What Was Happening When It Started?

The key question in therapy.

Key points:

  • Disease models for mental illness can prevent people from taking responsibility for dealing with what happens to them.
  • Asking what was occurring around the time that the symptoms started or recurred can yield information essential for recovery.
  • Without such information, most people cannot make lasting positive changes in their lives.

One of the biggest problems with the ‘disease model’ of mental ill health is that it leads people to miss key information that would help them deal with it.

I’m thinking of Anne-Marie. She had struggled with problem drinking during an abusive marriage, ending up in a hostel after losing her home and her daughter. She was a delightful, capable person, who went through detox and seemed well on the way to recovery, during which I was asked to support her.

Then, one morning, I received an anguished call from the hostel: Anne-Marie had starting drinking again.

When I arrived, I asked a highly distressed Anne-Marie, ‘What happened?’

‘I don’t know,’ she said. ‘It came completely out of the blue. I just woke up feeling so bad and had to go out to get a bottle.’

‘So nothing happened that could explain this, when you were doing so well?’

She was adamant.

I asked her what she had done the day before. She told me that she had done her laundry and gone to a café in the evening with her boyfriend. They had had a row and she had broken up with him.

I learned that the boyfriend had been a tower of strength during her bad drinking bouts, during which she would quickly become so out of it that she would fall and hurt herself, burn her body with cigarettes without noticing, and lose bladder and rectal control. He would dress her wounds and clean her up with loving care.

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