Beyond the diagnosisWe mustn’t box an individual seeking help for their mental health based solely on diagnosis.
I recall a male client I had met a few months ago who revealed that he was being harassed by a woman. I was concerned for the client; he reported that he was constantly troubled and his space was being violated. But as I continued to probe and asked for more details, I realised something was not adding up. I couldn’t understand where, how and why he had met the woman in the first place. Moreover, how he was being harassed was not making sense–he shared that she was controlling him completely ‘in his mind’.
That’s when I realised that the woman he was narrating about was actually an illusion. She didn’t exist, or even if she had, the actions he claimed she had done were not occurring in reality. He was experiencing auditory hallucinations, he was hearing her voice constantly, which was causing him distress and discomfort. This (as per the diagnostic criteria) correlates with the symptoms of schizophrenia.
I panicked internally after this realisation. All sorts of thoughts were running in my mind. On the one hand, I was feeling extremely intimidated, whereas, on the other, I felt very unequipped and incompetent in handling this case. I specialise in counselling psychology, which deals with individuals struggling with everyday stressors and relational difficulties with friends, family and colleagues. Clinical psychology, whereas, is the field that deals with mental health diagnosis and treatment.
I contemplated referring him to a clinical psychologist and discussed details about the client with my supervisor. The supervisor, noticing my dilemma, asked me something that stuck with me, “Are you viewing the client as a human being? Or as their diagnosis?”
This question hit me like a ton of bricks. Even as a mental health professional, I noticed that I was stigmatising the client. I was getting scared and intimidated by the client because of the diagnosis.
Research shows that individuals with mental illness are more likely to be victims of violence rather than the perpetrator. Much can be pointed out towards the portrayal shown in the media–scenes of mental ‘asylum’ and patients inside acting out of control. This narrative is very rampant throughout the movies in the past and present. In fact, it has been repeatedly pointed out that they are more likely to harm themselves than others.
An individual struggling with mental illness really needs encouragement and support. The diagnosis in itself can be complex for the people around him to comprehend. They can feel very isolated and misunderstood. So having someone to listen and understand them can be very reassuring.
Questioning their cognition, ie the why behind their beliefs, can be very confusing. But it is expected. Something that makes sense to them may not for us. Hence, staying with their feelings: how these delusional beliefs and hallucinations make them feel, as well as their behaviour: how they react as a result can be more fruitful in the session, rather than going in circles focusing on their thoughts.
My supervisor also mentioned that as counsellors, it is human to feel dissociated and hazy—even confused. This experience, in turn, gives us an understanding of how the client themselves would feel in their daily lives. And this insight can really help in elevating the empathy we feel towards the client.
So in the next session, I did the same and found that the session went very smoothly–I felt much more relaxed just like I did with other clients. I started to look to humanise the client and his issues, understanding that they have their own complexities and quirks we all hold, be it with a mental diagnosis or without.
The experience I had in my practice can be employed in our daily lives, especially if we have closed ones battling with mental illness. Rather than letting the diagnosis define them, viewing them as the person they are. Instead of saying, ‘You are bipolar’, rephrasing it as ‘You have bipolar disorder’ can make a huge difference.
Because stigma around mental health can also lead to scepticism in seeking help, it is imperative for the individual to feel that going to therapy or counselling is not something to be ashamed of. Therapy can be very empowering, and people can benefit greatly. Listening to them, making them feel validated and encouraging them every step of the way can make those seeking help feel less isolated in their experience. It encourages understanding and self-assurance.