Mental health and the society

A moral dilemma

In the medical institute I was getting trained, trainees would collect the client’s history and then report to a senior supervisor to decide the therapy plan. I was once seeing a female client in her 20s who had reported of anxiety. After discussing with the supervisor, there was a list of things I had to clarify after the lunch break. Post lunch, I was about to call the client, but the supervisor pulled me to his cabin and asked me to elicit any body image issues. I was puzzled by this sudden suggestion but decided to save my curiosity for later. After I had finished the clarifications, I was surprised to know that this client indeed had severe body image issues. I later asked my supervisor how he guessed so. He told me that when he walked in after lunch, he saw her and noticed that she had dark skin and was slightly overweight. This left me in a moral dilemma. Societal influences were at play.

As a clinical psychologist, I am required to be thorough with diagnostic criteria, symptoms, etiology, and prognosis for each disorder. Even though it’s rare to see a client who neatly fits just a single diagnosis, the diagnostic criteria helps guide the clinical interview in a certain direction. For instance, if a client experiences anxiety in social settings, they will probably have fear of judgement, low self esteem and avoidance of social situations. The clinical picture and diagnostic criteria help me ask specific questions regarding the clients’symptoms and everyday functioning.

This, however, was a completely different ball game. A judgement about her symptoms was made not based on any diagnostic criteria, but based on societal norms. In every society, there have always been certain desirable and undesirable traits. In the USA, independence and autonomy are rewarded while in many Asian cultures obedience and discipline is expected. Similarly, preferable skin color and body type are also social constructs that have been propagated by media and pop culture.

Mental illness or societal discrimination?

Since I am an inclusive therapist, I make it a point to be aware of my biases as much as I can and throw them outside a window before I see a client. This is probably what led to my naïve confusion about why my supervisor added that last clarification.

The irony is that many mental health disorders are a result of such discrimination. If a therapist is also falling prey to these stereotypes, how will the client feel safe in therapy? The therapist just becomes like the rest of the world, subtly pointing flaws and making assumptions.

The diagnosis of ‘gender identity disorder’ is a case in point. The symptoms exist because of minority stress and stigma. However, it has also been considered a disorder, indicating there is something wrong with the individual themselves. The right way forward, in my opinion, is to be sensitive to individual differences and be aware and sensitive about our own biases. Diversity is what makes us beautiful, look at the different kinds of trees, clouds and flowers around you. Nature doesn’t discriminate, why do we?

All said and done it is nearly impossible for me as a therapist or any person to be completely free of any biases. All we can do is look inwards and be aware.

Was my supervisor right or wrong in suggesting the body image related question? Feel free to reach out to me with any insights!