The field of psychology is suffering a crisis of identity which is devaluing its services and damaging its practitioners. The problem, in my opinion, is the paradigm of mental health versus mental illness. “Mental illness” is a terribly stigmatizing descriptor, and “mental health” is not a sufficiently attractive construct to warrant the average person subjecting themselves to the stigma of association with the mentally ill.
Who Are The Mentally Ill?
My discussions with contemporary psychologists lead me to believe that most therapists use terms like mental health and mental illness in an attempt to normalize their patients’ experiences. They conceive of mental illness as a spectrum parallel to that of medical illness, and assume that their patients feel the same way. And, for patients who are cultivating a dependency upon the mental healthcare system, this is the case.
However, I believe the average person has a very different idea of what mental illness is. The average person conceives of “the mentally ill” as the sort of folks who one sees babbling incoherently on the street, frightening children on public buses, and overturning chairs in psychiatric hospitals. There are some fairly good historical bases for this association, owing largely to the language used by mental health professionals over the past century and the inadequate treatments that have been available for severe mental illness.
People are afraid of the mentally ill, and you’re not doing anybody any favors by trying to tell them not to be. It is simply not an efficient approach to reducing stigma. A better way is to adjust your terminology so as to not activate preexisting stigmas.
The Message Of Psychotherapy
In other words, psychologists have entirely missed the point of their own services, and in so doing have degraded the entire profession. The message of psychotherapy is that any individual, at any stage of maturity and any station in life, can gain better control over his or her own mind. That’s it.
There is a wide body of literature which demonstrates that psychotherapy can improve the quality of life of normal people with no diagnosable psychological disorder. That it can improve relationships, coping, and enjoyment. That it can improve physiological health, both in healthy people and in people suffering from medical conditions. That it can prevent medical and psychological conditions for which one is at risk. There is scientific proof that psychotherapy can make people better.
And yet we focus exclusively on the curative aspects of our profession. We use terms like ‘mental health’ which draw on 20th-century associations to ‘mental patients.’ We offer ourselves up for relational handholding, condescending analysis of cognitive errors, and pseudo-medical advice-giving.
Psychotherapists have a unique, and extremely lucrative, opportunity to place themselves at the very cusp of the oncoming transformation of medicine from a remedial art to a preventative and cosmetic one. And, for the most part, we are wasting that opportunity.
What Can Psychotherapists Do?
It is our responsibility as therapists to reduce the stigma associated with our profession and with our patients. In the cultural climate that we have helped to create, this sounds like a very difficult thing to do.
Indeed, there is a fair amount of literature in which prestigious and otherwise intelligent flop around the issue of what can possibly be done to intervene in mental health stigma. They tend to focus on small presentations from individuals who have suffered from mental illness, and tend to show small to moderate effectiveness in modifying the attitudes of group participants.
Nope, That’s Not It
The narrowness of this approach is striking. Remember, it was not that long ago that psychotherapy (or at least psychoanalysis) was considered a luxury service. It was a sign of affluence to attend thrice-weekly sessions at substantial expense. There was an air of mystery and exploration around the process, and it was highly sought-after. And we actually have a lot more to offer now than we did back then!
But if there is one thing that contemporary psychotherapists seem to adore, it is demystification. And for the life of me I cannot understand why that would be. It does not add any benefit to the treatment, does not help keep patients in therapy, and does not help attract new patients to therapy. And yet we seem to want to give the impression that everything is all figured out and that we’re not really doing that much at all.
The human mind is incredibly deep and mysterious. In developing our intuitive sense of its inner logic, its cryptic compensations and metaphoric leaps, we are making ourselves nothing less than the shamans of the modern age. The process of psychotherapy should absolutely be based on scientific understandings, but we must not delude ourselves that we have really fully figured out what is going on in there. We have not.
And when we market our services based on the pseudomedicalization of functional disruption, that is exactly what we are implying. We are not only misrepresenting ourselves, we are actually doing so to our own detriment and to the detriment of our patients.
So Here’s What We Need To Do
If we are going to rectify the situation, we must begin using our knowledge of psychology to market our services for what they are and for what people want them to be. We must reintroduce the mystery of being human and suggest that we can help to explore, deepen, and enrich that mystery.
We must advertise the incredible improvements that skillful psychotherapy can introduce into a person’s life. We need to stop going on about this misguided notion of “mental illness” and instead start focusing on what people stand to gain from coming to see us. This is not rocket science; it’s not even slick advertising. It’s just plain good business.