The Wakefield Disturbance

A GIFT OR A CURSE? Lara Wakefield receives messages from the dead. Her latest “client” is a murdered young girl who wants to be put to rest. The girl's killer .
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Most people have what physicians call "benign anomalies", that is, minor malformations that are the result of genetic or developmental errors but that cause no significant problem, and such anomalies are not considered disorders. For example, benign angiomas are small blood vessels whose growth has gone awry, leading them to connect to the skin, but, because they are not harmful, they are not considered disorders. The requirement that there be harm also accounts for why simple albinism, heart position reversal, and fused toes are not generally considered disorders, even though each results from an abnormal breakdown in the way some mechanism is designed to function.

Purely scientific accounts of "disorder", even those based on evolutionary function as is the analysis below 9 - 11 , fail to address this value component. In the DSM and ICD diagnostic criteria, the symptoms and clinical significance requirement generally ensure harm and that the condition is negatively valued. The dispute remains about whether "mental disorder" is purely evaluative or contains a significant factual component that can discriminate a potential domain of negative conditions that are disorders from those that are nondisorders.

There are many negative conditions that are not disorders, and many of them contain symptoms and are clinically significant in that they cause distress or role impairment e. The distinction between disorders and nondisorders thus seems to depend on some further criterion. Contrary to those who maintain that a mental disorder is simply a socially disapproved mental condition 12 , 13 , "mental disorder" as commonly used is just one category of the many negative mental conditions that can afflict a person. One needs an additional factual component to distinguish disorders from the many other negative mental conditions not considered disorders, such as ignorance, lack of skill, lack of talent, low intelligence, illiteracy, criminality, bad manners, foolishness, and moral weakness.

Indeed, both professionals and laypersons distinguish between quite similar negative conditions as disorders versus nondisorders. For example, illiteracy is not in itself considered a disorder, even though it is disvalued and harmful in our society, but a similar condition that is believed to be due to lack of ability to learn to read because of some internal neurological flaw or psychological inhibition is considered a disorder.

Male inclinations to aggressiveness and inclination to sexual infidelity are considered negative but not generally considered disorders because they are seen as the result of natural functioning, although similar compulsive motivational conditions are seen as disorders. Grief is seen as normal, whereas similarly intense sadness not triggered by real loss is seen as disordered.

A pure value account of "disorder" does not explain such distinctions among negative conditions. Moreover, we often adjust our views of disorder based on cross-cultural evidence that may go against our values.

The challenge, then, is to elucidate the factual component. Based on common usage in the literature, I call this factual component a "dysfunction". What, then, is a dysfunction? An obvious place to begin is with the supposition that a dysfunction implies an unfulfilled function, that is, a failure of some mechanism in the organism to perform its function. However, not all uses of "function" and "dysfunction" are relevant. The medically relevant sense of "dysfunction" is clearly not the colloquial sense in which the term refers to failure of an individual to perform well in a social role or in a given environment, as in assertions like "I'm in a dysfunctional relationship" or "discomfort with hierarchical power structures is dysfunctional in today's corporate environment".

These kinds of problems need not be individual disorders. A disorder is different from a failure to function in a socially or personally preferred manner precisely because a dysfunction exists only when something has gone wrong with functioning, so that a mechanism cannot perform as it is naturally i. Presumably, then, the functions that are relevant are "natural functions", about which concept there is a large literature 12 - Such functions are frequently attributed to inferred mental mechanisms that may remain to be identified, and failures labeled dysfunctions.

For example, a natural function of the perceptual apparatus is to convey roughly accurate information about the immediate environment, so gross hallucinations indicate dysfunction.

WHY PSYCHIATRY CAN'T ESCAPE THE CONCEPT OF MENTAL DISORDER

Some cognitive mechanisms have the function of providing the person with the capacity for a degree of rationality as expressed in deductive, inductive, and means-end reasoning, so it is a dysfunction when the capacity for such reasoning breaks down, as in severe psychotic states. The function of a mechanism is important because of its distinctive form of explanatory power; the existence and structure of the mechanism is explained by reference to the mechanism's effects.

For example, the heart's effect of pumping the blood is also part of the heart's explanation, in that one can legitimately answer a question like "why do we have hearts? The effect of pumping the blood also enters into explanations of the detailed structure and activity of the heart. Talk of "design" and "purpose" in the case of naturally occurring mechanisms is just a metaphorical way of referring to this unique explanatory property that the effects of a mechanism explain the mechanism.

So, "natural function" can be analyzed as follows: A "dysfunction" exists when an internal mechanism is unable to perform one of its natural functions this is only a first approximation to a full analysis; there are additional issues in the analysis of "function" that cannot be dealt with here 8 , 21 , The above analysis applies equally well to the natural functions of mental mechanisms. Like artifacts and organs, mental mechanisms, such as cognitive, linguistic, perceptual, affective, and motivational mechanisms, have such strikingly beneficial effects and depend on such complex and harmonious interactions that the effects cannot be entirely accidental.

Thus, functional explanations of mental mechanisms are sometimes justified by what we know about how people manage to survive and reproduce. For example, a function of linguistic mechanisms is to provide a capacity for communication, a function of the fear response is to avoid danger, and a function of tiredness is to bring about rest and sleep. These functional explanations yield ascriptions of dysfunctions when respective mechanisms fail to perform their functions, as in aphasia, phobia, and insomnia, respectively.

However, discovering what in fact is natural or dysfunctional and thus what is disordered may be difficult and may be subject to scientific controversy, especially with respect to mental mechanisms, about which we are still largely ignorant. This ignorance is part of the reason for the high degree of confusion and controversy concerning which conditions are really mental disorders. However, functional explanations can be plausible and useful even when little is known about the actual nature of a mechanism or even about the nature of a function.

For example, we know little about the mechanisms underlying sleep, and little about the functions of sleep, but circumstantial evidence persuades us that sleep is a normal, biologically designed phenomenon and not despite the fact that it incapacitates us for roughly onethird of our lives a disorder; the circumstantial evidence enables us to distinguish some normal versus disordered conditions related to sleep despite our ignorance.

Obviously, one can go wrong in such explanatory attempts; what seems nonaccidental may turn out to be accidental. Moreover, cultural preconceptions may easily influence one's judgment about what is biologically natural. But, often one is right, and one is making a factual claim that can be defeated by evidence. Functional explanatory hypotheses communicate complex knowledge that may not be so easily and efficiently communicated in any other way. Today, evolutionary theory provides the best explanation of how a mechanism's effects can explain the mechanism's presence and structure.

In brief, those mechanisms that had effects on the organism that contributed to the organism's reproductive success over enough generations thereby increased in frequency and hence were "naturally selected" and exist in today's organisms. Thus, an explanation of a mechanism in terms of its natural function may be considered a roundabout way of referring to a causal explanation in terms of natural selection. Since natural selection is the only known means by which an effect can explain a naturally occurring mechanism that provides it, evolutionary explanations presumably underlie all correct ascriptions of natural functions.

Consequently, an evolutionary approach to mental functioning 7 , 24 is central to an understanding of psychopathology. One might object that what goes wrong in disorders is sometimes a social function that has nothing to do with natural, universal categories. For example, reading disorders seem to be failures of a social function, because there is nothing natural or designed about reading. However, illiteracy involves the very same kind of harm as reading disorder, yet it is not considered a disorder. Inability to read is only considered indicative of disorder when circumstances suggest that the reason for the inability lies in a failure of some brain or psychological mechanism to perform its natural function.

There are many failures of individuals to fulfill social functions, and they are not considered disorders unless they are attributed to a failed natural function. If one looks down the list of disorders in the DSM, it is apparent that by and large it is a list of the various ways that something can go wrong with the seemingly designed features of the mind. Very roughly, psychotic disorders involve failures of thought processes to work as designed; anxiety disorders involve failures of anxiety- and fear-generating mechanisms to work as designed; depressive disorders involve failures of sadness and loss-response regulating mechanisms; disruptive behavior disorders of children involve failures of socialization processes and processes underlying conscience and social cooperation; sleep disorders involve failure of sleep processes to function properly; sexual dysfunctions involve failures of various mechanisms involved in sexual motivation and response; eating disorders involve failures of appetitive mechanisms, and so on.

There is a certain amount of nonsense in the DSM and criteria are often overly inclusive. However, the vast majority of categories are inspired by conditions that even a lay person would correctly recognize as a failure of designed functioning. When we distinguish normal grief from pathological depression, or normal delinquent behavior from conduct disorder, or normal criminality from antisocial personality disorder, or normal unhappiness from adjustment disorder, or illiteracy from reading disorder, we are implicitly using the "failure-of-designedfunction" criterion.

All of these conditions - normal and abnormal - are disvalued and harmful conditions, and the effects of the normal and pathological conditions can be quite similar behaviorally, yet some are considered pathological and some not. The natural-function criterion explains these distinctions.

It bears emphasis that even biological conditions that are harmful in the current environment are not considered disorders if they are considered designed features. For example, the taste preference for fat is not considered a disorder, even though in today's foodrich environment it may kill you, because it is considered a designed feature that helped us to obtain needed calories in a previous food-scarce environment.

Higher average male aggressiveness is not considered a mass disorder of men even though in today's society it is arguably harmful, because it is considered the way men are designed of course, there are aggressiveness disorders; here as elsewhere, individuals may have disordered responses of designed features. In sum, a mental disorder is a harmful mental dysfunction. If the HD analysis is correct, then a society's categories of mental disorder offer two pieces of information. First, they indicate a value judgment that the society considers the condition negative or harmful.

Second, they make the factual claim that the harm is due to a failure of the mind to work as designed; this claim may be correct or incorrect, but in any event reveals what the society thinks about the natural or designed working of the human mind. One of the disadvantages of pure social- constructivist views of mental disorder, like antipsychiatric views, is that they offer no place to stand from which to critique current diagnostic criteria and to improve their validity.

Once one has a conceptual analysis of disorder that offers a "place to stand" in evaluating whether diagnostic criteria identify disorders, one can consider whether current criteria get the intended distinction right. A distinction central to an adequate assessment is whether the client's problem is a mental disorder or a problem in living that involves a normal though problematic reaction to stressful environmental conditions.

The way we think about a case may influence the treatment we think most appropriate, so that, for example, thinking of a client's condition as a mental disorder tends to suggest that something is wrong internally and that the locus of intervention should be the client's mental functioning rather than the client's relationship to the environment. There are many other potentially harmful effects of such misclassification as well, ranging from stigma to confusing research results about etiology and treatment when disordered and nondisordered clients are mixed together.

The international use of DSM-style symptom-based criteria to diagnose mental disorder raises two basic challenges. The first is that symptom-based criteria themselves, even as used within the U. Criteria are consequently often too broad and incorrectly include normal reactions under the "disorder" category. Here are three brief examples from earlier work of mine 6 , The DSM-IV criteria for major depressive disorder contain an exclusion for uncomplicated bereavement up to two months of symptoms after loss of a loved one are allowed as normal but no exclusions for equally normal reactions to other major losses, such as a terminal medical diagnosis in oneself or a loved one, separation from one's spouse, the end of an intense love affair, or loss of one's job and retirement fund.

If one's reaction to such a loss includes, for example, just two weeks of depressed mood, diminished pleasure in usual activities, insomnia, fatigue, and diminished ability to concentrate on work tasks, then one's reaction satisfies DSM-IV criteria for major depressive disorder, even though such a reaction need not imply pathology any more than it does in bereavement. Clearly, the essential requirement that there be a dysfunction in a depressive disorder - perhaps one in which loss-response mechanisms are not responding proportionately to loss as designed - is not adequately captured by DSM-IV criteria 29 , Because of these flaws, the epidemiological data on prevalence of depression can be misleading, yielding potentially inflated estimates of the social and economic costs of depression.

Based on international epidemiological studies using symptom-based criteria, the World Health Organization WHO has publicized the apparently immense costs of depression. However, the claimed enormity of this burden relative to other serious diseases, and the consequent influence on priorities, may result from the failure to distinguish depressive disorders from normal sadness.

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The WHO calculations of disease burden are extremely complex, but arise from two basic components: The first component of burden, the frequency of the condition, derives from symptombased definitions that estimate that 9. The second component, disability, is ordered into seven classes of increasing severity, stemming from the amount of time lived with a disease weighted by the severity of the disease. The severity scores come from consensual judgments of health workers from around the world that are applied to all cases of the disease. Depression is placed in the second most severe category of illness, behind only extremely disabling and unremitting conditions such as active psychosis, dementia, and quadriplegia, and is considered comparable to the conditions of paraplegia and blindness.

This extreme degree of severity assumes that all cases of depression share the depth, chronicity, and recurrence that are characteristic of the severe conditions that health workers see in their practices. But, the epidemiological studies encompass everyone who meets symptom criteria, a group that, due to the possible confounding of normal sadness with disorder, may be heterogeneous to a greater degree than clinical patients would indicate, yielding an invalid overall estimation of disease burden.

Unraveling these confusions could lead to a more optimal distribution of WHO's health resources. The DSM-IV diagnostic criteria for conduct disorder allow the diagnosis of adolescents as disordered who are responding with antisocial behavior to peer pressure, threatening environment, or abuses at home For example, if a girl, attempting to avoid escalating sexual abuse by her stepfather, lies to her parents about her whereabouts and often stays out late at night despite their prohibitions, and then, tired during the day, often skips school, and her academic functioning is consequently impaired, she can be diagnosed as conduct disordered.

Rebellious kids or kids who fall in with the wrong crowd and who skip school and repetitively engage in shoplifting and vandalism also qualify for diagnosis. However, in an acknowledgment of such problems, there is a paragraph included in the "Specific culture, age, and gender features" section of the DSM-IV text for conduct disorder which states that "consistent with the DSM-IV definition of mental disorder, the conduct disorder diagnosis should be applied only when the behavior in question is symptomatic of an underlying dysfunction within the individual and not simply a reaction to the immediate social context".

All About THE WAKEFIELD DISTURBANCE

If these ideas had been incorporated into the diagnostic criteria, many false positives could have been eliminated. Unfortunately, in epidemiological and research contexts, such textual nuances are likely ignored. Whereas social phobia is a real disorder in which people can sometimes not engage in the most routine social interaction, current criteria allow diagnosis when someone is, say, intensely anxious about public speaking in front of strangers. But, it remains unclear whether such fear is really a failure of normal functioning or rather an expression of normal range danger signals that were adaptive in the past, when failure in such situations could lead to ejection from the group and a consequent threat to survival.

This diagnosis seems potentially an expression of American society's high need for people who can engage in occupations that require communicating to large groups 32 , A second problem that arises in the use of symptom-based diagnostic criteria is specific to the international context: To illustrate this problem, I return to each of the above diagnostic categories and suggest how additional problems might occur in using the DSM criteria for these disorders in the context of Taiwanese society.

The classic finding is that Asian populations express their depression through an "idiom of distress" that focuses on somatic complaints rather than more mental DSM symptoms 34 , This poses a challenge in applying DSM criteria. However, the data suggest that, if asked, Asian populations do often report the DSM-type symptoms as well, so that this may be an issue of self-presentation rather than actual variation in the symptomatic expression of a dysfunction.

Another issue concerns gender expectations: Folk understanding of female versus male nature tends to allow for a large amount of normal expression of depressive-like misery expressed by women as part of their "natural" life situation and innate tendencies. Different expectations apply to males.

Thus, especially in applying DSM criteria to some older women, there might be a challenge in deciding whether the symptoms indicate a disorder as they might in the U. In Taiwanese society, expectations and supervision of some children and adolescents appear to be more demanding and more rigid than in the U.

In some cases, this is because of the academic testing system, in which a youth's entire future may depend on his or her performance on a single test. These factors could affect the interpretation of antisocial behavior in several ways.


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For example, early misbehavior could more frequently be a normal response to excessive family pressure. On the other hand, some children may not express inherent antisocial tendencies until a later age than would be typical in U. It is also possible that Taiwanese hold a culturally implicit theory of adolescent development that is less accepting of youthful misbehavior as normal than is the American implicit theory, leading to overpathologization. DSM-IV criteria for social phobia require anxiety only about social interactions with unfamiliar people.

One can be perfectly comfortable with one's family and with those one knows, but still be diagnosed with social phobia if he feels anxious in certain situations with strangers e. There may be a strong cultural loading here that poses challenges for the Taiwanese diagnostician. These criteria are influenced by American culture's belief in individuality, independence from family, and open interactions of unfamiliars. I draw upon a range of techniques and approaches to support you.

The difficulties associated with living are as numerous as there are people alive today. I believe that each individual carries the seeds of future contentment in the difficulties that they face in the present. My approach to psychotherapy seeks to harness the potential for individual wholeness by creating a safe and unjudgemental space in which clients can obtain clarity on their past and present whilst shaping a sought-after and fulfilled future.

Eating Disorders Counselling in Wakefield

I offer counselling over the phone, online or face to face. Telephone or online counselling allows you to access therapy from the comfort of your home or another suitable space. This can be at a time of your choosing, allowing your counselling to remain anonymous and you don't have to travel to meet me. You can access counselling with me from anywhere, all you need is you and a phone or computer.

I recognise that this may not be for you, if you prefer to meet face to face then I offer this. How you decide to access your counselling is up to you and ultimately your choice.

It can help a person to identify ways of thinking and interacting with others and recognising deep rooted thoughts which are impacting upon your present thoughts and emotions. I am a qualified counsellor and I have experience working with a diverse client group but for several years I have gained experience working with depression, anxiety, bereavement, addictions, low self esteem, suicidal thoughts, PTSD, relationship difficulties, career difficulties, life changes, addictions and abuse.

My experience includes supporting people who care for a loved one and those facing bereavement, anxiety, depression, low self-esteem, and relationship difficulties not couples. I work alongside you to help you grow and reach a 'better place'. This is provided within a confidential, safe, and welcoming environment which is non-judgemental and empathic. You will be respected for who you are and valued as a unique and resourceful individual. I will support and encourage you to find your own way, so you gain a better understanding, acceptance and awareness of yourself.

I am passionate about supporting others. I work with children from 11 years old, young people and adults who need help with a wide range of difficulties, experiences and life stages. Counselling can help overcome your painful experiences and feelings. I provide a confidential, warm, friendly space where you are listened to and what you say matters. My role is to help you make sense of your world so you can discover how to move forward in your life.

This can be overwhelming and sometimes hard to process. Feeling sad, low, angry, scared and anxious are just some of the emotions we can feel when faced with these challenges and often it can be hard to discuss these with those closest to us. Counselling is a safe place to explore life events and the emotions, thoughts and behaviour they bring with them, in a non-judgmental and confidential environment.

Together we can unearth the way you want to think, feel or act; your future goal, and together we can work towards achieving this. I am a professionally qualified Counsellor, who can offer a supportive and empathic working space for all individuals to explore their worries and concerns, working on a one to one basis, via face to face sessions.

Together we can address issues past and present and uncover useful coping mechanisms to embrace challenges old and new. Life can be hard and we all experience difficult times when we would benefit from support and additional ways of managing. I provide an individual approach to ensure the therapy best meets your needs. I will help you to make sense of your difficulties and learn new ways of coping to help you to move forward.

Please contact me at carolinedunsmuirwhite protonmail. Refine Results Eating Disorders. Show only women Show only men. Treatment Centres Support Groups. Try expanding your search for Eating Disorders Counsellors in Wakefield to a larger area e. West Yorkshire , England. Eating Disorders Anorexia, Bulimia Counsellors If you're looking for help with an eating disorder in Wakefield or for a Wakefield eating disorder counsellor, these professionals provide therapy for eating disorders and eating disorder counselling.

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