I was riffing today on a walk with my husband and the dogs, about the future of psychiatry, psychology, and generally mental health care. What's it going to look like, or more importantly, how efficacious is it going to become in helping people to live better lives in the future?
We currently inhabit a paradoxical situation in mental health post panini (!) where on the one hand, talk therapy and pharmacological support have never been better accepted or more in demand, but on the other hand IMHO we seem to be arriving at a bit of a diagnostic crisis.
What I mean is, if we (not me actually, but I'll get to that) keep diagnosing people with attentional deficit disorders, autism spectrum disorders and the like, at the rate we're going, we could reach a point where more people are being diagnosed as 'disordered' than not. That just doesn't sit right with me. It means there's something off about the criteria.
Of course one of the arguments for increases in diagnoses of mental health disorders is that the panini (I'm kidding, I know what it's actually called!) screwed people up a lot, and that the aftermath will resolve in time. That's a fair theory. Another is that we used to under-diagnose things like ADD and now we're more aware, leading to a surge of new diagnoses. The diagnostic criteria are also being regularly updated and reviewed, which can of course lead to subtle shifts in rates of diagnosis.
All that taken into consideration, this old psychologist reckons we need to calm the diagnostic farm a tad. Live and let live a little more, label a little less. Don't read me wrong, I'm actually not against solid diagnosis or thoughtful medication (100% on board), but I am very much in favour of careful consideration of the usefulness of labels.
We seem to be culturally loving labels right now, and I get why. It's because people want to identify as 'something' so they have a place, a deep belonging, so they fit in, maybe even exemplify something. Everybody wants their 15 minutes. Everyone wants to belong too, but labelling our character or defining ourselves with diagnoses is not always a healthy path.
I have a couple of examples from my practice. One couple who were very sad came to me for couple therapy years ago and the man was to me, clearly Aspergers. Most of the wife's anger at him and complaints were directly related to his Aspergers behaviours which she disliked and judged him for, with no understanding why he had them or why he found it difficult to change them.
Due to the strong connection between the partners and their desire to stay together, I offered my observations with extreme care and talked to each separately, mainly to ascertain from the man whether he wanted to pursue diagnosis. He felt no stigma and was very keen to involve his wife in the process as a team. His diagnosis was positive and gave rise to enormous compassion and epiphanies all round, saving their marriage.
In another instance a person came to me with a diagnosis they had long believed in, which they allowed to control their life choices. So much pain and limitation came from believing in that label. Fortunately, the part of them that wanted to break free from the label 'depressive' finally smashed through. Depression didn't define them, it was a place they had traversed and exited, that's it.
There's a place for labels being helpful, opening doors, feeling connected, feeling like a justification or a vindication of a behaviour or opinion. Labels can be cool, like in my first example.
I would argue however, that very often they are not cool, not helpful. In the end, it's a personal choice and takes some introspection to decide whether you think a label will help you or hinder you or your loved one in life. It's for that reason I do not like to label unless it seems very clear it is going to help heal and grow. Label with extreme caution.
I wonder where my profession is heading with this over the next 50 years and beyond...fascinating.
Love to you,
From an anonymous reader:
And therein lies an insight I've had for some time:
How do we turn those possibilities into current realities? It's through stepping out...
I think that accepting a label can act as a severe brake on taking those initiatives, or more insidiously, a way of validating inaction, or even excusing ourselves for errors that we "can't help making". There's a hidden payoff in that, but it's ultimately opting out of taking responsibility for our own actions or inaction. And we are the losers...
I think we grow more, learn more, can give more, when we step out into the "edge" of our comfort zones, and take a small risk to confront our anxieties. I observe that my parents' generation did that much more than myself or subsequent generations. Times were tougher, and people just had to be more self-reliant.
I don't think Psychologists are making any mistakes; rather it's a reflection of a huge shift in societal values from being aware of the needs of society versus the rights of the individual. Or to put it another way: awareness of the needs of others versus self as centre of the universe, and that's not helpful for our own health, or the health of the wider community.
I always love hearing your thoughts on every day life, Dr. A panini indeed! Personally, am not a fan of labelling and putting people in boxes. As humans I believe we are constantly evolving, and that is a good thing and I would be happier if more people pursued change, in that regard. Psychiatry loves a diagnosis, loves nothing more than to wrap someone up with a name tag and pop them in their respective box. Because this kind of thing can help certain personality types find their 'tribe' it can be beneficial, but the downside of that is that they may be misrepresented. I believe that people are multi faceted and are never only one thing at any one time. Australia, IMO, has no real cultural practices, thought there are religious/spiritual practices (and sports!!!?! ;) )and, to clarify, I am not including the many Indigenous cultural practices (that I hoped had the 2023 Referendum had a positive outcome we may all have had the benefit of). Therefore many young people, that is those under 30, have nothing to hang their hat on, so to speak, other than accumulating labels. I say let us all discover whom we are, with professional guidance or spiritual guidance or insight or a blend of those and more, but in doing so try to avoid any band wagon that may be going by. 'Group Think' only perpetuates a lack of curiosity, and serves those who want to control the zeitgeist, the status quo. It is vital to challenge that status quo every day. Rise up against complacency and have the only label be ones name. (stepping off my soap box now, Miss.)