By David Joel Miller.
What is Behavioral Health?
The term “Behavioral health” is getting associated with anything from a place that treats mental illness to healthy lifestyles. Additional areas of concern have been added to the things the local mental health agency concerns itself with and some of the old concerns are getting eliminated. The further we stretch the term behavioral health, the more it includes, the less meaning it has.
Some consumers, who were used to going to mental health, resent the name change to Behavioral Health. They point out that they are not their behavior and that being depressed anxious etc is not a behavior. At the same time, consumers are complaining about the new “behavioral healthcare” name, a major national group, the National Council for Community Behavioral Healthcare is pushing forward with programs aimed at reducing the stigma of mental illness and informing the community about mental illness and related issues. So why the need for a name change?
You would think that Behavioral Health and Healthy Behaviors would somehow be related. There are lots of programs, blogs, and books on living and behaving in a healthy manner. Adult-onset Diabetes is highly correlated with being overweight and with having a sedentary lifestyle. So exercising is a part of healthy behaviors but not part most Behavioral Health Departments program. We keep changing the names for a reason.
We have a tendency to avoid words that have unpleasant connotations. First, we see someone with a disability or problem. Next, we try to define what exactly is their difficulty. Defining requires a word or term. Before long the word goes from defining this person’s challenge to being a label people attach to the person, not the condition. So the term that began as a definition of an issue someone was experiencing became a negative derisive term that we can no longer say.
Consider a historical example. We discovered that given two people, both age twenty, one might be able to do advanced Calculus and another might still be struggling with basic addition. To explain this we invented the concept of I. Q. or intelligence quotation. IQ was understood as the number that resulted from dividing their mental age by their chronological age. Let’s avoid the math and the changes in the test that measure this idea for now.
So people with a high score were called geniuses, or gifted. For people with a low score, we needed terms that described just how much lower their score was than the average. So at first, some people used terms to describe a particular range of low scores with terms like moron or imbecile. Before long these terms moved from describing a score on a piece of paper to describing people. Calling people by those labels was offensive to them and to others and we don’t use the labels anymore. We invented new labels.
So the new terms became Mild, Moderate, Severe and Profound Mental Retardation. This set of terms is still in use in the most recent DSM diagnostic manual but already I notice people are uncomfortable describing anyone with these terms and we are using newer labels to avoid describing people by their IQ score.
For a long time, the same social service department that worked with the mentally ill also worked with people with lower than average IQ scores. We had places called “X county department of mental illness and mental retardation.” Someplace changed that name to the department “FOR the mentally retarded and mentally ill,” because the first name sounded like all the employees had a mental illness or low IQ scores. Many people with a mental illness like depression or anxiety avoided going to a place for the mentally retarded because they were “not like that.” So recently we have split off the services for those with low IQ scores. They now go to special places which in my area are called “regional centers.” I expect before long all places called regional or centers will have to change their names when people find out that regional centers serve those with low IQ’s and their families. This separation creates another problem. People with low IQ scores can and do get Anxious or Depressed and they need both kinds of help.
So we have started using another term “Developmentally delayed,” which is also fuzzy because this can be applied to a lot of things besides low IQ. Eventually, we will have to stop using this term when people catch on that some “Developmentally Delayed” people have physical or learning problems and some have low IQ scores. I have written before about the trend to diagnose all people with a low IQ as having ADHD and then give them a stimulant med. We keep hoping there will be a pill that will make all people geniuses.
But our story does not end there.
Over the last few years, mental health and substance abuse programs have begun to integrate. So the mental illness label, while it did fit some substance abusers, did not fit all. And other times we find high but not universal levels of substance abuse among clients who have mental illnesses. So we started looking for a name that might be inclusive of everyone the agency was trying to serve.
The prevalent form of therapy these days is not the traditional Freudian model but the newer Behavioral and cognitive behavioral types. My understanding of thoughts is that they are also events. Electricity moves through nerve cells and chemicals (neurotransmitters) move between cells. So every thought also involves an event and is a behavior we could see and measure. Yanking your hand out of a fire is a behavior but it is not likely to be something you think over and decide to do. So I can easily see how someone who starts out drinking can reach a point where they are dependent on alcohol. Someone who thinks about negative events in their life may become depressed. In both cases, there are behaviors going on but in neither case do I think the person is choosing to be sick.
Among children “behavioral health” diagnosis mostly include bad behavior like being very oppositional or not meeting parents and teachers requirements. So some people have started to think that people who go to “Behavioral Health” for help are just poorly behaved and need to knock it off. I can assure you they would if they could. Having a mental illness or an addiction is not fun.
People can also get knocked down by life events like losing a loved one. The ability to get back up is called resiliency. People who have trouble getting back up may need help in the form of counseling. It is hard to see how those problems are “behavioral health” problems except in terms of an event of thoughts moving around in the head. Very often clients who can’t get back up are referred to Behavioral health. They are certain they are not crazy and know they are not doing this deliberately so they tell us they don’t need to see a counselor.
I agree with them, they are not crazy and being depressed or anxious or having another life problem does not mean you are behaving badly. But you still just might benefit from counseling. Things will get even more complicated in the future when Behavioral Health becomes more fully integrated with physical health. Negative thoughts can actually really make you sick and physical illnesses can change your mood.
Until we find a better name for the way in which we try to help people by teaching and talking – Behavioral Health just may have to do.
Staying connected with David Joel Miller
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