Addressing Psychological Misinformation through therapy’s major tools
I admit it – calling it a secret is a little disingenuous. There are no secrets to the therapeutic process: acceptance of all that is in human experience is a cornerstone to all psychological theories. There is, of course, respect for privacy, but that’s not the same.
No, it’s not a secret – it’s the frustration that most mental health workers share that is in plain sight, that we try to address early and often, yet inevitably, rears its head over and over. This is because, unfortunately, it is baked into the mental health system. More than that – it is baked into our culture.
We see its ravages everywhere. Rising rates of mental illness diagnosis, in parallel with increasing use of medications and therapy. Rising suicide rates. Vast substance misuse. Increasing loneliness.
Get on with it! What’s the (non-)secret?
I am talking about the pathologizing of internal experience. I’m being inclusive here – I’m not just referring to emotion, which I’ve covered before. I also mean thoughts. And pain. Desires. Identity. And other sensory processes – sight, sound, touch, taste, smell, body-in-space, etc. These are the fundamental tools by which we navigate the world. Billions of years of evolution have made these tools very adaptable to a constantly changing world.
But when the readout from these extraordinary tools isn’t precisely what we want it to look like, we call it illness. We try to control it. Look at the diagnostic manual, the DSM-5-TR: 13 of the 22 chapter categories are specifically named for these tools. Anxiety disorders. Psychotic disorders. Paraphilic disorders.
We shoot the messenger.
What happens when you shoot the messenger? The message is lost, or obscured, or at least misdirected.
Which brings up two questions. First, instead of shooting the messenger by pathologizing, what do we do instead? And second, what are these messages about?
Antidote to pathologizing: Listening
It’s obvious when you step back and think about it, isn’t it? When a message arrives, whether desired or not, the first thing to do is listen. You won’t know how to respond to it until you understand it. Ninety-nine percent of the time (the only rule in psychology is that there are always exceptions to every rule), the first step is to put aside judgment and acknowledge the experience. Whatever you are feeling, whatever is happening, a 5 second pause to listen can make a huge difference.
This is not just ‘count to five.’ When you do that, you’re listening to yourself count. That’s not hearing the message. Really, listen to it. For example, I’m furious [emotion] that this person has it out for me [thought]. Or, I’m scared [emotion] that I’m not strong enough to handle this situation [thought]. Your body is giving you these experiences for a reason. Whether and how they help you is a more complicated matter. But the point is, they are, without exception, there to help.
Common next step: Opposite action
Now this is not always the answer – definitely, less than 99%. In fact, if you step back and take in every action we make, day after day, this is probably the next step a small minority of times. Your body says you’re hungry? Go eat. Your body is bringing up worries? Think them out. Most of the time, our body receives and responds to these messages without even thinking about it, and that is a highly effective pattern.
However, people don’t come to therapy or get diagnosed with mental illness for these situations. Generally, people are dissatisfied with how something is working. This dissatisfaction is a message, too, and worth listening to.
And in those situations, we’ve been trained to see the internal experiences themselves as the problem. Now that we’re stepping back and listening, often the way forward is the opposite action to what we’ve been doing. Feeling anxious and inadequate to handle a situation, and so you’ve been avoiding it? Engage with it. Try it out anyway. Feeling like no one cares about you, and so you’ve been hiding away? Reach out to someone you trust and connect with them. Or a different type of situation – feeling uneasy without constant stimulation, and you typically respond with a drug, or gaming, or social media? Stay with that unease. Dive into it, and get to know this part of yourself you’ve been avoiding.
Opposite action is a crucial part of many treatments. In cognitive behavior therapies, this is connected to both exposure and behavioral experiments. Psychodynamic therapies use this as corrective emotional experiences. In Buddhist tradition, this is part of how mindfulness works (holding to just internal experiences, before the external response).
Important distinction for opposite action
Again, opposite action is not always the right next step after listening. I’ll briefly talk about the messages themselves next, but here’s a quick guideline for thinking about whether opposite action might be helpful.
Ask yourself, is this message about me? If yes, then opposite action might be helpful. If not, you can’t fix external problems by changing yourself. Opposite action might then itself become pathologizing.
Sometimes, it’s both. For instance, if someone who you know cares about you says something hurtful to you, you may feel angry and scared. The anger is about them, not you: you might want to speak up to them (assertiveness). The fear is about you: you might want to engage rather than avoid, by trusting in yourself and in the relationship to speak up. It could be even trickier: you may not know whether the person is able to take care of your needs alongside their own, such as someone who is verbally abusive. In that case, the fear may very well also be about them. Maybe even to the point of overriding the anger, and suggesting a different action.
What are these messages about?
The main purpose of this post is about recognizing the misinformation that internal experiences are pathological, and instead, listening to them first. Interpreting the message is also important, of course. But this is much harder, and can mean an infinite number of things.
Messages can tell us about needs that aren’t being met. For instance, “maybe I need to get more sleep.” They can be about safety, or connection, or pleasure, or nourishment, or comfort. Messages can help us decide whether to approach or avoid. They can help us stay active and vibrant in our lives.
Sometimes, we’ve had years and years of problematic training on these experiences, and the timing, intensity, and other aspects of the messages have become distorted from their original aim. At that point, it may be really hard to connect them back to what’s happening around you. These messages are often more about understanding yourself, rather than understanding the immediate situation.
Sometimes, the messages are getting misdirected in service of maintaining power imbalances. Telling you that your fear or anger or hopelessness at circumstances keeping you from living your life is your fault by medicalizing them. As I mentioned in the previous section, these are not opposite-action situations, because it’s not about you. It’s happening to you, and you might need to do something about it. But you may not be the one needing to change.
Final thoughts: psychological misinformation and listening to experience
And so, there you have it. Despite pervasive messages out there, including from many of those in authority, internal experiences are not illnesses. By first listening to what your body is telling you, and then fitting this into what you’re going through and what’s important to you, you can find a way forward.
Just please: take care of yourselves and each other. And, don’t shoot (pathologize) the messenger.