Is it crazy for a therapist to use the word crazy?
I need to begin with a qualifier: As an established therapist in NYC, some of you may be a bit thrown off by my casual use of the word crazy. I get it. It may not fit your expectation of a therapist. If you've stumbled upon here as someone seeking therapy in NYC or as a therapist meandering on the internet, you may hear this not as the call to action for those invested in good outcomes in therapy but as an irreverent provocation. I must take that risk, because there's an urgent conversation for us to have about the state of therapy in NYC and beyond, as well as about craziness in all its manifestations.
The fact is, we need to talk about crazy--our own craziness and the various forms of craziness that we experience in other people as we navigate the world. There is, perhaps, a critique similar to the critique railed against political correctness (though I believe such critiques are, at times a defense of racism or sexism) that's needed in the context of the need for honest conversations of
We talk about both in my NYC therapy office and online and in the world. A failure to discuss craziness is as problematic as a failure to discuss race or gender. At a point, an attempt at delicacy closes off this vital conversation.
Crazy is kinder
Aside from the matter of honesty and directness is this: Psychologists, psychiatrists and psychotherapists have developed a manner of speaking about those who seek therapy that uses only the most proper of terminology--they describe maladies in the coded offense of psychiatric diagnoses and their corresponding terminology. Many would balk at the word crazy and never consider it's use, yet willingly use diagnostic language to confer a lesser status to the therapy patient or otherwise "disturbed" person they're describing.
A group of therapists go out for dinner in NYC. Mayhem ensues.
A few years ago I was invited to a gathering of therapists at an Upper East Side NYC restaurant. Between the appetizers and the main course, the therapists were asked to describe their NYC therapy practices and areas of specialization. There was the usual talk about PTSD therapy and depression, but one particularly painful elevator speech that demonstrates my broader point about pejorative use of diagnostic language by therapists. A psychologist in the group introduced her Manhattan therapy practice as having a specialization in working with women providing therapy for eating disorders. She added, with a laugh, "I do really prefer working with bulimics because they're much less concrete than anorexics." Several therapists in the room returned the laugh, as if to convey a sense of knowing:
"Yeah, anorexics and their concreteness. Hee, hee. I get it."
The language was strictly clinical and there's not a word that, in abstraction, is offensive. And yet... Gross! The blunt categorizing of human beings! The use of those categories to imply an understanding to produce a sense of collectivity... Gross!
We don't hang out anymore.
Don't even get me started on how therapists talk about borderline personality disorder
Actually, we've written quite a bit about borderline personality disorder treatment. That diagnosis, along with related personalities disorders (a set of "disorders" that are understood by therapists as part of a fixed personality) are, in many psychotherapy office in NYC and elsewhere used as code for unhelpable and pain-in-the-butt. And there's manic to describe the symptoms of intense euphoria often associated with bipolar disorder or even depressive or psychotic used in a manner that technically comports with the language of the discipline of therapy but speaks in the same sort of code I encountered at the dinner party.
Depression is real. Bipolar disorder is real. Eating disorders are real.
I'm not interested in denying or minimizing that. These words reference very painful, complex emotionally experiences that demand serious respect. Too often, however, through a therapist's very insistence on using these pseudo-medical classifications, we have placed people in a box and presumed through the very invocation of the name on the label of that box ("depressed," "bipolar," "borderline personality disorder") that we understand that complex, vulnerable human being who has come into our psychotherapy office seeking help.
The fact is, when we identify that a therapy patient checks off a sufficient number of symptoms to qualify them for a diagnosis of depression or anxiety or whatever we actually know terribly little about what's going on for them and (most critically) how to shape the therapy so it can be helpful to them.
George Carlin said it better in this bit about trauma and PTSD treatment
You should watch the whole thing, because it's Carlin at his best. Here's the most biting part:
Then of course came the war in Vietnam, which has only been over for about sixteen or seventeen years, and thanks to the lies and deceits surrounding that war, I guess it's no surprise that the very same condition was called post-traumatic stress disorder. Still eight syllables, but we've added a hyphen! And the pain is completely buried under jargon. Post-traumatic stress disorder. I'll bet you if we'd of still been calling it shell shock, some of those Vietnam veterans might have gotten the attention they needed at the time. I'll betcha. I'll betcha
I'll betcha.
