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The dangers of over medicalising

Earlier this month (October 2019) the government announced a new service for gaming addicts aged 13-25 at the Centre for Internet and Gaming Disorders.  According to the World Health Authority Gaming Disorder is a pattern of persistent or recurrent gaming behaviour so severe that it “takes precedence over other life interests”.  This description could equally be applied to any addiction be it an addiction to gaming, alcohol, dieting, exercise, drugs or sex to name a few.

New addictions and other mental health categories are being ‘discovered’ almost weekly.  The current version of The Diagnostic and Statistical Manual of Mental Disorders – DSM-5 published in 2013 contains 541 categories of mental disorders. This version replaced DSM-IV published in 1994 containing 383 disorders.  That’s an increase of 158 categories in 19 years – just over 8 new categories per year, a little more than 1 every couple of months.

GPs, psychiatrists and other mental health clinicians use the DSM to diagnose their patients.  Each category has a list of symptoms and as long as the patient presents with a required number of symptoms within the category a diagnosis is given.  Alongside a diagnosis there is a choice of treatment or treatments which will typically be a combination of medication and/or some form of psychotherapy to treat the symptoms.

So far so good, however with new diagnostic categories based on surface symptoms springing up so regularly the structural causes that lie beneath these symptoms are given less and less attention.  Two people may present with the same surface behaviour, for example, a pattern of persistent or recurrent gaming behaviour.  In both cases the person might describe significant impairment in important areas of functioning like work, relationships, their social life, education or occupation and so the label gaming addiction may be applied.  Dialogue however may show that for one the symptom is linked to how they wish to escape from feelings of anxiety and depression whereas for the other it is a consequence of the delusional belief that the gaming world they enter is in fact the real world and one in which they have a real place.  Similarly we might consider two people who are persistently restricting what they eat leading to weight loss or a failure to gain.  Again a discussion may show that for one person the reason they are dieting is because they imagine that the thinner they are, the more lovable they will be whilst another person may be refusing food because they believe it to be poisoned.

In this way the same symptom covers two very different causes and psychological structure.  In order for the symptoms to be reduced the underlying cause needs to be explored.  This is the work of long term psychotherapy where the person is treated as a whole and is encouraged to speak about themselves and their relationships both as they are now and also as they were in the past.  Personal history and family dynamics are thought about so that the meaning behind the symptoms can slowly emerge.

Anna Reynolds is a UKCP registered Psychoanalytic Psychotherapist qualified to work with a broad range of psychological issues as well as more complex mental health conditions in adults.  Anna works with individuals and couples.  Anna is available at our Lewes Practice.

 

Further reading by Anna Reynolds –

Attachment styles & how they affect relationships

The language of love: how couples communicate

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Home is in my Head: Rediscovering your Identity in a New Culture

The urge to migrate twists through the marrow of our bones; the restless energy moving our ancestors across vast wastelands in search of a better life mirrors our journey to self-actualisation.  With global migration on the rise what happens to your relationship to yourself and to others when  you leave your birth country for a different life? How do you fit yourself to a culture that is both exciting and un-lived and yet as closed as an unread book?

Years ago my mother an economic migrant and native french speaker, studied French A Level at my school together with my peers. Back then I didn’t understand and was embarrassed by her presence in the school corridors.  Now I see how courageous and important it was to navigate, and excel in, a world of English teenagers (she achieved Grade A).  Undoubtedly she struggled with her inner voice that continues to taunt ‘you are a guest in this country’.  How much I ingested of her shame I can’t say. It is impossible to separate the hidden toxicity of shame from my identity – the me who lives, breathes and continually adapts to the pull of three different cultures: my parents’ and the British culture I was born into.

Whether through choice or forced migration the traumatic consequences of relocation can include rootlessness, alienation, difficulties in relating to others and disconnection to yourself – it requires emotional investment to redefine yourself in an alien culture, to start to fit in, to feel a sense of belonging.  Dislocation leads to a sense of disease, of being ill at ease with the person you thought you were, without a clear sense of yourself in relation to others. Says Gestalt theorist Yontef (1993)  ‘Living that is not based on the truth of oneself leads to feelings of dread, guilt and anxiety’.

You might ask who am I in this new place I inhabit, how do I move, talk, occupy this alien environment? Whose space is it? Am I allowed in? Will the other give up some of their space for me in the territorial dance between us?

“I can’t stay in one place, my home is in my head”* state A-wa, an Israeli pop group who sing in Yemeni as an homage to their grandparents.  This sentiment is felt as a spiritual and physical load, the burden of those who carry the heart and soul of their homeland with them wherever they go.

I hold inside me poignant stories of others’ longings for a secure base: the European man who seeks love looks for a woman who understands the food he used to eat at his mother’s table.  The woman whose future lies in repeated migrations – whose only home is her partner.

Perhaps a way to reorient yourself to a new country is in finding allies in people from your own culture or embracing your partner’s family. In the therapy room you may want to explore finding a way back to yourself, the you who hasn’t stood still but hasn’t yet found a way to fit in.  Therapy can support you to restore the sense of who you are, what you want to say, what you want to ask for.

By rooting yourself in your own identity, you can re-build self esteem and ultimately risk new and exciting relationships in the world around you – your colleagues, peers, future friends and family.

 

Resources: 

*  A-wa, (2019) from the album Bayti Fi Rasi

Yontef, G (1993) Awareness, Dialogue & Process: Essays on Gestalt Therapy. Highland. N.Y: The Gestalt Journal Press

 

Suzanne Worrica is an experienced psychotherapist who works with individuals and couples. She is available at our Lewes Practice.

 

Further reading by Suzanne Worrica –

Emotionally Focused Therapy: For Couples in Distress

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How being ordinary is increasingly extraordinary – On the role of narcissistic defences

Who wants to be ordinary? The word has unpleasant connotations; like something that offers little that is good or substantial. And yet it is a word I often think about and return to in my clinical practice. It could even be one of the primary goals of therapy: to become ordinary.

In the world today there is more and more in place to protect us from being ordinary, that is, to protect us from being ourselves.

We have an almost infinite number of television channels, live streaming of every conceivable film and box-set and console games set in technicolour virtual reality.  The whole world is modelled on making us all feel special. And it is within reach for us all, if only we have just enough about us to win the latest talent show broadcast at primetime, or to garner enough Youtube followers or win the Lotto – after all ‘it could be you’.

All this presupposes that being simply ordinary is wrong; that being ordinary is settling for something less than. However, being ordinary in the truest sense of the world means being able to be in relationship with our inner world and make decisions and life choices – choices based on desire rather than the need to shore up our defences.

What is ordinary?

If being ordinary has little to do with accepting the mundane or second-rate life, then what does it mean?  Being ordinary means being in the real world, rather than retreating to a ‘fantasy world’ each time the real world becomes uncomfortable.  Or in some cases retreating from the real world to avoid it even the anticipation of discomfort.

On defences

I have previously written about manic defences enlisted in order to protect us from discomfort.  And whilst this blog in essence remains about manic defences, the use of certain defences to avoid ordinariness and strive for the extraordinary are a particular subset in the cluster of manic defences known as narcissistic defences.

Neglected children always construct a story of specialness

Whether it is story of being ‘special’ to a parent who leans on them for emotional support, or it is specialness born out of surviving a difficult childhood, being special or extraordinary can be a short-term invaluable solution to feeling helpless, hopeless, enraged and depressed. Or even mad.

Being extraordinary shores up the empty core of the neglected and abused child.  It enables them to cope and to construct a ‘pseudo-self’ so they can navigate the world. At least for a while.

A special kind of defence

There is an argument that as a society (western), we are becoming increasingly narcissistic: focused on consumerism and fantasy rather than connection and relationship.

The consumer world makes it easy to ‘sell’ specialness or the attainability of extraordinariness.  Even in the western spiritual model specialness is promoted through maxims such as ‘you are unique’; ‘you have a special gift to offer the world’ and so forth.

What’s so bad about being extraordinary?

Life should not be a choice between being extraordinary or being nothing (feeling like one does not exist).  Being ordinary is not the contrary of being extraordinary, at least not in psychotherapy. Being ordinary is the third position.

Being ordinary is a mature position of being able to withstand and navigate real life without flights of fancy; it is a position whereby we can make decisions from a position of strength and desire rather than from an ongoing defence of the fragile self.

In tangible terms, being ordinary means living a real and fulfilling life without a constant need for external validation and approval.  Without being defined by Facebook or Instagram ‘likes’.

Being ordinary is an authentic position and one through which we may have extraordinary experiences if we are lucky, but they will be rooted in reality.

All in all, it seems to me that being ordinary has really become something extraordinary in the modern world.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer –

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

What is the difference between fate and destiny?

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Death Anxiety

This blog follows on from my previous blogs – Existential Therapy and A consideration of some vital notions connected to Existential Therapies.  

In Existential Therapy reflecting on death anxiety would not be the same without a consideration of Heidegger. Heidegger (1927) regarded human beings as always ‘being towards death’. He asserted the significance of anticipating death as a vehicle to address the possibility of being itself.  Heidegger (1927) described the earnest recognition of our being towards death and its possibility in the following way:

“Impassioned freedom towards death – a freedom which has been released from the illusions of the ‘they’ and which is tactical, certain of itself, and anxious”

(p. 266) [1]

To me it seems Heidegger postulated that by confronting our finitude we can take responsibility for our existence and be released from the illusions surrounding a life of conformity.  However, this does not remove anxiety from living but reframes it as something inherent in being.

To a greater and lesser extent ‘death anxiety’ is considered by existential therapists as a central theme. One’s mortality is recognised as a continuing condition of human beings. It is perhaps the only thing that belongs to us,  and we can knowingly and unknowingly be living in the anticipation of its possibility and eventuality. This theme holds much uncertainty and reflects back to us the pervading uncertainty of life. It gives birth to the existential angst inherent in the human condition. This angst is generated by the fragility and unreliability of a life lived in this existence.

This does not have to be a pessimistic view. It is in fact allowing an exploration of the boundaries of life. By confronting our mortality, and in fact any pain and suffering experienced along our path, we have the opportunity to clarify our limits and identify that which is out of our reach rather than evading it. Simultaneously it can support us to become aware of our potential and the elements in our lives that it is possible to do something about. It can make us feel more adventurous and alive.

Existential Therapy frequently espouses the importance of facing up to our life and death and all that is experienced between the two poles of our existence, whether it be inevitable suffering or joy. We must find the capacity to confront our difficulties in living and permit the experience to feel it, without needing to linger for too long.

Equally we must see the good in our existence and recognise these times as they happen. Allow learning to ensue so that we can augment this in our lives, but without getting caught in the pursuit of unending happiness. Ultimately all aspects experienced, wherever they fall on the spectrum of suffering or joy, do not stand alone. They are all parts of the same indivisible perspective that each individual experiences as they travel within their existence.

So whether or not death anxiety is viable to consider, angst or anxiety is seen as an inevitable part of existence by Existential Therapists. Many will emphasise the significance of valuing, understanding and tolerating anxiety. Many recognise anxiety as a sign that something in our life needs our energy and attention rather than it being a threat or something to be eliminated. Perhaps it may be the very thing that unshackles us from conformity and seeking validation or permission from others. Perhaps it is the vehicle within which we may feel our aliveness, engagement,  and vital connection.

 

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice and Lewes Practice.

 

Further reading by Susanna Petitpierre –

A consideration of some vital notions connected to Existential Therapies

Existential Therapy

Being embodied in Therapy: Feeling and listening to your body

 

Resources –

[1] Heidegger, M. (1927) Being and Time (transl. J. Macquarrie and E.s Robinson) Londo: Harper and Row, 1962 edn.  

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