Importance of Considering Emotional Factors in Psychiatric Diagnoses: Guest Blog by Dr. Terry Lynch
Psychiatric diagnoses are generally seen as primarily biological problems requiring primarily biological solutions. Not much attention is generally placed on the emotional or psychological aspects of psychiatric diagnoses.
This approach is misguided. Of course there are physical aspects to depression, bipolar, schizophrenia, OCD, eating disorders etc. There are physical aspects to all human experiences, but a wealth of helpful information emerges when the emotional and psychological aspects of psychiatric diagnoses are fully taken into account.
There are major gaps in knowledge and understanding within each of the various psychiatric diagnoses. Incorporating the emotional and psychological aspects of psychiatric diagnoses –to a far greater extent than currently happens – can greatly help join the dots and make sense of the various psychiatric diagnoses.
Here is just one example.
The usual explanation for paranoia is that it is a feature of mental illnesses such as schizophrenia. This explanation provides no real understanding of paranoia or why it occurs. A more complete understanding of paranoia emerges when we factor in some important emotional and psychological aspects.
Projection is a well recognised concept in psychology. To “project” means to “throw”. When we watch a movie on the cinema screen, we know that the images appear on the screen because they are projected – “thrown” – from the projector at the opposite end of the cinema.
Paranoia can be understood as the projection of the inner world of the individual onto the screen of life. A common error made in such circumstances is to evaluate people’s experiences and behaviours from the benchmark of what is broadly considered “normal”. Rather, they should be evaluated from the perspective of the individual’s inner world, taking the context fully into account.
If doctors cannot identify a factual external basis for the person’s fear, it is quickly concluded that there is no basis for the person’s fear other than biological, as evidence of mental illness. But if we tune in to the person’s inner world, we find that the person generally feels terrified, desperately unsafe. In 15 years working fulltime in mental health, I have met well over a hundred people whose experiences could be described as paranoia. In every case, the inner experience was one of terror, feeling completely unsafe, unprotected, and totally unable to protect themselves.
Understanding projection helps us understand paranoia. To a person who feels completely unsafe and totally unable to protect themselves, threats may appear to come from all directions. It is a case of experiencing the world not as it is but as we are.
This information presents possibilities. Perhaps helping people in this situation to feel safer can help people experiencing paranoia? This is what I have repeatedly found. Paranoia is the product of feeling very unsafe. Feeling unsafe is a regular characteristic of people diagnosed with schizophrenia.
It is high time that important emotional and psychological aspects of psychiatric diagnoses – such as feeling profoundly unsafe and the projections that result from this – were given the importance their presence merits.
Why are these and other important emotional and psychological aspects regularly missed by mental health doctors? Two reasons: (1) The training of psychiatrists and GPs does not sufficiently prioritise such emotional and psychological aspects; (2) Giving such aspects of psychiatric diagnoses the importance they merit risks raising serious questions of the medical model that currently dominates global mental health care.
Dr. Terry Lynch, mental health activist, author. physician, psychotherapist. www.doctorterrylynch.com
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