Quick summary: I am offering a discussion concerning the drive to label and how labeling impacts suffering. There is a heated debate in the field of
psychotherapy as to whether psychiatric (DSM) labels help or hurt the client’s recovery. I am commenting on what encourages our emotional reactions and behavior related to the topic.
What questions might arise from such dichotomies concerning to label or not to label? Should psychotherapy be governed by modernist or post-modernist principles? There is the dialectic “and” that might surface here… this helps me to identify a label that could describe my own ego related to this subject (as my ego has a rather rigid view on the subject of labels). I hold my own dichotomous beliefs in awareness and attempt to grow from them… this subject finds me humbled… I strive to be open-minded as opposed to being dogmatic… and now I arrive at another false dichotomy and fool myself into believing that open-mindedness is simply the opposite of being dogmatic… do I strive for open-mindedness to a degree that I find myself dogmatically in favor of open-mindedness… dogmatically against dogma? Can I strive and still be truly open?
Existentialism would help this debate to arrive at a point of universality… what fear or anxiety drives us to such emotionally reactive views related to labels and the resulting intervention strategy? If we cannot find consistency must we live in chaos? Without stable labels can life avoid meaninglessness? Without having an indisputable knowledge and protocol, can we in this field still consider ourselves adequate or competent? The dialectic answer is a coexisting yes/no… And for the voice of yes let me propose an irony… isn’t it our ability to offer empathy from a place of acceptance which nurtures the therapeutic relationship, which is the most important variable in relation to outcomes? To be truly accepting do we need to accept that we don’t know… or to know that our labels are relative, transient, and infinitely tied to our own subjectivity? How do labels help us to know that we don’t know? Who are the labels for… the client or perhaps our own existential anxiety? Both?
When a human’s desire to label and quantify the environment leads them to act against their own best interest or the best interest of others, do they then have a personality disorder related to a lack of control surrounding judgments and projections? I say this in complete seriousness… if the subject is suffering, do we label hypo-control more than we label hyper-control? If control was put on a bell curve would we see equal amounts of suffering on both ends? Are labels a symptom of being overly concerned with controlling existence? Is life controllable or predictable? If life is neither controllable nor predictable than is our drive to label (ironically) pathological?
Is labeling a symptom of our existential anxiety? Is labeling a behavior of avoidance? If we have failed for centuries to find a universal truth and yet we persist in our search using primarily the same methods, what label could be used to describe this search for absolute?
I believe that therapists have the good intentioned goal of reducing suffering and I struggle with the realization that labeling might be our way of avoiding or resisting the suffering which arises from our own relationship with meaninglessness… which arises when we attempt to quantify the unexplainable…. when we attempt to know and do not allow ourselves to simply be. Perhaps there is both hope and nurturance within the presence of acceptance… perhaps the felt sensation of healing arrives in this space.
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When contemplating this subject, I always end up reminding myself that a diagnosis is nothing more than a list of criteria that have been seen in other people. This list may be helpful if it can help people feel that they are not alone, that these similar experiences have happened to other people, and that things that other people have found helpful could possibly be helpful again. When diagnosis is used as a tool (and explained to clients as a tool), I think it can be helpful. Unfortunately, I think diagnosis is often leads to a rigid set of expectations and a feeling of having an inescapable “illness”.
I agree… like so many things in our field – good intention poor follow through.
I think you are being dogmatically openminded here. Try to keep an open mind to the importance of occasional close-mindedness on some issues.
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Really enjoying your blog!