Narratives and meaning in psychotherapy

“I’m just an angry person….”

We all have a narrative, or story, that we tell about ourselves. It may be that we are easy to anger, or that we are an introvert, or even that we’re a “hot-blooded person.” What if many of the the things that we think of as part of our personalities are really stuck points in our nervous system? What does it mean for how we think of ourselves, and what does it mean for the potential for change? For one thing, thinking of mental disorders in terms of the nervous system functioning may make a lot more sense than thinking of mental disorders in terms of diagnoses. I say this because we have been talking about the problems with diagnosis for a long time. Now, a new research study suggests that psychiatric diagnoses are meaningless. (See: https://www.technologynetworks.com/neuroscience/news/psychiatric-diagnoses-found-to-be-scientifically-meaningless-321555).

Despite the meaninglessness of diagnostic categories, so many people I see in my office have come to incorporate a diagnosis into their narrative. For example, they may say “I have ADHD” or “I have depression.” This may be a way for people to understand their symptoms, but it unwittingly incorporates it into their story of who they are. If, instead, we look at how the nervous system has organized, we find that both ADHD and depression have under-arousal in common. This then leads us to different interventions including neurofeedback to increase arousal. It also changes the narrative from, “I have depression…” to, “my nervous system is stuck in a chronically underaroused state.” Thus, the narrative that may have been interfering with symptom improvement can now change. Instead of trying to put us in a diagnostic box, it helps us to see our “self” as separate from our symptoms. In summary, I find people to be more than the sum of their symptoms and diagnoses.