Morning reductionism, mental health edition

(Pictured: Joan Crawford in 1947’s ‘Possessed.’ Though the term had not been coined at the time, Crawford’s character suffered from what we now know as Borderline Personality Disorder with heavy dissociative features and at least implied dissociative fugue.)

I’m a reductionist. Identifying common denominators and patterns that connect phenomena has done more for my interests than “nuancing” ever has. Attending the liberalest of liberal arts colleges, Sarah Lawrence, I was taught that being “a reductionist” was an epistemological sin. Really, it was a moral sin, but this was never admitted. The liberal academy must see itself as pursuing “truth,” not adherence to moral dogma.

One was supposed to “complicate” and “nuance” everything. Books, “the text,” movies, political beliefs, bodies, sexes, genders. To suggest that something might be better explained by a reductive appeal to, say, evolution, was to signal intellectual and moral philistinism.

The academic imperative to nuance escaped the university and infected everyday social life. Today, normal non-academy people tend to urge others not to be “reductive,” not to “generalize,” but to “see the complicated/variegated/rich-n-beautiful tapestry” of things. This is not an epistemological project, it’s a project of excuse-making. It’s an easy way to deflect difficult questions that get too specific and reveal too much that might be true.

Nowhere has the urge to nuance and disaggregate been more unhelpful than in how we conceive of mental health conditions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has expanded in every edition, adding hundreds and hundreds of allegedly discrete “mental disorders” with every revision.

We can see this when we talk about transgenderism. We say (those of us who dare to reference mental health in the same conceptual breath as transgenderism) that so-and-so has co-morbid anxiety, or co-morbid OCD, or co-morbid cPTSD, etc. The unspoken reason that we do this is to avoid grasping the obvious, but unpopular, truth: “transgenderism” doesn’t have “co-morbidities”. It is the morbidity. It is one symptomatic expression of a deeper and broader state of mental unwellness. Almost always, early childhood trauma can be found at the root. ¹

All the “co—morbidities” are better thought of as siblings, additional symptomatic expressions of underlying trauma that forms the baseline mental state in which such suffering people find themselves.

I came to this point of view after 30 years of being variously diagnosed and treated for a variety of allegedly self-contained “mental illnesses.” I use the quotation marks not to question the idea of a state called “mental illness”. That is very real, and I have been mentally ill for sure. I use them to question the idea that a wide variety of symptomatic expressions are best thought of as separate disease states.

My various diagnoses are not, I’m now pretty well convinced, separate disease states. They have been symptomatic expressions of underlying trauma from severe and prolonged child abuse followed by an early adult life of predictable self-harm through alcoholism, promiscuity, and other behaviors.

Here is a list of the various “discrete mental illnesses” that I have experienced and/or been formally diagnosed with and treated for:

1. Major Depressive Disorder (diagnosed)

2. Panic Disorder (diagnosed)

3. Obsessive-Compulsive Disorder (diagnosed)

4. Tourette’s-typical tics (self-diagnosed; related to or part of OCD, various breathing/coughing/blinking tics that wax and wane over time and with stressors)

5. Complex Post-Traumatic Stress Disorder (clinician-confirmed, multiple times, after self-diagnosis)

That last, cPTSD, is the base to which I reduce all the others. Whether it is the perfect descriptor/model or not (and yes, I do know that it is not formally recognized in the DSM), it is rational and makes sense of what would otherwise be a higgledy-piggledy set of “discrete” mental illnesses that all need their own names and their own backstories and their own separate approaches.

There is rarely only one “final cause” for any state. However, it is obvious to me that these various allegedly discrete mental disorders of mine are not discrete. And I think they are more than merely “related.” I think they are all faces of the same underlying state that is best described by cPTSD.

The tics, the rituals and compulsions, the delusional panic attacks; these are all just symptoms. Coughing, sneezing, and fever are not separate diseases, they are symptomatic expressions of influenza (for example).

That’s what I think. What do you think? I’m particularly interested in your thoughts as a mental health patient or as a mental health professional who treats patients.

1. Yes, I recognize that autism is also a frequent feature of transgender identification, especially in children. I so stipulate. But no, I do not think “most” such cases are because of autism. I believe most (but not all) cases are better explained by early childhood trauma. Yes, I also recognize that autism and early childhood trauma can co-exist. Remember that I’m speaking in broad strokes, and that it is acceptable to do that. It does not mean I do not recognize complications. It’s OK to talk in broad strokes; not every piece has to “complicate” everything, and that can obscure, rather than illuminate.