Sadness, anguish, anxiety and exhaustion are all signs that may indicate psychological distress. A set of signs can be encompassed by a diagnosis: depression, panic disorder, generalized anxiety disorder… the list is long. Within clinical medicine, the diagnosis serves the purpose of explaining certain phenomena so that a prognosis can be given and treatment prescribed. Increasingly, treating psychological distress has become synonymous with medication. Medication can be helpful and is sometimes necessary.

However, psychological suffering is complex. It is multidetermined: a combination of genetic and environmental factors. Frequently, the growing medicalization of life processes has lead to a circular logic, “I have depression because I am sad” and “I am sad because I have depression”. The circle, however, offers no exit. The symptom is an effect, not a cause. Even though a pill can help stabilize certain physiological reactions, it is not able to answer: what is your symptom telling you?

A symptom is the result of unconscious dynamics and its development speaks of the patient (their story and the historical and social processes that pose an effect on them) and to the patient. That is, the symptom relays a message. Although the expression may be similar (sadness, fear, anxiety…), the production of the result always refers to a singular equation. The historical moment, the social conventions and cultural norms, act on the psyche’s development and, also, on psychological distress. It is not by chance that different forms of suffering correspond to each historical period: Freud’s hysterics express the suffering of women who lived in a period that repressed them; today’s burnout expresses the digital era of capitalism and the pressure to be eternally producing. How each one will suffer, however, speaks to each person’s singular journey: their generational history, the context in which they developed, the resources and lacks thereof that made up their trajectory, their (unconscious) choices…. Imagine someone whose burnout is the effect of professional choices that are not aligned with their desires or whose relationships at work are marked by a lack of boundaries. Medicating and simply returning that person to the exact same context will not serve their recovery.

A symptom is a metaphor that represents something unique to each person, but that remains to be discovered. Thus, it is an enigma to be solved throughout the therapeutic process by supporting the patient as they remember and work through experiences and feelings, as well as through reflective questioning (when did this come about? What was happening at that time? In what situations does this manifest itself? What thoughts accompany it?….) that help “connect the dots”. Therapy is a process that, through speech and attentive listening, and through grasping what lies between the lines and reflecting it back with care, seeks to hone the patient’s ability to listen and understand oneself, deciphering the messages they receive from their own selves. In doing so, therapy seeks to create a breach in the circular logic and open a path forward.