Many to One Relationships of Mental Health Conditions

The other day I met up with someone who I’m hoping to do a podcast interview with. The interview will be about The Portrayal of Psychosis in Comics and Films. We met up to get to know each other first. As you can imagine, we spoke a lot about mental health, particularly psychosis. Him and his partner said some people, including professionals, have a very fixed understanding of particular mental health conditions. For example a lot of mental health professionals assume that hallucinations in psychosis can be completely controlled with medication, i.e. complete cessation of hallucinations will occur, sadly this is not the case for this particular person, and yet professionals continually disagreed with them even when they showed them research that backed up their own personal findings. The level or both ignorance and arrogance in these mental health professionals is astounding. It is the individual who knows more about their mental health condition than anyone else. Even the best psychiatrist in the world doesn’t know your individual experience better than you.

Many to One
U is the set of possible causes for a mental health condition, e.g. neurological damage, behavioural conditioning, hormonal imbalance etc. V is the set of mental health conditions, e.g. PTSD, anxiety, bipolar etc.

The other issue I feel is not understood by professionals, is that mental health conditions have what I call a multiple to one relationship. That is, multiple causes causing the same condition. For example depression could be caused by a difficult childhood and a small amount of neurological damage caused by an accident in middle age. In this case counselling alone might not help, as even though the difficult childhood issue could be addressed, the small amount of brain damage is unlikely to be fixed by counselling (although brain chances do occur with counselling, a specific locally damaged area, is unlikely to heal).

Some conditions, physical or mental, might be one to one. i.e. have a single cause, for the same condition. These can fairly be seen as being the same condition, however a condition that looks the same externally, but which has multiple causes, is not the same condition.

The unfortunate pattern I see, is that mental health professionals seem to treat mental health conditions as one to one, or at best many to one, but with the same causes for each condition.

It could be worse, imagine your depression is causes by childhood abuse, neurological damage caused by a bang to the head at a certain age, and a hormonal imbalance. Fixing one out of three, won’t cure the condition, neither might fixing two out of three. The problem here is that someone might get counselling for their childhood abuse, but the psychiatrist is ignorant of the other two causes. Again the hormonal imbalance would not be caught by a psychiatrist as in the West we still separate the body and the mind within medicine. So you would have to get the hormonal situation fixed by a doctor focusing on the physical. In this case the psychiatrist would see you try medication and counselling, however this would be unlikely to fix the situation. The patient might be told that they are resistant to change by the counsellor, or finally be told by the psychiatrist that their depression is treatment resistant (which is a metaphor for “Sorry, we’ve completely failed you, but rather than us taking responsibility, we blame YOU! So there!”. Talk about ignorance on so many levels. Hardly any psychiatrist would consider that all options need to be looked at. The fix of this particular depression might end up with the brain damage slowly healing over time by say 50%, with the hormone problem being caught years later. ECT might be randomly applied for the treatment resistant depression, and this might, just by luck, somehow jolt / rewire the area of the brain that is damaged, and by sheer luck it might bring the functionality of that part of the brain to 70% functioning, and some memory loss of the abuse might occur. This is why mental health treatment at the moment is all about fumbling in the dark. Recently a psychiatrist on Twitter was disgusted that I’d used the word fumbling, however we know that in the early part of the 21st century, treating mental health is definitely an art form, that is iteratively applied until success occurs, or failure is admitted (but blamed on the patient!).

So to conclude, I feel mental health professionals need to be educated in the many to one concept, and need to admit that treatment choices are made as more of an art form, than a science. Let’s also start believing a patients experience is unique to them, and not assume that everyone needs the same treatment option. Conditions that LOOK identical from external observations, or via ICD / DSM diagnostic criteria, could well have varying levels of multiple causes that are different per patient! This means treatment options are different, even though the condition looks diagnostically identical. My background in computer programming makes this obvious, I just wish mental health professionals would realise this.

[Thanks to @BipolarBlogger off Twitter for corrections in some areas of my article]

Copyright MEN HEAL 2016.

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