Humans spend a lot of mental energy attempting to control the uncontrollable. People attempt to make sense of things. Yet, if you believe
the world's great existential thinkers, the world is chaotic, unpredictable, and you can only truly know yourself. It is the human tendency of being uncomfortable with the chaos of life that leads to seeking meaning. A place one might not consider this evident is in psychology. When a therapist makes a diagnosis, he or she might be doing so to make him or herself more comfortable.
Psychology, and especially the disease model of mental health disorders, seeks to name, understand, explain, treat and predict the course of mental health "diseases." It is not the purpose of this post to claim that this is not a worthy cause, but to discuss how it oversteps its bounds in its façade of certainty, and how it undermines the uniqueness of the client.
First it is important to demonstrate how people find comfort in the labeling of an event. This is true both inside and outside of psychology. For example, if something is medically wrong with someone, they seek to know the name of the malady. This, in turn, prescribes the treatment course. Even when there may be no treatment, just knowing the name of the malady is sufficient. For example, when a dying person's breathing becomes heavy and erratic, and dry spittle foam forms in the corner of their mouth, hearing that this is pulmonary edema, and is normal as the heart fails, seems to comfort their loved ones.
In psychology an example is in the grieving process. There is no cure for grief. Time and working through the pain is the prescription for the best outcome. However, just knowing what is being experienced is normal: the anger, pain, depression, thinking you've seen the deceased, and other feelings associated with a significant loss, is often enough to help the person on the track to appropriate grieving. This is called normalizing.
Again, there is nothing wrong with explaining and normalizing what someone is experiencing. Psychology often does its best service when doing so. However, when psychology attempts to lump every person with similar symptoms into a category, and then provide cookie cutter treatment, it is obviously doing its clientele a disservice. That being said, is providing a diagnosis going too far?
I purport that often a diagnosis is provided to soothe the therapist as a result of their lack of comfort with not knowing. Providing a diagnosis gives the therapist an illusion of control; he or she knows what is wrong, and as long as the client follows the designed treatment plan, they will get better. The therapist is soothed by correctly diagnosing the malady.
This can be helpful when the diagnosis helps the client. Some clients want nothing more than to know what they are experiencing has a name, such as in the example above. Realizing their malady has a name makes it "normal" enough to soothe their mind. People are comforted by names.
It is possible this is simply a Band-Aid. Perhaps, by providing names for things, the real issue is going unaddressed. Life is chaotic, people are different, diseases take different courses, and knowing the outcome of many things is impossible. Believing we know is just a pacifier to quell our nervous ego. Many clients will be better off accepting that life is unpredictable and sometimes knowing is impossible. Therapists will be better off not covering their butts and acting as if they know; or by providing empty reassurances that, although making people feel better, they have no way of knowing.
A mistake all beginning therapists make is quickly diagnosing a problem and believing they know what the client needs to do to get better. One of the first lessons in graduate school is that, despite the clinician taking all the courses and earning a degree, it is the client who is the expert. It is their life, their thoughts, and their experience. Too often beginning clinicians jump to inaccurate conclusions, offer premature solutions, and leave the client feeling misunderstood. Unfortunately, with clinicians diagnosing often demonstrates their belief they "know", and it stands in the way of truly experiencing the client. In therapy, knowing interferes with experiencing, empathizing, and understanding. Often, "knowing" allows the clinician to feel more comfortable with what is actually unknown.
People should be helped to come to grips with the inevitable existential fact that certainty doesn't exist. Clinicians should be more comfortable with treating individuals in uncertainty rather than providing a diagnosis. Therapists should help clients understand life is chaotic, and thereby help them become more Zen, more in the moment. This serves a better purpose than focusing on attempting to predict the unknowable future to make everyone more comfortable.
Copyright William Berry, 2012