I didn’t wake up one day with a severe shortage of serotonin in my body and all of a sudden, for no obvious reason, become depressed. I have depression because I was abused. Mental illness is caused by trauma. We may be able to explain our feelings broken down to the chemicals which are or aren’t floating around in our body in recommended quantities, however to see mental illness as only a chemical imbalance is to miss the entirely human factor of it. We don’t live in a bubble. We hurt when people hurt us.
Sometimes its not even obvious that we have lived through trauma, for example we may have a disorganised attachment relationship with a parent or carer during our formative years. Sometimes trauma is more obvious: we lose someone close when we are very young, or we are neglected or abused. Whatever trauma may be the cause, mental illness happens when our relationships with people don’t go as well as they could, or sometimes are wildly different to how they should be. I’ve not met a person with a mental illness who can’t relate to at least one trauma in their life. Of course all of us live through some pretty tough shit, but not all of us become mentally ill. That isn’t to say that the tough shit isn’t the main causal factor of mental illness, although its certainly possible that other factors can make some more susceptible and some more resilient.
Mental illness manifests itself relationally too. Whether its our relationship with our self (our ourselves, in some cases), or our relationships with others, mental illness changes things. This is perhaps most markedly apparent in the cluster of traits known as Borderline Personality Disorder. The deep interpersonal difficulties people with this diagnosis experience just screams out the obvious: the problem is rooted in earlier experiences of relationships which were confusing, turbulent, hard to pin down or make any sense of. Now, their own identity is hard to suss out, and their relationships with others swing between idealisation and devaluation. We live what we learn, to simplify it down a little bit.
And just as it is people who fuck us up, it is ultimately people who can help us get better. Medication may or may not help plaster the wound for a while. Motivational posters can get us so far. But what really brings about lasting healing is a positive relationship with an individual, sometimes a friend, sometimes a partner, often a therapist. This relationship is boundaried, unlike the abuse where boundaries were blurred, or discarded entirely. The relationship is consistent, not like the abuse where it could blow hot and then cold, sometimes being told how special you are, sometimes being threatened in order to keep you quiet. And the relationship is transformative, just like the relationship which caused our problems was, but this time the change is for the better.
One of the hardest parts of being a therapist is trying to both convey genuine empathy at just how hopeless and dark things are right now, but also hold the hope that things can get better – for me, I hold this hope not from naive optimism but experience. I spend most of a session really relating and holding space for just how crappy the emotions unlocked during recovery are. But I also express how much I care about them making it through the darkness, and that I truly believe that the darkness will end, even though it doesn’t feel like it right now. And this is when the relational approach really hits home for me. These sort of words are empty if they are just read in a self-help book or a motivational poster. They are even empty from a therapist, at first. But when they come from someone who you are building a relationship with, they slowly gain a little more weight. Often my therapist has held hope for me. At first I thought he was another do-gooder trying to say nice things. Now I trust him when he says he cares and encourages me to keep on keeping on.
Its not so much what I say but what I do and who I am as a therapist that matters. And that’s why therapy is a long haul process not a quick fix. Short term talking therapies can certainly be helpful, but any lasting change in our lives comes when we form a relationship with someone and are changed by the positive qualities of that relationship. It is both liberating and fills me with a deep sense of responsibility. I don’t have to give the perfect response to everything my clients say. But I do have to be consistent, kind, compassionate, honest, genuine, and all the other qualities which can help them to repair from the damage which occurred earlier in their lives. My job is one long journey in learning about me, how I do relationships, what my weaknesses are, and how to better be in relationship with another so that I help rather than harm them. It’s a journey of a lifetime, and its changing me as well equipping me to provide an environment conducive for others to change.