I’ve been thinking about mental health a lot lately. We use words like diagnosis and disorder pretty freely in working with clients. We’re trained in school to think in terms of pathology and symptoms. To look for disorder or illness. To search for dysfunction.
In my DBT skills group the other day, we started talking about whether anxiety and depression are illnesses. Some in group felt empowered by calling their diagnosis an illness, because it implies that one can get better or fix the problem. They also find that the word illness lessens the sense that this is something they should just get over or something that they CAN just get over. It takes away the stigma of it being all in the minds.
I agree with all of this, but I feel a personal rejection of the word illness with regards to depression and anxiety. They are parts of personality and an individual’s neurological make up and must be coped with and dealt with, but they aren’t caught and they aren’t necessarily cured in the way that an illness might be. I think of them as more akin to chronic conditions than to illnesses. They are a function of the way that the brain is wired and the environment that someone grew up in, but that is also the case with someone’s accent or even their sports or academic aptitudes.
They’re a predisposition more than they are an illness.
I worry that looking at mental health conditions as illnesses creates a sense that its contagious or catching. We fear the things we don’t understand and reject those things that we worry will contaminate us – that’s the entire purpose of disgust, it helps to steer us away from things that might harm us or make us sick. But that’s the whole thing about our emotions, when they’re rational they’re super useful and not to be avoided – avoidance leads to even greater problems!
Much like in the movie Inside Out, all of our emotions have a genuine purpose to serve and we don’t benefit from wishing them away. Anxiety helps us to care about things. If we weren’t anxious about the test, we wouldn’t study for it. If we weren’t anxious about being accepted, we wouldn’t have reason to follow social norms. Depression can make change how we process information and slow us down to be more detail-oriented and accurate at complex tasks. It’s also a beneficial response to genuinely sad and traumatic circumstances.
Clients come in looking to be fixed and part of how I see my job is in helping them to see that they’re not broken. They’re wonderful and valuable people as they are when they come in.
This is not to say that they are not suffering and that we don’t need to change how they’re coping and thinking to alleviate some of their distress, but it’s also not to say that when they’ve finished with therapy that they will not experience sadness or anxiety again. The reality is that people who have anxiety, will likely always experience some amount of anxiety, but people who have anxiety can learn to cope with it better and to live with it in a way that does not prevent them from true joy and a life that feels worthwhile and fulfilling. People who have experienced a depressive episode are more likely to experience another, but with improved mindfulness, self care and coping strategies they can learn to manage their emotional responses in an effective and useful way.
So much of my job is making people see that they’re not broken, that they’re not sick in the way that people have possibly told them they are, that they’re not WRONG for feeling the way that they do. That they are good and worthy and just need to cope differently given the hand that they were dealt in life.