"Do I Have Anxiety?"

I have already talked about the myth of mental illness in a previous post, but there are other aspects to this issue that I failed to address earlier.  In fact, I am not sure the issue can ever be settled definitively as there are so many  factors to consider.  But perhaps at bottom the question is about the nature of psychological suffering , a matter which has vexed the consciousness of humankind as long as people have been reflectively self aware. But what I am interested in here is how the language or discourse of mental illness affects the self understanding of people who experience mental and emotional suffering. This is not merely a question of semantics, but relates to something far more fundamental to our understanding of what it is to be human. But let me begin by restating what I said before about the concept of mental illness. First, if there is a myth of mental illness there is no doubting the reality of the mental agony which is very similar to an illness in the suffering that it causes.  Second, the idea of mental illness as an affliction has an extremely ancient heritage. Indeed, the Buddha himself used the trope and he was certainly not the first to use it. Finally, severe mental illness may require medical treatment and can, in the short term at least,  be effectively treated, if not cured by the judicious use of psycho-pharmaceuticals.  I think all three points are fairly incontestable, though there might be some people who remain adamantly opposed in principle to the use of psycho-pharmaceuticals under any circumstances. But of the three points the first is surely the most important.  

Regardless of whether or not mental afflictions are actual illnesses, there is at least one unfortunate consequence of categorising them as such. And that is how the language of medicine influences the way we express our psychological suffering. Understood as illnesses, psychological afflictions might require diagnosis and treatment from a medical  doctor who should have the required expertise, grounded in scientific evidence, to deal with any problems that might be presented to them. In fact, I suspect that few people give much thought to what science is and what constitutes medical evidence, especially when they are suffering from a psychological affliction. Yet people may still be reassured by the prestige of an MD and even more so by a diagnosis that seems to pin down the nature of a psychological complaint in terms that sound reassuringly scientific. But the values of science should not be given preeminence in dealing with psychotherapeutic matters.  Although a medical perspective must inform psychology (we are embodied creatures, after all), medical science is conceptually unequipped to deal with the problems of living, that is of being a person grappling with human dilemmas in open, unpredictable situations. My position may sound dogmatic---and I admit I would stick to it doggedly--but human beings and their experiences cannot be grasped by the necessarily abstract concepts of medical science.  A person can, however, be understood sympathetically and intuitively by another person. This is the basis for psychotherapy as Laing described it: "...a stubborn attempt by two persons to recover the wholeness of being human through the relationship between them." For many people though, this hardly seems enough. 

Not that people should be blamed for their reluctance to admit the possibility that their psychological suffering could trace to a mere "problem in living". The phrase was coined by Thomas Szasz to counter the authority of psychiatric terminology, but it may seem to trivialise the intensity and intractability of psychological suffering.  When someone suffers from depression, say, he may feel literally sick, particularly if the symptoms of what is taken to be an illness are physically painful. To suggest that the root of his problem could be some existential quandary may seem cruel or insulting to him, as well as wildly off the mark. By contrast, if a psychological problem is thought to be rooted in something physical such as genes or hormones, such a manifestly physical cause might seem to offer some moral relief. For in that case he could not be faulted for his problems; his problems would have happened to him, much like catching the flu or suffering an accident. In truth, people may be victims of circumstances that are beyond their control. Trauma, abuse, emotional neglect first come to mind as examples, but other, less obvious reasons may also contribute to  a variety of psychological afflictions for which the sufferer should not be held responsible. But to suppose that some hormonal or genetic defects are the only real possible causes of psychological afflictions-- especially in the absence of  an identifiable pathogen-- is to discount passion, our lives of emotional feeling, as a potential cause of  prolonged psychological suffering. More importantly, by passively accepting medical designations for psychological suffering we may be neglecting the development of our self expressive capacities which would help us make sense of our experiences, especially those painful ones that give rise to psychological afflictions. It is as if we allow the exploration of our emotional suffering to become restricted by blind faith in a doubtful medical nomenclature  

All of this was made vividly clear to me by a recent visit to a popular website where I found such questions as: "Am I schizophrenic?" ; and "Do I have a character disorder?"; But even more surprising were "Do I have anxiety?" or "Am I depressed?" both of which seemed rather like asking if a painful sensation is actually pain. Although real suffering is expressed in such questions, they don't really enquire into the nature of the questioner's experience. They are, rather, requests for a diagnosis that will rid psychological suffering of its mystery. The mystery of any psychological affliction is, of course, an intrinsic part of its misery. "Why do I feel this way? There is no reason for it!" is one of the most common complaints to  be heard in therapy.  To be told that it has something to do with serotonin might be reassuring,, as well as factually correct. But it won't eliminate the mystery of suffering as much as it will explain that there is a biochemiical component to psychological pain . In truth, it is in exploring the personal experience of suffering, in fathoming its painful mystery, that psychotherapy leads to the self insight that can bring about meaningful change. Indeed, finding meaning in suffering is the great endeavour of psychotherapy.  But it may seem dubious to invoke mystery as a key to psychic healing, as if psychotherapy were some sort of mystery cult with psychotherapists acting as its officiants.  In fact, the mystery that psychotherapy explores  inheres in the happenstance of the everyday world  in which a person's life unfolds according to a hidden logic of emotion that always eludes self understanding. Helping a client find out what he actually feels and why he feels as he does is to offer him the possibility of awakening from the somnambulism of mindless habit. To me, it is what psychotherapy is all about.