Anxiety and Depression: A Fundamental Difference in Treatment
“Yes, there are two paths you can go by
But in the long run
There’s still time to change
The road you’re on
And it makes me wonder. ” (Led Zeppelin – Stairway To Heaven)
Helping someone who is psychologically unhealthy become normal, is not the same as helping them become healthy. In this article I want to highlight this distinction and, in so doing, demonstrate the differences in the underlying assumptions, therapeutic efforts and expected outcomes between these two approaches.
While much of our suffering in this world arises from physical pain, the overwhelming majority comes from emotional/psychological pain. These experiences have numerous labels such as unhappiness, sadness, fear, anxiousness, loneliness, confusion, and so on.
We all have such experiences. In and of themselves they are well within the “normal” range of experiences and usually dissipate in a short amount of time.
But when they don’t go away, when we cannot get ourselves out of such states and they begin to adversely affect the quality of our life, or if we have have never been able to enjoy life because of them, it seems perfectly reasonable to try and do something about this.
In an effort to make the pain go away, or at least hide it, some people try using alcohol or drugs, some begin to work longer hours, look towards another relationship, start gambling, or any number of other possibilities. If those solutions ultimately do not work, and don’t destroy us, and we are willing to believe someone else can help us, then we might seek professional assistance.
So where are we likely to go for help, what kind of help will we get, and what will we be helped with?
In our society, the primary options recognized for mental health concerns are medical and psychotherapeutic. Depending on which of these choices is made, there will be important differences in how your suffering is going to be viewed and treated.
Within the standard medical/disease/pain model of illness, such suffering is typically understood to either cause or be caused by an imbalance in our brain chemistry which adversely affects how we think, feel, and subsequently act. Given this level of understanding, it is not surprising that numerous types of drugs have been developed to address such imbalances.
If you go to your GP, family doctor, or a psychiatrist, for the most part they will suggest one of several medications designed to increase, or decrease, the amount of certain neurotransmitters in your brain depending on how your problem is diagnosed.
From the psychological model of illness, while these experiences may indeed have neurochemical correlates, the primary source of the problem is typically understood as flowing from disturbances in our thoughts and feelings. Given this level of understanding it is not surprising that individual psychotherapy is mainly oriented towards modifying how we think about ourselves and our life, with the implicit understanding that this modification will also affect how we feel and act.
While there have been literally hundreds of therapeutic approaches developed over the years, the dominant therapy today is Cognitive Behavioral Therapy. As you might surmise, it is designed primarily, to modify how you think.
While these description and explanations are highly simplified, it is nonetheless the case that both the standard medical and psychological approaches follow a similar line of reasoning that goes something like this: because you are suffering, there is something wrong which requires correction. This correction will be considered successful when you no longer report feeling depressed, anxious, stressed, and so on. In other words, success is measured by the removal of your symptoms.
Certainly these approaches seem sensible. After all, suffering is difficult and painful, and when we hurt it is natural to want to get rid of this pain.
But given that we are seeking treatment from people designated as having expertise in the field of “mental health”, do these approaches actually help people become mentally and psychologically healthy?
If we view the function of mental health experts as offering services designed to help us think, feel and act “normal”, then providing assistance in removing symptoms defined as abnormal fits that definition.
But if one views mental health as referring to an ongoing process of psychological development and maturation, then they do not: removing symptoms or altering how we think offers no avenues or directions for learning – it encourages no growth.
I do not consider being normal as equivalent to being psychologically healthy. In my experiences, most people seem primarily interested in trying to be comfortable and secure, even though few actually seem to achieve this. Scratch just below the surface and most people become anxious and uneasy, being very careful about what they let out, and what they let in.
So much of what we are seems to flow from fear. Directing our energies to protect our self from harm, whether real or imagined, ultimately leads to an orientation in which we avoid, rather than embrace life. Shutting down rather than opening up is a natural consequence; no wonder we hurt
In keeping with this observation, I would argue that much of what we call “being normal” is actually unhealthy; a general condition where the particular ways in which we think, feel, and act, actually impairs our growth, and in so doing creates suffering in our self, and unfortunately, also creates suffering for others. To the extent that this is true, attempting to return people to normal offers a very limited solution to our suffering
The sad part here is that we do not see how much of our suffering is related to how we live and act in our normal lives. Mainly, we do not seem to recognize the fear-based ways in which we view our self, others, and our world. Since we seem to possess such a poor understanding of the role this plays in creating suffering, our responsibilities and capabilities for resolving this are also limited.
Unfortunately, rather than waking up to this condition and finding constructive solutions that could benefit our self and others in our world, we are encouraged to remove or ignore that pain, and almost every other experience we find to be difficult. This, I believe, is a serious conceptual mistake supported by the prevailing medical and psychological framework. There is little chance we will find lasting solutions through such avenues.
Rather than simply getting rid of this pain, we need to learn from it. Our suffering needs to be re-conceptualized as providing us with a powerful source of motivation for learning about this suffering, and the harmful consequences of our normal ways of doing things. With these experiences as our teachers, it can also provide us with the right motivation for learning how to properly nurture our growth and development.
Otherwise, it seems unfortunate that once we have gone for help, the very motivation which drove us to seek assistance in the first place cannot be put to more productive use than to remind us to take our pill or practice thinking differently.
Dr Reid, thank you for this article. Happy New Year