5 ..9
Note that the notion of ‘disease’ and its quasi-medical treatment with either medication or CBT forecloses a meaningful exploration of the client’s world. No doubt many CBT practitioners would protest that this is not the case and that enquiry into the client’s circumstances and experiences and inner mental world are all crucial to their work. However, the NICE conceptualisation of the client’s problems as ‘disease’, inherently annihilates meaning and individuality by homogenising emotional distress. Moreover, it implicitly reduces psychological therapy to a standardised (manualised) product resembling a drug.
When I began preparing this presentation I thought about the clients I had seen that day. My first client was a psychotherapy trainee. She talked of various experiences in her training. I made some reflective comments. These seemed to deepen her awareness of what she was feeling and thinking. Nothing remotely resembling a medical model was relevant to her presentation. Then I saw a man who talked nonstop in a slow relentless discourse that was difficult to follow and seemed to require no comment from me – he alluded to strange experiences that I could not understand and displayed volatile emotions, of both elation and despair, that were also essentially incomprehensible to me. I had the impression that his mind was very ill – and that whatever I might say would simply be absorbed by this illness. I felt overwhelmed and disturbed by the experience of listening to him for an hour – and worried about him. Next I saw a woman who told me that the depression she had experienced for years had been completely alleviated by having a hysterectomy – suggesting that her previous dysphoric states of mind had been essentially driven by a hormonal disturbance. My next client was a woman who had been depressed following the death of her beloved husband – she told me the stress relief methods I had used with her had enabled her to be left with happy memories of her husband rather than the traumatic memories of his death that had haunted her previously. Then I saw a young woman who was suffering from the effects of being sexually abused for a couple of years during her childhood – we used natural stress relief methods to address the traumatic aspects, as well as her complex feelings of guilt, shame, and rage. She was followed by a man who talked of his struggles to find a viable occupation having lost his previous job after developing severe RSI. My next client was a woman who has suffered with severe and disabling anxieties, about leaving the house and being on her own, since being abandoned by her fiancé some years ago.
Are any of these people suffering from ‘specific diseases’ – the term used by NICE to describe their remit?[3] In some cases the medical model may have some relevance – for example, if hormonal disturbances were indeed causing a woman’s chronic depression. Some states of mind may be abnormal enough to merit the term ‘ill’ – perhaps ones which are beyond the scope of psychotherapy. Mostly we are dealing with people who are stressed by life events, adverse childhood experiences, and developmental challenges. Mental health conditions, such as depression and the various manifestations of anxiety, are essentially states of stress with physiological concomitants. Early experiences of stress sensitize us to later experiences and also lay down the templates for our characteristic ways of trying to cope with stress and for our expectations of how others will respond to us, Whilst there is certainly a place for science in all of this, along with skills and knowledge from many other realms of human endeavour, there is limited legitimate role for a medical disease model.