The doctor arrived towards dinnertime and said, of course, that although recurring phenomena might well elicit apprehension, nonetheless there was, strictly speaking, no positive indication, yet since neither was there any contraindication, it might, on the one hand, be supposed, but on the other hand it might also be supposed. And it was therefore necessary to stay in bed, and although I don't like prescribing, nevertheless take this and stay in bed.
Leo Tolstoy, The Devil
January 31, 2023
Personal narratives and history inform our emotional experience in unique ways. In this sense, mental health is fundamentally distinct from other medicine. Two people with broken legs can be treated the same way without knowing much about the individual. But no two people with anxiety have the same experience, think of their challenges exactly the same way, or want to be in the same frame of mind when they overcome their anxiety.
This is the well-known problem of medicalizing individual experience, which is inappropriate in mental health. The British Psychological Society (BPS) has stated that the “top-down” approach to mental health in the Diagnostic and Statistical Manual of Mental Disorders (DSM), where patients are made to “fit” a diagnosis, is not useful for the people who matter most – the patients. The BPS says
We believe that any classification system should begin from the bottom up – starting with specific experiences, problems, symptoms or complaints. Since – for example – two people with a diagnosis of ‘schizophrenia’ or ‘personality disorder’ may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person’s real problems would suffice.
In addition, at the core of issues like anxiety and trauma is a sense of lack of control. As a clinical psychologist expert told us: “Pathologizing experience and challenges and receiving a mental health diagnosis and a medication prescription from a doctor is yet another case of someone telling the person who they are and prescribing what to do.”
The narrative embedded in the DSM is again one of uniformity, this time in order for the treatment to be regulated and efficient.9 Currently, what happens in real life is that the clinical psychologist uses the DSM to tick a box and then engages with the person using their own terms and
experience. That is why therapy is more effective than medication alone. The issue that concerns us is what happens when products start taking on the role of the practitioner. We can imagine a desirable future where a machine fixes all our broken legs the same way, but what is the future where mental health technologies try to do the same?
