How The Medical Model Creates Learned Helplessness- Mental Health Diagnoses - Anxiety Course 7/30

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, "Oh, that's cool, but I have clinical depression. " And what they usually  mean by that is that they've been diagnosed with depression and they assume that their diagnosis  means that their depression is a biological trait, a genetic trait, or it's something inherent,  or it's a chemical imbalance - that it's part of their being or their identity, and they assume  that it's going to be a permanent characteristic that they just cope with for their entire life.  Now, 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.  Anxiety disorders, depression, trauma and many other mental-health conditions are really really  treatable.

Now, I saw this in action when I worked in residential treatment. Clients would come  in with severe depression, anxiety, trauma, and sometimes a bunch of other co-occurring diagnoses  like substance use, learning differences, learning disorders, eating disorders, and and more.  Right?

Like many of my clients had six or eight diagnoses. And one of these programs did robust  testing before and after treatment and found that at discharge, 93% of clients, they no longer met  the criteria for depression or the issue that 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 to medical treatment.

They got tons of support from professionals. Right? But you  can create these changes too, little by little, as you apply one new skill at a time.

So 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 six to eight weeks, and 80% recover within a year. So in this video  we're going to talk about what a mental-health diagnosis really means and how an accurate  understanding can open doors for you to change.

[Music] Okay, 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 his extraordinary abilities, the elephant was held captive by a small  rope tied around one of his legs. Now, one day a traveler approached the elephant's  keeper and asked why this mighty creature didn't break free from the seemingly flimsy rope that  held him back.

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. And as the elephant grew  he 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. And just like that,  many people get overwhelmed by depression or anxiety when they don't have the support, the  resources, or the 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.

Okay. Let's  talk about where this huge misunderstanding came from. Let me give you an example of a diagnosis  from the medical model.

So let's say you have symptoms like vomiting or diarrhea, body aches,  chills, and 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 the influenza virus is what's causing your  symptoms. Now, if on the other hand you have symptoms like sadness, low energy, frequent crying  spells, and you're feeling hopeless and suicidal, right, if you went to your doctor and you have at  least five out of nine 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, we call it depression, but we don't know what is causing it for you. "  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, right?

But again, all that's telling you is  that 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.

Now, 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 I think it confuses a lot of people.

Many mental-health  professionals prefer the biopsychosocial model. So to explain this I'm going to use depression as  an example, but this really applies to most most mental-health conditions. So one of my favorite  conceptualizations of depression is drawn from Dr Charles Raison.

He's a psychiatrist, a professor  of psychiatry, and the co-author of the book The New Mind-Body Science of Depression. And I'm going  to summarize what he says. He says depression doesn't exist as a single thing or cause. 

Its causes are incredibly complex. It may be 1,000 different disease states. It does exist. 

It is a real experience, and it's common to all the societies across the world, including  hunter-gatherers. He says depression is the most common way humans break down under adversity. Now,  I would I would change that just a little bit, and I would say the depression response is  actually a chance for our body to rest and heal and recover and try something new when what  we've been trying seems hopeless.

So I take a little bit different approach to it, but this is  how he describes it. And I believe that humans are actually 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 this shutdown state for self-protection. And depression has many contributing factors. And in  mine Change Your Brain course you learn that for some people their depression is contributed to by  a nutrient deficiency or by a lack of sleep, and 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, but so can things like inflammation and allergies and loneliness.  Then we also know that genetics are involved. So 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 similar; they're somewhere between 27% and  40%. Now, 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  contributing factors has to do with other causes.

Now, this is actually really helpful because when  we can decrease just a few of these hits we can actually often overcome depression. Now, we know  that medication helps around 65% of people reduce the symptoms of depression, and research  shows us that there are a ton of other effective treatments for depression too. So 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're 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 if  you get a mental-health diagnosis that this is permanent. Don't assume that you're stuck  feeling this way forever. It's just not the case, and it'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 you are experiencing this. Because a diagnosis doesn't  tell you the cause.

It doesn't say, "You have this gene, and here's the cause. " When we reduce or  eliminate the symptoms of depression or anxiety, you no longer qualify for the diagnosis. So 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, we  limit our potential, simply because we don't believe our life could be different than it is. 

And you'll see this when people who have over over-identified with their diagnosis, they  might have a bad day and they might say, "Oh, why is life so unfair? Why do I have to feel this  way? Why do I feel so depressed?

Why does it make me feel so awful? " instead of a more flexible  approach where they maybe look at what caused a bad day and exploring what options you have to  make your life better. So when people use their diagnosis as an explanation for why they feel  the way they do, it simply limits their options.

Please don't resign yourself to just giving  up, to feeling miserable for the rest of your life. Tiny changes can add up over time to huge  results. So I would just say, like, let's keep chipping away at it.

You don't know what you don't  know. There's so many options for treatment. Like, let's learn what some of them are and try them  out.

I do want to say depression is real. It's not a weakness. It does have biological contributing  factors.

And by me saying, like, we're gonna shift away from this medical model, it doesn't mean that  mental illness isn't real. It is is real. And most of the people I work with are doing everything  they know to make things better, but the things they've tried in the past just aren't working.

I  want to clarify: mental illness is not laziness. It's not a moral failure. But it's also not your  identity.

Now, some mental illnesses are chronic, but that's just 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  more as being about a lack of resources; you just don't know what skills can help you to overcome  your challenges.

I would say it's certainly not helpful to blame yourself or beat yourself up for  the way that you're feeling. You say, "Let's take a step back," and just ask, is there something  that you can do that's going to improve your life? If your gut reaction to that question is  like, "I'm offended," then it's possible you've over-identified with your diagnosis. 

Instead, hold labels and diagnoses flexibly. Use a diagnosis when it's helpful for you, but  don't cling to it so tightly that it limits your options. Explore multiple treatment options before  deciding that your situation is chronic.

Again, if you do 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 is so much that can be done to resolve the symptoms and sometimes the cause of  mental illness. You really can learn the skills to get better at feeling and change your  life.

Um this video is day seven of my Break the Anxiety Cycle in 30 days course. If you'd  like to watch the entire course without ads, with all the bonus exercises, with the  workbook and the live Q&A's, please check out the link in the description. And again,  thank you so much for watching, and take care.