9 (comparatively) neglected principles for mental health/therapy?

[status: pretty unsure about many thoughts and some phrased a bit more strongly than I find 100% convincing to test ideas- and would I hate to claim undue confidence due to importance of subject matter. However, I reasonably suspect many to be largely true, even if not received wisdom.]

[also- this is my cringe first post- but maybe you can already tell...]

From having experienced therapy and mental health 'culture' from multiple angles- including trying therapy personally, having family therapy and making initial steps to retrain in this field- there seem to be a few recurring issues with therapeutic approaches or people's approaches to mental health and/or therapy.

Personally, the following principles seem to be true and helpful guidelines that are generally minimized or neglected in much therapy and pop psychology but I thought having them analyzed (torn apart?) here could be a good sanity check (unimpressive pun not intended).

In no particular order:

1. Never attribute to the emotional until you've ruled out the physical (and don't assume big emotional effects require big emotional causes).

• e.g. Mental health sometimes works like the Frasier episode where the psychiatrist has a patient with lethargy and assumes there's a deep psychological reason requiring years of intensive therapy, while the medical doctor cures the issue quickly by rectifying a nutritional deficiency. Check for easy solutions first and don't necessarily assume that an extreme emotional output can't come from seemingly trivial biological input.
• Mental states (naturally) come from physical processes and emotions involve combinations of various physical processes. Disrupting one of the major biological systems needed for a negative emotion- e.g. such as just changing breathing in a situation of potential anxiety- can sometimes be enough to prevent the expression of a major negative emotion, or be a stop-gap solution.

• Therapists are trained to deal with psychological problems so often have some bias towards seeing problems as purely psychological- this can often lead to physical cause/exacerbation being missed. Those who are trained in emotion/mental causes should, all other things being equal, err on the side of biological causes (just as those trained in biology should err out of caution on the side of psychological causes).

   

2. Emotions are reactions to perceptions, which are best guess interpretations of factual situations- factual accuracy first, emotions second

• While some stimuli lead directly to experience (pain etc.), often we experience stimuli, we create an interpretation that best explains the experience, then we feel based on the interpretation. 
• Some therapy schools can often spend too much time asking how we feel (based on our interpretation) and not challenging the validity of the interpretation itself. E.g. if you believe your partner might be cheating on you but this in fact isn't the case, then talking you through the emotional impact of worry over infidelity is probably less helpful than a careful examination of the facts here. No problem perceived, no negative emotion. 

• As a personal aside about factual accuracy- one member of my family has a (diagnosed) Cluster B personality disorder. An otherwise very good family therapist got this confused with schizophrenia in his notes and the mistake only came out after a few weeks. Even otherwise high-quality therapy based on faulty information could well be more harmful in some aspects than no intervention at all. Double-check the accuracy of all major details first and gather as much info as possible- perhaps even more than seems relevant- before talking about the emotional impact.

   

3. Nature and nurture of course- but in practice, probably more nature than you (want to?) think

• Of course both nature and nurture play a role and many scientists would say the nature-nurture debate is a false dichotomy as they constantly influence each other.
• But in a more practical, conventional sense, it probably is fair to say some traits come more from nature and more from nurture and- as genetic causes are often seen as depressing and deterministic while environmental causes are seen as more malleable and fit with the meritocratic and liberal values of society- most people probably have a bit of a comparative bias towards nurture explanations.

• Therapists probably have an even greater bias towards nurture, because believing in the malleability and improvement potential of clients is usually a pretty strong prerequisite for moving into that line of work. So, when all other things are equal, err on the side of considering genetic influences. (Equally- though this is probably much less common for people involved in therapy- if you find environmental causes intuitively unappealing because, say, the room for human malleability and change damages your psychological need for order, then err on the side of considering more nurture factors.)

   

4. Don't assume everything that's typically traumatic is a trauma for each person

• People are much more diverse in emotional reactions and mental landscapes than we previously assumed, not even just with things like ASD and ADHD neurodiversity but things like internal monologues and aphantasia.
• As most people's natural tendency is to assume other people have similar activity going on in others' minds, this leads to the view that what is traumatic for me is traumatic for you.
• When another person then truthfully mentions not being too bothered by something that other people generally find traumatic (e.g. not being too hurt by a parental divorce, despite this generally being seen as a major event for a child), this could then lead to a therapist assuming a lack of emotional awareness or denial and cause them to dig deeper to find a non-major/non-existent problem. 

• Similarly, if a client shares a deep personal issue that isn't widely recognized (yet), a therapist might assume this isn't the real issue and dig and dig for a more suitable cause- at which point a client might genuinely come to believe themselves to be traumatized by something that wasn't an issue before. This might prevent real growth and even lead to increased psychological distress. Equally distressing might be if clients don't feel their deepest (niche) issues are taken seriously.

   

5. People are not consistent- know which incarnation of a person you're talking to (open and honest communication can sometimes be really dangerous)

• People can be very different based on factors like sleep, hunger, anger/frustration and other causes and you too are likely to be different based on these factors, whether you're always aware of it or not.
• A serious conversation between two people when one isn't at their best is probably at least sub-optimal and likely harmful. A conversation where two people aren't at their best is probably nearly always going to do more harm than good. 
• Open and honest conversation is seen as a virtue in itself but someone's honest emotions can vary greatly by state- people can be open and honest about the truth according to one mind-state, be convinced by that mental state that this is a permanent truth of their life, then cause lasting damage (we already acknowledge this for alcohol/drugs etc. but should also with spiraling  effects from internal biological fluctuations).

• The skill of preventing potentially disastrous conversations when someone/some external force is exerting pressure for poorly-timed deep, emotional chat is probably as important as learning how to have productive open chats when the time is right. Sometimes deep and open chats are vital détente; sometimes they can be Gavrilo Princips for largely stable relationships.

   

6. Memory is deceptive- don't necessarily believe a present view of the past; don't focus on trauma that might not be accurate 

• It's widely known that memory is often inaccurate but this knowledge seems to be under-applied to those in therapy when talking about past trauma. 
• I know someone who claimed not to have any happy childhood memories but I and others remember witnessing more than a few moments of spontaneous joy, almost certainly beyond the acting abilities of a young child. The past is constantly being made to fit current narratives to some extent and so is it possible that sometimes therapy and pop psychology "trauma culture", by putting extra attention on these issues, can make people reinterpret their past in a much more negative way, to fit the new focus on and narrative of childhood trauma?

• Maybe, like political revolutions have to exaggerate the pains of life under the old regime to justify the new one, could the current focus on trauma (especially in TikTok pop psychology) lead to some subconsciously exaggerating the pains of the past to reassure themselves that they are genuinely improving with therapy and as a defense against the possibility that life might actually be getting worse?

   

7. Excess focus on emotions can exacerbate negative ones

• Somewhat related to the point before but there is a tradeoff between giving attention to and healing past pains and minimizing negative emotions by gradually not giving them as much attention.
• Meditation is often effective by allowing less direct engagement with negative emotions and expert meditators like Matthieu Ricard etc. often have so much experience not giving into negative emotions that the neural circuitry needed to produce them greatly diminishes. Meanwhile those who vent their anger actually become more angry.

• A lot of therapy schools value digging into past pains but maybe some people would benefit more from not examining them as much and learning strategies to give them less attention (as some schools already do)? And maybe the helpful therapy that does dig into the past should give a bit more weight to exploring then moving on, as anecdotally, I know many people who seem to get addicted to exploring past pains but without many/any objective signs of present day-to-day well-being improvements.

   

8. Solving a problem is always better than managing a reaction to it

• There are very few "always" rules for anything in life but, pragmatically, this might be about as close as you can get to one in mental health.
• It's often said that some people just want to vent about a problem and have emotional support for it rather than having their problem solved. But emotional support might reduce the suffering of a problem by, say, 50% (and probably only temporarily)- solving the problem naturally reduces the suffering of the problem by 100%. And if it doesn't and the person doesn't feel fully better then that wasn't the real/entire root cause, so you can focus on trying to work on the deeper problem. 

• Solving the entire root cause might not be easy- it might even be impossible/near-impossible- but it's still logically better, if/when possible, to solve a problem than palliate it. And if a person gets more positive emotion out of the support than negative emotion reduction from solving the problem, this again likely suggests a real root cause around a dysfunctional use of problems for emotional attention. Just soothing people's emotions on a short-term basis and validating them is generally worse than attempts to tackle causative negatives. 

   

9. Some disorders are characterized by delusions; some by not being delusional enough

• Perhaps the most uncertain one- just as many diagnoses are thought to be extremes of traits that are often found in moderation in the general population (e.g. schizophrenia arguably being a negative extreme of tendencies which, when more moderate, can just increase creativity), perhaps self-awareness and realism are probably also best (for the person with them) in moderate amounts.
• Some delusion and excessively positive view of self is probably quite helpful for most people and many conditions are probably, at least in part, the cause or result of a lack of normal delusion in various areas.
• Depressed people and autistic people perhaps have more accurate assessments of themselves and their future, lacking the common irrationality of optimism bias (uncertain as some research supports this while other research disagrees). Though Beck was right to acknowledge that much depression and anxiety etc. comes from irrational negative thoughts (CBT probably wouldn't work if this wasn't correct), it's also worth acknowledging that the average happy person might have more irrational thoughts that keep them happy/functioning than a depressed person has irrational thoughts making them miserable. 
• Maybe mental health is often therefore about maintaining just enough realism to function and prevent future crushing disaster, while not challenging too many delusions that aren't likely to lead to fatal miscalculations.
• While many disorders are characterized by excess and harmful delusions (e.g. schizophrenia), there probably still are a minority of disorders that are characterized by too much realism in one area. Slightly cynically, perhaps depression is being too realistic about oneself/the present and anxiety is being too realistic about the potential for future harms- e.g. many people wonder, after negative events, why it happened to them- perhaps anxiety is often just lacking this irrational exceptionalism? And maybe even psychopathy is mainly being too rational in interpersonal dealings? Perhaps the only people to truly conform entirely to homo economicus models of rational behaviors are psychopaths. So perhaps some "disorders" come from thinking more rationally, but just in a way that's personally deleterious or socially undesirable?

Again, many of these are pretty uncertain even in my own mind but I wanted to see which ones might redress relatively common issues in modern psychological approaches, which might be stating the obvious and which might just be plain wrong.

Thanks! :)