By Jide Omotinugbon
Diagnoses given to clients by the mental health therapist (psychotherapist) are subject to changes and updated as the need arises. One major reason is that it takes the client a while to gain the trust of the therapist. Opening up to someone (the therapist) you have never met before or barely know is difficult, much less telling him/her the story of and/or challenges in your life after a few sessions. For the clients, it is, initially, more convenient to talk vaguely about feeling depressed and/or having some anxiety. The psychotherapist would even need to prod most clients before they can put into words, the symptoms of depression or anxiety they are experiencing.
When individuals talk about the physical, emotional and behavioural symptoms of anxiety or stress they experience, they mention such physical symptoms as fatigue, sleep difficulties, headaches, muscle pain and tension and increased sweating. They also talk about the emotional symptoms, including the loss of motivation, increased irritable moods and anger, restlessness, inability to focus, mood instability and decreased sex drive. And in their wisdom, they resort to unhealthy eating habits (over- or under-eating), drug or alcohol use and social withdrawal, among others, as coping mechanisms – all of which are deceptive ways of dealing with the real problems.
The psychotherapists do not rush the clients into telling their stories and that is why subsequent visits are scheduled for the client to gain their trust, so they can eventually open up.
For most people, and it might sound tautological, the symptoms of depression and anxiety they talk about are actually symptoms of something else: The after-effect of an earlier trauma they suffered either in the distant or recent past. And most of us do not feel comfortable talking about these.
Human nature is such that we tend to blame people for their actions or inactions before we know the whole story behind such actions or inactions. This should not be. We need to always take a breath before passing judgement.
Take as an example: A young teenage girl thought to be “misbehaving.” The tendency in our society, mostly by parents and guardians, is to verbally abuse and berate her, charging at her that her behaviour is probably because of the fact that she now sees herself as an adult. It might be deeper than that. It might be because of some traumatic experience in the hands of someone terrorising her, maybe through inappropriate sexual experiences that she is too embarrassed to talk about.
The diagnostic features of post-traumatic stress disorder (PTSD), as stated in the Diagnostic and Statistical Manual of Mental Disorders, vary and the symptoms are myriad. Symptoms may not even appear until several years after the event. Symptoms of PTSD may include distressing dreams and harrowing memories of traumatic events, flashbacks, persistent fear, anger, guilt or shame. It may also include feelings of detachment from others and irritable or aggressive behaviour. All of which are symptoms of depression and/or anxiety. Yet, it might be more important to deal, first, with the underlying cause, which might be a traumatic past.
Most common traumatic pasts may be due to exposures to war and/or combat experiences, sexual assaults, childhood physical abuse, the lack of good support systems, fire and natural disasters, robberies, kidnapping, etc. All of these affect the performances of victims on their jobs, relationships with other people and enjoyment of everyday activities.
If, for an example, a person who was in the warfront hears a sound similar to that of gunfire in an environment devoid of war, s/he literarily jolts as if reliving the experience. Someone who was sexually molested as a child would continue to be suspicious of anything that reminds him/her of that experience. A child that literarily lost his/her childhood due to a lack of care would almost grow up not knowing what being loved is and may have difficulty expressing the same to others.
The purpose of cognitive behavioural therapy is to assist people turn around negative thoughts and replace them with positive ones. Anger management therapy and group therapy may also be helpful, as they present the opportunities to talk about whatever could be burdensome. Anything from our past that interferes with our daily living or which makes it difficult for us to enjoy life requires treatment. Unfortunately, the field of psychotherapy has not really caught on in the Nigerian environment as we still blame people for their outward expressions, rather than seeking to know the story behind such actions. A combination of therapy and medical attention goes a long way in dealing with a traumatic past.
Jide Omotinugbon, a psychotherapist writes from Kentucky, USA. He can be reached via [email protected].