Positive explanations for psychological problems

I am a clinical psychologist working in an anxiety and OCD Clinic at the University of Oslo, Norway. In this clinic we do almost all the treatment without starting drugs, and for many patients we help them taper the drugs. One of the reasons for this is that taking drugs for psychological problems often may be seen as avoidance behavior, and this is exactly what maintains the anxiety or in many cases makes it worse.

 If a person starts taking a benzodiazepine every time he feels anxious, he will never discover that it passes by itself and is not dangerous. When doctors give strong drugs to “combat” anxiety symptoms, they may actually be signaling to patients that anxiety is dangerous.

The most effective treatment for anxiety disorders of all kinds, is exposure, and that is exactly the opposite of running away through drugs. Actually stepping down on drugs very slowly (less than 1% per day) may be very good exposure training.

I often tell my patients: it is great if the stepping down gives you a bit more symptoms. Then you get the possibility to learn that anxiety is not dangerous and that it is by going into it, instead of avoiding, that you get better.

Many people who have anxiety actually think the worst part of anxiety is the self loathing. They hate themselves for being so weak, not daring enough, always worried etc.

The opposite should be the case. The ability to be afraid has enabled humans to survive. Those who were of the worrying kind were the best survivors in hard stone age times. They would worry about food supplies for the winter, living conditions, cleanliness, safety for themselves and their offspring.

Many of the best survivors of hard times could be diagnosed with generalized anxiety disorder, phobias, OCD and even social anxiety. In stone age tribes it could be very dangerous to talk to strangers. People with very low social anxiety could be a risk for themselves and their tribe.

Fear of heights, snakes, spiders, open spaces etc. have a distinct survival advantage for humans. It is just in the last centuries that conditions have changed so that some of these fears are problematic.

Even psychotic symptoms may have given a survival advantage in earlier times. We all have several thousand verbal thoughts every day, and often we don’t really pay attention to them. The internal dialog just keeps on chattering.

How can  the brain signal to us that a thought is more important than others, e.g. “you are in danger, run to the cave”? The logical thing would be to give more sound to it than normal thoughts, in other words a thought that sounds like it is spoken by somebody. This would today be called an auditive hallucination. We often see that hallucinations come in response to extremely stressful situations.

Trauma victims may develop internal audible voices in order to make sure the internal dialogue around possibly dangerous situations is very clear.

Depression may be a very useful reaction to overwork, in order to slow the person down and avoid exhaustion. It may also function to slow people down so that they have time to think about things they may have done wrongly, so that they will be able to change their ways.

Bipolar behavior and ADHD may have its function in getting projects started, and bringing up many new ideas, even if most of them have no merit. The energy that is pathologized by these two diagnoses is probably the reason why we are not still in the stone age and why we have works of art. Inventors, artists and entrepreneurs are often seen by others as overly energetic and unrealistic. But they are needed in order to get development.

So what is characteristic with people who get psychological problems and what some may want to call mental illness?

I see this very clearly after 25 years as a therapist. People who get anxiety and depression have three positive traits in common:

1.  They are sensitive in a positive sense. They are very aware of others feelings and actions, and they may react strongly to things that happen in their surroundings, both positive and negative.

2.  They are analytical and thorough thinkers. They think of all possibilities of what may go wrong, often like chess players planning for all possible future problems. “What if” thinking is very useful in hard times, but may be annoying when conditions are very safe.

3.  They have good imagination. They are able to imagine possible things that may happen so vividly that they react strongly to them and take action, or avoid possibly dangerous action in the case of depression. 

All psychological problems are on a continuum from not problematic to very disturbing. It is impossible to put a clear cutoff point, and what is dysfunctional in one setting may be very desirable in another. That is why the concept of mental illness is useless. We may talk of patterns of behavior thoughts and feeling that are more or less functional in different situations, but it is usually not difficult to see that the behaviors thoughts and feelings may be appropriate in other contexts. The most classical may be over active children who would learn much in natural environments but who get diagnosed for their active exploration in classroom settings.