromise their rigidity and work with you instead of on you.

As for the second, it is important to be human when interacting with another person. Why on Earth would I trust a person who is clinically detached and perfect? How can they possibly understand or empathise with my life if they have only ever lived a book perfect life? Of course, very few have lived such a life, and even fewer choose to go into a professional health career. Or simply put, most people who go into health careers have lived interesting lives. By refusing to professionally and responsibly share your own experiences, you deny your humanness and the necessarily real element in a dialogue.

To accomplish this well, one must consider where the focus of the conversation is. It must be more towards the client than the professional, but it must not be divorced from the professional. Real interactions require genuine content. Another important consideration is why are you, the professional, telling the client this part of your life? If it is to frame an idea, to give context to a method of health, or to give an example that promotes empathy, then you are using your own stories well. If you find that you are processing your story for your own gain, or your story is becoming a one up man ship kind of contest, then this is definitely straying into inappropriate use of your experiences. Of course it is important to not out friends, family, phone numbers and addresses in your stories. I will usually tell my stories and refer to people indirectly, since the who is not as important as the what of the story.

The Thriving Framework

How does thriving feel to you? Or, how should it feel?
Defining the Thriving Framework
The Thriving Framework is a heuristics for achieving a State of Thriving. It takes advantage of person centred planning, personal empowerment, the right for people to choose their own destinies and methods of achieving these destinies.  It does not require people to admit to some ill, being faulty, broken or helpless.
Achieving a State of Thriving is the end goal which is defined by individual people as their destination at the end of their progress through the framework.While the emotional experience of most people who have reached this stage is similar (safe, satisfied, confident, content, empowered, capable etc), the specific context will vary widely and the string of goals needed to achieve this state will be individualised such that the journey through the framework will be the individual persons, not anyone else’s.

Defining the State of Thriving
Thriving is a state of doing well, being well and succeeding at all of the important things in your life. If life were a game, it may defined as winning. Thriving does not mean that your life is over, only that you now have abundant resources to do what you want, how you want and as you want. People who are thriving are generally happy, are not struggling often, have most of what they want, have all of what they need and are generally fully integrated into society in such a way that they feel both wanted by and useful to society.

The State of Thriving is made up of two components. The Feeling of Thriving and the Context of Thriving.

Separating the Feeling and the Context
The State of Thriving is defined as the context you would fine yourself in to achieve the feeling of doing well and having “made it”. Core to thriving is feeling like you are thriving. Their is no point to living prosperously if you are miserable.

The Context of Thriving allows you to define the most likely situation that you are going to find yourself thriving in and the components of this context act as the elements of your goals. The goals create a flexible path for you to journey over from where you are now to where you wish to be such that you are thriving.

An emotion that I may identify as being part of my thriving might be safety. To understand why this is important I need to look at how safety plays a part in my current and past experience. For this example, it is because I have moved houses many times and could not rely on my home being home. To achieve the feeling of safety does not mean bars on the window, or a security force, or that I think I am being followed. To achieve a feeling of safety I want my own home, which can’t be taken I can not loose. In this example, the feeling is safety and the context in which I will feel safe is security in housing. If I do not recognise both components to this sub goal, then I may very well attempt to achieve the wrong thing and find myself escorted by safety professionals who do not actually address my feelings of fear at loosing my home.

The Spectrum of Thriving
Thriving is the end point on a spectrum of well being. In this case I define well being as how well my being is. My spectrum looks like this:

Death – Existing –  Surviving – Coping – Achieving – Thriving

The size of the steps between each of these increases exponentially. 

Death is the end of life, it is clinical death.

Existing is moving through life without feeling, without thought or personal power. It is close to death in that you can not or will not act and life just passes you by. Some people may wish to put this in a separate spectrum, but I feel it is the state of being just passed death. It can be placed alongside Surviving. People who  are Existing do not feel a future that is different is possible and often have no motivation to change. People in this stage may feel that they are not worth goodness or positivity. Self esteem is the main challenge, followed by motivation.

Surviving is that state of managing minute by minute, or hour by hour, or day by day the meager resources you have so that you have control over your destiny. This is the point where you can act to prolong the event horizon (the point where you can no longer influence) of your destiny. People who find themselves in this state are generally worried about personal safety, housing, food, paying the next bill and just making it through the day.

Coping is easy to mistake as Surviving, however it generally means you are managing to succeed at Surviving and are further away from slipping down to Existing or Death. Often people who are coping have a plan for a week or two and the resources to influence that. The focus is less on the immediate now and more on goals for the future. A person who is Coping can actually make plans for more than today because, on the one hand, they can see a future is possible, and on the other hand, they have command of enough resources that they can start to make future plans. This shift in controlling resources is the primary distinction between surviving and coping.

This is the beginning point of where discussing the Thriving Framework makes sense. Before this, it is too vague to make sense since it does not answer the immediate needs.

Achieving is the making progress in plans made towards Thriving. Often people feel capable and accomplished during this part of the journey. It is easy to feel that this is the whole point to life and just to stay in this aspect of the Thriving Framework. It is particularly appealing to those who have spent some time Existing, Surviving or Coping. Some people may become disillusioned with Achieving if they spend their whole lives Achieving and never quite accomplishing Thriving. Generally people who are Achieving have very few supports as they are managing this stage on their own.

Thriving is the end goal of the Thriving Framework. It means having achieved the majority of the Context Goals and feeling like you are Thriving. If you have achieved the Context Goals and do not have a feeling of Thriving, then it is important to go back and look at what you want to feel and what you may need to change to achieve this.

If the stage of Thriving can never be achieved, why aim for it? It must be achievable. This does not mean that the early Thriving Goal should be practical or achievable. When first working with your own or someone else’s goals, allow for unrealistic goals. This helps you to determine the governing emotions behind the unrealistic goals. From their you can work out how else to achieve these goals that is practical. The person on the journey through the Thriving Framework must choose and own these goals and this journey, otherwise you achieve nothing.