Graham Fawcett on BBC World News

In the first of a new series of blogs on 'Transdiagnostics', our Director of Psychosocial Services GRAHAM FAWCETT casts a critical eye over the 'medicalisation of misery', and explores fresh understandings of why we get upset and what to do about it.

Nadia came to see me.  She came to see me because she was sad and had been diagnosed with depression. I asked her why she was sad, and she said it was because her daughter died.

Mamadou came to see me. He came to see me because he was sad and had been diagnosed with depression. I asked him why he was sad, and he said it was because he kept thinking about his problems over and over again for hours every day.

Mornu came to see me. She came to see me because she was sad and had been diagnosed with depression. I asked her why she was sad, and she said it was because she had no money, was starving and stateless.

Kuate came to see me. He came to see me because he was sad and had been diagnosed with depression. I asked him why he was sad, and he said it was because he only ever thought about the bad things he encountered.

The same ‘diagnosis’, but with wildly different causes, implying completely different interventions.

Imagine going to your health care provider with a cough. If the provider gives you cough linctus that may well work, so long as the cough isn’t due to tuberculosis. We have to understand the underlying cause. A problem with mental health is that diagnoses have become confused with ‘symptoms’. If only the symptoms are treated, then there may only be symptomatic relief, not cure.

Imagine if we went down a layer and asked what was causing the symptom? When we do so we enter a very startling world but the same question – what do different symptoms have in common? Let’s think again about Mamadou.

Mamadou came to see me. He came to see me because he was sad / angry / anxious / traumatised / and had been diagnosed with depression / anger issues / anxiety disorder / PTSD.  I asked him why he was like this, and he said it was because he only ever thought about the bad things around him and that made him feel permanently sad / angry / anxious / traumatised.

When I asked some more questions, it became clear that thinking all the time in this way repeatedly and extensively resulted in symptoms consistent with how he was thinking. The solution was to deal with his thinking style and get out of the persistent negative loop.  The intervention, intriguingly, is the same whether the symptom is sadness or anxiety or something else.

We call this ‘transdiagnostics’ - an approach also emerging all over the field of medicine as we look at, for example, cancer in new ways.

In this series we will look at a number of key transdiagnostics that are emerging in mental health – perfectionism, rumination and visualisation - as well as some common effects reported across mental health, such as low distress tolerance, emotional dysregulation, hopelessness and poor problem-solving. Finally, we will look at the ‘McMindfulness’ phenomenon – the drift towards being content in all circumstances even when the circumstances such as Mornu is experiencing are outrageous.

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