I had two clients last week who said the same thing to me. Both new clients, they sat in my office and by way of explaining their purpose for being there they announced, “I’m just mentally unstable.” Both of them. In two different sessions. Coming to me fresh from a recently terminated therapy relationship.
With the prompting of open ended questions and active listening, they both went on to tell me the rest of their stories. Their stories were remarkably similar - trauma, self-injury, suicide attempts, unstable households, constant conflict. Of course they had their individual nuances; I was not unaware of these, but the thing that stayed with me after the session was over were the similarities, one in particular. “Mentally unstable.” They declared it like it was Gospel truth, imparted to them by someone who, luckily, could give them the key to their inner turmoil.
It was just a first session. I didn’t challenge their words but I wanted to. My diagnosis for both would have been complex PTSD. They both show all the signs - hypervigilance, hyperarousal, avoidance of triggering memories, unstable relationships, push/pull behavior, unstable sense of self, insecure attachment styles. I am certain of my diagnosis. I am also certain that diagnoses are only valuable in that they communicate a cluster of symptoms to other treatment providers and insurance companies. Perhaps there is also some normalizing value to having a label for one’s problems as well.
The problem, as far as I’m concerned, is that “mentally unstable,” the term that both attached to themselves, is not a useful one. It does not communicate symptoms nor does it provide a sense of understanding to the person that has it. Instead, it is pathologizing. It focuses on abnormal behavior and not the situations that make that very behavior understandable. It places the responsibility securely on the shoulders of the person who holds the label and removes any responsibility from the environments that created the traumas.
I am simultaneously struck by the fact that another mental health professional has used and approved this term and by the fact that both have accepted their inherent broken-ness and abnormality without a second thought. This is the danger of the mental health profession - into our hands goes the care of vulnerable people who depend on us to care for them and help them get “better.” The problem is, we define what better means. I believe that we all do the best we can, with what we have, in any given moment. When we know better, we change that behavior. Looked at this way, people who have been traumatized have learned a certain way of being in the world. They have learned to exist in a way that keeps them safe from the harm that they have experienced in the past. It makes sense. Yes, the behavior is ultimately unhelpful and we, the therapists, can help them see that over time and can help them develop new ways of interacting with the world. But it is not our right to interpret and label the behavior abnormal or irrational.
I would argue that the way these new clients behave and feel is the most normal part of them. If you look at the way they grew up, it makes sense. If you have never experienced a stable relationship, how can you create one? If you have had no sense of predictability to emotions in the past, how are you supposed to regulate your emotions now?
In the upcoming weeks and months I will continue to work with these two clients. Their stories will develop and change and become clearer to me with each new session. Each life story will take on its own plots, and the story lines will diverge. This is the way it always happens because individuals are so very different. However, for now, I will sit with the knowledge that our words are powerful and what we say to our clients sticks. I would argue that both of these clients are traumatized, not mentally unstable, and I’ll try to help them see that. The very behaviors that we sometimes pathologize are really the very behaviors that make the most sense, if we just step back, suspend judgement and ask ourselves if what they do and perceive is really all that abnormal given the trees in the forest. Sometimes seeing those individual trees does more for us than just looking at the growth of the overall forest.
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