As With The Body, So With The Mind

As medicine is to the body, so psychology is supposed to be to the mind or soul.

Doctors and surgeons are in the business of fixing stuff that is obviously and identifiably wrong or broken: broken bones, lumps in the brain, wounds from accidents or fights, really bad cases of food poisoning, malaria, the pox, chlamydia (the STD of preference for straight people), cleft palate… something that can be identified and treated in some way.

At the other end of the spectrum are the physical trainers and dieticians working with (say) a movie star or a Olympic team, or cosmetic surgeons. The aim is to improve something that is already okay and provides a foundation for that improvement.

It’s the in-between that’s awkward. People who aren’t actually sick, but who keep getting colds and infections. People who aren’t actually obese, but who can’t sustain much physical effort. People who have poor diets or can’t get enough exercise. There’s nothing broken and they aren’t suffering from the effects of a virus or bacteria, but they aren’t exactly shining examples of the potential of the human body either. Doctors can’t help because there’s nothing much wrong, and the trainers can’t help because there’s not enough right either.

As with the body, so with the mind.

Psychiatrists are in the business of fixing stuff that is obviously so wrong that the patient is experiencing distress and impaired functioning in their everyday life over an expended period, usually at least six months and often more than a year. That’s a general condition for a psychiatric disorder in the DSM-5. Look at the symptom lists and you will realise that to get a DSM-grade diagnosis, you’re in a bad way. There are symptoms which on their own would have people backing away from the patient slowly and politely and blocking their calls - and DSM diagoses usually require three of more of these. Psychiatrists are also doctors, can prescribe, and insurance companies will often stump up on their signature. Their medical training leads them to want to deal with conditions where there is obviously and identifiably something wrong.

At the other end are of the spectrum are life coaches, dating coaches, PR coaches, dieticians, beauticians, and physical trainers, who work with the (usually) well-off and high(er) functioning middle- and upper-classes. The aim is to improve something that is already working reasonably well.

It’s the in-between that’s awkward. The people who aren’t quite distressed, but don’t feel happy either. They are holding down a job suitable for their abilities, paying the bills, eating reasonably, not getting blitzed every night, and otherwise taking care of everyday maintenance… but they might not be having much fun either. They aren’t scared of talking to people, but it’s not their favourite thing to do. They don’t think they are awful, but there’s a nagging voice in residence somewhere in their head. Or maybe they are just oblivious and wonder why they only ever meet people once. They may get hugs, but not from the person they really want to be hugged by - just someone who will do.

These people are the market for psycho-therapy. They need to be working or have access to money because they will need to pay the therapist themselves - the insurance companies only pay for psychiatrists - and maybe they could get some therapy on the NHS. If they could get to see a GP, and the GP didn’t just write for some low-grade prescription anti-depressants.

What are psycho-therapists supposed to do with these people? Find something wrong and try to fix it? Give the patient what amounts to a self-improvement programme of exercise, dietary change, sleep routines, removing negative thinking and all that jazz? If the patient comes in with a specific problem, the chances are that what they need is a specific solution, and specific is self-improvement.

At first they seemed to follow Freud’s example, and sit quiet while the client talked, or not. The few techniques they used were close to, if not outright, hacks, from so-called “active listening” to suggesting people wrote with their other hand, as it let one’s creativity flow more easily. Some would head for childhood, to find fault there (and be rude about the client’s parents in the process), and some would look for patterns of behaviour that needed changing. Some would interact with the client and some would stay quiet. And some use the “models” from so-called “positive psychology”.