Illness vs. Hubris: What would you choose?

Recently when I have been seeing couples or families or individuals in which an Axis I psychiatric illness (major depression, anxiety, bipolar illness, schizophrenia according to the current psychiatric diagnostic nomenclature that usually requires some sort of medication) is clearly not present I have offered them the following choice.

“Either I can diagnose you as having a sickness or illness and direct you towards treatment with psychotherapy (possibly long term) and possible medication and refer you to someone else who does much more of both currently than I or…

I and you can view you as being factually wrong, psychologically flawed and emotionally immature and work with you to correct all of these. By this I mean you are first looking at the world through a filter that is just a filter and not necessarily accurate with regard to the facts of a particular situation. Next you are psychologically processing that misperception in a way to cause you to view and treat your interpretation as an absolute immutable fact. Finally when you feel disappointed, hurt or frustrated in conjunction with that belief instead of pausing momentarily to reflect and then consider your options you immediately act on those feelings in ways that nearly always makes matters worse.”

When I offer this “pick one or the other choice” to many clients, they are at first taken aback to see if I am serious. When they see that I am, they pause and seriously consider the implications of either choice and then choose the second.

At that point we work as partners moving towards the common goal of their adjusting their perception to an alternate and more positive interpretation, processing even that positive interpretation as a possibility vs. a hardened fact, and then pausing before they react.

What would you choose?

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