“It’s All in Your Head”

LicensedMentalHealthCounselor has a thoughtful post on parents’ denial of their children’s mental health problems. It reminded me of a pet peeve: family members who ask clients, “What wrong with you?” then dismiss the answer with, “That’s all in your head.”

What does “It’s all in your head” mean? “You’re incorrect”? “You’re making excuses”? “You’re lying”?  It might mean, “Please don’t talk about this.” Talk about mental health problems can trigger others many ways. For example,

1. Not everyone with problems is in treatment. If a client admits they are vulnerable to emotion, others remember they’re vulnerable,  too.

2. “I can’t,” isn’t in our vocabulary. Our culture values hard work, personal responsibility and triumph over adversity.  Only the most severe mental health issues are visible to others.  Most skeptics have long experience with The Jitters and The Blahs. They can have a hard time understanding what separates those from Panic Disorder or Major Depressive Disorder.

3. As a culture, we don’t talk about emotional problems. If we talk about them at all, we do so in an understated, hesitating way. When someone explains they have mental health issues, the other person is left to guess how much understatement just occurred. Does, “My nerves make it hard to go outside,” mean they have a moderate case of agoraphobia? Or does it mean the entire family will be murdered in their sleep? Much easier to sweep the entire topic aside by saying, “That’s all in your head.”

In fairness, “It’s all in your head,” often means, “You can do it.” It can come from the same well-meaning and wholly-useless intentions as, “Don’t worry about it,” “Relax,” and, “Just cheer up.” It can also channel condemnation those other tips don’t. Clients say this disregard is worse than insensitive – it’s invalidating. Even when their family hopes they’ll feel empowered, the client is often to wonder, “Do I actually have problems, or am I just a lazy coward?”

Different clients have handled dismissive relatives differently.  Shrill didactic lectures haven’t always been the answer. When a pithy conversation-ender seems appropriate, I’ve suggested, “Sure it’s all in my head. And your diabetes is all in your pancreas.”

@ 2012 Jonathan Miller All Rights Reserved

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