The diagnostic promise: How can a door open to true understanding of one’s own

THere is a national conversation – or perhaps more a national conversation with each other, which currently takes place on a “overdiagnosis” of mental health conditions. Health Secretary Wes Streeting is concerned about many people who are “written” in this way. I spend quite some time thinking about this, alone, with colleagues, patients as a therapist and as a patient in therapy. I think our answer is crucial to building not only a better life, but a better society.

I think the diagnosis can be a vital part of the treatment of mental health. It’s not something I do as a psychotherapist; I respect my colleagues of psychiatrist who do it for their skill, knowledge, experience and compassion. When the system works, a diagnosis can bring relief, it can open the door to the best therapy and medication, and finding a name for your experience can feel and valuable.

But.

A diagnostic approach to oneself is not always useful. I think we all have a tendency to use a diagnosis to close a door, instead of opening it. Often we can use a diagnosis (for example, an obsessive-compulsive disorder or a spectrum disorder of autism or anxiety) to stop any more thought, to close any sense search in our own experience as human beings, with our individual stories, relationships and pain. Close the door to our minds like this can close the possibility of building a better life.

Take, for example, a diagnosis of ADHD. Many people feel seen when they receive this diagnosis: they feel like a answer to a question that they have been asking for much of their lives.

In my work with patients, I see its value not in response, but as an opening of a new question. ADHD is a description of a collection of symptoms; Experience and research indicate that medication can help, which may be some genetic basis and neurodeveloped to these difficulties. But it does not have to end here. A person can get an even more valuable understanding of herself if you take advantage of this diagnosis and explore what unwanted feelings avoid when they are late for appointments, what trauma or memories or thoughts move away when they cannot remain -what unconscious dynamics repeat when they find it impossible to complete a task. These difficulties, not always, but sometimes are understood in therapy so that it contributes a different type of meaning and a deeper feeling of self-compensation. These feelings and beliefs can be aware and work; The ability to tolerate difficult emotions can grow. Or you could close -all with “This is just my ADHD”.

It was once my privilege to interview Gianna Williams, a child and adult psychoanalyst, and caught my attention on a powerful dimension of the word “ understand ”: understanding how to be under something and looking up, trying to explore phenomena from a position of not knowing it and be curious about what you could find. This is a very different approach to diagnosis. Instead of knowing something and applying a label to an experience from above, you are developing the ability to tolerate not knowing it and trying to explore a feeling and put it in words.

This type of understanding is what my psychoanalyst has offered me and it is the type of understanding I seek to offer my patients as a psychodynamic psychotherapist (these forms of therapy are rooted in the same theories). But it takes time. It can only happen in a robust and sustained therapeutic relationship, in which the difficult feelings can be confronted and evaluated, the unconscious can begin to be aware, they can tolerate and repair the ruptures and a person can grow and develop.

Sometimes a remarkable recovery can occur with this type of therapy. Patients who had been “ written ”, to use the words of the Secretary of Health, who had written, may find resources they did not know, and maybe before they did not have to understand where their difficulties came from, they went to themselves and they attended to these difficulties in a way that is not punitive, but helpful. They can realize that the unconscious dynamics that have assaulted them since their first days are no longer needed and can rest. It is not uncommon, for example, to see that patients are within themselves a desire and a ability to seek, find and sustain work that had been impossible before.

Unfortunately, I have not seen the Health Secretary’s plans to provide funding for psychoanalytic psychotherapy sustained for patients who want it. There is a lot of evidence that this type of therapy can help patients with rooted difficulties, including so -called treatment resistant depression. But I suspect that this treatment does not fit with the “diagnosis” of the problem problem. He has his eyes on the cost of benefits and not in the savings that may result from investing in well -trained therapists that can help patients find their own way to go in their lives. It is a transvestite for us as a society and as individuals, because talking about reducing the benefits of a person, while also denying the treatment they can use to build a better life, is, by my mind, a safe way to perpetuate the type of writing it seeks to avoid.

Moya Sarner is NHS Psychotherapist and When and Grow Up