ABSTRACT
Formulation of problem: In its classic form the doctor-patient relationship implies that the problem is essentially an 'illness'. The doctor will consult his diagnostic classificatory system and label (and may later re-label and re-label) the 'illness'. Any insistence by the client (who is now known to be suffering from 'depression', 'obsessionality', 'schizophrenia' and whose thoughts are therefore suspect) that his or her problem is to do with spouse, job, religious conflict or whatever, can only be seen as symptomatic evidence for the diagnosis itself. In practice, psychiatrists seem to find it easier to use diagnostic labels in the context of physical treatments in psychiatry: when involved in psychotherapy they often begin to listen credulously to the client's personal story. However, if the story becomes hard to understand the conviction that they are dealing with an 'illness' (he or she was walking along one day and caught 'depression') tends to come to the fore again. Clients often collude with the notion that they have been stricken by an illness, partly out of deference to the doctor's expertise (which seems very expert to someone in a confused and unhappy frame of mind) and partly because it relieves them of guilt (you can be 'guilty of making a mess of your life' but not 'guilty of falling ill'). It is easier to face friends, relatives and society as a sick person, rather than as someone whose interpersonal mistakes have caught up with them.
