Thinking about Therapy?
Take our quiz to see therapists who are a good match for you.
Take our quiz to see therapists who are a good match for you.
The Diagnostic and Statistical Manual For Mental Health Disorders is where you’ll find an indexed list of the diagnoses most people are familiar with. Most often, when people reach out to me looking for a therapist, they say, “I have anxiety,” or “I have depression.”
Rarely do people say, “I’m feeling anxious” or “I’m feeling depressed.”
Notice the small but important differences in these statements. The second two relate to a state or mood, whereas the first options speak to a trait. “I have a big nose. I also have anxiety.” Immutable and unchangeable.
The DSM certainly helped organize dysfunctions, and it provides an understanding of symptomology (the behaviors associated with problems), but disorders have become so integrated into our culture that we’re now defining ourselves by them.
People say, “I don’t go to parties because I have Anxiety.” People say, “I’m not motivated because I have Depression.” This way of speaking comes from “concept creep,” the tendency for phrases to acquire similar-but-off definitions from the original intentions. You’re not unmotivated because you have Depression; you’re depressed because you’re lacking motivation. The symptom describes the issue, not the other way around.
In an age of managed care where a diagnosis is splattered across every file; in an age where students only receive services if they have an “official diagnosis,” we’ve gotten lost in the woods of mental health. Disorders seem to be causing more problems than they’re solving.
People will seek me out for therapy and say, “I want to be social, but I have Anxiety so I can’t go to group events.” The treatment for something like this usually involves exposure, or contacting the difficult situations to work through them. Therapists can employ numerous modalities for therapy, from Freudian Psychoanalysis to the Gottman Method, to Cognitive Behavioral Therapy- but all would include some form of facing these fears. Certainly, the modality that I use, Acceptance and Commitment Therapy, involves helping people do the difficult thing in the service of living a meaningful life.
So I might tell someone anxious about an upcoming work event that the therapy is about going to the event and not about “getting rid of” the anxiety, the common response is, “No, I don’t do that because I have Anxiety.” Again, immutable and unchangeable. However, this isn’t true. I’ve helped many people struggling with anxiety. It doesn’t change. You do.
This is no individual’s fault. It seems everywhere I turn these disorders are named, discussed, and attached as labels. With little understanding of psychology or behavior, it makes sense that people go with what they’re told, and unfortunately what they’re told comes from a paradigm only about sixty years old but with a wide and strong reach.
However, I look beyond the disorder. I don’t care what you call it. If you have trouble calming down, we’re going to practice calming down. If you have trouble completing homework, we’re going to practice completing homework. If you have trouble concentrating, we’re going to build concentration. As I work with people and we dig beneath the surface-level behavioral challenges, we generally find more existential concerns. Sometimes people aren’t motivated because they believe they don’t deserve success. Some people are people-pleasers because they lack a sense of their own identity.
These aren’t disorders, they’re human problems.
Nowhere useful in the DSM are these deeper existential, very human concerns represented.
As cognitive science evolves and we learn more about the process of behavior change, the DSM will become more and more outdated. Increasingly, I hear other clinicians frustrated with the labels. Some updated systems to describe mental health difficulties are currently being developed, and I hope they replace the DSM.
Until then, I encourage you to see yourself beyond the disorder. We all respond to stress in interesting, complex ways, and sometimes these methods become painful as we, on some unconscious level, choose feeling safe over feeling fulfilled. Our world narrows as we try to manage our fears and disappointments. Approaches like Acceptance and Commitment Therapy specifically work on helping people live larger than their problems, and psychotherapy- before the age of managed care- was always concerned with freeing people from their own barriers.
