Part Three: Towards a Needs-Based System of Diagnosis
When we look closely at the current mainstream diagnostic and support system for so-called mental disorders today, the utter absurdity of it quickly becomes apparent. We have a system composed of literally hundreds of discrete “mental disorders” (those listed in the DSM), all of which are believed to be the direct result of soon to be discovered brain diseases, in spite of the fact that no reliable biomarkers have yet been found for any of them after a century of intense searching, a fact acknowledged just last month by the current designer-in-chief of this system himself. The disorders listed in this system have literally been voted in by a behind-closed-doors panel, the majority of whom are either directly or indirectly funded by an extremely powerful drug industry whose profit is derived directly from this system. And this system, as artificially crafted as it is, affects the lives of millions, arguably billions, of people all across the globe, creating a world in which many millions of people are placed on very powerful mind altering, aliveness dampening drugs for their entire lives in many cases, while genuine needs-based systems of support are tragically swept away. There’s no doubt about it—this enormous atrocity is the direct outcome of our positivistic thinking, combined with an essentially unbridled capitalistic system that itself has been shaped and fueled by positivism. There is, however, some hopeful news, in that a holistic paradigm such as the one presented here offers the possibility of a far simpler and more effective system of diagnosis and support.
In spite of the enormous complexity of living organisms, the issue of health is actually relatively simple when we consider it from the perspective of the holistic organismic paradigm being presented here. Optimal health is the default status of all organisms whose needs are adequately met, whether the organism be a single cell, a plant, a dog, a human being, a family or an entire society; and reduced health and even death may occur when these needs are not being adequately met. It’s really as simple as that. All organisms, by their very nature, have a strong desire and ability to maintain their existence and to work hard to meet their needs. Nothing special has to be added—there is simply nothing more natural than healthy existence. However, because organisms do have a lot of needs (and the more complex the organism, the more complex the needs), it’s nearly impossible to get through life without running into various obstacles to meeting these needs, obstacles I will refer to simply as nourishment barriers. Of course, there is the inevitable decline and ultimately death of all organisms; however, even death can be seen as an extremely important part of the process of life.
Based upon this framework, then, supporting an organism in either maintaining their health or in returning to optimal health after having lost it, consists really of only two things: (1) supporting the organism in continuing to meet the needs that are getting adequately met, and (2) identifying what needs are not being adequately met, if any, and supporting the organism in developing more effective strategies for meeting them. This will most likely include attempting to identify any nourishment barrier(s). Before looking more closely at these, it will help to first outline what I actually mean by “needs,” and then what I mean by “nourishment barriers.”
A Hierarchy of Needs
Based upon deep inquiry into subjective experience (as discussed earlier), we can say that there exists a hierarchy of needs, with those needs most fundamental to basic existence coming first. These include the basic requirements of the body—air, healthy food, water, adequate temperature/shelter, an adequate balance of rest and fitness—and the basic requirements with regard to the organismic process as a whole—both enough peace and enough meaning so that the organism’s natural desire to maintain one’s existence will continue. These most fundamental of the needs are then followed by the basic needs within the self/other dialectic (autonomy and connection with others), which is then followed by a wide array of needs that can generally be categorized beneath each of these more fundamental categories (see Figure 1 above for this basic structure of needs as it pertains to the human organism). It’s important to acknowledge that these overarching categories (existence/peace and autonomy/connection) are dialectics rather than dichotomies, so we find an interesting dynamic typical of dialectics in that having needs met on “one side” generally supports rather than hinders those on the “other side” being met, while none of these can ever be perfectly satisfied (e.g., existence will never entail perfect peace, and perfect autonomy can never coexist with perfect connection with others).
Considering the idea that optimal health is simply an innate quality of all organisms whose needs are adequately met, and that all organisms continuously strive to meet their needs, we can assume that when needs are not being met, there must be something that is acting as a kind of nourishment barrier. This barrier could be the simple lack of availability of a particular resource (such as the lack of water for a person who spent a little too much time in the desert, or the lack of affectionate love for a stray kitten). Or it could be that a particular resource is available, but that something has happened to the organism itself which has resulted in its inability to take in and be nourished by the resource.
Recall that an organism consists essentially of an organismic process from which emerges structure, both in the form of the subjective cognitive constructs and in the closely related physical structure (see Figure 2 above). The basic organismic process itself is essentially invulnerable—it’s innate within the very fabric of living beings and continues to function as long as there is life. However, the structures that provide enhanced capacity and specific guidance (the cognitive constructs and the body) can develop significant problems that reduce the various capacities within the organismic process. So when assessing for barriers to nourishment, it’s often helpful to try to determine which of these two aspects of the structure of the organism is most directly associated with it, although we need to acknowledge that this distinction is not always so clear given the very close relationship between these two. It may also be helpful to consider which phase of the organismic process—perception, interpretation/evaluation, desire, response, and learning/adaptation—is most directly affected by the nourishment barrier.
Although the topic of nourishment barriers that are most directly associated with bodily structure generally falls outside the area of my own expertise, I’ll give a few examples here of some of the more obvious such barriers that can occur. A damaged eye or ear will likely reduce the capacity for perception—the process of perception itself will still occur as long as there is life (being a fundamental component of the organismic process), but such damage will likely lead to a significant reduction in the organism’s capacity in this regard. The loss of a limb will clearly reduce the organism’s capacity for both perception (somatic perception in this case) and response. Damage to the central nervous system, ingestion of a psychoactive substance, or invasion by a harmful parasite can all lead to reduced capacities with regard to any and every phase within the organismic process, depending upon the particular damage done. And the list of other such possibilities is virtually limitless.
Turning to the idea of nourishment barriers that are most closely associated with the cognitive constructs, we enter the territory of what are generally known as mental disorders (also often referred to as “mental illnesses”)—those kinds of distressing subjective experiences that the DSM and other similar systems have tried so hard to categorize. The paradigm presented here offers us a way to recognize that there really do exist more or less common patterns of distress and limitation (i.e., nourishment barriers) that are most closely associated with one’s cognitive constructs without having to (a) try to reduce them to some pathological disease process occurring within the body, or (b) disregard the organismic wisdom (the continuous drive towards health and the meeting of one’s needs) that underlies these barriers.
Regarding the assumption that problems occurring within the mind must imply some physiological disease process, it’s important to acknowledge that this assumption comes straight from the outdated positivistic worldview, with its belief that everything can be reduced to matter (i.e., the body). Of course, as has been discussed, for anything that occurs within the mind, there will certainly be directly corresponding changes occurring within the body—after all, body and mind are merely two different perspectives of the same process. And the more extreme a particular experience or change is with regard to one, the more extreme an experience or change we would expect to find within the other. Indeed, we have identified significant and lasting changes occurring within the body as the direct result of emotionally traumatic experiences and other kinds of extreme subjective experiences. However, this does not imply that a disease process is occurring. Quite to the contrary, I believe it’s more appropriate to view these kinds of changes as simply being the physical manifestation of the organism’s attempt to adapt to these challenging experiences in the best way that it can. Even with this wisdom/health-oriented perspective, however, it’s important to recognize that once particular patterns are set up to deal with difficult situations, these can often result in lasting limitations (nourishment barriers) if and when the situation improves. In other words, a distressed organism is often put in the situation of having to sacrifice its capacity with regard to meeting one kind of need in order to reinforce its capacity with regard to meeting another. One example of this is the development of a suntan, which reduces the harm caused by UV radiation at the cost of a diminished capacity to synthesize Vitamin D via sunlight; another example is the development of a greater capacity to shield oneself from the pain of emotional rejection at the expense of reduced capacity for experiencing more satisfying intimacy with others.
Let’s turn now to look at the most common kinds of nourishment barriers that can result from issues within one’s cognitive constructs, and the phases of the organismic process that these are most likely to affect:
Problems with perception
Arguably, one’s cognitive constructs rarely have any direct effect on our raw perception of the world (the key word here being “raw”). Any problems that arise here are most likely to be associated with bodily structure—some physical problem occurring within the organs of perception themselves or the neural networks associated with them. An important exception to this rule is that one’s cognitive constructs do guide an organism with regard to what it is the organism chooses to pay attention to. I believe, however, that any nourishment barriers associated with attention are more appropriately considered to be problems with either interpretation/evaluation or response, as discussed below.
Problems with interpretation/evaluation
The interpretation/evaluation phase is guided greatly by one’s cognitive constructs, so many and perhaps most of the symptoms considered to be associated with so called mental disorders are likely to be associated with issues occurring within this phase.
Limiting core beliefs: These are beliefs that have developed that interfere with meeting certain needs. We can assume that such beliefs aren’t just formed out of thin air—after all, the cognitive constructs and the beliefs and interpretations contained within them are fundamentally in the service of meeting the organism’s needs. However, due to experiencing certain kinds of difficulties in life, it is very common to come to believe that certain needs must be sacrificed in order to meet other needs (e.g., sacrificing intimacy for safety or autonomy, authenticity for belonging, meaning for ease, etc.). While these assessments may be more or less accurate initially, if they remain in place after the situation has changed and whatever resources were scarce are now more abundant, then a problematic nourishment barrier can result.
Affective disorders (including the so called anxiety disorders and so called mood disorders): These are generally the result of assessing certain emotions themselves as being dangerous in some way, which in turn results in a combination of heightened vigilance and aversion towards these emotions, which in turn increases their intensity and leads to a painful positive feedback loop and an entrenched condition of feeling overwhelmed by the very same emotions one is trying so hard to avoid. Since emotions are actually just messengers letting us know how we’re doing with regard to meeting our needs, this is akin to “shooting the messenger.” It can be seen essentially as a strategy to achieve short-term ease but at the cost of increased long-term suffering.
Somatoform and pain disorders: These are similar to the affective disorders in that they are generally the result of assessing sensations that occur naturally within the body (often interoceptive sensations, that are closely associated with emotions) as representing a disease or other serious problem. This generally results in significant aversion towards these sensations, that ironically increases one’s vigilance towards them and actually results in them being felt even more intensely, leading to a painful positive feedback loop and eventually a serious difficulty with meeting one’s needs for peace and ease.
Addictions and impulsivity: Generally speaking, these are probably also similar to the affective disorders in that particular emotions or other inner experiences are assessed as being particularly harmful, which in turn leads to the propensity towards behaviors that elicit powerful pleasant feelings or even just simple relief (such as certain psychoactive substances, extreme sports, eating excessive amounts of “junk food,” risky sexual behaviors, etc.). In other words, particular emotions or inner experiences are experienced as so painful or harmful that the person resorts to behaviors that offer short-term relief at the cost of longer-term harm. The use of psychiatric drugs would also generally fall into this category. Obsessive-compulsive type behaviors also generally fit in here in that the compulsive behavior (e.g., repeatedly washing one’s hands, intensive “checking,” etc.) typically provides short term relief from the unpleasant affect triggered by the particular “obsession” (concern about germs, concern about causing harm, etc.), but at the expense of increased long-term distress as their lives become increasingly constricted.
Other kinds of intrapsychic conflict: These include other kinds of distressing or limiting patterns of thought or behavior similar to the affective, somatoform and impulse disorders mentioned above, in that the person is identifying some aspect of their inner experience (emotions, sensations, thoughts, images, impulses, etc.) as being harmful in some way, and so gets caught up in a kind of wrestling match with her/his own inner experience. This can lead to all kinds of painful intrapsychic conflicts and distressing patterns of thinking and/or behavior.
Trauma: Trauma is generally believed to be the result of mistaking a particular threat (typically that which initially caused the trauma) as continuing to exist in spite of significant evidence to the contrary, which suggests that this would generally be considered an issue most closely related to this phase. Some researchers, however, have come to the conclusion that a more accurate way of perceiving trauma is to see it as a kind of aborted response—the well-established fight-flight-freeze response remaining “stuck” somehow in the freeze mode—which suggests that trauma, or at least certain kinds of trauma, may be more appropriately considered an issue with the response phase, or perhaps a more complex issue that spans across both of these phases.
Anomalous beliefs (so called delusions): These refer to the development of belief systems that are not in accord with the general belief system held by the larger social group to which the person belongs (i.e., consensus reality). From the constructivistic and needs-based paradigm presented here, what’s of utmost importance is exploring whether these beliefs are interfering with the meeting of one’s needs, rather than trying to determine if the beliefs are “true” in any kind of absolute sense. Many anomalous beliefs actually are not particularly limiting; however, the very fact that they are nonconsensus indicates that they may make it more difficult to meet needs associated with belonging and acceptance from others who are more identified with the mainstream culture.
Anomalous perceptions (so called hallucinations): These refer to perceptions within any of the five somatic sensory modalities that are not in accord with the general perceptions of other members of one’s larger social group (i.e., consensus reality). It can be helpful to recognize that these are often the result of mistaking events occurring within one realm of perception (e.g., imagination, memory, the collective unconscious, etc.) as occurring within another (vision, hearing, somatic sensation, etc.). Again, when offering support, it’s not trying to determine whether or not they are objectively “true” that is likely to be most helpful, but determining whether or not they interfere with the meeting of one’s needs.
Psychotic disorders: Finally, we have disorders consisting of distressing anomalous perceptions and/or beliefs, which are usually combined with one or more of the other types of nourishment barriers in this and other phases of the organismic process. These conditions are generally given labels such as schizophrenia, bipolar disorder, mood disorders with psychotic features, schizoaffective disorder, etc., an act that probably causes much more harm than benefit. Such labeling suggests that all such conditions have a common underlying issue and therefore benefit from a common “treatment” (typically antipsychotic or mood stabilizing drugs). This is an idea that has not even come close to being substantiated—in fact, quite the contrary, especially in the light of the framework presented here, which suggests significant heterogeneity among many of these different conditions. Another problem with such labeling is that it often suggests a problem when there is none. For example, there are many people who have anomalous perceptions or beliefs without any significant nourishment barriers being associated with them. Having said this, however, it does appear that there may be one particular pattern of experience that may be seen to have a common underlying issue—that which we often think of as a more “florid” kind of psychosis. See Problems with learning/adaptation below for more about this.
Problems with desire
Arguably, we never really have a problem with desire itself (recall that desire in this context includes the broad categories of craving and aversion, and the wide array of emotions that these give rise to). Emotions are, after all, just the messengers. They are simply the generated desire or impulse to respond in a manner appropriate to the assessment that was made in the previous phase. So when we develop the so-called affective disorders, we are essentially making the mistake of trying to shoot the messenger, which is why I feel these are more appropriately deemed a problem with assessment rather than being a problem with the process of desire itself (see discussion of these above).
Problems with response
Response (also commonly referred to as behavior) actually involves two parts: determining the best response to meet one’s needs within the context of the current situation, followed by the response itself. So one’s cognitive constructs play just as important a role here as they do in the interpretation/evaluation phase. Clearly, many problems can result in this phase considering that this is the phase where direct action takes place, and of course, all actions have consequences, which is the point of acting, after all. I suspect, however, that the vast majority of problematic responses are simply the natural result of problems occurring within the interpretation/evaluation phase (as discussed above), and so would be more appropriately considered as nourishment barriers within that phase.
Addictions and impulsivity: As mentioned above, most likely the majority of addictive and impulsive behaviors are more appropriately considered issues with interpretation/evaluation. However, another reason such behaviors may occur, perhaps especially those sometimes labeled “ADHD,” is that the person doesn’t spend enough time considering the most effective response strategy before moving into action, and therefore often acts in ways that are not ideal for meeting one’s needs. This could be the result of a number of different factors, including a fixation on instant gratification of one’s needs at the expense of long term nourishment, a simple mismatch between the general temperament of the individual and those who she/he regularly interacts, or experiencing a chronic hyperarousal as the result of trauma or generally feeling unsafe in some way.
“Thought disorders”: It turns out that many and perhaps most of the experiences referred to as “thought disorder” are actually not the result of a person having their thoughts literally disordered (although this can be the case—see other kinds of intrapsychic conflicts above). This term refers to a “symptom” that is sometimes assigned to people diagnosed with a psychotic disorder, specifically referring to the act of speaking in ways that others find difficult to understand. Research suggests that in most cases, these would be more accurately considered a communication disorder, since the actual problem being pointed to is ineffective communication. In this case, we could consider this a response issue (the inability or unwillingness to respond effectively to the situation), but only if the person’s speech is actually interfering with the person meeting their needs. R. D. Laing and others have pointed out some interesting cases in which the person actually did appear to be meeting certain needs with this kind of behavior.
“Catatonic” or bizarre behavior: These are generally described as being either “bizarre” behavior or the lack of behavior altogether. The first consideration is that the “problem” may be primarily with the observer, in that she/he simply doesn’t understand what is going on for the person exhibiting this behavior, and so assesses it as a “problem.” Some people have reported, for example, that they utilized behavior that seemed “bizarre” to others (such as pacing or rocking oneself for long periods of time) as a way to provide some relief from overwhelming affect; so this would actually be considered an effective response to meet their needs given their situation, and not a nourishment barrier. There are individuals, however, who have reported experiencing significant distress during times in which they felt they either couldn’t stop moving in a particular way or they couldn’t move at all. People sometimes describe this kind of experience as occurring when they feel trapped in a particularly intense state of ambivalence (feeling intensely pulled to act in contradictory ways), which would indicate a kind of nourishment barrier that could either be seen as primarily associated with response or interpretation/evaluation (or some combination of the two), depending upon the specific details.
Problems with learning/adaptation
Rigid vs. Flexible Cognitive Constructs: Learning, or adaptation, is where an organism intentionally changes its own structure—both the mental structure (one’s cognitive constructs) and the associated physical structure— in an attempt to maximize efficiency with regard to meeting its needs in the face of an ever changing environment and an ever changing self. On the mental level, this manifests as changes within one’s cognitive constructs, and on the bodily level, this manifests as the modification of any relevant part of the body, including muscle tissue, bone density, skin pigmentation, neural networks, the components of the immune system, etc. With regard to changes made to the cognitive constructs, we can say that there is a more or less optimal degree of flexibility. If they’re too rigid, the ability to learn and adapt to changing circumstances is diminished. If they’re too flexible, achieving any kind of sustainable balance or order becomes difficult, and the potential to slip into a chaotic process (i.e., psychosis) becomes more likely.
Florid psychosis: It’s generally the condition of highly flexible cognitive constructs and the ensuing chaos that results in the kinds of conditions we often think of as psychotic disorders, especially the more florid varieties—one’s cognitive constructs become highly unstable and can change relatively quickly and radically. It appears that this can occur for a number of reasons, including as the result of certain powerful psychoactive drugs or other powerful mind altering experiences, and even as a process initiated intentionally by the organism when a particular configuration of one’s cognitive constructs has resulted in an intolerable and/or unsustainable way of being (an idea that emerged in my own doctoral research, and was presented in my book, Rethinking Madness—you can also find a brief summary of these ideas here). This process, then, could be seen as the organism’s attempt to reorganize one’s cognitive constructs at a very deep level, risky and precarious as that may be. Since the cognitive constructs play a particularly important role in guiding the organismic process, when they fall into such a chaotic state, it’s easy to see why the entire organismic process is so profoundly affected, and why so many of the different nourishment barriers that have been listed above can appear. Recalling that within living systems we have come to recognize chaos as being a particularly important condition in allowing for the emergence of new orders, it actually makes a lot of sense that an organism would intentionally initiate such a chaotic state as part of a desperate attempt to achieve a more sustainable order.
— Paris Williams
A version of this post previously ran on the website Mad in America.
LOOK FOR PART FOUR OF FOUR COMING NEXT WEEK IN THE NEW EXISTENTIALISTS!