What is a diagnosis?
I am now thinking about words such as 'depression' and 'anxiety', not names that indicate neurological differences (e.g. Dyspraxia, Dyslexia, Attention Deficit Hyperactivity Disorder, Dyscalculia, Autistic Spectrum, and others)
I wonder why certain people are so attracted by the need to identify and label what happens to them - I’m wondering if there is something reassuring in giving ‘it’ a name. Sometimes ‘you name it, you own it’. On the flip side I am questioning what would be my role as a therapist. I often ask myself: do I want to encourage this process?
For some people can be useful to say ‘I’m depressed’. It can even be an empowering process. If this happens with my clients I do recognise the importance of this. However, I feel that my job as a therapist is to get rid of labels.
The empowerment comes from being able to name the existential discomfort they feel. During my work with them I want to explore the existential distress and would use the label they chose. This is because I want to use their language and respect their choice. However, because of my personal believes, I tend not to encourage labelling.
Words like depression and anxiety often have a stigma attached to them. I don't want to collude with the idea that we can not use those words; on the contrary I believe we can learn to use them better. We may say ‘I have depression’, or ‘I have anxiety’. This sort of language encourage the understanding that depression and anxiety are something that only certain people have. My take is that we can all feel depressed or anxious at times, but the way we deal with those feelings can be different. The difference is in the effectiveness of the strategies we use. Depression is not pleasant, but we all can experience it.
Depression is a process of being stuck in a sense of numbness that brings us to withdrawal. This often presents with highly self-critical thoughts (e.g. ‘I shouldn’t be feeling like this!’). Those thoughts are something we all can experience at time, but ‘the depressed person’ is somehow stuck in those. Those thoughts can become sticky, and we end up becoming numb and withdrawn.
At this point, the label is functional for the client who is able to own this process. The client who is able to call this process ‘depression’, is definitely one step forward towards recovery.
However my work as a therapist is to get the client towards an even further level, where they can recognise those thoughts and move towards a more compassionate narrative. This would be a narrative where the label ‘depression’ is understood differently or even no longer required.
A compassionate narrative
Too often I come across clients with long-standing history of depression and very disempowered narratives. This is the main focus of my intervention: if the label helps the client, this can be maintained and reframed to be integrated. On the other hand, if the label does not help the client, it has no reason to exist. A diagnosis is only useful if it is functional and empowering. Otherwise the therapeutic goal can be to break away from it. The client needs to feel that the label has a function, otherwise it creates oppression.
Whenever a client comes with a diagnosis, I am always curious and would ask questions, such as: what’s helpful about that diagnosis? Is is something you want to change?