In the preceding posts I have argued for a complex understanding of suffering and distress which is very cautious of applying diagnostic criteria and of dividing people into 'ill and well' 'us and them' boxes. Perhaps a better model of distress is of a continuum which we all go up and down during our lives, and where we are not fixed at any given point. I've also emphasised the importance of not splitting up the bio, psycho, and social in our understandings of distress, and suggested that we must not neglect the social aspect of the biopsychosocial because societal ways of understanding people (which we internalise and which, no doubt, are represented on a neurological level) are involved in our difficulties. This is particularly the case in the way in which we are encouraged into self-monitoring, and in the way in which individuals who are in conflict with societal norms tend to be pathologised as disordered individuals.
If we resist the temptation to 'us and them' thinking then perhaps we can make more of a connection with people when they are distressed (rather than attempting to distance ourselves from them in ways that maintain them as 'them' and protect us from any sense that we might experience similar things ourselves). Then we might be able to ask questions such as 'what works for me when I am distressed?' which may lead to more helpful responses when others are struggling (although, of course, we must be cautious of assuming that everybody works in the same way that we do – perhaps the question is more like 'given everything that I know about this person, what might they be needing right now?') We might reflect, for example, on times when we've been under chronic stress or when a crisis has occurred in our lives.
Broadly speaking, when we reflect on what is unhelpful when we are distressed we might come up with things like: taking away the aspects which makes the person what they are (things that they regard as central to their identity such as work or relationships), removing people's sense of personal freedom and choice, and regarding them as inexplicable or baffling, for example questioning why they can't just stop feeling, or responding, in the way that they are doing. On the other side, we might find that what helps when we're distressed is not being overloaded with anything else, being treated kindly and patiently and being around those we feel safest with, being reassured that we are still free (but perhaps we don't have to make lots of decisions right now), and feeling that we are understood and that our response is a perfectly explicable way of responding to this situation (which involves somebody taking the time to understand what it means to us).
The vital role of compassion (from others and towards oneself) has been emphasised by many recently, and is part of the reason, perhaps, why various forms of mindfulness-based therapies are suddenly so popular (as they often encourage practices of self-care and compassion). Compassionate treatment of self and others is, perhaps, an opposite to the judging-comparing-monitoring mode which is so culturally encouraged at present. Rather than fearing that we are lacking, pretending that we aren't, and trying to prove that we are better than others, we accept that everyone is imperfect, are open about our struggles, and move away from a competitive way of relating with others.
Vitally, an alternative compassionate, or self-caring, form of working with distress does not present this as something that is necessary just for people who are struggling (reinforcing that 'us and them'). Rather it is seen as something everybody needs to engage in to counter those omnipresent self-monitoring messages (which affect us all) and to address the struggles and distress which we all experience.
Find Out More
Many of the ideas in these posts are explored, in more detail, in the textbook and module for D240.
A very accessible book that covers may of these areas is Richard Bentall's Doctoring the Mind.
New commentThese posts will also appeal over on Society Matters
ProfessorMeg, I'm a regular reader of your blog and always find it interesting and to the point. I've been thinking about problems of/with 'diagnosis' a lot lately, as I'm on the cusp of completing my psychotherapy training with a viva for which we have to have two ten minute sections of transcribed audio recording of sessions with clients on which to be quizzed. One of the requirements is an introductory bit to each transcript and a required part of that is 'diagnosis'. Now, given that we are being enculturated into the profession of psychotherapy, this puts enormous pressure on beginning practitioners to think in this way. As someone who is both a lot older and academically more confident than my peers, it seems easier for me to say 'I'm not happy with the role of diagnosis' here than it is for most -- though one of my fellow students does say consistently that she thinks the DSM is more dangerous than the bible. On happiness, one of the things I say in my dissertation (drawing on Adam Phillips book, Going Sane) is: I feel that the pursuit of happiness is a chimera: I do not want happiness per se for my clients, but that they develop a sense of agency in their own lives, able to manage difficulties, frustration, ambiguity and uncertainty—that they will be(come) ‘deeply sane’—believing ‘that confusion, acknowledged, is a virtue; and that humiliating another person is the worst thing we ever do’ (Phillips 2005, 245).
New commentAnd let it become that when someone makes a connection to a person in distress, that it is a stepping in to help, and not a stepping up to silence them and make them stop crying or speaking or being angry. It's like the weather, it rains or thunders, snows or blows, for as long as it does. Someone stepping in the middle and saying 'Can't you distract yourself'. Well it's a bit useless really. If these things you have spoken of, are the new ways being taught for the future, I hope they will be adopted, and soon, because there are still far too many thousands still being mis-diagnosed/labelled, drugged, and harmed by the current system.
Thanks for your comment Debbie. I had this very conversation lately with a colleague who felt that it behoved trainees to know the DSM and ICD back to front so that they knew what they were rejecting. I made the same point as you that there was a danger of enculturation in that though (easy to start seeing people as a BPD or an ED or whatever if you've been so drenched in this terminology). The viva you speak of sounds particularly problematic because you have to invest somewhat in that system in order to pass it. Perhaps a better model would be an equal teaching of the 'mainstream' and 'critical' perspectives, and an option for you to take either one. Like you say, it requires a lot of power - already - to be the one who always speaks against this stuff.
I must get that Phillips book. On happiness I keep meaning to write something bringing together Emmy Van Deurzen, Barry Majid, and Sara Ahmed - who've all written recent critiques from different perspectives (I doubt any of them would be familiar with the others' work) but with some fascinating overlaps.
Thanks Wren - I so nearly used that 'trying to stop someone from crying' as an example in my post! I think the weather analogy is a good one.
It is my hope that the current engagement with mindfulness in mental health and therapy may lead to a broader critique of the systems and ideologies involved (since mindfulness - in its original form) was counter-cultural and questioning in exactly these ways. But there is also a danger that people just see it as a range of techniques and don't challenge the status quo.
New commentThe power of words, to limit or free. It would be an interesting exercise, that before the giving of any books to trainees/students of these traditional subjects, they were given a set of a real clients words, thoughts and feelings about the what's and why's of their situation; then let the trainee/student find their own words for what was going on with the client. Sometimes it is in the 'not knowing' of what something is, that we then have to observe more closely, listen more intently, and in the doing so, arrive at a deeper and more meaningful truth. To enter such a situation is to enter without the shields and weapons of the (supposed) pre-knowledge, which although intended for help, can result in blocking or misdirection. ~~ Yes the new ways do need to enter and be within the mainstream (creating their changes from within) system. Otherwise they will be sidelined and wafted away as 'oh religion', 'oh spacey new-age fluff' when actually they are ancient.
New commentThanks for all your comments here Wren. I think this one is very interesting. So often counsellors and other professionals have so much language and theory for making sense of these things that it can get in the way of seeing the person themselves. I like Darren Langridges work on how to combine such knowledges with an openness to lived experience without imposing those ideas on it.
in response to this series by Meg:
Thanks to Meg for this stimulating stuff: I am a huge fan of Winnicott. Both my Dad and I are members of The Squiggle Society in London, which honours and continues to develop his ideas. Not only did Winnicott try to normalise depression, he also tried to challenge to endemic belief in capitalist, consumerist society, that we're 'not good enough'. Remember his classic 'good-enough mothering' aimed at new parents!
I have many other reactions to this debate, but little time right now. So, just one more for now: My own story has been powerful in my life (which is why I want to write a book about it!). Much of what has been written resonates with me personally. I'd like to add that once my own consciousness had been raised over some years, to convince me that my 'depressions' were part of a complex (bio-psycho-social) picture, I was somehow set free. Although I have a clear line of 'depressives in my family history, had excellent counselling (whilst in the depths of my last depression right through to coming out of it), a rigorous exercise/sport regime/ a supportive christian housegroup praying, understanding partner, GP and friends etc., I do continue to take anti-depressants, I have not had an episode for almost two years now. I still don't know exactly why, but I do sense that the 'social' part of this illness is absolutely central and the hardest to battle against - as Foucault makes plain - self-governance through agency, yet highly influenced by social norms. I believe more openness and consciousness-raising is key to change. But then so is our whole political system and the democratic/capitalist/Western individualism etc.
Thanks so much for sharing your thoughts Tania, and for the encouragement to engage more with Winnicott. I hadn't thought about the wider implications of 'good enough' but of course they apply more broadly - the idea of being a 'good enough' self is right at the heart of my own book but I hadn't put it in those terms
Also very much appreciate you sharing your own experiences. I think that finding ways of making sense of our own distress and suffering is vital, and that a biopsychosocial understanding may well help us in our own struggles. Part of my aim (with colleagues) on the D240 module and textbook was to make the multiple understandings of depression and anxiety which we have available to students/readers so that they could find what resonated for them. It's great that you're writing on these areas as well. I do hope to do a short book on depression myself in a few years which would go - very briefly - through lots of different strategies, all under a broader biopsychosocial understanding.