Well, I’d said I was wrapping up my half-year-long series last month unless you, dear readers (not sarcasm, I really do value each of you that engages with my work whether or not you leave a comment or I will ever know about you), had suggestions for me about unhelpful phrases I neglected to cover. Not only did several of you write to me with such suggestions, but the insightful discussions in the comments have sparked some thoughts for me that I’d like to respond to. So the Stop Saying This series is back for a final hoorah as we close out one hell of year, this post fueled entirely by reader suggestions and comments.
Any discussion of “chemical imbalances” or medication
It’s a strange time when even some who consider themselves “mental health advocates” push either directly for the chemical imbalance theory or promulgate it through their comparing “depression” to diabetes, which I’ve discussed before. But “mental health professionals,” with all that training and licensing and certification and whatnot, should know better: the chemical imbalance theory—and the biomedical model it often gets confused with—is a theory, and a pretty terrible one at that.
There are tomes written on why it’s a terrible theory both scientifically and advocacy-wise, so I’ll stick with the if-you’re-a-professional-stop-saying-it angle: aside from being dismissive and lazy, telling a client that you believe their struggles are because their brain randomly got imbalanced one day perpetuates deeply harmful deceptions.
The general public still believes that psychotropic medication is neutral or tolerable when it comes to “side” effects. The general public also believes that you, mental health professional, are an expert and whatever you suggest is at least with your clients’ best interests at the forefront of your mind. So the chances that an average client has done their research on the lasting damage the drugs manufactured under the guise of “correcting a chemical imbalance” can do, and the lifelong trauma that can result from entering the systems that prop up the companies who make these drugs, are quite low.
When you casually discuss chemical imbalances or suggest medication as if it is one option among other equal options, especially without discussing any of the side effects, risks for addiction, and other serious impacts these medications can have, you are at best misleading a client into a belief that medications are neutral, if not beneficial. At worst, you are leading them straight into danger.
What you’re discussing, essentially, is the possibility of giving a blowtorch to a toddler because they told you they were cold. Don’t miss the point of that comparison: I’m not saying clients are stupid children. I’m saying that you’re assuming the toddler is informed about risks they can’t even begin to comprehend.
Also, don’t miss the entirety of that comparison: the damage a toddler can do with a blowtorch is to themselves and to others, it can happen quickly and it can be total.
Antidepressants have been linked to increased risk of suicide and violent behavior in adults. And “all antipsychotic medications are associated with an increased likelihood of sedation, sexual dysfunction, postural hypotension, cardiac arrhythmia, and sudden cardiac death,” write John Muench and Ann Hamer, in the same article in which they brush off “life-shortening” symptoms because of the “trade-off” of “treating” “psychotic symptoms” and urge primary care providers (not, it should be noted, therapists or other mental health professionals), to understand the risk of adverse “side” effects.
This shows, among other things, that true education—the only kind that would allow for true informed consent—is left totally up to the client. The nonchalant way that most therapists discuss chemical imbalances or suggest that one “might try” medication as if it’s a new food contributes to funneling those seeking relief for their mental and emotional stress right into that minefield.
Discussions of “diagnoses” as medical conditions
This one is very tricky. Discussions of “diagnoses” are problematic for similar reasons as I discussed above, but it doesn’t mean they shouldn’t happen. The DSM diagnoses are not based on anything other than the votes of self-appointed experts and do not reflect anything in reality. They can, however, stigmatize people for life, damage their sense of self and agency, and affect how the systems of the world treat, mistreat, use and abuse them. I’ve never heard of or personally experienced a discussion with a therapy about diagnoses that included warnings about any of that or about the internalized stigma that can wreak havoc with one’s ability to live life on their own terms.
But a therapist should not simply be putting down a diagnosis on their insurance billing without talking to their client first. This, in fact, is the main reason therapists “need” to use diagnoses, but they should talk to the client about what diagnostic codes they are using for insurance billing purposes. This is important because you, the therapist, have the power to potentially create a pre-existing condition for your client on paper such that they could lose insurance coverage or access to future coverage in unpredictable ways that they will not be able to reverse.
To be clear, you are not “agreeing” with your client on whether or not they feel like “Generalized Anxiety Disorder” is the “correct “diagnosis; you are asking your client to collaborate with you on how you can paid for your “services” in such a way that does not damage their ability to access health insurance coverage in the future.
In any other industry, the word for using a name for something that does not actually exist in order to get reimbursed by insurance would be fraud, right? This is why it is important to talk to your client about the diagnostic codes you are using on your insurance submissions and simultaneously why these conversations are difficult to navigate. As the therapist, you essentially have to say, “So, um, I need to label you with this thing that isn’t actually real in order to make the insurance company believe I’m treating you for said unreal thing in order to get paid. I was thinking of using the code for the label Generalized Anxiety Disorder. Does that fit?”
If you’re paying attention at all to the world, the “generalized anxiety” part probably would fit, but it’s the world that’s disordered, not the person struggling to survive in it. More and more therapists are starting to acknowledge this, but that’s all the more reason why, rather than having discussions about which diagnostic names to use to get therapists paid, the entire diagnostic system should be put near that toddler with the blowtorch.
Until then, “mental health professionals” should stop talking about diagnoses as real things—depression is not like diabetes, and a diagnosis of depression is not like a diagnosis of diabetes, either—and more as the codespeak for insurance-approved “services” that they actually are.
“Calm down, don’t worry”
This is straight-up gaslighting for a therapist or anyone else to say. Not only does it not work to tell someone to calm down or not worry (as if such things have never occurred to the upset person), it’s tone policing, which only happens when someone is uncomfortable with your emotions (which is their problem, not yours) or as a deflection from the real issue that they don’t want to deal with.
While it can be easier to talk through an interpersonal conflict when you’re calm, our culture seems to have made a rule that you’re only allowed to talk about difficult things when you’re calm, which really means when you’re able to not display any emotion at all. So, to resolve things, we have to be sociopaths, basically. That is obviously dysfunctional.
Also, I don’t always find it easier to truly resolve things when I’m calm. I have, in the past, tried taking a break from talking through interpersonal conflict and, the majority of the time, one of two things happens. I will be able to regulate my nervous system and downshift into a lower state of physiological arousal during the break but will become reactivated and upset again the moment conversation resumes. Or I will be able to remain calm only be repressing how I really feel about things and thus create a false sense of resolution. This resolution will be false because it will either meet the needs of the other person at the expense of myself or it doesn’t take into account my truth and what I need, because I cut myself off from what I was really feeling in order to accommodate the inappropriate discomfort our emotionally abusive society has with emotions.
Most importantly, though, as I mentioned above, the current state of the world is, and has for a long time been, providing an unrelenting supply of things to genuinely be anxious and angry about. It doesn’t matter what your political beliefs are, it seems like the one thing we, the little people who do not have power or obscene resources or way more than any human could ever need, can all probably agree on is that things are an absolute mess.
It is, as Krishnamurti put it, “no measure of health to be well-adjusted to a sick society.” There are myriad things to be validly anxious about. Anger is so often these days an appropriate response. I find it dismissive, illogical, and a bit self-righteous when friends tell me to calm down, except in very specific cases where they have some control over the outcome of a particular situation I’m worried about. Given how appropriate anger and/or fear can be, it is self-serving and dehumanizing to tell someone to calm down or not worry, especially if no other solution, course of action, resource or connection follows.
For a therapist or other figure our society currently elevates as someone who is supposed to help people feel better, it is a deep, deep betrayal to tell people not to worry or to calm down in a world that stokes and provokes anxiety and worry without end.
I would now like to address a few delicious topics that came up in the comments of my post last month.
The “observer” and quantum theory
I discussed the dubious notion of “the observer” in my last article; how it was questionable whether such a construct could be neutral and, even if it could be, if neutrality is truly the most helpful approach (which is partly related to what I said above about how “calming down” has actually hindered me more often than not in my pursuit of true resolution in interpersonal conflict). What I neglected to mention, and what was brought up in the comments section, was the role of quantum mechanics in observation in general. I am far from an expert in quantum theory but, from what I know, one of its main principles is that the very act of observing something changes it. It doesn’t change the observer’s perception of the observed; it actually somehow changes the observed.
Again, I am neither a quantum physicist nor an expert in how to handle emotions, so this is a purely theoretical exploration sparked by a comment on a previous post that caused me to think I’m seeing a connection. I could be wrong, but I’m interested in respectful discussion about it.
The implications for this in relation to psychotherapy are too vast to explore fully here, but one thing this does mean is that neutrality actually is not possible even (or especially?) in the observer role. It could also mean that stepping into “the observer role” is both easier and more effective for positive change than I’d originally thought; perhaps “all” you have to do is simply look at/consider/call to mind something that you’d like to change.
I don’t know enough about quantum theory to speak about how much the intention of the observer plays a role in the outcome of the change that the mere act of observation has on the observed; is it possible that, if one holds a positive intention in one’s conscious awareness as one turns to observe whatever they would like to change, that they could affect change in the way they intend? I truly have no idea.
And I want to be careful here; I do not want to claim that people who are suffering injustice, abuse, or oppression can just think or “observe” their way out of their circumstances. Blaming the victim is the absolute last thing I want to do; there are always other people’s free will and massive, unaccountable systems involved in suffering.
Telling someone to just have better thoughts so they don’t keep creating shitty situations for themselves is a message therapists often send, not something that I actually believe is true. I’m simply trying to approach the role of the observer with a bit more nuance and uncertainty than I did in my previous post, due to the connection a commenter made between observation and quantum mechanics that I had not previously considered.
Therapists covering up abuse versus not knowing how to recognize it
Finally, more than one comment pointed out that, rather than covering abuse up, therapists often cover for it. This, too, gave me something to think about that I had not considered in my previous post. While I think many therapists do fail to recognize signs of abuse, I am now considering that this might be because the entire system built to train and license them doesn’t train them to do so intentionally. If that is the case, perhaps it is because the system itself is abusive so it would be against its self-interest to train people to recognize the signs of abuse.
One basic way the system is abusive is that it construes the very human need for connection and support into a profit node. This not only stratifies access to “help” based on financial resources, inevitably putting it out of reach for people who need support (which is not synonymous with any service the mental-health field proffers) the most. It further also demoralizes the person seeking help by pinning him on the bottom of a false power structure, then elevates the human with a license from the state to “help” above anyone needing help. This reinforces the stigma our individualistic culture has against asking for help.
Another way is it gaslights those seeking connection with others is that, while “the skills of a superb psychotherapist are mainly common-sense human skills—warmth, empathy, reliability, a lack of pretentiousness or defensiveness, an alertness to human subtlety, an ability to draw people out—the necessary qualities very similar to those one looks for in a good friend” (Martin and Deidre Bobgan in Psychoheresy: The Psychological Seduction of Christianity, p. 229), therapists are very clear that they are not their clients’ friends. In fact, it is against the code of ethics for therapists to be friends with their clients. And it would actually violate the standards of true friendship for therapists to be their clients’ friends, too, since friendship is free; the moment money is exchanged, we instinctively know that is no longer a friendship. Yet, the therapist needs to act in ways very similar to a good friend if they are to be a “superb” therapist, whatever that means.
The idea that therapists would purposefully cover up abuse, as opposed to simply not knowing how to recognize it, also helps me to understand what the hell my former marriage counselor might have been doing. She would tone police me, attempt to “manage” my emotional “outbursts” and stop the therapy session until I…wait for it…calmed down.
When I asked her why she never challenged my ex-husband on the damaging behaviors and verbal abuse I reported to her in session, she claimed she was “confronting” him. I asked her when she ever did that and she said, “Oh, when I ask him how he feels about that hurtful thing he said to you last week, when I ask him how his relationships with his brothers are, when I ask him about how he feels about his father.”
I felt dissatisfied, angry and completely confused about how what looked to me like coddling and permitting could be “confronting” and “challenging” to the therapist. It was baffling to me how she didn’t recognize my ex smashing glass near me multiple times, saying “I felt no love for you on our wedding day,” staying at work well into the evening even on nights it was his turn to cook, not telling his family about my food allergies when we went to visit them out of state (as in, I had no way of providing my own food without doing something painfully awkward like asking adults I’d met three times in my life to borrow their car), as abusive and neglectful (so, abusive).
I can’t know for sure that my former couple’s therapist saw the abuse I was experiencing and decided to say nothing (and thus enable it to continue) or if she truly missed it, but the former is a possibility I had not considered before and it makes more sense to me than her blindness to what was so obvious to the friends I told.
I don’t pretend to address all of these things, or even this topic (the list of things helpers and friends should not say to people in distress is likely endless) adequately or exhaustively. But thank you, readers and commenters and those who emailed me, for engaging with this series so thoroughly, for your suggestions and for your deep thinking that has helped my own, as well as to facilitate my healing and recovery from the abuse I have suffered at the hands of those professing (and getting paid, sometimes quite well) to help.
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.
Quantum Theory has nothing to say about human relationships. Nothing whatsoever.
New-Agers that have bitten off more than they can chew have a lot to say about how Quantum Theory affects human relationships.
Or in other words, many people who are not Quantum Theorists have bastardised Quantum Theory to attempt to legitimise or otherwise give a sciencey veneer to their hardcore Woo.
Although the Observer does change the Observed. And the Observed changes the Observer. Personally I think this observation is more useful when applied to the effects of the surveillance state and surreptitious surveillance in general on the human psyche.
Otherwise we’d be reinventing the wheel. Transference and Countertransference is well-established. As are all the many and various attributional and confirmation biases. As are expectancy effects.
The notion of neutrality or objectivity is something aspirational, rather than attainable. It’s something to strive towards (when necessary) with at-best effort. But no-one can transcend their subjectivity. Although plenty enjoy claiming that they can and then spending much of the rest of their life dodging scrutiny.
The first step toward neutralizing one’s subjectivity is to notice that it exists. Most do not get that far. Those who assure you they are “objective” are usually the most dangerous of all!
Steve McCrea wrote: “The first step toward neutralizing one’s subjectivity is to notice that it exists.”
The second step is abandoning the violence of neutralising subjectivity. You’ll permanently scar the psyche or at best leave blemishes that won’t budge.
Steve McCrea then wrote: “Those who assure you they are “objective” are usually the most dangerous of all!”
Aye, indeed. A subject claiming objectivity is a menace, no doubt.
I find the ability to temporarily step out of one’s own biases is helpful to making rational decisions. But I agree, engagement is inherently subjective, and trying to permanently remove subjectivity is a road to a dark place.
Jiddu Krishnamurti spoke a lot about how the way we look at something changes what we see. How the rush to label, judge, and proceed to an action prevents us from understanding what is actually there.
It’s not that the therapists observation changes the observed; it’s that the therapists actions stemming from it do. Observing paranoia, with “weird thoughts” and label someone being abused as a schizoprenic becomes self-fullfilling. They get cognitive impairing drugs and become incoherent. Now any claim that they are being abused can be rejected because they are certifiably so crazy they need less rights than a criminal. That itself might make someone lose it.
Good point Willow.
And so on we go, each society establishing what is acceptable as a norm. Those with power get to decide. They are the observers with objectivity or so the story goes. The harm that comes out and from these misconceptions is not a concern in the animal world. We are trying to become that which we profess to be. That we are human, and somehow are different and unique apart from the rest of the animal world. So far, our brains seem to be capable only of inflicting and watching the inflicted.
One time our society was led by God and no matter what, you were NEVER good enough. Basically only if you could pay your taxes, and see a priest. And you could also internalize the concept of hell.
It is led now by a god that calls itself psychiatry. Nothing is ever good enough.
Those taxes need to be paid. And you can internalize that you are the one with the illness that deviates from the norm.
“Quantum Theory has nothing to say about human relationships. Nothing whatsoever.” That doesn’t mean quantum mechanics are not affecting human relationships. In fact, it would be totally incoherent to claim it doesn’t, and we already have a big problem with coherence when it comes to the laws of physics. We humans are ants looking at everything around us through a straw; we know about 4% of what’s going on in the universe, so it’s kind of impossible to say whether quantum mechanics actually govern human relationships or not. At this point, it would take some mighty arrogance to definitively claim that they don’t (I was merely THEORIZING that they MIGHT). Just because the theory may not have anything explicit to say about human relationships doesn’t mean quantum mechanics are not at play. Silence on a matter does not equate to rejection (or approval) of that matter – that’s codified into law (aka the Miranda Rights) for a reason.
Hi Megan and thanks for writing another blog.
It is a strange phenomena that we can think of the word “neutral” within the context of understanding something. That we actually believe we can be something called “neutral”. The mind would not even know if it is being neutral lol. It is not capable of stopping all activity and ongoing process.
And we are very much affected by others who think they are neutral, or pretend there is such a thing. We might even make that our goal lol. to become “neutral” minded. I think often it is seen as something rational 🙂
A lot of therapists have no business “looking” for abuse. The manner in which they “look” or “dig” or their intentions of how to “fix” it, can have more horrible results and need therapy to get over it. Sometimes therapy is capable of taking away a resilience.
When the blasted industry was told to look for “abuse”, it resulted in spanking, not working with people without blame.
When it comes to two adults in relationship counseling, perhaps a therapist honestly could say “I cannot change him or her, so perhaps your best bet is to be tough and step out, but I am more than willing to help you”.
It might behoove a therapist to name something, a behavior, as abusive, but then, as a therapist she knows that even abusers can change or have maybe had bad experiences that make them act mean. I think of marriage therapy as “finding out” and then moving on. At some point then, the one who is being abused needs coaching on how to fight back or get out. This business of “how did that make you feel when he said that”, and then to turn to him and say “and how did it make you feel that she felt hurt”…I could not STAND IT to be a therapist. Not between people. I want my therapist to be on my side dammit lol.
I often wonder why more friendship relationships don’t go to therapy when they are on the brink of breakups. Friends often fight it out until it’s over. Our spousal relationships seem much more stuck, much more investment, our life partner, our dreams, our wants, being in the same houses without breaks, kind of “wedded” to that togetherness. And all that even after the “friendship” sours.
Maybe one reason the mental health industry tends to avoids abuse is because they don’t want to look in a mirror. This could simply be an emergent process.
Regardless of what you think of psychiatry their tactics resemble those used by emotions manipulators.
They partake in pretty much every sign of emotional manipulation mentioned in the bellow link.
When you are emotionally manipulating someone it is probably uncomfortable to tell them how someone else is doing the same thing.
And it’s awful to sit in a chair and realize that humans tend to not see when they engage in manipulation.
I think that is the problem in being “trained”. To be a good therapist, do we need “training” and what is the training about, or based on. Is it based on evidence of helpful or successful “treatment”, or evidence of money to be made in a “sickness” society where “help” is simply the certificate and the chair to be sat upon for $150 bucks for the hour.
Perhaps before therapists embark on “training” or seminars, they should ask for testimonies of the people that benefitted. And preferably the testimonies of people over the age of 50, not ones that are just starting to get involved with the idea that their minds or brains need services.
Megan writes that diagnoses do not “reflect anything in reality” and that “In any other industry, the word for using a name for something that does not actually exist in order to get reimbursed by insurance would be fraud, right?”
I disagree with that, up to a point. The person coming to see the therapist is typically doing so because they have some kind of real problem. It is true that the diagnoses themselves are not “real things” – the actual problem is unique and involves a complex interaction between the person and the systems in which they are embedded – o the diagnoses might best be understood as somewhat or sometimes very misleading labels that get put over real complex problems.
Anyway, since something real is going on and because help for the situation should arguably be paid by insurance, there isn’t anything like fraud going on. I think we need ways of talking about that which acknowledge that mental and emotional problems can be real even though labels and much of the “help” offered is unhelpful: otherwise we come across as advocating for a colder society where it would be harder for people to reach out for help of any kind, and might seem we are lacking interest in finding the kind of help that would truly be helpful.
I see what you mean in response to the earlier comment (and saying ‘up to a point’). However, bc you agree that the diagnostic labels are ‘not real’ and ‘somewhat or sometimes very misleading’ is where one could point to fraud, and systemic misappropriation of the ‘real complex problems’. The fact that the potentially unreal diagnostic labels, partly or always, are used for professional and coordinated financial gain and efficiency, and isn’t entirely justified and based on truth and accuracy, this is fraud, right? A soft deception, one rooted in the momentum of the past, gigantic social movements and habit? But a partial/potential untruth for accruing money (even sometimes taking away rights), isn’t this a type of fraud, no matter how well-intentioned? No matter how cordial and invisible? I see a kind of quasi-doublespeak that therapists/doctors are often stuck with.
It’s a waste of time to criticize the inherent contradictions of “therapy” if the unspoken assumption is that there’s a “correct” way to assuage the inherent trauma of capitalism on an individual level — without first defeating capitalism! “Personal growth” is a form of individualism when separated from the necessity of collective struggle.
This is becoming an ever more convoluted dilemma as more and more “woke” liberals present their reformist proposals as “revolutionary” and “socialist” when they are nothing of the sort.