We are currently living in a time of crisis. This period of time will be written about in history books. In the far-away future, we will be able to self-reflect, process, and make meaning out of this period. But for now, we are in the middle of it; self-reflection and meaning-making are hardly possible because we are in survival mode.
We are living at a crossroads between the continuing disturbance of COVID-19, the consequences of the war in Ukraine, the astronomical rise in the cost of living, the threat of poverty for many, and the increasing anxiety about climate change. We are in crisis. We are in survival mode.
One of our typical methods to cope with a crisis and trauma is what we term “the flight response.” It means that we want to run away from the threat to a safe place. When there is one tangible threat that we can move away from, it is a very good strategy.
But in our current state of crisis, the threat is omnipresent. Wherever we run to, the planet will keep warming up, the war will likely continue, the cost of living will rise, and COVID-19 will still be around. Nowhere seems safe these days. We can feel extremely powerless.
So, we use other ways to run away, attempting to feel safer for a bit, escaping to a different place, to give us a break from the bleak reality: we scroll through our phones, we watch Netflix, we masturbate to pornography, we overeat, we play video games, we flirt with people online, we have one too many glasses of wine, we retreat to fantasy imagination. All of those are pretty common ways of escaping.
Mental health professionals are some of the people on the front line of help when there is such a crisis. Unfortunately, some psychologists and psychotherapists shame and pathologise people who opt for those common ways of escaping the grim reality. I don’t blame those practitioners, as I’m sure they are trying to do the best they can, but I object to some of the clinical trainings and theories they base their interventions on.
Such a crisis as the one we’re facing today requires those of us working in the mental health professions to re-evaluate our clinical knowledge. Do our theories and ideas about people’s mental health still fit with the struggles of today’s populations? Isn’t it time that we seriously question and challenge the medicalised mindset of “diagnosis,” pathology, and labels? Instead, shouldn’t we validate and affirm people who are trying to cope the best they can?
Validating and affirming people does not mean we collude with their maladaptive strategies, but it simply means that we acknowledge they are human beings in survival mode. Can someone who manages to regulate their emotions by scrolling their phone be helped by being labeled a “phone addict”? Is using the diagnosis of “binge eating disorder” useful for someone who finds moments of pleasure with the content of their fridge, even if they overdo it? Is it helpful to call someone a “porn addict” because masturbating to porn is their primary way to soothe their existential upset?
In my opinion, those labels can make people feel more distressed. They can encourage people to think they’re broken when they were already struggling to cope. Moreover, attempting to help someone stop using their primary method of coping (even if maladaptive) might make them feel worse, not better. It’s akin to kicking someone who is already on their knees.
What about the ICD-11 (WHO) diagnosis of “prolonged grief disorder”? If I hadn’t been able to hold my spouse’s hand when they were dying of COVID-19 because of the quarantine guidelines; if my daughter died of a gunshot wound fired by a stranger; if my father was randomly stabbed to death; I would be in grief, sad, and angry for a very long time, possibly all my life. I wouldn’t take it too kindly to have a therapist stick a disorder label on my grief.
The behaviours that may be expressing my profound upset could even be inaccurately perceived by professionals as symptoms of borderline personality disorder, a label some clinicians are too quick to jump to. Immense grief does not only occur when someone dies. It can happen with all kinds of losses. Currently, we estimate that a great number of people will suffer a loss of quality of life because of the economic crisis. If you had to choose between feeding your child or heating your home this winter, wouldn’t you be intensely upset—perhaps even upset enough that it could look like a mental illness?
Don’t get me wrong. I’m not against all mental health diagnoses. Sometimes, receiving a diagnosis can be a good thing. They can be helpful to access psychotherapeutic and/or medical help through health insurance. They can help a clinician decide if they have the competencies to work with someone. For example, a therapist who has not been specifically trained in working with PTSD (post-traumatic stress disorder) should not be treating a client with this condition. Sometimes, a mental health diagnosis can help clients make sense of their struggles, such as an ADHD diagnosis, for example. But some of the time, diagnoses are more useful for the practitioner who prefers to work with classifications than they are useful for their clients who are just trying to cope.
Some diagnoses that are popular labels given to clients are not even “real” diagnoses because they haven’t been endorsed by scientific communities and you won’t find them in the two main diagnostic manuals DSM-5 (American Psychiatric Association) and ICD-11 (World Health Organisation). Some of those “diagnoses” are “digital addiction,” “internet addiction,” “sex addiction,” “porn addiction,” “love addiction,” “shopping addiction,” and “exercise addiction.” The word “addiction” is used inappropriately by many people, including therapists. (I wrote about it here.) There are also some real diagnoses that are arguably overused (prolonged grief disorder, gaming disorder, OCD, etc.).
Perhaps in this new world we live in, one of multiple threats and crises, we—psychologists and psychotherapists—should remind ourselves of our best skill: sitting with people, listening to their unique and specific stories, and helping them make sense of their struggles non-judgementally. We know that the therapeutic relationship is the healing agent for mental well-being, not the diagnoses, programmes, and protocols.
Let’s stop medicalising and pathologising our clients in distress who are trying to cope in this difficult world. Let’s return to the therapeutic practice of human connections.
