Throughout the years, when practicing Rational Emotive Behavior Therapy (REBT), I’ve encountered people who’ve expressed the desire for a diagnosis related to mental illnesses or disorders. One may wonder why this is the case.
While motives vary, some individuals have said that an official identification of a problem is believed to somehow absolve them of personal responsibility and accountability for their behavior. Here, “responsibility” relates to one’s duty or obligation.
“Accountability” concerns answerability or liability. As an example, I have a responsibility not to have sex with my clients. If I violate this obligation, I may be liable for the consequences associated with my actions.
To better understand this matter, consider how client X may state that a diagnosis of bipolar disorder could be used as a cause for his actions when involved in a road rage incident. It perceivably isn’t his fault that he behaved poorly, because client X apparently has no personal agency when his symptoms correlate with his actions.
In this way, client X irrationally believes that his diagnosis is powerful enough to deprive him of liability for the manner in which he has treated a fellow motorist. When I reject client X’s attempt to blame his behavior on a diagnosis, client X disregards my response and looks elsewhere for the treatment and management of his symptoms.
Still, other people have stated that a diagnosis is perceived as somehow empowering. For example, client Y may say that her diagnosis of attention-deficit/hyperactivity disorder (ADHD) is her “super power,” as she’s encountered a number of social media content creators who’ve expressed the belief in ADHD as a neurodivergent virtue.
When I dispute this absurd belief, client Y refuses my challenge to her assumption and spends the next several sessions trying to persuade me to accept her delusion. When I’m ultimately unconvinced by information stemming from TikTokers and Redditors, client Y abandons the therapeutic alliance.
I was recently reminded of the clients X and Y of the world when listening to episode 215 of the DarkHorse podcast with Bret Weinstein and Heather Heying. This remembrance stemmed from the following interaction:
Heying: Diagnoses feel empowering.
Weinstein: Diagnoses feel empowering. They also free us from responsibility for our errors.
Heying: Yeah, it’s simultaneously empowering and freeing, and disempowering, honestly. It takes away agency and it gives, like, a directionality to, like, “Oh, all I have to do is correct the chemical imbalance.”
It’s worth noting that I disagree with colloquial use of the word “feel,” as expressed by Heying and Weinstein. Nevertheless, I understand that in common parlance, “feel” is used synonymously with “think,” “believe,” or “hunch.”
Therefore, stating, “Diagnoses feel empowering” is understood to represent proper use of the expression, “Diagnoses are believed to be empowering.” Minor quibble aside, I agree with the critique offered by Heying and Weinstein.
Whether relating to bipolar disorder, ADHD, or other diagnoses for which psychopharmacological (medicine) intervention strategies are utilized, I’ve encountered a number of people who shirk personal ownership for their behavior by blaming their symptoms of diagnosis.
The same appears to be consistent for some individuals with whom I’ve worked that maintain personality disorders which aren’t treated with medication. Client Z may irrationally believe that his diagnosis of histrionic personality disorder is just cause for the way in which he treats others.
In addition to mental illnesses and disorders, I’ve encountered people who’ve express the belief that symptoms related to menopause, menstrual cycles, thyroid conditions, elevated or depleted estrogen or testosterone levels, and head injuries somehow excuse poor behavior.
I concur with Heying’s assessment, as she stated that “it’s simultaneously empowering and freeing, and disempowering” when people use diagnoses in place of personal responsibility and accountably. One may “feel” (believe) as though it’s empowering to avoid personal ownership for one’s behavior, because a diagnosis is to blame.
However, this is the essence of disempowerment, because it removes one’s personal agency—the experience of one’s own intentionality, forethought, self-reactiveness, and self-reflectiveness. Clients X, Y, and Z may irrationally believe (“feel”) as though they have no self-determined ability to alter their behavior, because of their diagnoses.
Noteworthy, I fundamentally disagree with such a proposition. After all, if I adopted the nonsensical belief that people have no personal agency I’d be wasting my time and the resources of my clients through the practice of REBT.
To put a final point on this matter, forgive me a personal anecdote. I’ve been diagnosed with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). Symptoms related to these diagnoses present significant challenges to my ability for rational living.
However, complication isn’t indicative of impossibility. Simply because I have diagnoses of PTSD and TBI doesn’t afford me an opportunity to behave like an asshole. Admittedly, I’m a fallible human being, though I don’t get to use my diagnoses to absolve me of personal agency for my actions.
When I’ve behaved poorly in the past, and as I inevitably won’t behave perfectly in the future, I assume personal ownership for the manner in which I treat myself and others. And for the reader who’s disgruntled by irrational beliefs regarding what I’m stating herein, I also have diagnoses attributed to so-called chemical imbalances – ADHD and major depressive disorder.
Nothing with which I’ve been diagnosed gives me a pass for poor behavior. Likewise, and albeit that one may “feel” as though diagnoses are empowering, I invite the reader to dispute beliefs which result in disempowerment and deprive one of personal ownership regarding behavior.
In REBT, the ABC model centers diagnoses in the Activating event portion of a self-disturbed paradigm. Nevertheless, the existence of a diagnosis doesn’t cause an unpleasant reaction to an event.
Rather, one’s Belief about the event is what causes an uncomfortable Consequence (i.e., emotion, bodily sensation, behavior, etc.). To better understand this Action – Belief – Consequence interplay, consider the following example:
Action – Client X, diagnosed with bipolar disorder, suddenly needs to take evasive action when driving on the highway, as another motorist abruptly swerves into his lane.
Belief – Client X unproductively assumes, “This bastard should watch the fuck where he’s going! I can’t stand assholes like him!”
Consequence – Because of his irrational belief, client X becomes angry, his heartrate increases, he grips the steering wheel tightly, and he speeds to catch up to the motorist, eventually running the offending vehicle into a concrete barrier.
Client X’s bipolar disorder plays a factor in the ABC paradigm, though it isn’t the cause of the road rage incident. Rather, the Belief-Consequence connection better explains client X’s emotion, bodily sensation, and reactive behavior.
In this way, the diagnosis doesn’t “feel” empowering. Rather, client X’s blame-shifting of his behavior onto a diagnosis is disempowering. As such, client X uses bipolar disorder as little more than a crutch—an excuse that deflects from the cause of his self-disturbance.
The clients with whom I work are taught the ABC model. As well, I invite people to take personal ownership when exercising agency for their behavior. I don’t use my diagnoses as a woeful excuse for poor behavior and I encourage my clients not to foolishly believe that their diagnoses are (dis)empowering, either.
If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
References:
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