Monday, 20 April 2015

Labels, pathologising or containing?

It seems as if life; both professionally and personally is getting me to think more about labels and pathologies. Generally humanistic therapists are concerned with the uniqueness of each person and want to support them to be open to everything they can without any restriction. Labels; particularly ones that point to a pathology can easily become more important than the person who has the label and with labels can follow formulaic ways of treating the label; not appreciating and seeing the person. However labels can have explanatory power; reduce feelings of chaos and aloneness and stop worse labels being applied. They can contain rather than limit. For example, years ago in schools, children that we now know have dyslexia were just labelled and dismissed as "thick"! It can sometimes be helpful for someone coming to therapy with what, to them, seems like a collection of random symptoms that are signs of failure, to be told that it sounds like they are depressed. What can be named can often be explored and known and transformed. 

Labelling can easily connect to diagnosis and a pull towards a medical model of diagnosis and treatment which ignores the uniqueness of each person's depression for example and give a pseudoauthority to what is little more than prejudice. However, over the years I have become increasingly convinced of the the usefulness of the concept of personality disorder. Anyone who thinks borderline personality disorder doesn't exist has never met one! There are plenty of people in certain professions with narcissistic personality disorders and sadly my professional association, AHPP has been taken over by someone with psychopathic personality disorder. Some research suggested that 5 - 10% of successful corporate CEO's sore highly on test of psychopathy. Of course you cannot convince anyone the have a personality disorder; that is its nature. It is ego-syntonic. However everyone around them knows eventually through their behaviour and how they are treated. 

In many ways, personality disorder is just a name for a cluster of behaviours and attitudes. It is not in the same category as a diagnosis of measles even though people talk of mental health categories in the same way as diseases with real pathogens. It itself personality disorder labels do not have to be more pathologising than an astrologer saying that someone is a "typical Leo" or a homoeopath saying someone is a "Sulphur type" or therapists talking about character structures. Everyone is unique and yet there are universal recurring patterns. I firmly believe that personality disorder can be worked with in therapy and modified and the negative aspects reduced. There are positive aspects to all personality disorders when awareness and moderation are brought to them. Of course the hardest part is for the person to believe they have one but this is not necessary. The label can help guide the therapy and the issues to be worked on in much the same way that character structure can be used as a guide to origins, issues and ways of working. 

I have recently had a client who has now become dominated by a fixed paranoid idea with delusions and possibly hallucinations. They are unshakable in their belief and very difficult to work with. No amount of rational argument or evidence or common sense shakes their belief which fills their life and the sessions. I cannot say if this is paranoid schizophrenia but if does feel very powerful. I also have a client who, with my encouragement, took a test for autism and scored highly. I hope it helps us to understand what they need to give them the means of working around their difficulties in relationships that this explains. No label is ever a sentence if it is held lightly; but it is a starting point, and may be a relief