When it comes to our mental life, nothing else matters.
Posted Oct 27, 2018
Despite many years of research and debate, the most appropriate way to think about psychological problems remains elusive. Even with our increasingly sophisticated methods and gadgets, the nature of psychological difficulties has not been revealed. Appealing to areas such as genetics, epigenetics, and neuroscience has not brought us any closer to a solution. It is clear that the mainstream Western approach of creating categories based on observed or reported symptom patterns does not “carve nature at its joints.”
One idea about psychological mayhem is both simple and profound. It has been right under our nose for a long time. It is the idea of being “bothered.”
“Bothered” is simple, because it’s a commonly used term, at least in my part of the world, to which people can easily relate. It is profound, because it captures both the nature of psychological functioning as well as providing a clue regarding the way in which someone’s raging mind might be calmed.
While much of our effort has been leading us ever-further down a rabbit hole of symptom identification, the main point which is frequently overlooked in the area of psychological disruption is that the symptoms themselves are relatively unimportant in terms of a person’s level of distress. For any particular symptom to which someone who is highly agitated might point, it is possible to find other people in the population with the same apparent symptom who are not bothered at all.
Many people, for example, hear voices. Some people are terrified by the voices they hear, and others are inspired by them. Because mental health professionals typically only see the terrified, rather than the inspired, people, it’s easy to forget that voice hearing itself is not the problem. The problem is that the person is bothered by hearing that particular voice or bothered about what the voice is saying. Similarly, of all the people who experience what might be considered a traumatic event, some people will continue to be bothered about the event far into the future, while others will not. It is, therefore, the bothersome aspect of the event that needs to be addressed, not the event itself.
This simple fact about the importance of botheration makes psychological problems fundamentally different from physical problems. If someone becomes infected with the bacterium Mycobacterium tuberculosis, then they will be diagnosed as having the disease Tuberculosis and receive the appropriate treatment. Crucially, the diagnosis and treatment of Tuberculosis will be made without ever inquiring if the person is bothered about the disease.
Due to prolonged exposure to the sun with inadequate sun protection as a child, I have had numerous basal cell carcinomas identified and removed by GPs and dermatologists. Not once have any of these medical professionals checked, as they were examining my skin, if I was bothered about the anomaly they were inspecting. Apparently, the way I feel about the little patch of flaky skin has no bearing on the diagnosis.
With psychological problems, however, how a person feels about their current predicament has everything to do with the way we think about the problem, as well as the treatment we provide. Focusing on a person’s botheration should be a much more explicit aspect of treatment than it currently is. In fact, knowing the areas of a person’s life that they are bothered about should be the deciding factor regarding where to focus treatment attention. Finding sensitive ways to curiously ask about a person’s level of botheration should be a central pursuit for anyone who helps other people resolve psychological troubles.
If someone reports that they haven’t been sleeping well, asking if they are bothered about that and what, specifically, they are bothered about will often be illuminating. And we needn’t stop with one line of questioning about the person’s bothered state. As one source of botheration is revealed, we can continue to delve deeper into the problem and move ever closer to the ultimate source of the troubles.
sychological help is only ever helpful when it reduces a person’s current level of botheration. Help is not necessarily helpful just because it might change a thought or a behavior. During the provision of helpful help, thoughts and behaviors might certainly change, but if only they change, and the botheration remains, then the change will be unsatisfactory. If a therapist is able to help someone change the things a troublesome voice is saying to them, but the person remains bothered about the voice, then the intervention won’t seem to have been particularly valuable. On the other hand, sometimes people can learn not to be bothered about a voice even when it continues muttering its dastardly ideas.
While psychological distress can manifest in a multitude of ways, the sense of being bothered is a common theme. It is the presence or absence of bother that determines the contentment of a mind, not any particular thinking style or behavior pattern. Understanding the nature of botheration is the key to a more accurate appreciation of the psychological battles that occur within, as well as the most appropriate way to achieve a personal peace treaty.
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