Skip to main content
×
×
Home

Everybody gets stressed … it's just the way we react that differs

  • David Kingdon (a1)
Summary

Public mental health messages have stressed divisions between people who are experiencing mental health problems and those who are not, for example by using slogans suggesting ‘one in four’ individuals have mental disorder. Simple unambiguous messages that convey that ‘we all get stressed, we just react differently’ may be more inclusive and effective at destigmatising mental health problems. This is analogous to the attitude towards physical health problems which are accepted as affecting everyone. Such a theme is scientifically sustainable.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Everybody gets stressed … it's just the way we react that differs
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Everybody gets stressed … it's just the way we react that differs
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Everybody gets stressed … it's just the way we react that differs
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Hide All
1 Time to Change. How does Mental Health Affect Me? Time to Change, 2008 (http://www.time-to-change.org.uk/challenging-discrimination/how-does-mental-health-affect-me).
2 Claridge, G, Davis, C. Personality and Psychological Disorders. Hodder Arnold, 2002.
3 Nuechterlein, KH, Goldstein, MJ, Ventura, J, Dawson, ME, Doane, JA. Patient–environment relationships in schizophrenia: information processing, communication deviance, autonomic arousal, and stressful life events. Br J Psychiatry 1989; 155 (suppl 5): 84–9.
4 Zubin, J, Spring, B. Vulnerability – a new view on schizophrenia. J Abnorm Psychol 1977; 86: 103–26.
5 McLaren, N. A critical review of the biopsychosocial model. Aust N Z J Psychiatry 1998; 32: 8692.
6 Kendell Re. The classification of depressions: a review of contemporary confusion? Br J Psychiatry 196; 129: 1528.
7 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM–IV–TR). APA, 1994.
8 Peters, ER, Joseph, SA, Garety, PA. Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al Delusions Inventory). Schizophr Bull 1999; 25; 553–76.
9 Strauss, JS. Hallucinations and delusions as points on continua function. Arch Gen Psychiatry 1969; 21: 581–6.
10 Strauss, JS. Mediating processes in schizophrenia: towards a new dynamic psychiatry? Br J Psychiatry 1989: 155 (suppl 5): 22–8.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 9 *
Loading metrics...

Abstract views

Total abstract views: 37 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 21st July 2018. This data will be updated every 24 hours.

Everybody gets stressed … it's just the way we react that differs

  • David Kingdon (a1)
Submit a response

eLetters

Medicalisation of stress belittles major mental illness

Richard Braithwaite, Specialist Registrar in Old Age Psychiatry
30 December 2009

Dear Madam

Few would argue with the statement in the title of Professor Kingdon’s editorial(1). Indeed, as Kingdon asserts, there can be no doubt that continua exist between normality and certain states currently classified as mental disorders. However, the artificial dividing lines toward the ends of each spectrum, set purely by societal expectations, surely call into question the validity of these very diagnoses that have perpetuated the myth of massive unmet need in psychiatric services(2). Rather than adopting a stress model of diagnosis based on dimensions, perhaps diagnoses such as mild depression, social phobia and personality disorder should instead be dispensed with altogether.

On the other hand, major mental illness is not primarily stress-induced. Whilst environmental risk factors exist for schizophrenia, bipolar and unipolar (endogenous) mood disorders and dementia, there is noconvincing evidence to suggest that these illnesses are any more likely than peptic ulcer, cancer or myocardial infarction to be triggered by psychosocial stress.

Furthermore, in psychiatric practice, a diagnosis is not a checklist of symptoms; it is a process we have each spent many years learning to craft. Symptoms and signs such as hallucinations and delusions undoubtedlysit on continua, but it does not follow that schizophrenia sits on a similar continuum. Using Kingdon’s analogy, chest pain may vary in aetiology and sit on a continuum of frequency and severity, but myocardialinfarction remains a categorical diagnosis.

Lastly, one should not reconceptualise and reclassify mental disorderas a response to the stigma attached to it. If cardiac illness were to suddenly become stigmatised, I doubt physicians would rewrite the diagnostic criteria for myocardial infarction. On the contrary, diagnosis would remain necessary for both immediate and long-term management and it would still be vitally important to separate the cardiopaths from the non-cardiopaths.

Yours sincerely

Dr Richard Braithwaite.

Specialist Registrar in Old Age Psychiatry.Portsmouth City Teaching Primary Care Trust, Langstone Centre, St James’ Hospital, Locksway Road, Portsmouth, PO4 8LD.Tel: 02392 684681.Email: richard.braithwaite@ports.nhs.uk

1. Kingdon, D. Everybody gets stressed … it’s just the way we react that differs. Psychiatr Bull 2009; 33: 443-4.

2. Richman A, Barry A. More is more and less is less: the myth of massive psychiatric need. Br J Psychiatry 1985; 146: 164-8.
... More

Conflict of interest: None Declared

Write a reply

Re: Everybody gets stressed . . . it’s just the way we react that differs

Temi Metseagharun, Locum Staff Grade Psychiatrist
09 December 2009

I was quite pleased to read the editorial by David Kingdon and the invited commentary by Michael king.1 The underlying issues are those in the foundations of the theory and practice of Psychiatry. Interestingly, the views expressed echoed at least in part, some of the views I have expressed “privately� (not in an academic journal):

“Now let us ask the question again: “what is mental illness?� Mental illness is never far away as it is simply one end of normality. In other words, we all have thought processing difficulties (TPD) from time to time. Depression is the best example of a thought processing difficulty. However, “difficulty� may become “disorder� when the normal thought processing mechanisms and adaptations fail. A basic mental breakdown, without complicated diagnostic categories, takes place. The manner of the breakdown is unique to the individual sufferer whose internal life is surely more than the standardised criteria set in the scriptures (ICD – 10 and DSM IV)!� 2

The definition of “stress� adopted by the UK Health and safety Executive recognised stress as relating to pressure and demands:"The adverse reaction people have to excessive pressures or other types ofdemand placed on them at work." 3The intuitive thinker will immediately see the metaphorical relationship to a hydraulic or fluid-based system. If we accept that the mind is metaphorically fluid, then there will be no real boundaries and categories, making vague but universal concepts valid according to the demands of the specific situation. TPD is as defensible as “stress� from a psychopathological perspective and in terms of social acceptabilityand (best of all) accuracy. I have creatively used the acronym “TPD� (with “D� either as “difficulty� or “disorder� according to the patient’s preference) to successfully resolve diagnostic disputes with virtually allmy patients who felt stigmatised and erroneously labelled as “schizophrenic� or as suffering from “borderline personality disorder�. Most chose “D� as representing a difficulty for which they seek help in a collaborative fashion. It is of course less bruising to anyone’s ego to accept having a “difficulty� (or stress) than to accept having a “disorder� (an implicit indication of socially undesirable or deviant behaviour). TPD has indeed been my Occam’s razor for all psychiatric diagnoses and I recommend it to fellow colleagues. I understand that it will not be specific enough for the “square� thinker (to use Robert Pirsig’s reflection of the views of some African Americans who believed that too much intellectuality and too little soul made a person square. “Such a person could not recognise quality, and nothing was real for them unless it was put into boring categories and defined� 4

References:1. David Kingdon - Everybody gets stressed . . .it’s just the way we react that differsPsychiatric Bulletin (2009), 33, 441 -4442. Temi Metseagharun - ABC of the Mind (2008) page 253, Author House Publishing3. Health and Safety Executive -http://www.hse.gov.uk/stress/furtheradvice/whatisstress.htm4. Tom Butler-Bowden - 50 Spiritual classics, page 207, Tom Butler-Bowden,2005 Nicholas Brealey Publishing

Author's current appointment: Locum Staff Grade Psychiatrist, Ten Acres Centre, Birmingham and Solihull Mental Health NHS Foundation TrustDogpool Lane Stirchley Birmingham B30 2XHcontact telephone: 0121 6782800 and fax: 0121 6782801
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *