Male and female created he them and blessed them, called their name Adam, in the day when they were created. Genesis 5:2 (KJV)

There are a myriad of challenges pertaining mental distress widely known as ‘mental health’ issues. Chief amongst them is the challenge of pseudo-science or scientific propaganda masquerading as scientific evidence or empiricism. It is from this epoch that understanding of mental distress has been blighted. Scientific propaganda marketed as hard science or data has often led to iatrogenic injury of users of psychotropic drugs.

The first challenge can be found in the terminology used to refer to mental distress. In government hospital settings and literature, mental distress is commonly referred to as ‘mental illness’. The terminology gives the false impression of mental distress as having an underlying physical cause(pathogenesis).  This hypothetical stance has been the bedrock in the marketing of psychotropic drugs by pharmaceutical giants. The propaganda has been that psychotropic drugs work as wonder drugs (miracle working drugs) or correcting a chemical imbalance.  Such fictitious claims have been paraded as science in media and academic circles as panaceas of mental distress commonly referred to as depression, schizophrenia among other problems of living. These claims of correcting a chemical imbalance in the brain or miracle cures have never been supported by scientific knowledge since antique to this day.

The second challenge is the use of nosological systems and in particular the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).  The DSM from 1980 thus claims to be non-theoretical thus theoretically neutral. The nomenclature within the DSM has been justified as important for research, reimbursement purposes with welfare and insurance organizations. The nomenclature within the DSM has done little to help people living with mental distress. People given labels from the DSM nomenclature are often stigmatized and discriminated even long after remission from mental distress. Once a person is given a diagnosis like ‘schizophrenia’ whatever they say becomes suspect.

Nosological systems pose a third risk in that once they are applied; there is a general tendency amongst practitioners to focus on the diagnosis. In religiously focusing on the diagnosis the person is ignored in such an approach. The practitioner’s point of focus would be the diagnosis as a point to be treated & not the person. The focus on this fictitious diagnostic labels often ignores the person as of great importance in the healing process and also chides and negates possibilities of psychosocial factors which might have happened to them, in favor of bio-essentialist explanations which remain inconclusive to this day. Negation of psychosocial factors as a source of mental distress results in persons living with mental distress, often unable to make a resolve with life problems and also unable to receive real help which does not just musk their problems like what psychotropic drugs do to them.

A fourth challenge which nosological systems pose is that of listening to diagnose and treat only. The listening based on a bio-essentialist frame is done as a way to objectify and quantify human suffering. A whole person is reduced to a mere psychiatric label which then is subject to be treated by psychotropic drugs and or psychotherapy. It’s a task which l view as impossible and dangerous in the sense that it fails to recognize the limited nature of science in quantifying suffering and it seeks to ignore the complexity of the mortal man and his complex difference from other creatures. Listening in the view to apply a diagnosis often entails and assumes a pathological stance. The listening is done to find what is wrong within the individual or symptoms so as to ascribe a diagnosis which then iatrogenically harms the identity of the person.

It is from these four challenges that the ‘Them and Us’ phenomenon ensues. Once a different terminology is used in particular to identify person via nosological systems and persons are objectified the ‘Them and Us’ phenomenon is invoked. Once invoked a crisis is created were persons suffering with life distresses are denied to get in touch with their real challenges in life in favor of quick fix solutions packaged as psychotropic drugs meant to correct so called ‘chemical imbalances in the brain’.

I believe that our listening if it becomes empathetic and respectful to persons living with distress no matter their condition can in turn be therapeutic. Empathetic listening is deconstructive and can be called deconstructive listening as it helps the person experiencing the distress. The person would know that there are people willing to empathize with me in this crisis via listening rather than to listen as a way to find problems within me. When we start to view life in a way that we begin to understand that mental distress and mental wellness are just but in a continuum then the ‘Them and Us’ phenomena becomes extinct. This will give us an understanding that we are just but one, save that some of us have faced different challenges in life in a different way. With such an approach it is most likely that we will tend to be more human in our approaches as they are ‘Us’ and remain ‘Us’ even though they acted differently to life challenges. In this view when the lines of ‘Them and Us’ diminished then statements of survivors and those suffering from life distresses will be valued and no longer be treated with suspicious contempt because those voices would be the ‘Us’ and no longer the ‘Them’

Problem formulation can also be a necessary approach to mental distress. Instead of labeling people living with mental distress with DSM nomenclature which is often disabling, clients, caregivers and practitioners can converge and name the problem in a cultural language which is understood by all involved. This approach is useful in the sense that the problem is externalized allowing all to look for solutions to deal with the problem without objectifying the person. It also allows the person to remain with his dignity and respect, and more so to be given space even to be consulted on how issues can be resolved in their lives.

As we step in the direction of diminishing the phenomenon ‘Them and Us’  in mental distress issues, lasting solutions in mental distress can then be found. It is our hope that people living with mental distress can reach full remission with best functional outcomes in such a respectful frame just as under the moral treatment.

Prosper K Mushauri