Are Psychological Well being Diagnoses Useful in a Disaster?
We’re presently residing in a time of disaster. This time period can be written about in historical past books. Within the far-away future, we can self-reflect, course of, and make which means out of this era. However for now, we’re in the midst of it; self-reflection and meaning-making are hardly doable as a result of we’re in survival mode.
We live at a crossroads between the persevering with disturbance of COVID-19, the implications of the battle in Ukraine, the astronomical rise in the price of residing, the specter of poverty for a lot of, and the rising nervousness about local weather change. We’re in disaster. We’re in survival mode.
One in every of our typical strategies to deal with a disaster and trauma is what we time period “the flight response.” It signifies that we wish to run away from the risk to a protected place. When there may be one tangible risk that we will transfer away from, it’s a superb technique.
However in our present state of disaster, the risk is omnipresent. Wherever we run to, the planet will preserve warming up, the battle will probably proceed, the price of residing will rise, and COVID-19 will nonetheless be round. Nowhere appears protected lately. We will really feel extraordinarily powerless.
So, we use different methods to run away, trying to really feel safer for a bit, escaping to a distinct place, to offer us a break from the grim actuality: we scroll by our telephones, we watch Netflix, we masturbate to pornography, we overeat, we play video video games, we flirt with folks on-line, we have now one too many glasses of wine, we retreat to fantasy creativeness. All of these are fairly widespread methods of escaping.
Psychological well being professionals are among the folks on the entrance line of assist when there may be such a disaster. Sadly, some psychologists and psychotherapists disgrace and pathologise individuals who go for these widespread methods of escaping the grim actuality. I don’t blame these practitioners, as I’m positive they’re attempting to do one of the best they will, however I object to among the medical trainings and theories they base their interventions on.
Such a disaster because the one we’re going through immediately requires these of us working within the psychological well being professions to re-evaluate our medical information. Do our theories and concepts about folks’s psychological well being nonetheless match with the struggles of immediately’s populations? Isn’t it time that we severely query and problem the medicalised mindset of “prognosis,” pathology, and labels? As an alternative, shouldn’t we validate and affirm people who find themselves attempting to manage one of the best they will?
Validating and affirming folks doesn’t imply we collude with their maladaptive methods, however it merely signifies that we acknowledge they’re human beings in survival mode. Can somebody who manages to control their feelings by scrolling their telephone be helped by being labeled a “telephone addict”? Is utilizing the prognosis of “binge consuming dysfunction” helpful for somebody who finds moments of delight with the content material of their fridge, even when they overdo it? Is it useful to name somebody a “porn addict” as a result of masturbating to porn is their main technique to soothe their existential upset?
For my part, these labels could make folks really feel extra distressed. They’ll encourage folks to assume they’re damaged once they had been already struggling to manage. Furthermore, trying to assist somebody cease utilizing their main methodology of coping (even when maladaptive) may make them really feel worse, not higher. It’s akin to kicking somebody who’s already on their knees.
What concerning the ICD-11 (WHO) prognosis of “extended grief dysfunction”? If I hadn’t been in a position to maintain my partner’s hand once they had been dying of COVID-19 due to the quarantine pointers; if my daughter died of a gunshot wound fired by a stranger; if my father was randomly stabbed to dying; I might be in grief, unhappy, and indignant for a really very long time, presumably all my life. I wouldn’t take it too kindly to have a therapist stick a dysfunction label on my grief.
The behaviours which may be expressing my profound upset may even be inaccurately perceived by professionals as signs of borderline persona dysfunction, a label some clinicians are too fast to leap to. Immense grief doesn’t solely happen when somebody dies. It may occur with all types of losses. At present, we estimate that a large number of folks will endure a lack of high quality of life due to the financial disaster. In case you had to decide on between feeding your baby or heating your property this winter, wouldn’t you be intensely upset—even perhaps upset sufficient that it may appear like a psychological sickness?
Don’t get me mistaken. I’m not in opposition to all psychological well being diagnoses. Typically, receiving a prognosis could be a good factor. They are often useful to entry psychotherapeutic and/or medical assist by medical health insurance. They will help a clinician resolve if they’ve the competencies to work with somebody. For instance, a therapist who has not been particularly educated in working with PTSD (post-traumatic stress dysfunction) shouldn’t be treating a consumer with this situation. Typically, a psychological well being prognosis will help shoppers make sense of their struggles, reminiscent of an ADHD prognosis, for instance. However among the time, diagnoses are extra helpful for the practitioner who prefers to work with classifications than they’re helpful for his or her shoppers who’re simply attempting to manage.
Some diagnoses which can be well-liked labels given to shoppers usually are not even “actual” diagnoses as a result of they haven’t been endorsed by scientific communities and also you received’t discover them within the two essential diagnostic manuals DSM-5 (American Psychiatric Affiliation) and ICD-11 (World Well being Organisation). A few of these “diagnoses” are “digital habit,” “web habit,” “intercourse habit,” “porn habit,” “love habit,” “purchasing habit,” and “train habit.” The phrase “habit” is used inappropriately by many individuals, together with therapists. (I wrote about it right here.) There are additionally some actual diagnoses which can be arguably overused (extended grief dysfunction, gaming dysfunction, OCD, and so forth.).
Maybe on this new world we dwell in, one in every of a number of threats and crises, we—psychologists and psychotherapists—ought to remind ourselves of our greatest talent: sitting with folks, listening to their distinctive and particular tales, and serving to them make sense of their struggles non-judgementally. We all know that the therapeutic relationship is the therapeutic agent for psychological well-being, not the diagnoses, programmes, and protocols.
Let’s cease medicalising and pathologising our shoppers in misery who’re attempting to manage on this troublesome world. Let’s return to the therapeutic apply of human connections.