The Many Faces of Mental Health: The Intersection of Medicalization and Ignorance Management in Psychotherapy

Abstract

Despite psychotherapy being an increasingly popular mental health treatment, how practitioners of psychotherapy conceptualize mental health remains poorly understood. Using a grounded theory approach, I conducted 15 semi-structured interviews to elucidate how medical doctor psychotherapists and clinical psychologists in Ontario enact mental health. Practitioners were found to alternate between four enactments of mental health—restoration, enhancement, management, and stabilization—attempting to downplay patients’ expectations for therapy. Practitioners can then better achieve promised therapeutic outcomes, helping them appear competent rather than ignorant and ineffective. Practitioners have also medicalized—attached medical understandings to—emotional management and social support, re-positioning these practices as medical interventions. Ignorance management and medicalization can be at cross-purposes. Medical understandings are increasingly spread by promising patients a “happier, healthier you”, expectations that practitioners may not be able to achieve. Ambitious definitions of mental health can thus be paradoxical, simultaneously improving and undermining the reputation of practitioners and psychotherapy.