I dislike the term mental illness. I find it unhelpful. It seems to make assumptions that I find not to be true.

The first of these assumptions is the seemingly arbitrary line drawn between mental health and ill-health. In physical medicine, this can often make sense. My arm is broken or it is not. I have the flu virus or I do not. I do not believe this can be applied to psychological well-being in the same way. There is not a clear line to be drawn on one side of which I have depression and on the other side I do not. Where is the line between normal anxiety, which we all feel from time to time, and a diagnosis of General Anxiety Disorder? We all seem to live within an emotional continuum which is in constant flux.

Once this line is drawn you are given a Psychiatric Diagnosis. Actually, as I write this I notice how scary the phrase sounds. What happens when we fall out of the group marked “normal” and into the group marked “mentally ill” and all the stigma that comes with that?

In physical medicine, we have a sense of cause and effect. My flu is caused by a virus, my food poisoning by bacteria and my broken collar-bone by falling off my bike. In each of these examples, my body is seen to be reacting to my environment in a way that seems to be both understandable and acceptable. But this logic is not applied to “mental illness”.

Too often a psychiatric diagnosis is considered to be a character flaw to be mentioned in whispered terms then hidden away. However, psychological suffering is as much a natural reaction to our environment as physical pain. I suffer because I feel alone, inferior and disconnected from the people around me. I feel other, I feel alien.

Unfortunately, the cause and effect equation for our emotional states is not so linear or immediate. If I am exposed to a virus I may become ill within a few days, yet my diagnosis of “depression” may arise from a lifetime of cumulative misattunement. As a result, we seem to have lost the sense of connection between our sense of wellbeing and our environment. Mental illness becomes equated with weakness rather than a natural reaction to the vicissitudes of life. Our diagnostic system has become a way of medicalizing human suffering. In her moving and powerful TED Talk {https://youtu.be/syjEN3peCJ}, Eleanor Longden, a diagnosed schizophrenic, asks us to reframe the question asked of those in psychological distress. Stop asking “what is wrong with you?” and start to ask “what happened to you?”

As a Transactional Analyst and Humanistic Psychotherapist, I believe in the essential okayness of all human beings. I believe in that people have an innate capacity for growth and will naturally move towards health and happiness unless hampered by their environment. My role as the therapist is to help people remove the blocks that stand in the way of their natural tendency for growth.

Most of my clients are born into reasonably happy, stable families. A few have suffered significant abuse or trauma but this is not the case for most. Most suffering comes from those inevitable moments when we feel disconnected from those that we love and cherish. However hard we try to be good parents we will make mistakes. We will lose our tempers and shout. We will say things we don’t mean. We will forget to follow through on promises we made. Sometimes life simply gets in the way and we have to work during that school sports day or concert. It is in these small ruptures in a relationship that the seeds of suffering are shown. The Child internalizes these painful experiences and they form part of his decision on the place he takes in the World. At the simplest level the Child answers two key questions: Am I ok? And are the people around me ok? Brought up in good enough surroundings and the Child may answer “yes” to both questions but most of us grow up with some lack of self-esteem and/or some distrust of others.

As the Child grows and develops their natural desire for health and growth kicks in and they develop strategies to develop a sense of conditional okayness. One may say “I am ok if I am perfect” whilst another may think “I am Ok if I stay strong and don’t get emotional” whilst a third may decide “I am ok if I please others and put their needs first”. These beliefs can become the basis for a pattern of behaviour in relationships that lasts a lifetime.

There is a painful paradox that these behaviours, designed to make us more lovable can end pushing away our loved ones. Our perfectionism can be perceived as criticism. Our need to be strong can feel like we are disengaged and the need to please others may make us seem overwhelming and clingy. The very behavior that as a Child seemed our best chance for happiness becomes the block to our fulfillment. At this point, we may begin to search for a therapist.

If the root of suffering lies in disconnection and alienation then the solution lies in the very specific relationship that is formed between the therapist and the client. It is within this relationship that together we can identify and unpick the barriers to you achieving your full potential.

Working with the Person not the Diagnosis

Originally published at emergetherapy.co.uk


  • Nathan Gould PTSTA(P)

    Psychotherapist and Social Entrepreneur

    UK Counselling Network CIC LTD

    Nathan is a psychotherapist, trainer and supervisor based in West Yorkshire, England. His practice specializes in dealing with anger and rage in both individuals and couples. Nathan is also a founding Director of the UK Counselling Network CIC, which is dedicated to delivering low-cost counselling and psychotherapy.