Opinion piece
A colleague remarked to me recently that she was struck by the number of people getting in touch with her to talk about and discuss their mental distress who had been diagnosed with a disorder. Often these people had suffered a trauma in their lives (their primary reason for contacting this particular colleague so no coincidence there) but had also all at some point been diagnosed as having a mental disorder as defined by the DMS 5 (Diagnostic and Statistical Manual of Mental Disorders).
It got us to thinking – when does a negative experience or set of emotions become an illness or disorder? When does pain and distress stop being something that is happening to us and become something that is wrong with us? There can be no doubt that chronic mental illness requires careful intervention and clinical treatment but the definition of new mental disorders proliferates with each new DSM edition.
A disorder is defined as a disruption to healthy and normal functioning and so the name brings with it the implication that ongoing and persistent mental distress is neither healthy nor normal. Certainly most would agree on the ill health portion of that; mental distress should not be ignored any more than physical illness should – but is it abnormal? Some of the experiences and emotions mentally distressed people suffer through are universal, a symptom not of abnormality but of our shared humanity – the cost of overwhelming or painful experiences previously suffered.
Let’s consider the benefit of defining some states of mind as mental disorders. The DSM seeks to identify clusters of symptoms that occur most often, statistically speaking, within people who suffer with similar mental distress. So, for example, people diagnosed with Generalised Anxiety Disorder will exhibit many of the symptoms listed under that heading in the manual. It also seeks to recognise that these symptoms are ongoing and cause serious impairment to an individual’s life. This is very important; it is essential to acknowledge that Depression or Anxiety or whatever word you wish to use does not describe a “passing phase”. There is no “snapping out of it”. To hear clinicians acknowledge that and wield a weighty academic tome to back it up can be a huge relief to the sufferer. It says “we hear you”. Conversely there is damage done when there is no diagnosis and a mentally suffering person is told there is nothing really wrong – perhaps get some exercise and some fresh air. That can be hugely invalidating or even traumatic and so we should not under any circumstance discount the value of diagnosis. We should also be careful of dismissing newly defined disorders as over-medicalising.
However, there are dangers to diagnosis too. It can, in my view, be disempowering or even engender hopelessness. Naturally people often research deeply into their diagnosis and possibly begin to identify ever more closely with its various symptoms and characteristics. They might read anecdotal evidence on how likely they are to recover. In short they might find themselves more likely to focus on the disorder than the potential for recovery. There is also a danger that labelling your experience as a disorder misses its singularity and therefore its meaning. You may feel almost exactly the same as another who shares your diagnosis but the underlying triggers could be completely different.
My point here is that we are in danger of splitting off from our pain and mental distress; bundling it up and labelling it as illness or a disorder so that we can eradicate it. It’s an understandable urge and part of our instinct to thrive for happiness. It doesn’t always work though does it? The pain or distress does not go away. We still experience the same struggles and the same pain while more and more people are labelled with disorders to explain issues or to justify a prescription. That’s fine in a sense, who would deny anyone some relief? The danger is that we miss an opportunity to fully process our pain; to sit with it, learn from it and let it go, instead we may get stuck with this “label” and as a result place limits on the way we live our lives.
Let’s look for example at Generalised Anxiety Disorder. This is a relatively common diagnosis and for good reason; levels of reported anxiety are increasing. It is an issue common to us all and therefore not surprising that it can sometimes come to dominate people’s lives. However it is also unique to each of us; your anxiety is not quite the same as mine. The feeling seems to be the same but the nature and the manifestation of your anxiety tells a story about you and only you – if I label it a disorder am I really saying that I’m willing to hear that story? Are we really open to the idea that we can be free of our mental distress in time?
When it comes to pain, fighting doesn’t work. Fighting pain perpetuates it, medication eases it but listening can change it. Are we in danger of splitting off from our pain, abandoning the root causes of that pain by identifying it as a ‘disorder’ and failing to really listen to it?
Also perhaps we need to look at how our society/culture currently functions; maybe it is how we collectively currently function that is ‘disordered’, and the rising levels of anxiety and people being diagnosed with disorders are symptomatic of that. Rising levels of anxiety could perhaps be seen as beacons of light showing us as a society we are doing something wrong. How can fish be healthy in a sick sea? Rather than increasingly individually labelling people as disordered, perhaps we should go deeper and readdress how we function together as a whole.
The same colleague remarked to me that the experience of sitting with emotional pain is hardly ever as bad as the thought or fear of doing so and that held pain can dissolve quite quickly when its allowed into the present “here and now” experience. When pain is truly felt, processed, let go of, it can be released rather than numb it or push it away. This presents the sufferer with a huge opportunity for growth and healing.
This is not intended as an argument against diagnosis or clinical intervention and it is not intended as a rejection of the classification of mental disorders. I have no wish to undermine anyone who has received a diagnosis or to suggest there is “nothing wrong” with them. There may be people reading this who have had mental health experiences I can’t imagine and they might rightly ask why I would question any mental health diagnosis. One thing I am certain of is that it is extremely hard, and in some circumstances impossible, to move out of mental distress on your own. It is a collaborative and relational process with your loved ones or with a professional. I do however believe that with time and commitment a talking therapy such as Psychotherapy can help you to live with, experience and move on from your distress. On a broader level I think that until we can culturally tolerate the fact of mental pain in ourselves and others and stop denying, numbing or over-medicalising it then our collective distress will only increase.
“This pain, it is a glacier moving though you, carving out deep valleys and creating spectacular landscapes” – From John Grant’s song “Glacier”
Help information
If you need help please talk to friends, family, a GP, therapist or one of the free confidential helpline services. For a full list of national mental health services see yourmentalhealth.ie.
- Samaritans 116 123 or email jo@samaritans.org
- Pieta House National Suicide Helpline 1800 247 247 or email mary@pieta.ie – (suicide prevention, self-harm, bereavement) or text HELP to 51444 (standard message rates apply)
- Aware 1800 80 48 48 (depression, anxiety)
If living in Ireland you can find accredited therapists in your area here:
Support Our Campaign
We rely on the generosity of the public to fund our work and so far together we have achieved great things! Please do continue to support us so we can provide future generations in Ireland with the resources to recognise and talk about their emotions, and equip them to navigate the ever-changing world around them as they grow
