You are not broken. Period.
COVID-19, police brutality, and racism have shone a light on the urgent need for mental health care in our country. I am not even thinking yet about the calls to replace police with social workers and other mental health professionals. Specifically, I am inviting you to think with me about the psychological distress that so many of us are feeling during these turbulent times.
The practice of mental health counseling as we know it today is a relatively recent invention. Further, the idea that mental health is related to physical health in such a way that each and every one of us ought to attend to it is even newer. Some folks have yet to get that memo. As a profession, we have a long way to go in understanding psychological distress.
For many, the diagnosis of mental disorders feels like a pathway to healing. They say, “if you can name it, you can tame it.” I don’t disagree that for some folks, finding a term to describe lived experience can be liberating. In other cases, this same process of finding a name for an experience can lead to even more distress. Even still for some, settling on a diagnosis feels dissatisfying or inaccurate. This is all to say that the process of coming to a diagnosis in psychotherapy can be a vitally important step to the client’s healing process or it can be an administrative checkbox that represents very little in the course of treatment. I want to propose that we examine the entire concept of mental disorders as they currently exist and think about other pathways to healing.
There is no blood test for depressive, anxiety, personality, or any other psychological disorders. In fact, in many places around the world, the very notion of a “disorder” is utterly ridiculous. The western system of diagnosis is representative of clusters of symptoms that the individual experiences. There exists a great deal of disagreement in the field about whether or not there exist actual disorders in the individual or if the presence of distressing symptoms is representative of adaptive responses in the face of maladaptive circumstances. For example, the experience of anxious feelings make a whole heck of a lot of sense when your identity is constantly invalidated, under attack, questioned, or otherwise threatened. Our bodies have this wonderful talent of protecting from things that feel like threats even if they don’t look like it on the surface. Likewise, if you are actually under physical attack because of your identity, it also makes a whole lot of sense to have several different reactions (e.g., fight, flight, freeze, fawn, etc.).
Where this issue gets even more tricky though is considering what goes beyond the “norm” of “healthy” human functioning. I am all too aware of the history of our field to ignore that “normal” is based on the experiences of white, cisgendered, able-bodied, men of privilege. The deck is stacked against anyone who finds themselves falling outside of that norm group. Further, the label of being mentally ill carries with it stigma unlike most other health conditions. The history of mental illness is a troubled history whereby people were harmed based on entirely subjective evaluations of functioning. It continues to be the case that being diagnoses with a mental illness can carry with it a whole host of problematic consequences. While I actively work towards de-stigmatizing mental health, I am also interested in working outside of that framework entirely. So what would that look like? What would that accomplish?
It is already the case that much of the research on mental health is moving away from treatment targeting specific diagnoses in favor of understanding processes across a spectrum of psychological distress that help folks increase well being. It seems to be the case that this is a necessary first step in moving away from pathologizing different mechanisms of managing problems in the individual. Further, this leaves space for the process to be viewed as one that is actually an adaptive response to the maladaptive system.
Changing this system would begin to center our experience with mental health as a necessary component of a truly healthy person. No longer would “mental health” and “self-care” be an ancillary benefit for the privileged while “mental illness” is largely reserved for the poor and economically disenfranchised communities, particularly communities of color. Mental health care is health care. Health care is a human right. Because I believe these things, I want to push my profession, and all helpers to think more critically about the ways that we use diagnostic labels: who is this serving? Is this helping this person feel more empowered? Is this diagnosis helpful? Is this symptom a reaction to something larger?
If you’ve struggled to come to grips with a mental health diagnosis, feel like the problem doesn’t exist inside you, or want to more critically engage with these systems we have been handed, it might be time to reach out and think together with me about how you want to center your experience of mental health and your self-care. It might be the case that the problem in fact is not within you, it's actually pretty likely that you are not broken, our systems are.
B'well therapist Jake Jackson-Wolf is committed to helping his clients identify systemic dysfunction that contributes to their sense of health while recognizing personal strength & resiliency.
Jake's canine therapy side-kick, Chessie, is committed to being cute.