Unhelpful Parents

Sometimes our parents or other close family are not the supportive people we deserve. It is hard for me to be able to say how common this truly is, after all, if you had them, the odds are lower that you would see me for therapy, and if you didn’t the odds are higher. Letting go of some of the negative or unhelpful people in our lives is a hard but frequently necessary step.

This isn’t to say that all mental health issues are caused by parents – Freud was wrong. Mental ill health can be caused by a number of factors – genetic, enviornmental, biochemical, drug induced, organic brain damage, poor parenting, situational stress, ongoing trauma and so on. Parenting is only one of these, and a person may experience several. Good parenting can help minimise the impact of several of these, while poor parenting can exacerbate them.

Parents are not the only people who can have a strong influence on how you think mental health and your own self esteem should work and be handled. Other blood relatives like grand parents, who came from a quite different era, can give awful advice, your current social group can be bad for you and sometimes work mates are just completely unuseful to you.

Certain people seem to be of the opinion that mental health, managing stress, choosing the right thing and being functional are all a matter of will power, morals and some knowledge that you are supposed to just have.

They are wrong.

Image of angelic moral weakness
Being “strong”. “moral” or “virtuous” isn’t enough. Sometimes we need help.

We don’t live in isolation. We live in complex systems that sometimes fail us. As listed above, that failure can be a situational distress, an ongoing trauma, biological in nature or some other thing that has nothing to do with will power or moral judgement. This doesn’t exclude the occaisional person who is suffering through bad choices – consequences can be hard – but is to highlight that most people who are struggling and need help are generally struggling through things they didn’t chose or control, and being patient and waiting for it to be over is not enough.

These unhelpful people tend to fail to pass on good self management skills, good skills for managing other people and healthy ways to see the world. In short, they make shit parents, friends and colleagues.

Fortunately, as we get older (around 15 or so), pathways open up that allow us to learn from people besides our immediate family. We get to chose our own family, our own community and our own friends. We can go and get some professional help for the tricky bits, be inspired by awesome people for the general model of how to be, and go on a self discovery journey.

By no means is this journey easy. It is really hard. It means going against all of those lessons you trusted as you grew up, recognising that not only were you led astray, but that those who raised you were also led astray and they just got lucky. After all, people who see the world this way weren’t just born that way. Recognise their limitations in being the parents you deserve, their limitations in being able to support you and move forwards with your own path. Sometimes that means leaving them behind. Sometimes that means visiting them. Rarely it means retraining them.

The world is big. It is complex. It is made of more than one kind of people. There generally isn’t a “better” or “worse” kind of people (except nazi’s – they are just worse), there is just different. Some are tall, some are short, some have blue eyes, some are left handed, some have different kinds of blood, and some are very typical of the local group and some are a bit atypical of that group. They are all valid. Don’t blame neurotypical people for being normal, it isn’t really their fault. Once you learn to recognise your “self” and how your differences make some things easier, and some things harder, it makes it much easier to start adjusting to how other people may be.

The long and the short of it is, you are a different kind of people to your parents, or family, or friends, or colleagues (basically anyone that is giving you the “just try being normal”, or “toughen up”, or “moral weakness” or “willpower” style of line). They are, in this case, wrong. Don’t feel that you have failed to be them, and don’t listen to their wrong advice. Learn who you are, and find people who are your kind of people. Be inspired by those who seem to have it together and learn how they do it. And don’t hesitate to get some professional advice to get over some of the erroneous messages, skills and ways of thinking that you were raised with.

Medication – Part 2, The Stigma behind Medication and Mental Health

Last time [Link] we looked at medication itself as a general concept in mental health, comparing it to generalised medical treatment. Part 2 is about looking at some of the social causes of Stigma in Mental Health and how that affects the social view of Mental Health Medication.

Part 2 – The Stigma Behind Medication and Mental Health

Stigma is an interesting word – it can mean both a mark of disgrace and a mark of grace depending on the context. In mental health, stigma is the mark of disgrace that excuses bad behaviour to people labelled with mental illness.

Fear of the unknown  – they were all bad

Words used to insult people have often held a mental health component in it – lunatic, psycho, bipolar, crazy, mad, loopy, schizo and so on. As soon as we do not understand why someone does something we assume there is a mental illness in that other person rather than ignorance in oneself. People who commit acts of violence are frequently called schizo, psycho, loony or crazy, even though statistically people with a mental health diagnosis commit less general crimes and specifically less violent crimes than people without a diagnosis. Often times there is retroactive arm chair diagnosing of people who have committed violence and atrocities, despite authorities investigating and finding no good indication of mental illness.

These were just bad people.

Sometimes bad people do have a mental illness, and when that is the case it confirms in our minds all those times we thought a bad person should be diagnosed.

Another aspect of bad people is that sometimes they have blue eyes. Not all people who have blue eyes are bad people. When bad people are known to have blue eyes, it doesn’t confirm to us that all blue eyed people are bad. This is an example of stereotyping and false categorisation.

The assumption of normal

It is well known that people who come from different lands have different expectations than us, different values, different ways of doing things and so on. We have a clear and easy way to say “oh, their difference is because of where they come from”. We might think their values and culture are a bit odd, even seeming to be ‘crazy’ if the differences are hard for us to understand. We don’t call the individual from that far off place crazy though, just their upbringing.

We assume that all people from our land will have the same values and ways of doing things. “It’s just common sense” is a common statement of frustration when you see someone doing something that you think is stupid or wrong. We assume we are all the same, doing the same things in the same ways, while at the same time wanting to be better than others, wanting to be special and unique. I find this to be a fascinating contradiction in terms – we are all the same, but I’m unique.

Within our society we have found different types of humans. We have the false binary of male versus female (there are more sexes than that, but it is a starting point to discuss from), where we expect men to behave one way and women to behave another. We also have different kinds of women – airheads, nerdy, sporty etc. We can then split the categories further… So it isn’t just one type of human, nor is it one type of woman, or one type of nerdy woman, it is lots of sub categories.

Neurodiversity is bringing in some interesting concepts of differences in humans. Two well known neurodiverse groups are ADHD (three sub types currently recognised) and Autism (dozens of sub types currently known by dividing by 5 axes on a 3 point scale). I strongly believe that we will create new categories for as yet unknown different types of neurodivergent peoples. Sometimes medication can help with some of the challenges that being neurodivergent brings, either addressing primary difficulties or societal difficulties. Often though, medication is not the solution.

When someone solves a problem differently, responds to an event differently or just seems odd we assume there is something wrong with them rather than accepting that they are unique to you. The challenge here is the distance from how you see yourself compared to others. You want to be unique and special, but not that unique and special. Your difference is ok, but theirs is wrong.

That labelling of wrong is a stigma that is often used to justify not making adaptations, allowance or understanding.

Neurodiversity is just one example of difference within humans that we stigmatise and is to the only one in the umbrella of mental health.

Dunning-Kruger Effect

There are two parts to the Dunning-Kruger Effect.
1) A cognitive bias in which people of low ability have illusory superiority and mistakenly assess their cognitive ability as greater than it is.

2) A cognitive bias in which people of high ability misestimate how hard a task is, thinking that it should be easy and undervaluing their own ability.

First we are more going to look at the first part.

Pretend you get a sprain in your foot. It hurts to use your foot, so you will walk with a limp for a while. There is no good treatment for the foot injury except to avoid using it and sometimes some judicious use of pain relief. After a few weeks the sprain will heal and you will be fine. Simple, right?

Imagine your friend has a broken leg. The femur (the bone between their hip and knee) snapped in a total fracture, which requires an operation to fix, a metal pin inserted, several screws and a cast for 3 months with some rehabilitation afterwards.

As you too have experienced a leg injury, you falsely equate your experience for theirs. You don’t see why they are making all this fuss with operations, casts and physiotherapy. You got by on a few pills and taking it light for a few weeks. In principle they are the same injury so should have the same treatment.

Now obviously you can see the errors here because the difference between a sprain and a complete break of the femur is easily understood and can be shown on an x-ray. Even so, it amazes me how many people do not understand that a broken bone is serious.

Let us substitute your sprain for a time that you felt a bit down when you were between jobs. It was tough, you didn’t feel like socialising, you were worried that people would judge you, you may have even taken some medication – either official antidepressants or unofficial substances like alcohol or marijuana. You were stubborn and got through it and once you got your new job it all got better.

Your friend has major depression. They are frequently out of action for an extended period of time, take regular medication and sometimes go in for electroconvulsive therapy. You falsely equate the two, thinking that they are both depression, right? Why is your friend making such a fuss?

In your ignorance you assumed you knew the territory and the complexity of the issue, undervaluing how hard the major depression is.

While not technically part of stigma, the second part of the Dunning-Kruger Effect is important to consider. Those who have actual experience of major psychiatric illnesses frequently undervalue their experience, stating to me “other people have it worse”, or “I shouldn’t be having this much trouble with it – it’s only depression”. In effect, people undervalue how much they are dealing with and how hard their life is simply because they are expects in managing it.


A nasty side of medicine is the definition of healthy and unhealthy in an ideal sense. Ironically it is an evolution of the misunderstanding of evolution. Eugenics was the belief that we could take evolution into our own hands and create a better human, and with that belief the definition of inadequate humans. Medicine was the tool used to define what healthy and inadequate was. Much like eugenics is a misapplication of the concept of evolution – mistaking the world as a single static niche; the misapplication of medical definition to define fitness tarnishes medicine as eugenics tarnishes evolution.

That can seem a bit confusing. Evolution is a great tool that is very accurate and is mis used by those who believe in this concept of eugenics. The tool is not the fault, the misapplication of the tool is. Similarly eugenicists misuse the tool medicine. Medicine is not the enemy, those who misapply it is.

Different cultures in history have dealt with difference in different ways. Some have honoured difference and divergence as a message or gift from the gods, while others have burned it with fire. Our recent history – about the last two hundred years – has been more of the burn it with fire kind with only the last fifty years opening up to difference being okay.

Once mental illness was medically defined, we segregated our people into monasteries, asylums and madhouses. Johnny acting a bit odd? Off to the madhouse. The last twenty years has seen more and more people leaving institutions and being managed in the community (some well, some poorly) with the locked ward and open wards only being used for significant problems.

Even then, it has been estimated that two thirds of our Australian gaols are populated by people who have a mental health condition that weren’t being addressed, so they were gaoled instead.

Big Pharma and Addiction

I frequently talk to clients who have been prescribed medication to help manage symptoms while they are getting therapy. The most common reasons clients say no to pharmacological intervention (meds) are:

1) Big Pharma

2) Fear of addiction

Big Pharma is the concept that there is a conspiracy of those who make medications to not really cure the problem but to just treat the symptoms such that the patient becomes a life long depend user.  You’ve all seen the cartoon about a scientist in a lab saying  “I’ve just cured cancer” and the other saying “shhh… we make too much money on the current system” or words to that effect.

When someone is convinced that there is a conspiracy it is very hard to convince them that they are wrong. You are the one that has been fooled, the evidence is a plant, you are working for Big Pharma etc – any contortion of logic to keep the belief. Don’t ridicule people who have one of these conspiracy theory beliefs – statistically 90% of the population has an illogical belief that contradicts evidence.

In this case, I look at the medications available 20 years ago and shudder… except that I look at the medications available 20 years before that. Basically, the medication available keeps getting better, more effective and with less side effects. Our own Australian science group, the CSIRO developed and created the HPV vaccine, which in one stroke effectively killed several types of cancer simply by preventing people from getting it. Why didn’t Big Pharma stop it?

There is a smidge of truth to the belief though. If the medication is out of patent, is not profitable enough or can’t be effectively sold, then the pharmaceutical company won’t develop or market it. They are a business, after all. Generally though, most treatments that work are sold because they bring money.

With the opioid epidemic being the latest addiction crisis brought about by the misapplication and erroneous intentions of health professionals, people are very worried about addiction to mental health products. Much like Big Pharma, there is mostly fiction in this and a it of truth.

Most mental health medications are not addictive, per se.  It is important at this point to take a mild detour into what is and what is not addiction.

According to ReachOut Australia [Link], “Addiction happens when someone compulsively engages in behaviour such as drug taking, gambling, drinking or gaming. Even when bad side effects kick in and people feel like they’re losing control, addicts usually can’t stop doing the thing they’re addicted to without help and support.” This could sound like mental health medication – you have to take it, you don’t like the side effects, you feel like you lose control when you don’t take it and you need help to stop it.

But that is also true for food, oxygen, insulin for diabetics, heart medication for people with various heart conditions and so on. A substance that is required for existence, quality of life or medical needs is not a substance that you are addicted to – it is a requirement.

Opioid addiction is a different kettle of fish. For a start, the medication is addictive in and of itself – it can lose efficacy over time (you need more dose to feel the same effect), they can alter the state of your mind in negative ways and people who become addicted to opioids can and will do actions that they would have normally regretted to feed their addiction. Common medical opioids are Codeine,  Hydrocodone (Vicodin, Hycodan), Morphine (MS Contin, Kadian), Oxycodone (Oxycontin, Percoset), Hydromorphone (Dilaudid) and Fentanyl (Duragesic). These are based on the derivatives of the opium plant. Each of these have specific medical uses that when used for a brief amount of time for specific things do not lead to addiction.

The error came in when it was thought that long term use of these medications would improve quality of life without leading to complications. This was meant with good intent but met with bad results for many people. Pain is awful, and anyone who struggles with chronic pain will tell you that it can be crippling, debilitating and ostracizing. To feel relief from pain can be wonderful, but to know it will come back shortly is awful. Many people with chronic pain can pinpoint the source event that led to their pain while some cannot. It is easy for the armchair observer to make the Dunning-Kruger error of thinking that they have felt pain and dealt with it, that there is no clear source of the pain or that people should just “get over it”. If it were that easy, patients would do that.

Medication mismanagement leading to opioid addiction is a tragedy that most mental health medication won’t fall into because it misses two primary categories. First of all the medication generally is not in the category of being addictive as opioids are. There are a few exceptions to this and your doctor should warn you about these, use the medication as a short term solution to symptoms and be working on a treatment plan for how to find a longer term solution. If you aren’t sure, ask your doctor or psychiatrist which of your medications are addictive medications.

Secondly the mental health medication is required for quality of life, much like pain relief, glasses, hearing aids, heart medication and insulin. Pain relief can be a temporary solution to a problem that will resolve in time and is analogous to short term mental health medications to help you through a short term psychosocial crisis. The rest are long term solutions to ongoing problems that are not going to resolve themselves. Someone with type 1 diabetes is not going to wean themselves off insulin without dying, nor will someone with a heart condition not need that medication (some exceptions apply). We don’t count these medications as addictions, so nor should we mental health medication.

The Naturalistic Fallacy

Our last major category of stigma is the naturalistic fallacy. In a nutshell, the naturalistic fallacy says that if all things are natural then all things are good and any unnatural thing makes good things bad. If you eat a balance of good food, do reasonable exercise and think good thoughts all of your problems should disappear.

Tell this to the people on Naru island. Tell this to someone in an abusive relationship. Tell this to someone with a heart condition.

It is a privilege to only need good food, exercise and good thoughts to have a good life. People who manage this have never known true adversity and will frequently falsely mistake their mild challenges as equivalent to someone else’s nightmare. Refer back up to the Dunning-Kruger effect.

It is true that many people who are struggling in their life do not eat well, do not get adequate exercise and tend towards bad thought patterns. These are certainly not helping. But to think that is the cause of the person’s trauma is a fallacious assumption. and leads to victim blaming, that is, stigma. Helping a person to fix their diet, exercise well and think good thoughts is just simply not enough to solve someone’s bad relationship experience, recover from rape, escape false imprisonment, or manage a significant biological illness.

It is true that many people who are struggling in their life do not eat well, do not get adequate exercise and tend towards bad thought patterns. These are certainly not helping. But to think that is the cause of the person’s trauma is a fallacious assumption. and leads to victim blaming, that is, stigma. Helping a person to fix their diet, exercise well and think good thoughts is just simply not enough to solve someone’s bad relationship experience, recover from rape, escape false imprisonment, or manage a significant biological illness.

The naturalistic fallacy often suggests that pharmaceutical products are unnatural and you should just take natural medicines and supplements. Referring to the opioid problem above, opioids are derived from a plant. They are natural products. Cyanide is also natural and not recommended as a medicine – it will kill you. Most supplements have been found not to contain the labeled ingredient – in the best case they contain the wrong dosage, in the worst not containing the active ingredient at all. Supplements are also made by the same company that makes the medications you are being prescribed, but supplements are unregulated while medications are heavily regulated and quality controlled.

Many people I meet for therapy state they won’t take medications prescribed by their medical practitioners (GP or psychiatrist), because they are worried about drugs and unnatural products, while in the same breath telling me about the unregulated drugs they do consume, such as supplements, marijuana, MDMA and meth amphetamines while drinking their excessive alcohol and stubbing out a cigarette (not during session, but you get the point). These people are self medicating on things that haven’t worked (otherwise they would need to see me), but refuse medications that might. It is an odd world.

Seeing is believing – or is it?

We all perceive things that others don’t, simply because much of what we perceive of the worlds is within our minds, not in the world itself. It matters not what we each perceive, but how what we perceive forms our assumptions about the world, which inform our actions. Consider that 3 in 100 people regularly perceive hearing voices and seeing being that 97 in 100 people do not regularly see. 1 in 3 of these people are not at all bothered by the additional perception, 1 in 3spend a lot of time in and out of health institutions and the other 1 in three suffers in silence. The point here is that 2 in 3 people who hear voices and see beings do not use the health services to continue living their lives. If seeing and hearing these beings was the problem, then 3 out of 3 would be using health services. It is those who have not found ways of working their perceptions for their own gain that have the troubles.

Many of our reactions to the world are based on how we perceive the world. Perception is the interpretation of the sensory information that we are given to create a landscape of what the world around us is. Part of that perception is pattern recognition which helps us to predict what is coming next. We have many senses, the most common of these is sight, hearing, touch, taste, and smell (there are more, such as motion, temperature and so on – about 15 all up).

Despite your expectations, perceiving the world accurately, on average, is not vital to your survival. You are making many assumptions all of the time about what you think is there and these assumptions are often wrong. 

I will focus mainly on sight for this article, since it is commonly regarded that sight is the dominant sensory input and the most immutable. Sure we see the world for what it is? Consider the phrase “seeing is believing”, which is made up of the idea that to see something is to know it is real.

Take a gander at the video clip here.

In this video, you see what looks like an ordinary room. The girls are the same height, but when one goes to the right she seems to grow and as she goes left she shrinks. I appreciate that this room is artificially created to fool you, however it illustrates a point, which is that what you perceive is not necessarily what you perceive. After all, the girl does not actually change size at all, the room shrinks. Your memory of how rooms work tells you that rooms are square, thus objects in what looks like a square room must be the same size, therefore the girl must be growing and shrinking. In essence your expectations have fooled your mind.

In this perceptual illusion the dancer seems to be spinning. When you watch it, you will see that the dancer appears to spin in a particular direction. If you watch carefully, you can change the direction that the dancer spins. This is done via changing your expectations (I found staring at the shadow the dancer casts as a good way to switch directions). You haven’t changed the video image, but you have changed your interpretation of the images.

Of course vision is not the only perceptual sense that can be fooled. listen to this video clip. Play it twice to hear what I refer to. It is the same video the second time around, but you will perceive it to be a higher pitch rather than starting from where you first thought it should start. All the senses can be fooled by stimuli, or rather our perception of all of our senses can be fooled. Try sitting in the bus and sitting behind the driver. Look at the road passing in the reflection of the glass blocking you from the driver (if your bus is designed that way). After a while you will probably begin to perceive motion in reverse.

Moving back to sight, consider colour. Most of us have colour vision, yet half of the human species is partially colour blind. I can’t currently find a reference for this (sigh), but it is mostly manifest in the differentiation of blue and green. When does a colour stop being blue and start being green? Well, ask a sampling of men and women whether this colour is blue or green:

Yes, you have to pick one. Most women will call this colour green, while most men will call this blue (computer screens may cast this colour improperly and muck up this experiment, but drag someone to the fabric or paint store and see where they have a range of colour and argue about the different representations of teal and aqua). Part of this is a cultural definition but most of it is genetic. The part of the genes that corrects for colour blindness is on the second x chromosome that men don’t have. While this can influence fashion sense, it generally does not significantly affect survival. The point of this bit of the article is to point out that what you are expecting to see i the world is not actually what you probably are seeing in the world, but id isn’t harming you.

Much of what we perceive of the world is not really the world at all, it is merely expectations, what we expect to see, and thus our mind fills in the blanks. Consider the most efficient use of brain space – interpreting masses of information given to our brain from our eyes, or to assume much of the information from our memories of what is probably there. Try this exercise – pick an object and stare at it. Try really hard not to move your eyes or blink. Now notice that your peripheral vision shrinks, except for any moving object – don’t look away! If you manage to stay still enough, you may notice that your eyes are wiggling… see if you can still this too. If you succeed, and few do, you will notice that your vision fades. This is because we only see the bits that change. To see stationary objects, our eyes wiggle back and forth, helping as define different objects. Yet if we fix our attention on one thing much of the rest of our visual perception becomes simplified with only gross changes being picked up as relevant.

Hopefully we have established that much of what you perceive is not actually what you sense, it is informed by what you sense, but filled in with memory and expectation. Here is a good trick to do with babies. Put a ball on the table, place a cup on the ball. Lift the cup and the child sees the ball again. Now put the cup on the ball, move it to the side of the table and let the ball drop into your hand without shifting the height of the cup. Now lift the cup and see the look of surprise in the babies face. This illusion is called object permanence. We expect things to be where they were, whether we see them or not, and are surprised when they aren’t. This is the primary tool of the stage magician – distract you and mess with your object permanence.

We humans tend to apply the laws of motions physics to people in an attempt at something close to object permanence. That is, we assume that people continue doing whatever it is we have seen them do before, even when we don’t see them directly or at all. This can make it hard for us to see when people are not doing as they have always done as we shortcut seeing what people are actually doing and assume that they are continuing as they always have. This can be quite devastating to those of us who wish to change, by the same token, we can expect that people will and have changed, when they haven’t, creating the reverse of the perceptual illusion with equally potentially devastating results. While we can save ourselves troubles by seeing what is really there, often this is not actually easy or possible, so we need to keep an open mind about what may truly be. This takes more effort and more resources, and in times of stress we don’t always have these.

The Life Cycle of Psychiatric Diagnosis

After working with many people and speaking with many peers and consumers, I started to see a pattern for those who had been diagnosed.

I appreciate that this is going to be contentious, especially for people who either diagnose others, or have found that a diagnosis has given them a sense of identity.

This is a pathway to recovery and well-being beyond diagnosis. If practitioners used formulation to inform therapeutic styles rather than diagnosing to define someone, I believe that a lot of the following list could be skipped – that is, from steps 2 straight to 10. In effect, I believe that a diagnosis is much like a familiar, comforting scenic tour, which may indeed get to the final destination, but a detour that is not necessary to make.

Please keep in mind that this is a theory that has not been independently verified and no experiments or research have been done to confirm this life cycle. 

1- The Schism (between now self and society)
The feeling of separation creates distress. The distress results in behaviours which attempt to address the distress and are often mistaken for a fault in the person rather than an attempt to  save the self and survive the situation.

2- The Diagnosis of Behaviour
The behaviour is catalogue and compared to many others. The diagnostician is attempting to catalogue the behaviour to find a solution to the behaviour which is seen as disruptive to the person, without realising the behaviour is protective. The diagnostician often misses the underlying cause of behaviour and fails to solve the problem.

3- The rejection of diagnosis
The diagnosed person will often reject the diagnosis for various reasons. Often this is because the diagnosis is damning, stigmatising, degrading and not helpful towards a solution. Sometimes it is because the person perceives that the diagnosis implies fault in the person, either mental weakness or physical failings in the brain or genetics. Underlying this may be the intuition that the diagnosis does not address the root cause of the behaviours.

4- The doubt of self
As the diagnostically appropriate intervention continues, the person begins to doubt themselves — their identity, their sanity, their methods of survival. Often the questions of “what if they are right?”, “what if I am crazy?” and “they are professionals, surely they would know” enter the mind set of the person. Doubts undermine the survival mechanisms created to survive the root cause, often resulting in the person coping less. 

5- Acceptance of diagnosis
The person accepts the diagnosis as an accurate description of not only their behaviour, but their experience as well. Typical of diagnostically appropriate interventions requires “insight” – the acceptance of the diagnosis, and this is seen as diagnostically appropriate step towards minimising damage from the “illness”.

6- Incorporation of diagnosis into self
Often the person changes their behaviour to more closely match the diagnosis, making a better fit, and hopefully make the diagnostically appropriate intervention a better solution. Behaviours that protected the individual from the root cause are discarded for those which protect the self from the perceived dangers of the diagnosis. All actions are interpreted through the filter of the diagnosis. “I do this because I’m sick”, “I can’t change, I have no choice”, “we just have to find the right drugs” – all solutions are external to the person.

7- Redefinition of self as diagnosis
The diagnosis no longer describes the behaviour or the illness, but now describes the person. “I am a [disorder]” is a common phrase used by the person, reinforced by others saying “s/he is a [disorder]”. The sense of self identity has become corrupted by the behaviours originally adopted to minimise damage to self from a root cause. The person becomes the “illness”. This can result in isolation from others so as not to hurt them, or an excuse to take advantage of others since “I’m sick and can’t do it myself”.

8 – The rejection of self
Eventually the diagnostically appropriate solution is shown to not work, as the behaviours just recur, get worse, or adapt to the diagnostically appropriate intervention. The person is labelled as resistant, not wanting to get better and chronic. The person looses hope and faith, often retreating into the self, or acting out in violent, dramatic ways. These can be cries for help, acts against the self or an escape from grim and frightening reality. The person enters a crisis of identity.

9 – New definition of self without diagnosis
A solution to the above crisis of identity is to separate out the diagnosis from the self. This is not a return to a previous state, as too much erosion of the original self has occurred. Rather this is an evolution beyond diagnosis, seeking to put into context all of the experiences, good and bad, since the original schism. The person has gained both bad habits from the diagnosis and mal adapted survival traits, as well as a set of coping and survival tools.

10 – Acceptance of self
Evolving past defining the self allows for an acceptance of self as an existing being. There is an acknowledgement of pain, suffering and growth. If the person is able to go from Step 1 to here, then the person can move straight on to Step 11. Otherwise the person may need to pause to heal from erosion and self harm picked up from Steps 2-9.

11 – The healing of schism
The persons tries to work out where they belong in society, in life and what brings joy, contentment and meaning. The persons learns to love themselves for who they are, not what they do, not what others want them to do and not what they expect others think they should do. The behaviours learned to survive the original schism can be let go of if they are causing ongoing difficulties, or embraced if they create ongoing joy.