Symptoms are not the Disease

The practice of psychology and psychotherapy is oriented to the treatment of symptoms. This is true because a rough analogy exists between mental and physical distress, and insurance pays for symptomatic relief. For this reason, psychologists and psychotherapists append a diagnosis to the client, and, in accord with recommended guidelines, target symptoms. The elimination or reduction of symptoms is the focus of treatment. 

A focus on psychological symptoms creates a different agenda than a focus upon psychological health. Psychotherapy oriented to psychological health was pioneered by the psychoanalyst Karen Horney. In her classic book, Neurosis and Human Growth, Horney identifies key features of psychological health. These are: 

• Knowledge of the depth of one’s own feelings, thoughts, wishes, and interests.  
• The ability to tap inner resources.
• Strength of will power. 
• The development of special gifts and capacities. 
• The finding of values and aims in life.  
• The ability to express oneself. 
• Relating to others with spontaneous feelings. 

In Horney’s words, the purpose of therapy is to “free [and to promote] healthy development in accord with the potentials of one’s genetic and individual nature.”  

Horney embraced an essentialist meta theory, taking the view that one’s inmost human nature was uniquely one’s own in contrast to transient properties that are accidental, phenomenal, or illusory. The core of human nature, she called the real self. The real self is the “central inner force which is the deep source of growth.”  It is the font of the live forces that motivate and energize human awareness and behavior. In many respects, the real self is analogous to the ancient construct of the soul. 

Psychological symptoms occur by alienation from the real self. Alienation may be engendered in a myriad of ways, but early experiences are particularly significant to future development. Horney highlights relationships that prove toxic to the real self as those that are “dominating, overprotective, intimidating, irritable, over-exacting, overindulgent, erratic, partial to other siblings, hypocritical, indifferent, etc.”  The effects of poor parenting, sibling rivalries, indifferent schooling, bullying, confused messaging, cultural contradiction, etc. are cumulative and interact to form unique “solutions” to injury and indifference. To paraphrase T.S. Eliot, the self develops a face to meet the faces that it meets.  The false self is fabricated to adapt to circumstance for survival. The “conditioned self” is, at best, a compromise and may be diametrically at odds with the real self.  

The role of therapy and the return to health is the process of discovery and validation of the real self. The process of therapy entails growth of self-knowledge; use of inner resources; exercise of will power; development of abilities; embrace of values and aims; self-expression and spontaneity. As the real self resurrects, symptoms subside. Symptoms are not the disease. They are the tip of the iceberg.