Updated: Jun 26, 2020
Does a medical treatment that focuses on the identification and classification of symptoms to diagnose a mental disorder increase the practitioner’s curiosity to fully understand the client’s very own, individual suffering and life situation?
Most medical systems in the world are functioning on a diagnosis-based model.
While they ought to help medical practitioners to classify symptoms and to prescribe adequate treatment they also ought to help clients to understand their own suffering. Thereby, diagnosis-led medical support is not only offered for physical but also psychological issues.
The main resource that mental health workers (e.g. psychiatrists and psychologists) work with nowadays is the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA) – A purple, 1000 pages book which in its latest 5th edition seem to count 157 descriptions of various disorders.
When working with the DSM, the medical practitioner is interested in identifying symptoms, such as feeling stressed, feeling moody, experiencing a lack of energy, inability to focus, indecisiveness etc. Should various symptoms match with a description of a disorder in the DSM a diagnosis will be made and followed up with the suggested treatment by the APA. – A treatment that often includes prescribed medication.
By commonly applying terms such as “disease” and “disorder” within the medical model, the potential faultiness and illness of human nature is emphasised. Now, what does this intrinsic philosophy behind a disorder-based model mean for the practitioners and their clients? Does it increase the practitioner curiosity and deep understanding of the client’s suffering? And what about the client, does it help the client to fully understand themselves and the source of their suffering and despair?
While for some clients a diagnosed disorder can be a great relief – ‘Finally, I know why I feel so low – I have a disruptive mood dysregulation disorder (DMDD).’ For others, a diagnosed disorder or prescribed medication does not support them to feel at ease and to better understand why they feel the way they feel.
I understand that for many people a diagnosis and medication is exactly what they needed and were longing for – especially when holding the hope of finally being ‘fixed’. But have we enough considered potential losses for our clients in taking away their responsibility and curiosity to understand themselves; to connect with their bodies and felt senses? Is it possible that by trying to fix them, our clients are missing out on the possibility to heal themselves?
As a humanistic person-centred psychotherapist, I believe that by focusing on classifying symptoms and diagnosed disorders we do not facilitate an understanding and healing environment. Indeed, I believe we can do better than that.
For instance, we could try to stop looking for a ‘disease’ in the client but try to understand their dis-ease.
While a diagnosis of a disease seems to represent a full stop and conclusion in the medical process, the term ‘dis-ease’ invites powerful open questions and thereby the start of an exploratory self-discovery. As a therapist who is intrigued by my client’s individual life story and way of being, I’d be curious to carefully listen to my client and ask questions - What kind of dis-ease do you feel? Where in the body do you feel it and how does it feel like? When did you start feeling that way? How does this particular dis-ease impact your physical, psychological and emotional well-being?
The practitioner’s modesty to not know but to be open to meet the client’s idiosyncratic way of experiencing the world is needed in order to truly support our clients to understand their suffering as what it is – an unexplored dis-ease that deserves to be heard, understood and to heal without fixing.