Recovery from social anxiety and related conditions.

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The primary distinction between social anxiety and social anxiety disorder lies in the severity of symptoms experienced. Not everyone is affected in the same way; the intensity and persistence of symptoms vary greatly from person to person. Although the characteristics and traits of these conditions may appear similar across individuals, each person’s experience is shaped by a unique combination of environment, life experiences, and the diversity of human thought and behavior.

Additionally, it is important to recognize that comorbidities—other mental health conditions that occur alongside social anxiety—are highly prevalent. This reality highlights the complex nature of these anxiety disorders. As such, effective recovery mechanisms must address not only social anxiety, social phobia, and social anxiety disorder, but also the multiple related conditions that often coexist. When recovery methods are discussed for one of these conditions, they are intended to apply to all three.

Anxiety and Depression in the LGBTQ Community

Abstract. Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond.

Roughly 65 million U.S. adults and 18.5 million adolescents have major depression and anxiety. Estimates show that 60% of those with anxiety also have depression symptoms, and both are comorbid with substance abuse.

Similar numbers hold for LGBTQ+ persons with other mental and emotional disorders.

Anxiety and depression are primary causes of the 56% increase in adolescent suicide over the last decade. High school LGBTQ+ students are almost five times as likely to attempt suicide as their heterosexual peers, and 40% of transgender adults have attempted suicide in their lifetime.

Wellness must become the central focus of mental health because the disease model has provided grossly unsatisfactory results. Rather than obsessing on disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance essential to recovery.

Psychological science needs positive implementation through program integration, positive evaluation, transparency, and information management. Empathy and communication must supersede etiology and misdiagnosis.

Wellness impacts more than mental health; it is a paradigm that also seeks to promote complete physical, mental, and social well-being. This paper will show how the wellness model’s sociological emphasis on character strengths and attributes not only positively impacts the self-beliefs and image of a mentally ill person but also resonates with sexual and gender-based identities and portends well for the recovery-remission of an LGBTQ+ person with a mental illness.  

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Introduction

To illustrate the wellness model’s potential impact, this paper focuses on LGBTQ+ persons with anxiety and depression. “There is an urgent need to develop and disseminate tailored evidence-based interventions that improve the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. (Wilkerson et al., 2016, p. 358).

Depression and anxiety are the two most common forms of mental dysfunction impacting millions of U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. Johns Hopkins (2020) reports that around 25 million U.S. adults have a depressive illness, and 45 million have anxiety. Adolescent numbers fluctuate between 8 and 18 million (CDC, 2020; NIMH, 2017); the actual number is indeterminate.

Statistics are even less reliable for the LGBTQ+ community because large-scale mental health studies rarely include sexual and gender identity (NAMI, 2020b). “Federally funded surveys only recently have begun to identify sexual minorities in their data collections” (Medley et al., 2020, p. 1). Experts estimate the infection rate in the LGBTQ+ community is 1.5 to 2.5 times higher “than that of their straight or gender-conforming counterparts” (Brenner, 2019, p. 1).

Depressive illnesses tend to co-occur with anxiety and substance abuse (Johns Hopkins, 2020). “Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety” (Salcedo, 2018, p. 1).

Anxiety and depression are primary causes of the 56% increase in adolescent suicide over the last decade (Curtin & Heron, 2019). “High school students who identify as lesbian, gay, or bisexual are almost five times as likely to attempt suicide compared to their heterosexual peers,” and “40% of transgender adults have attempted suicide in their lifetime” (NAMI, 2020b, p. 1).

The psychological and sociological toll of anxiety disorders can be overwhelming. Physically, anxiety can cause sweating, trembling, fatigue, and rapid heartbeat, lower the immune system, and increase the risk of heart disease.

Persons with depression may experience a lack of interest and enjoyment of daily activities, significant weight fluctuation, insomnia or excessive sleeping, enervation, inability to concentrate, feelings of worthlessness, guilt, and recurrent thoughts of death or suicide.

Anxious and depressed persons frequently perform poorly in social situations (Hirsch & Clark, 2004; Hulme et al., 2012) for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers.

Symptoms can be repressive and intractable, imposing irrational thoughts and behaviors (Richards, 2014; Zimmerman et al., 2010) that govern perceptions of personal attractiveness, intelligence, and competence (Ades & Dias, 2013). Over time, these self-beliefs become automatic negative thoughts (Amen, 1998) that determine initial reactions to situations or circumstances.

Mental Health and LGBTQ+ Culture

Halloran and Kashima (2006) define culture as “an interrelated set of values, tools, and practices that is shared among a group of people who possess a common social identity” (p. 140). Culture impacts how mental illness is perceived or diagnosed, how services are organized, and how they’re funded. It also affects how patients express their symptoms…and how they cope in the range of their community and family supports. (Daw, 2001, p. 1)

Studies and research indicate that mental health culture is underscored by the same interrelated attributions to mental health stigma: public opinion, media representation, family rejection, distancing, and diagnosis. LGBTQ+ culture is defined by its sexual and gender identity as distinct from the heterosexual and cisgender community (NAMI, 2020b).

Subcultures within the community comprise “a diverse set of groups, including distinct groups based on sexual orientation and gender identity” (Lewis et al., 2017, p. 861), each struggling to develop their recognition.

LGBTQ+’s social identity is shaped by oppression and its role in overcoming it. The community faces “numerous challenges and instances of heterosexism and homophobia in their daily lives” (UW-Madison, 2020, p. 1), including “discrimination, prejudice, denial of civil and human rights, harassment, and family rejection” (NAMI, 2020b, p. 1).

Transition

Working within a wellness model of mental health has become a central focus of international policy (Slade, 2010). As psychologist Kinderman (2014) writes, “we need wholesale and radical change, not only in how we understand mental health problems but also in how we design and commission mental health services” (p. 1).

Decades of pathographic focus on psychological research and studies, negative diagnostic attributions, stereotyping and stigma, public and institutional resistance, and a doctor-client power dominance factor in the need to transition to a wellness paradigm.

Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond. Rather than obsessing over disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance to recover.

This paper does not endorse a total dissolution of medical model approaches, but a review of their efficacy and the psychological effectiveness of their pathographic dominance is highly warranted.

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Redefining Mental Health

Government agencies define mental illness as a “diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria” that can “result in functional impairment which substantially interferes with or limits one or more major life activities” (Salzer et al., 2018, p. 3). This ‘defective’ emphasis has been the overriding psychiatric perspective for centuries.

The pathogenic or disease perspective of diagnosis and recovery focuses on an individual’s history of suffering to facilitate diagnosis. Schioldann (2003, p. 303) defines pathography as a

historical biography from a medical, psychological, and psychiatric viewpoint. It analyses a single individual’s biological heredity, development, personality, life history and mental and physical pathology, within the socio-cultural context of his/her time, in order to evaluate the impact of these factors upon his/her decision-making, performance and achievements. (Kőváry, 2011, p. 742)

One only needs the American Psychological Association’s (APA, 2020) definition of neurosis to understand the mental health community’s pathographic focus. The 90-word overview includes the following terms: distressing, irrational, obsessive, compulsive, dissociative, depressive, exaggerated, unconscious, conflicts, anxiety, and disorders. DSM-3 abandoned the word ‘neurosis’ in 1980, but it remains the go-to term in the mental health community.

Coined by a Scottish physician in 1776, neurosis was defined as a functional derangement of the nervous system. Pathography focuses “on a deficit, disease model of human behaviour,” whereas the wellness model focuses “on positive aspects of human functioning” (Mayer & May, 2019, p. 159).

Studies and research portray the mental health care community drowning in pessimism (Henderson et al., 2014; Khesht-Masjedi et al., 2017; Pryor et al., 2009). “There is evidence to indicate the problem may be endemic in the medical health community” (Gray, 2002, p. 3), and it is also systemic (Knaak et al., 2017).

Noted psychologist Alison Gray (2002) argues that more disordered persons would seek treatment if psychiatric services were less stigmatized and stigmatizing. Patients commonly report instances in which staff members were inordinately rude or dismissive.

They cite coercive measures, excessive wait times, paternalistic or demeaning attitudes, treatment programs revolving around drugs with undesirable side effects, stigmatizing language, and general therapeutic pessimism (Henderson et al., 2014; Huggett et al., 2018).

Clients with more severe complications or illnesses are often deemed “difficult, manipulative, and less deserving of care” (Knaak et al., 2017, p. 2). Nurses and clinicians cite a lack of collegial support, insufficient knowledge and training, and the fear of client self-harm (Henderson et al., 2014), leading them to over-diagnose and over-prescribe (Huggett et al., 2018).

Transitioning from the disease model’s pathographic language to the optimistic and encouraging language of wellness models is everyone’s responsibility in the mental health community―its institutions, associations, practitioners, researchers, media, and clients. In the growing view among clinical psychologists, empathy and communication must take precedence over etiology. 

We must move away from the disease model, which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognizes our essential and shared humanity. Our mental health is largely dependent on our understanding of the world and our thoughts about ourselves, other people, the future and the world. (Kinderman, 2014, p. 3)

Language and Perspective

Language generates and supports perspective, and linguists agree that the relationship between language and power is mutual (Ng & Deng, 2017). It influences thought and action. Terms such as incapacity, deceit, unempathetic, manipulative, and irresponsible describe DSM-5 traits for various disorders.

The argument is not that these descriptions are invalid; rather, they are overwhelmingly negative and perceptually hostile. Judging by public opinion, media representation, and mental health stereotypes and stigma, these words help frame perceptions of people with mental disorders (DeMare, 2016; Pinfold et al., 2005; Pryor et al., 2009).

Realistically, we cannot eliminate the word ‘mental’ from the culture. For 70 years, the disease model has been guided by the Diagnostic and Statistical Manual of Mental Disorders. Unfortunately, the word ‘mental’ is a limited description of a disorder, and its negative implications reinforce perceptions of incompetence, unworthiness, and undesirability. It is the dominant source of stigma, shame, and self-denigration.

Psychologically, the word ‘mental’ frames a person or their behavior as somehow extreme or illogical. Adolescents derisively apply the term to the unpopular, different, and socially inept. The Urban Dictionary defines ‘mental’ as someone silly or stupid.

Hostile and demeaning language is pervasive throughout mental healthcare, promulgated by the disease or medical model’s pathographic undercurrent. This perspective influences public opinion, research, media representation, the doctor-patient power structure, community relationships, and clients’ self-beliefs and self-image.

Transitioning from the disease model to wellness models requires constructing a more reasonable mental health perspective by addressing misunderstanding, misinformation, and the disease model’s overriding focus on diagnosis, disorder, deficit, and denigration. 

Misinformation arises from the psychological community’s difficulty reaching agreement, due to changing criteria, “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata et al., 2015, p. 724), and the intractability of the American Psychiatric Association.

There are four common misconceptions about mental disorders. They are (1) abnormal and selective, (2) a consequence of behavior, (3) solely mental, and (4) psychotic. These misconceptions are corrected by the universality, age of onset, and complementarity of mental illness, and by clearly differentiating psychosis from neurosis. 

Universality 

A recent article in Scientific American speculates that “mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life” (Reuben & Schaefer, 2017, p. 1). It is a standard part of natural human development. One in four individuals has a diagnosable mental disorder.

According to the World Health Organization, nearly two-thirds of people who believe they have a mental disorder reject or refuse to disclose their condition. Including those who dispute or choose to remain oblivious to their dysfunction, we can conclude that mental disorders are common, indiscriminate, and universally impactful.

Age of Onset

The onset of a disorder, according to Mayo Clinic (2019), is ostensibly a consequence of early psychophysiological disturbances, although genetics and environment also play a role. Perhaps parental behaviors are overprotective or controlling, or fail to provide emotional validation (Cuncic, 2018).

The receptive juvenile might be the product of bullying, abuse, or a broken home. “LGBT youths experience greater stressors from childhood into early adulthood, such as child abuse and unstable housing, that exacerbate mental health problems” (Mustanski et al., 2016, p. 527).

LGBTQ+ youth experience disproportionately high rates of verbal and physical harassment and other types of peer victimization (Berlan et al., 2010; Reisner et al., 2015). “Gender minority youth had approximately four-fold higher odds of experiencing any bullying or harassment in the past year” (Reisner et al., 2015, pp. 35-36).

Childhood/adolescent exploitation or abuse are generic terms describing a broad spectrum of experiences that interfere with a youth’s optimal physical, cognitive, emotional, and social development (Steele, 1995). Any number of situations or events can trigger susceptibility to onset; it may be hereditary, environmental, or the result of a traumatic experience (Mayoclinic, 2019; NIH, 2019).

Statistically, the LGBTQ+ community is at “a higher risk than their heterosexual counterparts for traumatic life experiences such as childhood physical, psychological, and sexual abuse” (Bandermann, 2014, p. 3).

Despite the implication of intentionality in the words ‘abuse’ and ‘exploitation,’ a toddler might sense abandonment and develop emotional issues when a parent is preoccupied (Lancer, 2019). The child/adolescent is not accountable for their dysfunction; there may be no one intentionally responsible.

Similarly, scientific affirmation holds that, while sexual and gender-based identities may have a genetic or biological basis, they are not chosen, and the LGBTQ+ person is not accountable; unlike mental illness, there is no implicit or explicit responsible party.

Undoubtedly, this sociological model conflicts with moral models that claim, “mental illness is onset controllable, and persons with mental illness are to blame for their symptoms” (Corrigan 2006, p. 53), and that sexual and gender-based orientation is a choice.

Complementarity 

To early civilizations, mental illness was the domain of supernatural forces and demonic possession. Hippocrates and 19th-century diagnosticians looked at the relative proportions of bodily fluids. Lunar influence, sorcery, and witchcraft are timeless culprits.

In the early 20th century, it was somatogenic. The biological approach argues that neuroses are related to the brain’s physical functioning (McLeod, 2018), while pharmacology promotes the idea of chemical or hormonal imbalance.

Carl Rogers‘ study of the cooperation of human system components to maintain physiological equilibrium produced the word ‘complementarity’ to define simultaneous mutual interaction. All human system components must work in concert; they cannot function alone.

The simultaneous mutual interaction of all human system components—mind, body, spirit, and emotions—is required to sustain and recover from a mental dysfunction. The same mutual interaction is evident in sexual and gender-based identities as it is in all persons.

Psychosis and Neurosis

There are two degrees of mental disorder: neuroses and psychoses. When someone sees, hears, or responds to things that are not real, they are having a psychotic episode. While few people experience psychosis, everyone has moderate-to-high levels of anxiety, stress, and depression.

A neurosis is a condition that negatively impacts our emotional well-being and quality of life but does not necessarily impair or interfere with normal day-to-day functions. Since the overwhelming majority of mental disorders are neuroses, humans are all dysfunctional to some extent.

“Language reveals power, reflects power, maintains existing dominance, unites and divides . . . and creates influence” (Ng & Deng, 2017, p. 15). The wellness model has a similar impact on the mentally ill and LGBTQ+ individuals.

Revising negative and hostile language to embrace a positive dialogue of encouragement and appreciation generates new perspectives that contribute to self-belief and image, leading to greater disclosure, discussion, and, in the case of mental illness, recovery and remission. The self-denigrating aspects of shame should dissipate; stigma becomes less threatening.

Accepting that mental illness and sexual and gender-based identities are ubiquitous and nondiscriminating should make it easier to embrace the subject within the family structure. Recognizing their proximity and general susceptibility should mitigate the desire to distance and isolate.

Accepting their social pervasiveness should alleviate the prejudice, ignorance, and discrimination attached to mental illness (Khesht-Masjedi et al., 2017; Pescosolido, 2013; Pinfold et al., 2005; Wood & Irons, 2017), as well as sexual and gender-based identities (Adamczyk & Liao, 2018; Dodge et al., 2016; Lewis et al., 2017). Recognizing that neither the mentally ill nor the LGBTQ+ person is accountable disputes the belief that they are weak or amoral and that their condition reflects behavior.

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Resistance to Recovery

The term stigma-avoidance describes those who fear that public disclosure could stigmatize and discredit them. Statistics from the National Bureau of Economic Research “find that survey respondents under-report mental health conditions 36% of the time when asked about diagnosis” (Bharadwaj et al., 2017, p. 3).

A recent study by Salzer et al. (2018) reveals that only one-third of individuals with a disorder were in recovery-remission in 2017. Lower recovery-remission rates may be partly due to the inability to afford treatment, driven by anxiety-induced financial and employment instability (Gregory et al., 2018). More than 70% of patients with social anxiety disorder, for example, are in the lowest economic group (Nardi, 2003).

The LGBTQ+ community’s resistance to disclose a mental disorder, seek treatment, or accept a diagnosis stems from the same factors that underpin general reticence: stigmatization, victimization, public opinion, media representation, family rejection, and the diagnosis itself.

Stigmatization

Mental health stigma is the hostile expression of the abject undesirability of the afflicted. 90% of survey respondents with a mental disorder claim they have been impacted by mental health stigma (NAMI 2020a). Stigmatization is deliberate and proactive, distinguishable by pathographic overtones intended to shame and isolate (Pryor et al., 2009).

Disclosure of a mental disorder can jeopardize livelihoods, relationships, social standing, housing, and quality of life (Huggett et al., 2018; Pinfold et al., 2005; Sowislo et al., 2016; Wood & Irons, 2017). “The deleterious effects of stigma and prejudice on the health of sexual minority individuals have been well-documented across both physiological and psychological domains” (Dodge et al., 2016, p. 1). 

For LGBTQ youth, the minority stress theory posits that their health is affected by the degree to which their social environment stigmatizes sexual and gender minorities and the extent to which LGBTQ+ youth in these environments are expected to hide their nonconformity. (Wilkerson et al., 2016, p. 359)

Mental health stigma is expressed within three categories:

• Tribal stigma devalues.
• Moral character stigma implies amorality and weakness.
• Abominations of the body stigma refers to physical deformity or disease (Pryor et al., 2009).

Mental disorder occupies the last two categories. Ignorance equates a mental disorder with weakness or contributing behavior, while the medical model focuses on the disease and deformity aspects. LGBTQ+ persons face the added burden that their sexual and gender-based identity is socially and culturally tribal.

Victimization

“Community-based samples of LGBT youths have shown that as many as 30% may experience psychological distress at clinically significant levels” (Mustanski et al., 2016, p. 527). A study of the effects of cumulative victimization on LGBTQ+ youth’s mental health found that they “experience greater mental health problems, such as depression, anxiety, suicide attempts, and posttraumatic stress disorder (PTSD) . . . than do heterosexual and cisgender individuals” (Mustanski et al., 2016, p. 527).

Contributors include internalized homophobia, stigma consciousness, identity concealment, and experiences of heterosexism and victimization. (Heterosexism is the sociological term for discrimination or prejudice against gay people by heterosexuals who assume heterosexuality is the normal sexual orientation).

Sexual and gender-identity minorities are disproportionately subject to bullying, harassment, and other peer victimization (Berlan et al., 2010; Reisner et al., 2015). The LGBTQ+ community is “one of the most targeted communities by perpetrators of hate crimes in the country” (NAMI, 2020b, p. 1). 

Because of the greater risk of victimization in LGBT individuals compared with heterosexuals starting as early as adolescence, research is needed that examines how trajectories of sexual orientation-based victimization across development influence the risk for mental health problems for LGBT people. (Mustanski et al., 2016, p. 528)

Public Opinion 

“Although recognition, attributions, and service use may reflect prejudice associated with mental illness, the heart of stigma lies in social acceptance” (Pescosolido, 2013, p. 8). The image of the dangerous, unpredictable, mentally ill person is still widely endorsed by the public (Corrigan & Watson, 2002; Pinfold et al., 2005).

Stuart and Arboleda-Flórez (2012) analyzed two surveys (1990/2006) on public perception. They found, “between 80-100 percent of respondents . . . favoured involuntary hospitalization for that disorder when they thought that violence was an issue” (p. 7).

Attitudes toward sexual and gender-based identity became substantially more accepting between the 1970s, with the most significant shift among 18- to 29-year-olds (Adamczyk & Liao, 2018; Dodge et al., 2016). “It is clear that Americans have become more accepting of same-sex sexual behavior and relationships, but it is unclear how universal those changes are and whether they are due to age, time period, or cohort” (Twenge et al., 2016, p. 10).

Persons tend to be more supportive, in part, “because gay men and lesbians are then seen as less responsible for their orientation” (Adamczyk & Liao, 2018, p. 4). An overwhelming share (92%) of the U.S. LGBTQ+ community believes “society has become more accepting of them in the past decade and expect it to grow even more accepting in the decade ahead” (Pew, 2020, p 1).

However, many rights and benefits afforded to LGBTQ+ individuals depend on region, race and ethnicity, political persuasion, educational attainment, economics, and religiosity (Adamczyk & Liao, 2018; Dodge et al., 2016; UW-Madison, 2020).

Religion is strongly associated with negative beliefs about the justifiability of LGBTQ+ “sexual behavior and marriage” (Twenge et al., 2016, p. 8). The degree of intolerance is denominational and depends on the frequency of attendance. Jews and moderate-to-liberal protestants are more tolerant than Baptists, fundamentalists, and Catholics (Adamczyk & Liao, 2018; Schnabel, 2016). The Pew (2020) study shows that 29% of LGBTQ+ persons have felt unwelcome in a place of worship.

Heterosexual women consistently demonstrate more positive attitudes toward sexual and gender minority groups than heterosexual men, who are “traditionally expected to more rigidly conform to gender explicitly heteronormative norms and stereotypes” (Dodge et al., 2016, p. 4).

Attitudes toward lesbians and gay men are significantly more positive than attitudes toward transgender people (Adamcyzk & Liao, 2018; Lewis et al., 2017), whereas “bisexual individuals commonly report experiencing stigma, prejudice, and discrimination from both heterosexual and gay/lesbian individuals” (Dodge et al., 2016, p. 1).

Education and interpersonal contact mitigate prejudicial attitudes and behaviors toward both the mentally disordered and LGBTQ+ individuals. Contact-based education has emerged as the most influential factor in public attitudes and behaviors toward people with mental health problems (Pinfold et al., 2005; Corrigan, 2006).

“Multiple studies have found that knowing someone who is LGBTQ+ is associated with more supportive attitudes” (Adamczyk & Liao, 2018, p. 10) and “may increase knowledge, reduce anxiety, and increase empathy” (Lewis et al., 2017, p. 862). This benefit has not extended to transgender people, likely because “personal contact is relatively small” (Lewis et al., 2017, p. 871).

According to the Pew Research Center (Pew, 2020), 30% of the LGBTQ+ community reported being threatened or physically attacked, 21% were treated unfairly by an employer, and 58% were the target of slurs or jokes. Heterosexism operates at individual, familial, institutional, employment, political, and cultural levels and is openly evident in educational, career, religious, and social settings (Bandermann, 2014; Lewis et al., 2017).

While public opinion has improved significantly for the LGBTQ+ community, the perception of the mentally disordered person as dangerous and unpredictable, who should be isolated, has not changed substantially in decades (Stuart & Arboleta-Flórez, 2012). A primary goal of wellness models is to mitigate mental health stigma by changing public perspectives. 

Media Representation 

A 2011 study revealed that nearly half of U.S. media stories on mental illness mention or allude to violence (Pescosolido, 2013). News and social media, propelled by far-right politics, fundamentalism, and other fringe organizations, contribute to discrimination and prejudice.

Analysis of film, television, and tabloid presentations identifies three common misconceptions: people with mental illness are homicidal maniacs, they have childlike perceptions of the world that should be marveled at, or they are rebellious, free spirits (Corrigan, 2006).

Portrayals of sexual and gender-based identity in the latter half of the 20th century were, generally, stereotypical exaggerations. “Beginning in the 1990s, some highly likable gay and lesbian television and media characters began to appear in the media” (Adamczyk & Liao, 2018, p. 10).

Still, there is an abundance of gay-themed portrayals designed to arouse feelings of shock, betrayal, and titillation. Media coverage commonly promotes images that negatively impact the self-beliefs and image of LGBTQ+ and mentally ill persons.

Family Rejection

Family-stigmatization is the rejection of an LGBTQ+ or mentally dysfunctional child or sibling. A 2008 literature review found that around 38% of family members “attempt to hide their relationship to avoid bringing shame to the family” (Stuart & Arboleda-Flórez, 2012, p. 8). Another study showed that 34% of LGBTQ+ persons reported rejection by family members, 49% reported unfair treatment, and “52% were subject to anti-gay remarks from family members” (Bandermann, 2014, p. 3).

The implication of familial undesirability impacts a mentally disordered and LGBTQ+ person’s sense of positive self, a devaluation more potentially “life-limiting and disabling than the illness itself” (Stuart & Arboleda-Flórez, 2012, p. 3). “The experience of rejection magnifies the difficulties of living with psychiatric distress” (Gray, 2002), which can lead to psychological and physiological health issues, substance abuse, and addiction.

Etiology and Misdiagnoses

Etiology and diagnosis drive the disease model. Which disorder do people find most repulsive, and which poses the most threat? What behaviors contribute to the disorder? How progressive is the disorder, and how effective are treatments? (Corrigan, 2006). It is essential to recognize how these attributions affect public perception, treatment options, and client self-beliefs and image.

“Until the 1950s, most homosexual persons studied by psychologists and others were prisoners or mental patients, so it was easy to conclude that these were linked” (McFarland, 2018, p. 1). In 1973, the APA announced homosexuality was no longer an illness. DSM diagnostic criteria change dramatically from one edition to the next.

Lynam and Vachon (2012) cite therapists’ concern that criteria are “added, removed, and rewritten, without evidence that the new approach is better than the prior one” (p. 483). The social fears described in the DSM-II in 1968 became social phobia in the DSM-III (1980), and social anxiety disorder in 1994’s DSM-IV, resulting in the nickname, the ‘neglected anxiety disorder.’

Revisions, substitutions, and contradictions between DSMs are never universally accepted. Even under the best circumstances with a knowledgeable and caring clinician, it is difficult to obtain a proper mental disorder diagnosis. In addition to the nine types of depression, four anxieties, and eight obsessive-compulsive disorders, the current DSM lists five types of stress response and ten personality disorders, each sharing similar traits and symptomatology with varying degrees of impact.

Bipolar personality disorder, for example, shares characteristics and symptoms with generalized anxiety disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder (Sagman & Tohen, 2009).

The most common comorbidities associated with anxiety are major depression, panic disorder, posttraumatic stress disorder, and alcohol abuse/dependence. For example, social anxiety disorder is often comorbid with avoidant personality disorder, eating disorders, schizophrenia (Cuncic, 2018; Vrbova et al., 2017), ADHD, and agoraphobia (Koyuncu et al., 2019).

Self-Esteem

Abraham Maslow’s (1943/1954) hierarchy of needs shows how childhood disturbance can disrupt natural human development. Healthy growth requires satisfying fundamental physiological and psychological needs. The experience of detachment, exploitation, or neglect may disable the subject from meeting their physiological and safety needs and/or the need to belong and experience love, thereby affecting the acquisition of self-esteem. 

If the child is criticized, overly controlled, or not given the opportunity to assert itself, it begins to feel insecure in its ability to survive, and may then become overly dependent on others, develop low self-esteem, and experience a sense of shame or doubt in its own abilities. (Vanderheiden & Mayer, 2017, p. 15)

Research on people with depression and anxiety shows that the disease model “diminishes hope, self-esteem, self-efficacy, empowerment, and quality of life” (Garg and Raj, 2019, p. 124). LGBTQ+ youth rejected because of their identity have lower self-esteem, are more isolated, and receive less support than those accepted by their families (House, 2018). 

Self-esteem determines one’s relation to self, to others, and the world. Self-esteem is the umbrella for all the positive self-qualities that structure optimal functioning, e.g., self-respect, resilience, efficacy, reliance, compassion, value, worth, and other intrinsic wholesome attributes. It provides the recognition that one is consequential and worthy of love.

A grassroots poll by Unite UK (2016) found that 62% of LGBTQ+ persons believe they have low self-esteem. Exposure to historical alienation, ambiguous public opinion, adolescent bullying, heterosexualism, and other harmful elements, in time, will have an impact on an LGBTQ+ person’s self-beliefs and image (Unite UK, 2016).

Recovery

Recovery is an individual process. Humans have unique DNA and disparate sensibilities, memories, and abilities. One-size-fits-all approaches are inadequate to fully address the dynamic complexity of a person’s personality and the uniqueness of their owner. Mental illness is ubiquitous and non-discriminating; dysfunction embraces every walk of life. As well, “the LGBTQ+ community encompasses a wide range of individuals with separate and overlapping challenges regarding their mental health” (NAMI, 2020b, p. 1).

Recovery is “about seeing people beyond their problems – their abilities, possibilities, interests, and dreams – and recovering the social roles and relationships that give life value and meaning” (Slade, 2010, p. 2). Recovery programs must be fluid, integrating multiple traditional and non-traditional approaches developed through client trust, cultural assimilation, and therapeutic innovation.

Any analysis must consider the subject’s environment, hermeneutics, history, and autobiography alongside their wants, beliefs, and aspirations. Otherwise, the complexity of personality is not valued, and the treatment is inadequate.

Positive Psychology and the Wellness Model

In 2004, the World Health Organization began promoting the advantages of the wellness perspective, declaring health “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Slade, 2010, p. 1).

The World Psychiatric Association states, “the promotion of well-being is among the mental health system” (Schrank et al., 2014, p. 98). As psychologists point out, “psychological well-being is viewed as not only the absence of mental disorder but also the presence of positive psychological resources” (Sin & Lyubomirsky, 2009, p. 468). 

The wellness model’s chief facilitator is positive psychology (PP), which originated with Maslow’s (1943/1954) seminal texts on humanism; APA president Seligman legitimized it in 1998. Positive psychology and other optimistic approaches focus on the inherent ability, “not only to endure and survive, but also to flourish” (Mayer & May, 2019, p. 160). 

Positive psychology is a relatively new field (since 1998) that, ostensibly, complements rather than replaces traditional psychology. Defined as the science of optimal functioning, PP’s objective is “to study, identify and amplify the strengths and capacities that individuals, families, and society need to thrive” (Carruthers & Hood, 2004, p. 30). Cultural psychologist Levesque (2011) describes optimal functioning as the study of how individuals strive to realize their potential and become the best they can be.

Research supports the use of positive psychological constructs, theories, and interventions to enhance understanding and improve mental health. PP interventions have “improved wellbeing and decreased psychological distress in mildly depressed individuals, in patients with mood and depressive disorders, [and] in patients with psychotic disorders” (Chakhssi et al., 2018, p. 16).

As Carruthers and Hood (2004) point out, “The things that allow people to experience deep happiness, wisdom, and psychological, physical and social wellbeing are the same strengths that buffer against stress and physical and mental illness” (p. 30).

The academic discipline of positive psychology continues to develop evidence-based interventions that focus on eliciting positive feelings, cognitions, or behaviors (Schotanus-Dijkstra et al., 2018). Positive psychology offers promising interventions “to support recovery in people with common mental illness, and preliminary evidence suggests it can also be helpful for people with more severe mental illness” (Schrank et al., 2014, p. 99). 

Positive Psychology 2.0

One of the early challenges of positive psychology was its neglect of the negative aspects of character. Recognizing this, psychologists advocated a more holistic approach that embraces the dialectical opposition of human experience. As one psychologist put it, “people are not just pessimists or optimists. They have complex personality structures” (Miller, 2008, p. 598). Positive Psychology 2.0 (PP 2.0) emerged as a corrective to the singular focus on optimism, embracing a more inclusive and balanced perspective (Rashid et al., 2014).

The disease model of mental health bases recovery on the remission of symptoms or the suspension of substantial interference or limitation (ADAMHA, 2012; Salzer et al., 2018). The wellness model maintains that individuals with a mental disorder can live satisfying and fulfilling lives regardless of symptoms or impairments associated with the diagnosis (Slade, 2010).

Schrank et al. (2014) describe recovery as people “(re-) engaging in their life on the basis of their own goals and strengths and finding meaning and purpose through constructing and reclaiming a valued identity and valued social roles” (p. 98). By emphasizing wellness over dysfunction, the positive psychology movement aims to destigmatize mental illness by emphasizing “the positive while managing and transforming the negative to increase wellbeing” (Mayer & May, 2019, p. 163). Perkins and Repper (2003, p. 3) write: 

People with mental illness who are in recovery are those who are actively engaged in working away from Floundering (through hope-supporting relationships) and Languishing (by developing a positive identity), and towards Struggling (through Framing and self-managing the mental illness) and Flourishing (by developing valued social roles).  

Concluding Thoughts

Thomas Insel (2013), director of the National Institute of Mental Health, is “re-orienting its research away from DSM categories” (p. 2) and has declared that traditional psychiatric diagnoses have outlived their usefulness (Kinderman, 2014). NIMH is transforming diagnosis based on emerging research data and the doctor-patient communication dynamic rather than on current symptom-based categories. Kinderman (2014) suggests replacing traditional diagnoses with easily understandable descriptions of the issues.

A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and the design and planning of services. (1)

There are many approaches to recovery. Psychology textbook author, Farreras (2020) cites 400 different schools of psychotherapy. Mayer and May (2019) characterize current positive psychology as “a balanced, interactive, meaning-centered and cross-cultural perspective” (p. 156) that considers equally “positive emotions and strengths and negative symptoms and disorders” (Rashid et al., 2014, p. 162).

Positive psychology works best in conjunction with other programs, and its mental health interventions have proved successful in mitigating symptoms of depression, anxiety, and other disorders. “Growing research suggests that a positive psychological outlook not only improves ‘life outcomes’ but enhances health directly” (Easterbrook, 2001, p. 23).

In mental health, recovery remission is the sustained, long-term alleviation of symptoms. Wellness impacts more than mental health; it is a paradigmatic perspective that seeks to promote a state of complete physical, mental, and social well-being.

Its sociological emphasis on optimal human functioning, designed to counter the pathographic focus of other models, not only positively impacts the self-beliefs and image of a mentally ill person but also resonates in sexual and gender-based identities and portends well for the recovery-remission of an LGBTQ+ person with a mental illness.

Training in prosocial behavior and emotional literacy might be useful supplements to specific interventions. Behavioral exercises enhance the execution of resilient and generous social skills. Positive affirmations have enormous subjective value as well. Data support mindfulness and acceptance-based interventions to re-engage and regenerate positive thoughts, feelings, and memories.

Castella et al. (2014) suggest motivational enhancement strategies to help clients overcome resistance. Ritter et al. (2013) tout the benefits of positive autobiography to counter destructive thoughts and behaviors. The importance of considering the nuanced and unique dynamics inherent in the relationships among emotional expression, intimacy, and overall relationship satisfaction for dysfunctional individuals and LGBTQ+ persons should be thoroughly investigated (Montesi et al., 2013).

However, this paper balks at throwing out the baby with the bathwater, positing that the current diagnostic system should be utilized as a part of a more thorough analysis that embraces communication and emphasizes the character strengths that generate motivation, persistence, and perseverance towards recovery-remission. All “patients with mental disorders deserve better” (Insel, 2013, p. 2).

References

ADAMHA. (2012). S. 1306 (102^nd): ADAMHA Reorganization Act. 102^nd Congress (1991–1992). [Online.] https://www.congress.gov/bill/102nd-congress/senate-bill/1306/text  

Adamczyk, A. & Liao, Y.-C. (2018). Examining Public Opinion About LGBTQ+-Related Issues in the United States and Across Multiple Nations. Annual Review of Sociology, 45(1): 1-27 (2018). doi: 10.1146/annurev-soc-073018-022332

Ades, T. & Dias, S. (2013). Social Anxiety Disorder: Recognition, Assessment and Treatment. (Online.) NICE Clinical Guidelines, No. 159. https://www.ncbi.nlm.nih.gov/books/NBK327649/.

Amen, D. G. (1998). Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Oppressiveness, Anger, and Impulsiveness. New York City: Three Rivers Press.

APA. (2020). Neurosis. (Online definition.) Dictionary of Psychology. American Psychological Association. Washington, DC: American Psychological Association.  https://dictionary.apa.org/neurosis 

Bandermann, K. M. (2014). “Exploring Coping Mediators between Heterosexist Oppression and Post-Traumatic Stress Symptoms among Gay, Lesbian, and Bisexual Persons. ” Ph.D. Dissertation: University of Tennessee, 2014. https://trace.tennessee.edu/utk_graddiss/3108

Berlan, E. D., Corliss, H. L., Field, A. E., Goodman, E., &  Austin, S. B. (2010). SEXUAL ORIENTATION AND BULLYING AMONG ADOLESCENTS IN THE GROWING UP TODAY STUDY. Journal of Adolescent Health, 46(4): 366–371 (2010). doi: 10.1016/j.jadohealth.2009.10.015

Bharadwaj, P., Pai, M. M., & Suziedelyte, A. (2017). Mental Health Stigma. Economics Letters, 159 (57-60). doi:  10.3386/w21240

Carruthers, C., & Hood, C. D. (2004).  The Power of Positive Psychology. Parks and Recreation.  .file:///C:/Users/rober/ OneDrive/ Pending/New%20Psychobiography/carruthers%20x.pdf 

Castella, K. De., Goldin, P., Jazaieri, H., Ziv, M., Heimberg, R. G., & Gross, J. L. (2014).  Emotion beliefs in social anxiety disorder: Associations with stress, anxiety, and well-being. Australian Journal of Psychology, 66:139–148 (2014). doi: 10.1111/ajpy.12053.

CDC. (2020). Data and Statistics on Children’s Mental Health. [Online.]  Atlanta, GA: Centers for Disease Control  https://www.cdc.gov/ childrensmentalhealth/ data.html 

Chakhssi, F., Kraiss, J. T., Sommers-Spijkerman, M., & Bohlmeijer, E.T. (2018). The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and metaanalysis. BMC Psychiatry 18:211: 1-17 (2018). https://doi.org/10.1186/s12888-018-1739-2..

Chapdelaine A., Carrier J-D., Fournier L., Duhoux A. Roberge P. (2018) Treatment adequacy for social anxiety disorder in primary care patients. PLoS ONE 13(11): (2018). doi.org/ 10.1371/journal.pone.0206357.

Corrigan, P. (2006). Mental Health Stigma as Social Attribution: Implications for Research Methods and Attitude Change. Clinical Psychology Science and Practice, 7(1): 8-67 (2006). doi: 10.1093/clipsy.7.1.48

Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1: 16-20 (2002).

Cuncic, A. (2018). How Social Anxiety Affects Dating and Intimate Relationships. verywellmind. https://www.verywellmind.com/adaa-survey-results-romantic-relationships-3024769.

Curtin, S. C. & Heron, M. (2019). Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017. (Online.) National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf 

Daw, J. (2001), Culture counts in mental health services. (Online.) American Psychological Association. https://www.apa.org/monitor/dec01/culture 

DeMare, N. (2016). Exaggerations and Stereotypes of Schizophrenia in Contemporary Films. Elon Journal of Undergraduate Research in Communications, 7(1):1/1. http://www.inquiriesjournal.com/articles/1474/exaggerations-and-stereotypes-of-schizophrenia-in-contemporary-films.

Dodge, B., Herbenick, D., Friedman, M. R., Schick, V., Fu, T.-C., Bostwick, W., Bartelt, E., Muñoz-Laboy, M., Pletta, D., Reece, R., & Sandfort, T. G. M. (2016). Attitudes toward Bisexual Men and Women among a Nationally Representative Probability Sample of Adults in the United States. PLoS One, 11(10). doi: 10.1371/journal.pone.0164430

Easterbrook, G. (2001). Psychology discovers happiness. I’m OK, You’re OK. The New Republic, Article 27,  p. 136

Equaldex. (2020). Status of LGBT Laws by Country. Equaldex. https://www.equaldex.com/

Farreras, I. G. (2020). History of mental illness. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers. http://noba.to/65w3s7ex

Garg, R., & Raj, R. (2019). A cross-sectional study of self-stigma and discrimination among patients with depression. Open Journal of Psychiatry & Allied Sciences, 10(2): 124-127 (2019). doi: 10.5958/2394-2061.2019.00027.2.

Gray, A. J. (2002). Stigma in Psychiatry. Journal of the Royal Society of Medicine, 95(2): (2002). doi: 10.1258/jrsm.95.2.72

Gregory. B., Wong, Q. J. J., Craig, D., Marker, C. D., & Peters, L. (2018). Maladaptive Self-Beliefs During Cognitive Behavioural Therapy for social anxiety disorder: A Test of Temporal Precedence. Cognitive Therapy and Research, 42(3): 261–272 (2018). doi.org/10.1007/s10608-017-9882-5

Halloran, M., & Kashima, E. (2006). Culture, social identity, and the individual. In Individuality and the group: Advances in Social Identity. London: Sage. doi:org/10.4135/9781446211946.n8.

Henderson, C., Noblett, J., Parke,  H., Clement, S., Caffrey, A., Gale-Grant,  O., Schulze,  B., Druss,  B., Thornicroft, G. (2014). Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry,  1(6): 467-482 (2014). doi: 10.1016/S2215-0366(14)00023-6.

Hirsch, C. R. & Clark, D. M. (2004) Information-processing Bias in Social Phobia. Clinical Psychology Review, 24(7): 799-825 (2004). doi: 10.1016/j.cpr.2004.07.005.

House, Harris. (2018). LGBTQ+ Addiction Factors: The Importance of Self-Esteem, (Online). Harris House. https://www.harrishousestl.org/LGBTQ+-addiction-factors-the-importance-of-self-esteem/ 

Huggett, C., Birtel, M. D., Awenat, Y. F., Fleming, P., Wilkes, S., Williams, S., Haddock, G. (2018). A qualitative study: experiences of stigma by people with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, 91: 380–397 (2018). doi: 10.1111/papt.12167

Hulme, N., Hirsch, C., & Stopa, L. (2012). Images of the Self and Self-Esteem: Do Positive Self-Images Improve Self-Esteem in Social Anxiety? Cognitive Behaviour Therapy, 41(2): 163–173 (2012). doi.org/10.1080/16506073.2012.66455

ILGA. (2019). State-Sponsored Homophobia report. (Online.) ILGA World. https://ilga.org/state-sponsored-homophobia-report 

Insel, T. (2013). Post by Former NIMH Director Thomas Insel: Transforming Diagnosis. (Online.) Washington, DC: National Institute of Mental Health. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

Johns Hopkins. (2020). Mental Health Disorders Statistics. (Online.) The Johns Hopkins University, The Johns Hopkins Hospital, and The Johns Hopkins Health System.https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-health-disorder-statistics 

Khesht-Masjedi, M.F., Shokrgozar, S.,  Abdollahi, E.,  Golshahi, M., & Sharif-Ghaziani, Z. (2017). Exploring Social Factors of Mental Illness Stigmatization in Adolescents with Mental Disorders. Journal of Clinical and Diagnostic Research, 11(11) :(2017). doi:  10.7860/JCDR/2017/27906.1083.

Kinderman, P. (2014). Why We Need to Abandon the Disease-Model of Mental Health Care. (Online.) Scientific American. https://blogs.scientificamerican.com/mind-guest-blog/why-we-need-to-abandon-the-disease-model-of-mental-health-care/ 

Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare. Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2): 111-116 (2017). doi: 10.1177/0840470416679413

Kőváry, Z. (2011). Psychobiography as a method. The revival of studying lives: New perspectives in personality and creativity research Europe’s Journal of Psychology, 7(4), 739-777 (2020). doi: 10.5964/ejop.v7i4.162

Koyuncu, A., İnce, E. , Ertekin, E., & Tükel R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context 2019, 8. doi:10.7573/dic.212573

Lancer, D. (2019). What is Self-Esteem? (Online.) PsychCentral. https://psychcentral.com/lib/what-is-self-esteem/ 

Levesque, R. J. R. (2011). Optimal Functioning. In Levesque R. J. R. (eds) Encyclopedia of Adolescence. New York City: Springer. doi:https://doi.org/10.1007/978-1-4419-1695-2

Lewis, D. C., Flores, A. R., Haider-Markel, D. P., Miller, P. R., Tadlock, B. L., & Taylor J. K. (2017). Degrees of Acceptance: Variation in Public Attitudes toward Segments of the LGBT Community. Political Research Quarterly,  70(4): 861–75 (2017). doi/full/10.1177/1065912917717352

Lyliard, R. B. (2001). Social anxiety disorder: comorbidity and its implications. Journal of Clinical Psychiatry, 62(Suppl1): 17-24 (2001).

Lynam, D. R. & Vachon, D. D. (2012). Antisocial Personality Disorder in DSM-5: Missteps and Missed Opportunities. Personality Disorders: Theory, Research, and Treatment, 3(4): 483– 495 (2012). doi: 10.1037/per0000006

Maslow, A. (1943). A Theory of Human Motivation. Psychological Review, 50 (4): 370–396 (1943).

Maslow, A. (1954). Motivations and Personality.  New York City: Harper & Brothers; Early edition.

Mayer, C.-H., & May, M. (2019). The Positive Psychology Movement. PP1.0 and PP2.0. In C-H Mayer and Z. Kőváry (Eds.), New Trends in Psychobiography (pp. 155-172). Springer Nature Switzerland. https://doi.org/10.1007/978-3-030-916953-4_9.

Mayoclinic. (2017). Social anxiety disorder (social phobia). Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561.

Mayoclinic. (2019). Mental Illness. (Online.) Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968 

McFarland, S. G. (2018). How psychology has helped society accept homosexuality. (Online.) Psychology Teacher Network. Washington, DC: American Psychological Association. https://www.apa.org/ed/precollege/ptn/2018/05/society-accept-homosexuality 

McLeod, S. (2018). The Medical Model. (Online.) Simply Psychology. https://www.simplypsychology.org/medical-model.html

Medley, G., Lipari, R. N., Bose, J., Cribb, D. S., Kroutil, L. A., & McHenry, G. (2020). Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm

Miller, A. (2008). A Critique of Positive Psychology— or ‘The New Science of Happiness.’ Journal of Philosophy of Education, 42(3-4): 591-608 (2008).  

Montesi, J. L., Conner, G. T., Gordon, E. A., Fauber, R. L. (2013). On the Relationship Among Social Anxiety, Intimacy, Sexual Communication, and Sexual Satisfaction in Young Couples. Archives of Sexual Behavior 42: 81–91 (2013). doi: 10.1007/s10508-012-9929-3.

Mullen, R. F. (2018). Social Anxiety Disorder. (Online.). https://rechanneling.org/page-20.html

Mustanski, B., Andrews, R., Puckett, J. A. (2016). The Effects of Cumulative Victimization on Mental Health Among Lesbian, Gay, Bisexual, and Transgender Adolescents and Young Adults. American Journal of Public Health, 106(3): 527–533 (2016). doi: 10.2105/AJPH.2015.302976

NAMI. (2020a). Mental Health by the Numbers. [Online}. National Alliance on Mental Health. https://www.nami.org/mhstats 

NAMI. (2020b). LGBTQI. (Online.) National Alliance on Mental Illness. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI

Nagata, T., Suzuki, F., Teo, A.R. (2015).Generalized Social Anxiety Disorder: A still‐neglected anxiety disorder 3 decades since Liebowitz’s review. Psychiatry and Clinical Neurosciences, 69(12): 724-740 (2015).  doi: org/10.1111/pcn.12327. 

Nardi, A.E. (2003). The social and economic burden of social anxiety disorder. BMJ, 327 (2003).doi: 10.1136/bmj.327.7414.515

Ng, S. H., & Deng, F. (2017). Language and Power. (Online.) Intergroup Communication. doi:10.1093/acrefore/ 9780190228613.013.436

NIH. (2019).Child and Adolescent Mental Health. (Online.) National Institute of Health. https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml 

NIMH. (2017). Any Anxiety Disorder. (Online.) National Institute of Mental Health.  https://www.nimh.nih.gov/ health/statistics/ any-anxiety-disorder.shtml 

Perkins R., & Repper, J. (2003). Social Inclusion and Recovery. London: Baillière Tindall.

Pescosolido, B. A. (2013). The Public Stigma of Mental Illness. What Do We Think; What Do We Know; What Can We Prove? Journal of Health and Social Behavior 54(1): 1-21 (2013), doi: 10.1177/0022146512471197

Pew. (2020). A Survey of LGBT Americans. (Online.) Pew Research Center. https://www.pewsocialtrends.org/2013/06/13/a-survey-of-lgbt-americans/ 

Pinfold, V., Thornicroft, G., Huxley, P., Farmer, P. (2005). Active ingredients in anti-stigma programmes in mental health. International Review of Psychiatry, 17(2): 123–131 (2005). doi: 10.1080/09540260500073638

Pryor, J. B., Reeder, G. D., Monroe, A. E., Patel, A. (2009). Stigmas and Prosocial Behavior Are People Reluctant to Help Stigmatized Persons in S. Stürner, M. Snyder (Eds.) The Psychology of Prosocial Behavior, (pp.59-80). New York City: John Wiley and Sons.  doi: 10.1002/9781444307948.ch3

Rashid, T., Anjum, A., Chu, R., Stevanovski, S., Zanjani, A., & Lennox, C. (2014). Strength based resilience: Integrating risk and resources towards holistic well-being. In G. A. Fava & C. Ruini (eds.), Increasing psychological well-being in clinical and educational settings,8: (Vol. 8, pp. 153–176). Dordrecht, Netherlands: Springer.

Reisner, S. L., Greytak, E. A., Parsons, J. T., & Ybarra, M. (2015).  Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity. Journal of Adolescent Health, 56(3): 243-256 (2015).  doi: 10.1016/j.jadohealth.2014.10.275

Reuben, A., & Schaefer, J. (2017). \Mental Illness Is Far More Common Than We Knew. [Online.] Scientific American. Retrieved from https://blogs.scientificamerican.com/observations/mental-illness-is-far-more-common-than-we-knew/

Richards, T. A. (2014). Overcoming Social Anxiety Disorder: Step by Step. Phoenix, AZ: The Social Anxiety Institute Press.

Richards, T. A. (2019). What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis. (Online.) The Social Anxiety Institute, Inc. https://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis.

Ritter, V., Ertel, C., Beil, K., Steffens, M. C., & Stangier, U. (2013). In the Presence of Social Threat: Implicit and Explicit Self-Esteem in Social Anxiety Disorder. Cognitive Therapy & Research, 37(6): 1101-1109 (2013). doi: 10.1007/s10608-013-9553-0.  

Salcedo, B. (2018). The Comorbidity of Anxiety and Depression. (Online). National Alliance on Mental Illness.  https://www.nami.org/Blogs/NAMI-Blog/January-2018/The-Comorbidity-of-Anxiety-and-Depression 

Salzer, M. S., Brusilovskiy, E., & Townley, G. (2018). National Estimates of Recovery-Remission from Serious Mental Illness. Psychiatric Services, 69(5): 523-528 (2018). https://doi.org/10.1176/appi.ps.201700401

Sagman, D., & Tohen. M. (2009). Comorbidity in Bipolar Disorder. (Online.). Psychiatric Times. https://www.psychiatrictimes. com/view/comorbidity-bipolar-disorderSchnabel, L. (2016) Gender and homosexuality attitudes across religious groups from the 1970s to 2014: Similarity, distinction, and adaptation. Social Science Research, 55: 31-57 (2016). doi: 10.1016/j.ssresearch.2015.09.012

Schotanus-Dijkstra, M., Drossaert, C. H. C., Pieterse, M. E., Walburg, J. A., Bohlmeijer, E. T., & Smit, F. (2018).  Towards sustainable mental health promotion: trial-based health-economic evaluation of a positive psychology intervention versus usual care. BMC Psychiatry 18:265: 1-11 (2018). https://doi.org/10.1186/s12888-018-1825-5

Schrank, B., Brownell, T., Tylee, A., & Slade, M. (2014). Psychology: An Approach to Supporting Recovery in Mental Illness. East Asian Arch Psychiatry, 24: 95-103 (2014).

Sin, N. L., & Lyubomirsky, S. (2009). Enhancing Well-Being and Alleviating Depressive Symptoms with Positive Psychology Interventions: A Practice-Friendly Meta-Analysis. Journal of Clinical Psychology: In Session, 65(5): 467–487 (2009). doi: 10.1002/jclp.20593

Slade, M. (2010). Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Service Research 10 (26): 1-17 (2010). https://doi.org/10.1186/1472-6963-10-26 10(26)

Sowislo, J. F., Lange, C., Euler, S., Hachtel, H., Walter, M., Borgwardt, S., Lang, U. E., & Huber, C. G. (2016). Stigmatization of psychiatric symptoms and psychiatric service use: a vignette‑based representative population survey.  European Archive of Psychiatry and Clinical Neuroscience, 267(4): 351-357 (2017). doi: 10.1007/s00406-016-0729-y.

Stangl, A. L.,  Earnshaw, V. A., Logie, C. H., van Brakel, W., Simbayi, L. C., Barré, I., & Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC 17(31): 1-13 (2019).https://doi.org/10.1186/s12916-019-1271-3

Steele, B. F.  (1995). The Psychology of Child Abuse. Family Advocate, 17 (3): 29-23.

Stuart, H., & Arboleda-Flórez, J. (2012). A Public Health Perspective on the Stigmatization of Mental Illnesses. Public Health Reviews, 34: Epub ahead of print.

Twenge, J. M., Sherman, R. A., Wells, B. E. (2016). Changes in American Adults’ Reported Same-Sex Sexual Experiences and Attitudes, 1973–2014. Archives of Sexual Behavior, 45(7): 1713–1730(2016). https://doi.org/10.1007/s10508-016-0769-4

Unite UK. (2016). What is causing Low Self-Esteem in the LGBTQ+ Community? (Online.). Unite UK. https://uniteuk1.com/2018/06/low-self-esteem-LGBTQ+-community/

UW-Madison. (2020). LGBTQ+ Culture and Life in the U. S. (Online.) University of Wisconsin-Madison. https://iss.wisc.edu/resources/LGBTQ+/LGBTQ+-culture-2/LGBTQ+culture/#:~:text=LGBTQ+%20issues%20have%20emerged% 20 as%20a%20 major%20social,on%20geographical%20location%2C%20local%20culture%2C%20and%20individual%20backgrounds.          

Vanderheiden, E., & Mayer, C.-H. (2017). An introduction to the value of shame―Exploring a health resource in cultural contexts.  In E. Vanderheiden, C-H. Mayer (Eds.) The Value of Shame. Exploring a Health Resource in Cultural Contexts (pp, 1-42). New York City: Springer Publishing. doi: 10.1007/978-3-319-53100-7

Vrbova, K., Prasko, J., Ociskova, M., & Holubova, M. (2017). Comorbidity of schizophrenia and social phobia – impact on quality of life, hope, and personality traits: a cross sectional study. Neuropsychiatric Disease and Treatment, 13: 2073-2083 (2017). doi:10.2147/NDT.S141749

WEF. (2018).  This is the state of LGBTI rights around the world in 2018. World Economic Forum.  https://www.weforum.org/agenda/2018/06/lgbti-rights-around-the-world-in-2018/

WHO. (2019). Mental disorders affect one in four people. (Online.) World Health Organization. https://www.who.int/whr/2001/media_centre/press_release/en/#:~:text=Mental%20disorders%20affect%20one%20in%20four%20people%20Treatment,neurological%20disorders%20at%20some%20point%20in%20their%20lives.

Wilkerson, J. M., Schick, V. R., Romijnders, K. A., Bauldry, J., & Butame, S. A. (2016). Social Support, Depression, Self-Esteem, and Coping Among LGBTQ+ Adolescents Participating in Hatch Youth. Health Promotion Practice. 18(3): 358-365 (2016). doi:  10.1177/1524839916654461

Wood, L., & Irons, C. (2017) Experienced stigma and its impacts in psychosis: The role of social rank and external shame. Psychology and Psychotherapy: Theory, Research and Practice 90, 419–431 (2017). doi: I:10.1111/papt.12127.

Yeilding, R. (2017). Developing the Positive in Managing Social Anxiety. (Online.) National Social Anxiety Center. https://nationalsocialanxietycenter.com/2017/09/18/developing-positive-managing-social-anxiety/.

Zimmerman, M., Dalrymple, K., Chelminski, I., Young, D., & Galione, J. H. (2010). Recognition of irrationality of fear and the diagnosis of social anxiety disorder and specific phobia in adults: implications for criteria revision in DSM-5. Depression and Anxiety, 27(11): 1044-9 (2010). doi: 10.1002/da.20716.

INDIVIDUAL RECOVERY. The symptoms of social anxiety make it challenging for some to participate in a collective workshop. Dr. Mullen works one-on-one with a select group of individuals uneasy in a group setting. ReChanneling offers scholarships to accommodate the costs. What is absent in group activities is provided in our monthly, no-cost Graduate Recovery Group. In this supportive community, graduates interact with others who have completed the program.  Contact ‘rmullenphd@gmail.com’.        

Committing to recovery is one of the hardest things you will ever do.
It takes enormous courage and the realization that you are of value,
consequential, and deserving of happiness.