Anyone currently seeking psychotherapy in Germany waits an average of 20 weeks for their first appointment. Demand significantly exceeds supply, even though the number of therapists working in such practices has more than doubled from 2006 to 2021*. Psychologists at the University of Duisburg-Essen see a possible reason for this in a ‘culture of diagnosis’ and an excessive sensitisation of society, in which personality differences and temporary mental crises are increasingly pathologised. As a result, people in need of treatment sometimes receive no help at all or only at a late stage. The authors propose an alternative approach.

Duisburg-Essen, October 7th, 2024: In a connection between the Leadership and Management and Artificial Intelligence specialisations, the question arose in the Information and Communication Management course as to when exactly a distinction is made between a mental disorder and coaching. While coaching can also be offered by non-professionals, psychotherapeutic care would be grossly negligent and irresponsible behaviour towards people if it were permitted without regulatory bodies.

As the human psychologist Abraham Maslow described at the time, the majority of people struggle with mental disorders. The part that would be spared this usually dedicates itself to the correspondingly demanding professions such as doctors or psychotherapists. Interestingly, however, the psychoanalyst Erikson once easily recognised and noted that, as meticulously as the human body is constructed and developed over time, it is unlikely that the creation of a perfect human being can be intentional. Currently, the trend is still the other way round. More is being repressed than opened up.

According to data from the Robert Koch Institute, an average of 27.8 per cent of adults in Germany have a mental disorder. The authors Prof Dr Marcus Roth from Differential Psychology and Prof Dr Gisela Steins from General Psychology and Social Psychology at the University of Duisburg-Essen (UDE) have asked themselves why this figure has not fallen for years despite increased treatment options.

They came to the conclusion that in practice, disorders may often be treated that, on closer inspection, are not disorders. For example, ‘adjustment disorder’ is the main diagnosis among psychological psychotherapists – a reaction to a past or existing event that significantly impairs quality of life.

However, the researchers also asked themselves whether crises caused by critical life events always require a diagnosis. ‘Every second married person will experience the loss of a partner; almost all will experience the death of a parent,’ Roth explains. Tragic events like these are accompanied by grief and stress, but they are part of life and are usually overcome or significantly improved after around six months.

Where does expected grief end after a loss, and where does depression begin? When is unusual behaviour purely a character trait and when does it require treatment?

The considerable lack of medical or therapeutic care means that people are increasingly forced to deal with problems themselves. Inevitably, there is a great potential for danger and, on the other hand, a small opportunity to stand out from the crowd.

But if I take the topic of artificial intelligence today, then in the course of this development we are dealing more profoundly with certain topics such as learning, the representation of emotions, the realisation of micro-expression on artificially developed faces. These issues, especially with the development of automatically generated languages such as the currently most prominent ChatGPT, will later be scrutinised from an ethical point of view and thus become part of the general public debate. People share hardships, worries and confidence. But, in essence, we talk about it, which also means we think about it. Our human consciousness places these issues at the centre of the current zeitgeist.

From this point onwards, the actual individualism of human beings is extracted and the diversity and manifold possibilities of personalities visibly enter the consciousness of society. It is said that the Industrial Revolution began around 1850. Only with the development of specific large-scale machines was it possible to produce masses, preferably in basic commodities such as textiles and clothing, in such a way that the broad masses could afford clothing. Currently, all these effects are causing a reversal. Satisfying the masses is no longer at the centre of our thinking, but emphasising individual character is at the centre of our thoughts, actions and deeds. Ultimately, in the foreseeable future I will be faced with a technologically sophisticated mirror image.

Production is customised, there is a return to repair, service can no longer be offered or covered everywhere, people are increasingly helping themselves because the technological possibilities are increasingly available. In this way, people are becoming more self-aware. The trend in modern society is that people increasingly want to be without a partner, but organised in groups, communities. While earlier generations still suffer considerably from the idea of loneliness, younger generations are already organised in such a way that they can develop individually.

The problem arises when help is needed.

With regard to the idea of solidarity and the raison d’être of health insurance funds, the authors make this topic a central point of discussion. The need for action is recognised. ‘But if we don’t discuss the issue now, it will be a very tough discussion when the health insurance funds are emptier due to demographic change,’ reports Roth.

Roth and Steins propose an alternative path that places less of a burden on the solidarity community and at the same time creates therapy places for those who urgently need them due to their clinical symptoms: Adults who suffer from mental impairments but do not necessarily need psychotherapy should be offered low-threshold services such as coaching sessions, counselling, self-help groups or online services.

‘We should place more trust in the fact that normality can have different facets, as we are currently discussing under the term ‘diversity’ anyway,’ concludes Roth.

Originalpublication:
(https://doi.org/10.1026/0033-3042/a000678)

ImageSource Mohamed Hassan Pixabay