Hello,
I’m a licensed Clinical Social Worker, a mental health professional, and I’d like to talk to you about something that has been concerning me — I’ve seen an increase in people writing articles about psychology who are not psychologists, or mental health professionals. This really concerns me, mainly because when I read these articles I see some common mistakes that are potentially damaging, or misleading at best.
- caveat — I am not a psychologist, I am a psychotherapist and a social worker. Psychology permeates through my work, as does sociology and other related fields that center around human behavior. Not all psychologists engage in direct patient care, but all psychologists should understand the basics of research and diagnosis, though being permitted to actually diagnose and treat someone is not as straight forward as completing a course on psychology — there is a long process of supervision and licensing needed to be an actual psychologist orpsychotherapist.
- This is an important distinction because there is a nuance to understanding human behavior that comes from working in the field under supervision, that is why it is illegal for an unlicensed or unsupervised person to diagnose someone — it is also why there are strict guidelines regarding research, and why research is peer reviewed.
I know that psychology is a fascinating field, it is the one thing that we can be certain we all share in common, well that and having internal organs. I understand the draw to speak to modes and frontiers within psychology, and I understand the thrill of feeling like you have ‘unlocked’ a formula for success or wellness. I get it. I also understand that lay-people actually talk about psychology all the time, the water-cooler being the hub of discourse, or the supportive friend who gives you a gem of advice. The trouble with this is it lends itself to bias, and further to cognitive dissonance. This is because humans are inherently prone toward failing to see the proverbial woods for the trees, and as such we often make a comfortable home for ourselves within the woods, believing ourselves to be in the center of things.
So what are the mistakes I see? My trifecta are listed below:
- Using the Diagnostic and Statistical Manual of Mental Disorders (DSM) like it is catalogue:
One of the first things you are told when handed a DSM is ‘Do not diagnose yourself, or anyone you know’ — why? Because we are biased, we cannot ‘see’ the back of our own head, and without a ‘mirror’ to help us (read a mental health professional) we are likely to ‘feel’ our way into making a misdiagnosis. A wonderful mentor of mine once told me that the differential diagnosis (the rule-out and exploration of correlating symptoms) is the most important aspect of using the DSM. It is a manual, a tool to be used in exploring and attempting to solve a puzzle. Like how the symptom list for Borderline Personality Disorder has many of the same traits as Bipolar Disorder II, or how even with the correct number of symptoms for a diagnosis you have to meet the frequency and duration measure also to complete the puzzle — otherwise keep going, keep working on theories and don’t settle… any diagnosis is a work in progress.
I see people reference the DSM like they have looked up an item in a catalogue, found the page and are buying it. I’m willing to bet they are simply pulling information from a website, and not actually using the manual to read, correlate, differentiate, research etc.
I see people making use of the DSM to refer to ‘what it is like’ to have a specific diagnosis, or ‘what happens’ with a certain mental health issue — this is both dangerous and toxic, it reduces an individual down to a symptom set, increases stigma and dehumanizes them.
Conversely I see people attempting to throw away the DSM, making reference to the manual as if it is a crude branding that marks a person for life. I accept that some mental health practitioners operate like blunt objects, without nuance or insight, and with little thought to the holistic picture of a person, but as a manual the DSM works, it saves lives, it helps us to communicate, and (when used properly) it can help an individual to separate their personhood from their symptoms. It can heal.
2. Using research as if it is a concrete fact:
Research, and the data sets within, relate to specific fields of study with specific (and limited) aims. When used correctly it can identify trends and it can bolster a theory toward a more comprehensive understanding or application. Sometimes the best thing that research does is show you why something is not true, or why nuance is so important. I often see people citing research as if it is universally applicable, or as if it means something other than the limited findings. I think this can be the most dangerous (and hyperbolic) when relating to medication. I cringe when I see people writing articles about how others should manage their mental health, citing papers that illustrate the problematic nature of psychotropic drugs in treating mental health. As a professional who works directly with individuals who use medication in combination with talk-therapy and supportive services I often meet the same scenario: someone read something, or was told something, about how antidepressants don’t really work, or how medication makes you more unwell.
Yes, there are some irresponsible psychiatrists, and no you shouldn’t really be using your primary care doctor to manage your mental health symptoms — but look, mental health and pharmacology are very complex fields, and each individual is a complex system of their own. I have been working for years with a brilliant psychiatrist who is leagues above some others I have met, and I understand that people can have some scary experiences when attempting to get their medicine correct- but look, unless you actually know what you are talking about you should leave it well alone, or at least interview some professionals for your piece vs. misquote a Psychology Today article or some incomplete study.
3. Using positive psychology like it is the messiah:
Ok, yes, how you think about what you think can have grand implications on how you experience your life, and conversely it can greatly improve the content of your life — but it is a band-aid when applied in simplistic fashion, without a therapist and without considering the myriad of intersecting factors that contribute to wellness / malaise. There is a very strong argument that the ‘no bad vibes’ movement that is currently passing through pop psychology is inherently privileged and discounts the complex reality of marginalized groups.
I find that when people write articles about ‘how to improve your X / the psychological trick to Y / what psychology tell us about Z’ that they are talking about their own experiences, their own bias, their own privileges and their own lack of understanding regarding mental and behavioral health. A friend’s advice can be a wonderful thing, but it doesn’t always take into account what lies beneath the surface, nor make an accommodation for intersecting factors that undermine wellness.
When I sit with my patients and explore their narrative I commonly find that they have been unable to see the very thing that is glaringly obvious to me — how then could an individual take a piece of ‘self-help’ and apply it to something they are inherently unaware of? Similarly, I have sat with people who have ‘self-help’ slogans coming out the wazoo but have chronically failed to re-order their understanding of themselves, their history and their own psychology — therefore doomed to repeat the same attempts to elicit change with similar enough outcomes constituting insanity.
There are lots of people who can help people, lots of advice and ‘tips’ to life that are wonderful, and you should gobble all of those up — but they are not the same as the deep and complex work that comes with real therapy. They are not the same as speaking to a licensed mental health professional who is adept at studying and exploring your psychology with you. Be wary of anything less.
OK — now I hinted at it above, so I’m going to talk a little about coaches, gurus, etc.: you are free to do as you wish, and perhaps a pep-talk or some pop psychology is all you need to get yourself back on track, or to get yourself firing on all cylinders, but I’ll tell you this — I’ve never met anyone outside of a professional setting who can safely and comprehensively help another human being, and even within a professional setting I’ve met some individuals who are less than capable, and here is the danger — we largely want to be helped and as such we are prone to feeling better when someone comes to help us, and perhaps it works on the surface, and perhaps it will last your whole life, and perhaps you’ll pass the gift onward, but I’m telling you (as someone who provides therapy and receives it) it is a dangerous thing to apply good intentions and bias to mental health, and if you aren’t a mental health professional then that is all that you are doing, because you simply aren’t trained to actually understand the complexities of psychology and how it applies to individuals.
Working in the field of mental health, psychology and social work is as much about understanding what you don’t know as much as how to make effective use of what you do know — the danger is in ego trying to make-up and fill in vs. refer to an expert or someone more experienced.
So please, stop writing like you understand something that you do not — it might make you feel good, and you might be good at writing, but if you aren’t legally permitted to given mental health advice then you certainly shouldn’t be writing it online as if you know what you are talking about.
*edit / If you do, please have comments open, it is paramount that discussion is permitted.