A question that new clients often ask is whether they are ‘ill’ or if something is ‘wrong’ with them. It’s natural to ask this when in personal crisis. If there is a psychiatric or other medically based disorder, it is important that appropriate specialist help is sought. But frequently this is not the case and if you decide to visit a counsellor they will make an assessment of whether counselling might be helpful.
So why do so many people assume that their difficulties stem from an illness or abnormality when this isn’t really the case? And what role should medication play, if any? Does it help to have a label (e.g. depression or anxiety) so that at last it feels like the problem has been identified, or does a label unnecessarily pathologise (i.e. represent as a medical condition) the client’s situation?
If things don’t feel right with us it’s natural to want to know why. And of course there is a wealth of information available now via the internet, both helpful and not so helpful. So we can easily be tempted to self-diagnose (with varying degrees of accuracy) on the basis of our perceived symptoms.
The problem with this is that symptoms can easily be misread. It’s possible to explore a condition – for example, borderline personality disorder – and find symptoms or syndromes that perfectly healthy people might experience at times or at certain stages of life.
Whether or not a ‘diagnosis’ is appropriate when dealing with mental health conditions is controversial. Even the terms ‘mental health’ and ‘mental illness’ can be unhelpful, suggesting that we are either mentally well or mentally ill. And the media are less than constructive when psychological issues are popularly pathologised due to distorted perceptions of mental illness.
A fellow counsellor recently commented to me that although a person’s condition may initially seem to call for medical help, the underlying cause will often be an upsetting episode or period in life, such as trauma, abuse, loss, or bereavement.
Counselling may be a more appropriate way of addressing the client’s needs in such cases; in other words, this could be the best ‘medicine’. In developing a shared understanding of their clients’ needs counsellors will demonstrate openness and acceptance. It helps to have our difficulties acknowledged and validated.
In her regular column ‘The Doctor’, Sophie Harrison, a hospital doctor in South Yorkshire, recently wrote: ‘What can be helpful … is acknowledging that problems exist – and matter – even if they’re unpleasant, even if they’re unfixable … There is medicine in all kinds of things other than medication: in helping people to understand what’s gone wrong, in taking away fear, in kindness’*.
This helps form the foundation of the work that client and counsellor then embark on together.
*‘Sometimes the best medicine is no medicine’, The Doctor, Financial Times Magazine 8/9 March 2014