When the president of the World Psychiatric Association Dinesh Bhugra came out last week with a forceful commentary characterizing his own profession as a house “divided,” “alienated,” and “embattled,” and charging it with “diagnostic confusion, including the medicalization and inappropriate treatment of individuals with normal human emotions and experiences”–a wake-up call if there ever was one–I found myself reminded of Eleanor Longden’s TED talk:
“An important question for psychiatry shouldn’t be what’s wrong with you?” argues Longden, “but rather, what happened to you?”
Longden’s lesson may have been aimed psychiatrists, but I think her story speaks to all of us. Maybe we aren’t hearing voices. (Or maybe we are; it’s a lot more common than we think). Maybe instead it’s depression, insomnia, addiction, obsession, craving, compulsion, or anxiety we’re struggling with. But whatever form our distress takes, what’s the first question we ask? When we list our symptoms for the doctor or type them into the search engine, what are we really asking them to tell us? What’s wrong with me? What do I have?
Maybe something is wrong with us. Maybe there is some biological condition underlying our distress. Maybe there’s even a bum set of genes that predisposed us to that condition in the first place. Our brains are a part of our bodies, after all.
But biology isn’t destiny. Genes aren’t fate. We may be born with certain genes that predispose us to this or that condition, but whether or not those genes get expressed depends in large part on our environment—i.e., on what happens to us—and how we respond to it. We know that those who develop schizophrenia, bipolar illness, and depression are likely to show some genetic markers for these conditions, but we also know that these same people are up to three times more likely to have endured some Adverse Childhood Experience such as abuse, neglect, death of a parent, or some other trauma.
What if, instead of seeing our depression or anxiety or craving or insomnia simply as signs of something wrong with us, we also considered them, as Longden suggests we do, complex and significant experiences to be explored? As sane reactions to insane circumstances? Meaningful responses to painful life events? Ingenious adaptions to untenable situations? As sources of insight into solvable emotional problems?
I’ve never met a symptom without a story to tell. Depression, obsessive thinking, craving, cutting—all these so-called “symptoms” give voice to something, some unmet need or unexpressed feeling or unthought known we haven’t yet found the words for or the tools to cope with. That’s their job. Take an aggressive stance towards them, and they often do what Longden’s voices did: respond in kind, either by multiplying or turning up the volume or both.
Listen to what they might be trying to say, on the other hand, and we often discover a whole story waiting to be told—not just about what happened to us, but about what we’ve done or left undone; about what we had, what we lost, what we’re still looking for; about what excited or humiliated or nourished or enraged or aggrieved or almost killed or ultimately saved us; about what we want, what we hope for, what we don’t dare hope for; what we knew but weren’t allowed to tell; about who we are and who we’re trying to become. In my experience, that’s where meaningful change begins, and where the real healing happens. Our symptoms may not go away entirely, but they’ll have a lot less say over how we live our lives.
When you aren’t feeling well, when you’re down or anxious or angry all the time, when you’re not living up to your potential, when you find yourself reaching for that fourth glass of wine for the fourth night in the row or still under the covers at 2:00 in the afternoon, when the activities that used to thrill you leave you cold, what questions do you ask?