Does My Therapist Think I’m Crazy?

If you’re in therapy, what are you in therapy for? Are you crazy? These are reasonable questions. I’ve had clients ask me the exact question: “Doc, am I crazy?”

Aside from my not being a doctor, there are other things wrong with the question. One of them is a translation problem. The Diagnostic and Statistical Manual of Mental Disorders (now fourth edition, about to go to fifth, or DSM V) has lots of mental disorders in it, but no dividing line between “crazy” and “not crazy.” A boy with ADHD might drive parents crazy, and we all know what that means. But is Attention Deficit Hyperactivity Disorder a form of craziness? The DSM doesn’t say, and most folks on the street would say no.  On the other hand, the DSM also has, for example, Obsessive Compulsive Disorder (See Jack Nicholson in As Good as it Gets if you haven’t) and a lot of people might feel this behavior is kind of crazy.  A lot of people would say that if you hear voices you’re crazy, but I’ve known people who heard lots of voices who acted completely normal.

So what do I say when someone asks me, “Am I crazy?” If I’ve just met them, I can honestly say, “I have no idea,” and that’s a starting point to doing a complete assessment.  If I’ve known them longer, I might say lots of things– it depends on the person. But what we’re really talking about here is people having a fear of being branded with the stigma of mental illness. A recent New York Times story on suicide in the military touched on this– the military culture is such that soldiers don’t want to be seen as mentally ill. Given that it’s largely composed of young white men, you could just as easily say that young white men– or women, or folks of any ethnicity, really– don’t want to be stigmatized. Who does? In this case, the aversion to seeking help has turned out to be fatal for hundreds of soldiers. You could say they were stigmatized to death.

So here’s the thing about stigma and mental illness– your therapist is probably the last person in the world to see someone in that

English: A child not paying attention in class.

English: A child not paying attention in class. (Photo credit: Wikipedia)

way. They’re more likely to reframe the question to something more like this: how do your symptoms prevent you from having the life you want? That’s the kind of question that can lead to an action plan for recovery.


About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
This entry was posted in behavioral health, mental health, Recovery, stigma of mental illness and tagged , , , . Bookmark the permalink.

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