Down by the Riverside motel
It’s ten below and falling
By a ninety-nine cent store
She closed her eyes and started swaying
But it’s so hard to dance that way
When it’s cold and there’s no music
~ Hold On, Tom Waits
It’s hard to heal from depression when you have no home. Treating mental health while ignoring the social context of people’s lives is a little bit like this. Poverty, racism, transphobia, disconnection – to name a few – are not separate from mental health, they are factors in it. You can’t treat one without addressing the other.
The go-to resource for diagnosing mental health issues is the Diagnostic and Statistical Manual, or DSM. It’s considered by many to the authoritative reference on psychiatric illness. As I’ve mentioned before in other articles: a potential danger in one perspective reigning supreme is that we tend to accept it as ‘truth’, drowning out perspectives that challenge the status quo. Dominant narratives often come from the top down, positioning medical and government agencies as experts and discounting lived experience.
There are benefits to consulting the DSM. Sometimes diagnostic clarity guides treatment (medically and therapeutically) in a helpful way. For example, if someone has a diagnosis of bipolar, it’s unlikely that they will be prescribed a stimulant or an SSRI, as both can trigger mania. In this circumstance, the diagnostic clarity that the DSM offers creates greater accountability from the helper, and increased safety for the person receiving help.
Here are a few potential dangers inherent in the medical model of mental health:
- Almost everything in the DSM is classified as a disorder. Language shapes our understanding, and disorder implies a ‘wrongness’ or pathology.
- Though some mental health diagnoses are fairly stable and consistent, many more are subjective – they come and go as social norms change. Transgender identity was classified as a disorder until the most recent edition of the DSM in 2013; homosexuality as a mental illness wasn’t removed until 1973. The work of LGBTQ+ activists has brought change to cultural understanding broadly, and the DSM specifically.
- Its emphasis is on symptoms rather than context, and an individual’s mental health symptoms always occur within a broader social context. Which pill, for example, treats a person’s depression when they’re homeless?
Fortunately, there are mental health activists out there doing very good work. By and large, they have lived experience with mental health issues, ranging from bipolar and schizophrenia to anxiety and trauma. If you’re hungry for differing perspectives on how to consider mental health issues, please check out the following sites.
One of the best sites I know of, I refer (and defer) to it frequently. The project:
…seeks to overcome the limitations of a world determined to label, categorize, and sort human behavior. We envision a new culture that allows the space and freedom for exploring different states of being, and recognizes that breakdown can be the entrance to breakthrough. We aim to create a language that is so vast and rich that it expresses the infinite diversity of human experiences. We demand more options in understanding and navigating emotional distress and we want everyone to have access to these options, regardless of status, ability, or identity.
The site is a font of resources for navigating crises; considering psychiatric medications; alternate perspectives on hearing voices; and much more. I cannot recommend it strongly enough as both a community for “people who experience the world in ways that are often diagnosed as mental illness”, and an educational tool for those wanting to understand more.
This enterprise “is a non-profit whose mission is to create a platform for rethinking psychiatric care.” It aims to challenge the ‘disease model’ approach to mental health, and houses a vast collection of articles on the intersections of science, psychiatry, and social justice. You will find a library of books written by “psychiatric survivors”; educational resources for parents; and reviews of research on psychiatric medications.
The invitation from this movement is to “take charge of your mental health through enquiry and action.” It offers guidance on questions to ask of oneself, one’s helpers, and the current medical system of diagnosis and treatment. You can find a reading list of over 100 books that offer alternative perspectives to the dominant mental health paradigm. There’s also an interview series with innovative thinkers in the field, covering topics ranging from indigenous views on mental health, to first-person narratives on madness.
These websites are but a sampling of the array of conversations we can have on mental health, yet there’s room for even more. If you’re someone who experiences the world in ways traditionally defined as mental illness, I hope you find some connection and empowerment through these sites. And for those who have never experienced the stigmatization that can accompany a label, may these websites illuminate and educate. Let’s co-create a culture where mental health is much more than diagnosis and medication. While these may be a part of healing, we must also address the multiple factors that comprise true well-being, from dignity and respect to food and housing.
In health and well-being, Deirdre.