Editor’s note: This piece was originally published on Mad in America and is reproduced with permission.
Since childhood, I have been fascinated with the mind. My beliefs and moral stances regarding mental health, however, have changed dramatically over the years. My story really begins in high school: I was 15, and as is the case for most teenagers, felt overwhelmed in a world I could not understand. I was distressed, anxious, and lost. I sought answers to my problems in the facets of the medical model — diagnosis, the DSM, and the hope that there was an easy fix for the teenage angst I was experiencing. I would spend hours on internet quizzes attempting to find out what was wrong with me. I would check out books on mental disorders, hoping I might see myself in them. Eventually, I saw a therapist who told me I had an anxiety disorder.
I was not as relieved as I thought I would be. Indeed, anxiety felt like an insurmountable label. On one hand, I felt less alone — other people have anxiety — but on the other, it felt like something entirely out of my control. I was disordered, after all. But because I was scared of the things I was feeling, it provided an easy explanation for my situation that would allow me to continue hiding from my emotions. If my feelings were so ubiquitous because of my disorder then why should I spend any time with them?
In hindsight, my anxiety and distress as a teenager were easily traced to stressful situations in my personal life. They were not something I could not control; they were not something simply caused by a chemical imbalance. I found discomfort in the lack of control I felt I had, but I also found an excuse to avoid doing real work on myself. I believe my therapist colluded with my desire to shield myself from my emotions, enabling me to intellectualize and rationalize my way around them. She should have been asking me why I was so desperate to have a label in the first place.
I tried two different antidepressants at age 17, an SSRI and an SNRI, but found they did little for me. After spontaneously deciding to quit the SNRI, I spent a week vomiting — believing I had the stomach flu, having never been informed by my GP of the potential withdrawals. This did not discourage my support of the medical model; I simply assumed the drugs hadn’t worked because I was beyond help. If I couldn’t control my anxiety, why could something else?
By the time I started university, I spent my entire first semester filling my schedule with introductory psychology classes in hopes of meeting the prerequisites for Abnormal Psychology in the second semester. When I finally began the Abnormal Psychology course, I was taught that some people, such as those with personality disorders, can simply be born wrong. This on its own felt rather unhopeful, but was only exacerbated when a professor casually made a bigoted remark about how those with borderline personality disorder are the people ‘you should avoid when dating.’ In this way, he contributed to the idea of irrevocable brokenness in those with mental health issues. A different professor argued vehemently for the benefits of electric shock, outwardly denying the critiques he was countered with. He felt that it was a great solution for lost causes. We were taught about chemical imbalances causing depression and other disorders despite evidence against this theory already existing at the time. But because I was the student, and they were my professors, I believed them.
The medical model may present as pro-mental health yet across three different universities it felt more like stigma in disguise. Misinformation such as this, especially at an academic level, is damaging. The students in these classes are the future workers of mental health care. These workers may now base a lifetime career off of misguided and sometimes even bigoted teachings.
Awareness surrounding mental health care has become a lot more prominent in recent years with the internet providing a refuge for those with mental health issues to meet like-minded others. This in many ways is deeply heartwarming to see, because, of course, mental health is not something we should be ashamed of! I often see posts and videos circulating social media encouraging others to not be embarrassed, that it is okay to seek help and to not be okay. But I also see posts saying that mental health problems are no different than physical disability, that they are out of your control. I see helpful tips encouraging others to keep taking their medication because it is ‘no different than a diabetic taking insulin.’ When I read these posts I can’t help but hear the echoes of Robert Whitaker’s book Mad in America where he discusses how nearly that exact sentiment was used to force ‘schizophrenics’ to take unhealthy and adverse doses of Thorazine against their will. I can’t help but wonder how a marketing statement used to keep ‘schizophrenics’ tranquilized so they would be easier to control and less of a bother to bystanders has been flipped to be one of positive affirmation and support.
It was this community I myself participated in as a teenager and while in some ways, much like diagnosis, it made me feel less alone, it also contributed to deep feelings of brokenness. I will spend my lifetime having to undo these feelings in myself. I will spend an entire career helping others to help themselves feel whole again.
Both my parents worked in mental health care, so I would often bring my newly learned tidbits from classes to them. My mom would express her concerns regarding diagnosis. She was frustrated that her clients had to receive a diagnosis in order for insurance to pay. This requirement meant that anyone who wanted to receive financially covered mental health care would be branded ‘disordered’ regardless of why they attended. In one such conversation with my dad, he mentioned evidence that ‘schizophrenics’ could improve without psychiatric drugs. He said that, in some cases, psychiatric drugs were causing more harm than good. At the time, this felt like a very radical piece of information. He told me that the DSM-V was in many ways more of a generalization of common symptoms than it was the say-all on how people actually work. He recommended I read Anatomy of an Epidemic by Robert Whitaker, which I did. This was the first time the medical model had been critiqued so blatantly for me and it sparked an entirely new way of thinking in me.
I initially started my bachelor’s as a film major. A choice that initially might seem irrelevant in the development of my psychological beliefs but eventually helped me to secure an internship editing promotional interviews for Gina Nikkel at the Foundation for Excellence in Mental Health Care (FEMHC). FEMHC has aligned itself closely with the research of Anatomy of an Epidemic. I spent hours editing interviews of researchers, therapists, and other mental health care workers discussing the real flaws that they saw in the system. I learned about clients who were stuck on psychiatric drugs for life, how therapy and lifestyle changes would be pushed aside in favor of prescriptions, and workers’ first-hand experiences in a system that they felt lacked the compassion necessary to aid mental well-being. Information sharing such as FEMHC does is our best chance at creating societal change. Indeed, it is information sharing that led to my own change. For this reason, it was an honor to work for FEMHC and to help others on their journey. Organizations like FEMHC and Mad in America help to fill the gaps in mental health care both in the media and academically.
Although I never completed my bachelor’s in film, instead graduating with a BSc in Psychology, I still hold a deep admiration for what film can teach us about people. As a medium, film has the ability to engage empathy in the viewer, allowing them to live out, with great understanding, the experiences of another. It allows for both learning and growth which I hope my work with FEMHC was able to inspire. My love of film has always really been a love of hearing other people’s stories — a love I continued to pursue when I moved to London, U.K. to pursue an MA in Psychodynamic Counseling.
Psychodynamic counseling is a modality of therapy born and grown from the works of those such as Sigmund Freud and Carl Jung. At its core, psychodynamic therapy emphasizes the exploration of a client’s unconscious. The unconscious is the part of the mind that, while inaccessible to consciousness, readily impacts a client’s emotions and behaviors, often in ways that don’t seem immediately clear. Clients are helped to reflect on how their relationships and past experiences have manifested unconsciously and are influencing them today. In particular, the working relationship between client and therapist is deemed essential to the success of the therapy. Therapists must be compassionate, open, and prepared to hold the client’s feelings. Psychodynamic therapy is collaborative at heart; a connection between two people.
When I began my master’s, I was extremely wary of psychodynamic theory. The emphasis that psychodynamic practice placed on feelings and compassion, in all honesty, felt a bit saccharine to me. To be able to practice a form of therapy, you have to really believe in what it does. The expectation for clients, and thus myself, to be vulnerable made me uncomfortable. In some ways, it felt too good to be true. I had grown up believing in a medical model that told me my mental health problems were a chemical imbalance; something I could not control, a flaw. Counseling told me the opposite — it put the responsibility onto the individual to begin healing. The medical model has always bolstered an easy, fast solution and although counseling offers hope of personal change and control, it is undoubtedly hard work. When you are made to feel that your negative thoughts and feelings have made you disordered or broken it is difficult to believe you are worth that hard work. It feels challenging to commit to a lifetime process of self-reflection and self-improvement when someone is offering you an easy way out.
The medical model conditions us to believe that our feelings and reactions to real-life traumas and problems are something to be ashamed of. Something diseased. Feelings are something to be stifled with pills, not explored. Psychodynamic counseling teaches that healing comes from the expression of feelings. This terrified me. How was I ever to approach my feelings when they had grown into monsters?
It is difficult for me to pinpoint when I changed my mind. Like most change it happened slowly. But I have to believe a large part of the change in me can be attributed to some of the fantastic people I have gotten to know. I had a brilliant course head who was brutally honest about her experiences working with clients and who taught me to prioritize a client’s well-being over all else. I had, and continue to have, a phenomenal supervisor who teaches me the importance of compassion at every meeting. She has shown me the momentousness of telling someone it is okay to feel all that they are. I have had the privilege of working with a truly amazing counseling charity, The Deborah Ubee Trust, where my line manager and one of the founders, Denise Hubble, has been nothing but supportive, modeling for me what a compassionate health care system can look like. Lastly, I have had the honor of sitting across from clients who are brave enough to be vulnerable with me. I have felt nothing but care for them and their experiences. If I am able to feel such empathy for them, then I must show the same empathy towards myself.
I was wrong about psychodynamic theory. It wasn’t saccharine. I was just scared. Scared of feeling things I had long since pushed aside. I had been conditioned to be scared. It was this realization about myself that allowed me to start seeing similar fears in clients and in people around me. It changed my relationship with psychodynamic therapy and made it something I could both practice and live. This is not to say that psychodynamic therapy is the only model of counseling worth using — I myself practice integratively — but embracing and understanding psychodynamic theory allowed me to connect my prior concerns about the medical model to an idea of what I thought mental health care should look like.
It was around this time I began writing my dissertation. It was a literature review that examined the ways that the medical model and psychodynamic therapy conflicted and the problems that arise in these differences. Specifically, it utilized SSRIs as a vessel to explore these incongruences. It was a 10,000-word piece that took me a little over a year to complete. My dissertation acted as more of an exploration and examination of the problems caused by the medical model rather than as a guide for how to fix them. Despite this, it inspired many of the values I put forward in my own practice and reminded me of the significance of information sharing.
If I had not had parents who questioned the system or had I not stumbled across Robert Whitaker’s and other researchers’ work, I may have never changed my mind about the kind of care I wanted to give. Counseling is more than just a career. It is impossible to not have who you are and what you believe influence your work unconsciously. If I still wanted to categorize people and explain their traumas away with disease then I would be hurting my clients despite my best intentions. Information sharing can help therapists personally and professionally to provide the best therapy for their clients.
I want to create a space where my clients don’t have to feel broken because they are struggling. A place where they can learn to show compassion to themselves for what has happened to them and for how they have reacted. I want to help them amend their relationship with their feelings to be one of empathy and not fear. If I believe that they can heal and that they are worthy of empathy, then they can too. I believe my clients are simply people reacting to a world that can be undeniably cruel. I do not believe they are diseased or ill, but people who need affirmation and love. They are people who just need the space to feel understood and heard. I hope to model and reflect these values to my clients so that they can learn to feel it for themselves. I am only a single person, but I can go to bed hopeful if even one person begins to see themselves with the compassion I view them with. I can dream that they will help another to feel the same.
Systems do not change overnight. They change through the passing down of knowledge. As a therapist, I am a single link in a chain. Indeed, there are many people I will never have the honor of sitting across from in the therapy room. The hardest part of self-improvement is the decision to face your struggles, to approach them even when you are scared. I cannot convince clients I never see that this healing is worth the initial fear. While I believe in the benefits of therapy wholeheartedly, I cannot help someone who is not ready to be helped. This is why what Mad in America is doing is so important. Similar to the way I model compassion to my clients, Mad in America and similar movements model it on a much greater scale. In discussing the flaws of the medical model and modeling what we want from compassionate health care, we can help people to understand that they aren’t broken or beyond help. That their feelings aren’t something to turn away from and shun, but something to be held and empathized with.
Information sharing can inspire researchers to explore what a healthier mental health care system can look like. It can assist professors in teaching and shaping future mental health workers. It can aid therapists, general practitioners, and other mental health workers to shape their practices into something representative of the values they hope to pass on. It can influence what the mental health awareness movement shares with potential clients. And it can nudge potential clients to seek the help they were initially too scared to ask for. Every part of this chain is invaluable; every part is contributing to the day when the average person can model compassionate mental health care to another.
This is how change happens. This is how change happened for me.