Staff Perspective: A Strengths-based Lens of Depression, Trauma, and Suicide

Dr. Andrew DevendorfBy Dr. Andrew Devendorf

If we each had a choice, none of us would choose to develop a mental health difficulty. None of us would choose to feel the devastation of depression, the tribulations of trauma, or the suffering of being so hopeless, trapped, and alone that we want to end our own lives. We label these experiences as difficulties for good reason.

The thing is—it’s not a choice to endure these challenges. Most people in their lifetimes will experience a mental health difficulty. For some, these experiences can be easily managed; for others, they can dramatically alter their lives. Zooming out, almost everyone knows, or will know, a loved one affected by a mental health condition. Although these experiences are normal, many people with lived experience of depression, posttraumatic stress disorder (PTSD), and suicidal thoughts continue to feel immense stigma.

I have seen this stigma play out in my clinical work, my research, and my own life. As a former psychologist at the Department of Veteran Affairs, I worked with many Veterans who expressed shame about seeking therapy. I’d hear things like, “My PTSD has made me a shell of my former self,” and, “I’m weak...I can’t believe I need to seek help.” Even after a person improves or recovers, they may feel reluctant to share their experience for fears of being negatively judged or mischaracterized. These fears are not without foundation. Research shows that acceptance of mental health treatment has improved over the years, yet the public continues to have negative attitudes about mental illness. Some members of the public still see depression as “laziness,” PTSD as “dangerousness,” or suicidal thoughts as a “weakness.”

What perpetuates this stigma? And how can we reduce it?

The Deficits-view
There are many drivers of stigma. In this post, I want to focus on a systemic factor: that our American society takes a predominantly deficits-view of mental health difficulties—we see them only as something wrong with the person. This deficits-view, in my perspective, stems from how we define mental illness.

In the United States, we use the Diagnostic and Statistical Manual (DSM) of Mental Disorders to diagnosis mental health conditions. There is much utility of the DSM. It was developed to establish a consensus for diagnoses and help patients receive insurance reimbursement via diagnostic codes. It has thus helped legitimize psychopathology that may otherwise be considered “invisible” or “just in someone’s head.” It does this through giving clinicians a common language to identify and treat patterns of mental, behavioral, and emotional “symptoms.”

But an unintended design flaw of the DSM is that it takes a purely deficits-view of mental health experiences. In other words, the DSM is designed to characterize disorders without consideration of the potential value in specific mental health experiences. For instance, although sadness can be a sign that something is wrong in someone’s life (as a way to motivate making a change), the DSM does not—and was not designed to—list the potential value in this emotional experience.

This deficits-view is likely a big reason why clinicians, patients, and the public at-large will, by default, have only negative associations with depression, PTSD, and other diagnoses. Diagnostic labels have helped patients receive compassion, yes. But also, these labels carry the weight of being primarily defined by dysfunction, impairment, and distress. Thus, it makes sense why there is public acceptance about the treatment of mental illness but continued stigma toward people with lived experience.

A Strengths-based View
While we do not need to dismantle the DSM, I believe we can reduce stigma by being open- minded to the strengths, value, and assets that accompany mental health difficulties. I want to be clear—we should not discount the distress that comes with psychopathology. But, among people with these experiences, we can extract the “silver linings” of the experience to improve coping and self-acceptance.

There is a quote by Dr. Victor Frankl, a psychiatrist who documented his experiences in a concentration camp, that comes to mind. In his memoir, A Man’s Search for Meaning, Frankl advocates that we seek to find meaning in our suffering:

“We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into triumph, to turn one's predicament into a human achievement.” (Frankl, 1985, p. 112).

Here, Frankl is presenting a strengths-based view of tragedy, which we can apply to mental health difficulties. In my own practice, I’ve heard many patients reflect on how their depression, PTSD, or suicidal thoughts have helped them grow.

I list some strengths-based themes below and give an example.

  • Leveraging emotions as a signal: “My depression helps me determine if something is going wrong in my life.”
  • Self-awareness and insight: “Battling suicidal thoughts, it’s made me grapple with what’s really important, and how I want to spend my time.”
  • Compassion for others: “My trauma has given me perspective about what it’s like to go through hell.”
  • Resilience and self-confidence: “Overcoming my dark times taught me that I can overcome just about anything.”
  • Meaning and purpose: “Having gone through this, my new mission is to get other people the help they need.”

Enhancing Clinical Practice
As clinicians, we can embed this strengths-based view into our practice to help reduce feelings of shame, brokenness, and worthlessness. Of course, we should not enforce a strengths-based view onto our patients. But, we can help clients explore the potential value and meaning from their suffering with focused reflections and open-ended questions.

Here are some reflections.

  • Depression: “You’ve been through a lot, and it shows your resilience.”
  • PTSD: “From what I’m hearing, your trauma has given you new perspective.”
  • Suicide attempt: “You know what extreme pain feels like, and it’s given you compassion for others.”

And here are some questions.

  • “I recognize you’ve been through a lot. And, I’m wondering, what have you learned from your experience?”
  • “How has your experience made you grow?”
  • “Has going through your depression changed your perspective on anything? If so, how?”

By adopting a strengths-based view of lived experience, I believe we are better positioned to empower our clients and reduce stigma.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Andrew Devendorf, Ph.D., is a Military Behavioral Health Psychologist with the Henry M. Jackson Foundation for the Advancement of Military Medicine. He serves as a subject matter expert in suicide prevention for the VA SAFEGUARD project.

References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, Text Revision (DSM-5-TRTM). American Psychiatric Pub.

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Schroder, H. S., Devendorf, A., & Zikmund-Fisher, B. J. (2023). Framing depression as a functional signal, not a disease: rationale and initial randomized controlled trial. Social Science & Medicine, 328, 115995.