It’s clear that different people relate to the idea of “mental illness” and labeling differently. Many people find the experience of being diagnosed with a mental illness stigmatizing and disempowering. However, there are others who find the idea of “having an illness” liberating. They say that it helps them to stop feeling overly identified with their symptoms. Believing that “I have an illness” helps them to stop thinking, “There is something wrong with me, deep down.”
As a therapist, I’ve worked with hundreds of people who have been diagnosed by someone else before coming to see me. The overwhelming majority of them had a negative reaction to being diagnosed and strongly prefer my non-labeling approach to therapy. However, I’ve worked with a few people who strongly identified with their diagnoses. From the first session they have been clear with me that they want me to understand their disorder is “real.”
When someone strongly identifies with their diagnosis, I never argue with them. Instead, I proceed to try to get to know them just like I would any other person seeking therapy. I want to know what’s important to them and what changes they’re hoping to make. In order to learn these things, we talk in terms of their unique experience and their suffering. I do my best to relate to and empathize with their symptoms as completely coherent responses to their suffering. After working in this way for some time, almost everyone I’ve worked with has become much less attached to their diagnoses.
While I believe the idea of “mental illness” comes from a deeply flawed logic (more on that in a later post), I’m not sure that it is always harmful. There might be cases in which it is not. However, I challenge all of us to reflect on how thinking in those terms changes how well we can connect with another person’s suffering.
An illness is something that some people have and others do not. It is, by definition, a qualitative break from the norm. It also carries with it the idea of something not functioning as it should. In my experience (and my reading of the research), what seems to help people most is another person’s willingness and ability to empathize with their experience of suffering. The kind of empathy I have experienced as the most healing is when one person is able to relate so deeply that they really see themselves in the experience of the other and see the beautiful humanity in their response to suffering.
While some people might be able to empathize deeply while viewing the other person as “having a mental illness,” it seems to me that such a way of thinking can only get in the way of connection.
The question then arises, “If I stop believing in mental illness, how will I communicate with my colleagues?” In my experience, a sentence or two describing the person’s symptoms and when they show up conveys much better information than a diagnostic category that could mean any number of symptom clusters. Ideally, we can communicate in terms of what the person’s hopes and goals are, so we also know what’s most important to them.
Through reflecting on the idea of “mental illness,” we might find a way of thinking that helps us to better connect with people who are suffering.
Tim Desmond, LMFT offers therapy and consultation through www.phonecounseling.net
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.