We counsellors are fond of transparency, and I feel inclined to set out my stall early by saying – I’m not a fan of medicalised language in the world of counselling. I’m not convinced that counselling belongs under the banner of ‘healthcare’ or ‘medicine’ at all. This might sound surprising, but it seems to me that counselling could just as easily sit under ‘education’; it is, arguably, more like coaching than medicine, a form of personal development.
One reason I’m averse to medical language is down to the people I work with. In my job I regularly ask people why they’ve come to counselling; most people will talk about a stressful situation, troublesome thoughts and emotions, or low personal confidence. I’d find it pretty difficult and unnatural to regard these sorts of concerns as medical issues.
A second reason I’m wary of diagnostic labels is because, to be blunt, they’re not as reliable or scientific as they ought to be. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the main ‘catalogue’ of mental health diagnoses that medical professionals work to. I think it’s fair to say that the DSM has always been subject to criticism and controversy; but in recent years its’ plausibility has taken further tumbles amid claims of non-scientific methodologies; and also of some of the authors having connections (and large stockholdings) with the pharmaceutical industry. Diagnosis is usually a pre-requisite to treatment, in effect the foundation of medical care. In my mind’s eye, the whole medical approach to mental health looks like a house of cards.
This brings me round to my third reason for steering clear of medicalised thinking: I’m not sure that the medical/scientific approach is the best route to improving our understanding of our mental lives. You’d have hoped we would have made better progress after all this time. Science is great for gaining information about the physical properties of things and has yielded life-changing innovations in the realms of chemistry, technology and medicine. The world would be a very different place if we didn’t have antibiotics, electric motors, or telecommunications technology. But the human psyche, I believe, goes beyond the limits of the physical sciences. The philosophical and methodological systems which underpin the so-called “scientific method” might prove to be the wrong tools for the job when it comes to understanding mental health.
I dare say I’ll come back to these sorts of issues in in later blogs. For the time being however, I am trying to weed out the medical terms which have crept into my vocabulary over the years, and to substitute more normal, “common sense” language. In some cases this is no challenge at all; I find it natural to use words like “distress” in place of “disorder”. One I am struggling with though is the banner itself; “mental health”. As indicated above, I’m not sure the word “health” is ideal – it has inevitable associations with “illness” – but whilst I’m about it, I’d have to say I’m not too keen on the word “mental” either. If or when I think of a good alternative, I’ll let you know.