Is Disorder Healthy? Rethinking the Language of Mental Illness

In the program notes of a recent concert at my son's university, the choral director wrote: "while the music in this concert is mainly secular in nature, each piece contains imagery which tells the story of our collective movement through the life cycles of order, disorder, and re-order." 

The phrase brought to mind the groundbreaking research of developmental psychologist Ed Tronick, who in his moment-to-moment analysis of videotapes of our earliest love relationships, offers evidence for the critical role of moving through mismatch to repair in healthy development. Tronick’s research, founded in dynamic systems theory, shows us how disorder followed by re-order is in fact the process by which we gain energy and grow. 

If disorder, and the process of moving through disorder to re-order is a not only healthy, but an essential part of human development, perhaps it calls for a rethinking of what we now name mental "illness"

A recent controversy on Twitter exemplified the emotionally charged nature of this conversation. My colleague Suzanne Zeedyk referenced my blog post Big Pharma and the Question: Is ADHD Real? Below is an excerpt that speaks directly to this question.

The latest research by Peter Fonagy, psychoanalyst and director of the Anna Freud Centre in London, leads us to focus not on “what is the disorder” but rather “what makes us well?” In a brilliantly laid out argument, Fonagy and colleagues present the concept of a “p” factor that is common to all forms of mental suffering now categorized under the structure of mental health “disorders.”

An irate twitter follower responded with this provocative comment, "ADHD is not a mental illness, Suzanne. What a horrific insult." Suzanne responded with a comment that in my view is right on the mark. "There is no shame in any life struggle, whatever you call it. All struggles are real."

She makes an essential point, that may account for the intensity of reaction to any questioning of our current paradigm of mental illness. Questioning of the language may be heard as a denial of an individual's experience of suffering. Can we recognize that the suffering is real, without calling it an "illness" or a "disease?" 

How is her twitter follower right? When we recognize that from the moment we are born, our behavior and emotions are a vehicle for communication and for making sense of our experience, we can understand behaviors associated with ADHD not as an illness, but as a form of communication.

As I describe in my book The Silenced Child, the problem comes when rather than listening to the meaning of that communication, we instead silence the communication either with behavior "management" or medication.

For if behaviors serve an adaptive function, are actually a way of coping or holding ourselves together, eliminating the symptoms might be a short-term solution. While medication can have a role to play in relief of profound emotional suffering, if we fail to offer ample time and space to listen for the meaning of behavior, we should not be surprised if "symptoms" reappear in different and sometimes more problematic forms.

“But its genetic” or “these are brain diseases,” are frequent response to this reframing of our concepts of mental wellness and illness. Once we recognize that our genes, brains, and bodies develop in relationships, the false duality of biology and experience, of nature and nurture collapses.  Expression of our genes and wiring of our brains occurs in the interactive process of mismatch and repair in our closest relationships starting from birth. It used to be thought that brain wiring was pre-determined; that our brains had a fixed wiring plan. But now we know this is not true. Formation of new neural connections- the “wires” that make up the brain- is flexible not only in early development, but throughout our lifespan.  

If we understand "disorder" as "normal" we need to re-think our system of mental health care that now equates "disorder" with "illness." Fonagy points us in the direction of a solution when he writes:

“In that sense, many forms of mental disorder might be considered manifestations of failings in social communication.”

 When we move through the experience of disconnection to moments of connection and healing, we grow and change. Relief of emotional suffering lies not in naming and eliminating problematic behavior, but in creating ample opportunity for a mosaic of social connection, with all its inherent messiness and disorder.