This post delves into the truth about mental health diagnoses and how the medical model has created learned helplessness. Read on if you want to learn more.
Mental Health Diagnosis: You’re not Broken
Sometimes, when I teach a mental health skill– like how exercise treats depression or how mindfulness is a powerful tool to decrease anxiety, people will tell me “That’s cool, but I have Clinical Depression” and what they usually mean by that is they have been diagnosed with depression, and they assume that that diagnosis means that their depression is a biological trait, a genetic trait, something inherent, a chemical imbalance, part of their being or identity, and they assume is that it’s going to be a permanent characteristic that they just cope with for their entire life.
This is a misunderstanding of how mental health diagnoses work. We have this interesting problem in America where we’ve applied the medical model to mental health, and it’s created a lot of learned helplessness. In our attempts to remove the stigma from mental health, many people have come to believe that all mental illnesses are permanent, genetic traits. And it’s just not true. Because anxiety disorders, depression, trauma, and many other mental health conditions are really, really treatable.
I saw this in action when I worked in residential treatment, clients would come in with severe depression, anxiety, or trauma, and sometimes a bunch of other co-occurring diagnoses like substance use, learning differences, eating disorders and more. One of these programs did robust testing before and after treatment and found that at discharge 93% of clients no longer met the criteria for depression or the issue they originally came to treatment for. We also found that many of these results lasted for years after treatment. We saw people change in a massive way, they became so much healthier and happier. Now granted, in residential treatment, these clients were getting literally hundreds of interventions a week- from a daily schedule to exercise to nutrition and medical treatment, they got tons of support from professionals. But you can create these changes too, little by little as you apply one new skill at a time. For many people depression, anxiety, or PTSD can be completely resolved. And for others, the symptoms can be greatly reduced. Research shows that over 30% of people recover from depression without any treatment within 6-8 weeks and 80% recover within a year.
So in this post, we’ll talk about what a mental health diagnosis really means, and how an accurate understanding can open doors for you to change.
Let’s start with a story. Once upon a time, there was a huge elephant. This elephant was super strong, he could uproot enormous trees and lift heavy logs. However, despite its extraordinary abilities, the elephant was held captive by a small rope tied around one of his legs.
One day, a wise traveler approached the elephant’s keeper and asked why this mighty creature didn’t break free from the seemingly flimsy rope that restrained him.
The keeper explained, “When the elephant was very young, we used a similar rope to tie him up. At that age, the rope was strong enough to hold it back. As the elephant grew, it never realized his own strength. He believed that he could never leave because of the rope. The truth is, that this elephant had the ability inside to break free from this rope easily, but because he didn’t believe that he could, he never did.
This story is an example of Learned Helplessness. That baby elephant couldn’t break the rope when he was tiny, just like many people get overwhelmed by depression or anxiety when they don’t have support, resources and skills. But unfortunately, many people believe that they will never be able to overcome depression or anxiety, and because they believe they can’t, they don’t.
The Medical Model Approach to Mental Health- The Flu Example
OK, so first let’s talk about where this huge misunderstanding came from. Let me give you an example of a diagnosis from the medical model.
Let’s say you have symptoms like vomiting or diarrhea, body aches, and chills. The doctor sees you and swabs your throat, the lab runs the test and diagnoses you as having the flu. That medical diagnosis means that influenza virus is what’s causing your symptoms.
If on the other hand, you have symptoms like sadness, low energy, frequent crying spells and you’re feeling hopeless and suicidal. And if you went to your doctor, and you have at least 5 out of 9 of these symptoms, he would diagnose you with depression. But what’s different about mental health diagnoses is that when they say “You have depression” they’re not telling you anything about the cause of your symptoms. They’re telling you “This cluster of symptoms, we in the scientific community call it depression but we don’t know what is causing it for you.” Or they may give you a survey or an assessment that ranks your symptoms on a numerical scale, with a clinical cutoff- so for example if you take the Beck Depression Inventory and your score is over 20, you have moderate depression or higher. But again, all that’s telling you is “you have these symptoms” it doesn’t tell you the cause. A depression diagnosis is not the cause of your symptoms, it’s the outcome of your symptoms. Right now we have a very limited way of understanding the individual biological factors that lead to depression. No doctor is going to scan your brain or extract brain fluid to diagnose depression.
So the medical model doesn’t perfectly fit mental health and it confuses a lot of people. Many mental health professionals prefer the bio-psycho-social model. To explain this I’m going to use depression as an example, but this really applies to most mental health conditions.
One of my favorite conceptualizations of depression is drawn from Dr. Charles Raison, he’s a psychiatrist, professor of psychiatry, and the co-author of The New Mind-Body Science of Depression. He says (and I summarize) “Depression doesn’t exist as a single thing or cause, it’s causes are incredibly complex. It may be a 1000 different disease states. It does exist. It is a real experience. And it’s common to all societies across the world, including hunter gatherers. Depression is the most common way humans break down under adversity”
Now Humans are inherently very resilient, we can handle a lot of adversity, but when your mind and body get overwhelmed, it’s like your body shifts into a shut down state for self-protection.
Depression has many contributing factors. And in my Change Your Brain course, you’d learn that for some people their depression is contributed to by a nutrient deficiency or by lack of sleep, for other people their thoughts and actions lead to feeling hopeless or overwhelmed. Things like childhood trauma, abuse, and faulty thinking can also contribute to depression, and so can inflammation, allergies, and loneliness. We also know that genetics are involved.
Twin studies have shown us that depression is around 35% heritable, meaning that there’s around a 35% chance that your genes are contributing to your depression. The estimates for Anxiety are between 27% and 40%, and for some other mental health disorders, genes play a much bigger role. Research indicates that a genetic predisposition for depression might get turned on by life circumstances like abuse or trauma. But, if 35% of depression is genetic, that also means that about 65% of the rest of the contributing factors has to do with other causes.
This is actually really hopeful, because when we can decrease just a few of these hits, we can actually overcome depression. We know that medication helps around 65% of people reduce the symptoms of depression, research shows us that there are a ton of effective treatments for depression. When we improve social connection, or physical health, when we change thinking patterns, or process trauma, or improve nutrition- all of these factors can tip the scale toward no longer meeting the criteria for a diagnosis.
Anxiety Disorders are similar, they are caused by a combination of factors and we can treat various aspects of anxiety- from the biological side of things to the psychological and behavioral side of things.
So please don’t automatically assume that you’re stuck feeling this way forever. It’s just not the case and that’s not what a mental health diagnosis really means. What I’d like for people to know is that a mental health diagnosis does not mean “You have this” or “You are this” it means that “You are experiencing this.”
Mental Illness Doesn’t Have to be Permanent
Because a diagnosis doesn’t tell you the cause, it doesn’t say “You have this gene and it’s the cause” when we reduce or eliminate the symptoms of depression or anxiety, you no longer qualify for the diagnosis. What I’m saying is that mental illness isn’t always permanent.
When we fuse our identity with our diagnosis, when we label ourselves as “A depressed person” or “An anxious person” we limit our options, we create learned helplessness. Just like that elephant, we tie ourselves down and limit our potential, simply because we don’t believe our life could be different than it is. You see this when people who have identified with their diagnosis, they might have a bad day and say “Why is life so unfair! Why do I have to feel this way! Why do I have depression! It makes me feel so awful!” Instead of looking at what caused the bad day and exploring what options you have to make life a little better. When people use their diagnosis as the explanation for why they feel the way they do, it limits their options.
So please don’t resign yourself to just giving up to just feeling miserable for the rest of your life. Tiny changes over time can add up to massive results. Let’s keep chipping away at it!
Depression Is Real. It’s Not a Weakness. It does have Biological Contributing Factors
That doesn’t mean a mental illness is not real. It is real. And most of the people I work with are doing everything they know to make things better, but nothing’s working. Mental Illness is not laziness, it’s not a moral failure, but it’s also not your identity. Some mental illnesses are chronic, but that’s not the first assumption I would make about a case of depression, anxiety or PTSD. It’s also not inherent to who you are. I see it as being more about a lack of resources, you don’t know what skills can help you to overcome your challenges.
It’s certainly not helpful to blame yourself or beat yourself up for feeling the way that you’re feeling. Let’s take a step back and just say “Is there something you can do that’s going to improve your life?” Hold labels and diagnoses flexibly. Use a diagnosis as it’s helpful for you, but don’t form it into your identity. Explore multiple treatment options before deciding that your situation is chronic.
So if you have a mental health diagnosis please don’t resign yourself to just coping with it or feeling miserable for the rest of your life. There’s so much that can be done to resolve the symptoms and sometimes the cause of mental illness.
This video is day 7 of my 30 days to less anxiety course. You really can learn the skills to change your life. So stay tuned, let’s get better at feeling.
You can learn more about the course below.