Yesterday on Twitter, I noticed various people piling onto Time To Change, the campaign to end stigma against people with mental health problems. The objection people were raising wasn’t about the need to end stigma, but about the fact that they use terms such as mental health and mental illness. Time To Change was accused of perpetuating the medical model, with all that entails in terms of depicting psychological distress in terms of illness.
Seriously, people. Pick your battles.
Let’s get something out of the way. Is the medical model “true” or “false”? A while back I heard a clinical psychologist on Twitter confidently asserting that bipolar disorder “doesn’t exist”. She was clear that she wasn’t suggesting that people don’t experience cyclical patterns of low and elevated mood, and she wasn’t suggesting that this pattern couldn’t be corrected with medication. But it’s the category of bipolar disorder that “doesn’t exist”.
Well, yes, in a sense that’s true. But psychological formulations, or occupational therapy assessments of strengths and needs, or whatever else way of explaining things you want to use, don’t “exist” either. They’re descriptive frameworks that may be more or less useful for different people and different circumstances.
Here’s an example (with details changed for confidentiality purposes). I was recently working with an anxious teenager who we’ll call Pete. After commencing medicaton he told me that he’d started separating his identity from his mental illness. He’d come to think of himself as “Pete, who has an anxiety disorder” rather than “anxious Pete”.
If one wanted to, you could unpick that statement philosophically, argue about whether it’s correct to say that he “has an anxiety disorder” and whether it’s technically correct that this could be separated from his sense of self. Or, you could accept that this way of viewing things was useful to him in terms of his recovery.
Obviously that’s not to say that the medical model is always useful everywhere. It clearly isn’t. I tend to be particularly cynical about the diagnostic category of “oppositional defiant disorder” because I’ve met very few cases in which that way of explaining things provides a clearer understanding of the problem. In many cases it’s a too-simplistic description that ignores the wider circumstances of why a child might be angry and defiant.
All the different models – medical, psychological, psychodynamic, systemic, social constructivist, humanistic – are essentially ways of seeing, not truths. It’s also important to recognise that they’re not necessarily in competition with each other. It’s entirely possible for somebody to have both a psychiatric diagnosis and a psychological formulations and find both (or neither) useful. You wouldn’t think it from certain noisy Internet arguments, but there are countless examples of psychiatrists, clinical psychologists, mental health nurses, occupational therapists, family therapists, psychodynamic therapists, and of course, people with lived experience engaged in peer-to-peer support, working together to complement rather than compete with their respective ways of seeing. In fact, I’d say it’s more the norm than the exception. There’s simply no need for a One True God of explanatory models.
So, going back to whether Time To Change are wrong to use terms like “mental health” and “mental illness”, I’d question whether that’s a battle that needs to be fought right now. Whatever anyone wants to call it, the important thing is that people shouldn’t be ashamed of it and shouldn’t be stigmatised for it. Campaigns like Time To Change aren’t the enemy and aren’t the people who need to change. People who sack people from their jobs and ostracise friends and family for having a mental health problem are the people who need to change.