A Therapist Grapples With Diagnosis Culture

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From Mental Hellth: “For some critics, the face of the social media-based self-diagnostician is a privileged white woman who wants status and attention for what might better be thought of as personality quirks. But much more often, at least in the population I work with, a biology-based explanation is a way of side-stepping facing what they’ve actually lived through. I think of the young man who thought he might have Oppositional Personality Disorder or Autophobia (‘fear of loneliness’). This came after we’d worked together long enough for him to reveal his mother’s long battle with cancer during his elementary school years, his father’s betrayal of them during this time, and all the anger and mistrust he feels in relationships now. ‘The past is in the past, it doesn’t affect me,’ he’d say. I think of a young woman whose family was for years violently targeted for political persecution, then moved to the U.S. to get her life-saving medical treatment, only to encounter a fresh new batch of emergencies. She reported feeling on edge, vigilant, and distracted, and wondered if she had ADHD.

I find in most of the young people I work with, a powerful desire to minimize what has happened to them and how they’ve been hurt. Their past is a haunted, lonely, senseless cave. Diagnosis is a shareable infographic. Of course, these dynamics collude with the society-wide political incentives toward medicalization, which, as Danielle Carr writes, put ‘the focus on the individual as a biological body, at the expense of factoring in systemic and infrastructural conditions.’

Though diagnosis is approachable for young people and seems to offer something tangible, I think there is something crucially ambiguous about what exactly it confirms. That ambiguity seems perfectly suited to this age group. Does it confirm that there is a problem, or that I am a problem? Is diagnosis an exoneration, or is it an indictment? It’s a loop they get caught in, which is maybe the same loop all adolescents are in as they struggle to differentiate from their caregivers. Who is right and who is wrong? Does diagnosis mean they’re right and I’m defective? Or does it mean that they are wrong for blaming me so the blame is on them? Diagnosis can’t answer this question, it can only ask it.

. . . I see the craving for diagnosis against the larger backdrop of our time. The adolescents I work with seem to want an explanation that feels real in a stable way. The news, politics, religion, family, gender, the future of the planet, what bodies look like; there’s no unquestionable legitimacy in any of it. With this comes greater possibilities for freedom and authenticity. But it also makes us desperate for something more credible than our own disorganized thoughts and feelings.”

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8 COMMENTS

  1. The time came when feeling, something, anything and even everything is a problem. Even exhilarating joy can be labelled manic.

    Self absorbed extasis can be dissociation even temporal lobe epilepsy.

    And knowing why one is annoyed can’t help being annoyed. Aware that the feeling will probably be justified as part of one’s existence or used a as tool to “help” someone else. Apparently dissmisive or oblivious that the feeling is still there. It might not be that annoying after all.

    Like some feelings can’t go away even if a convincing explanation, even justification is provided or inferred.

    And what if accurate, unbiased, accesible, understandable knowledge is provided instead of rationalizations, in the sense of explanations, or the good ol’ inference?. A method of analysis of knowledge might be more valuable even when it comes to feelings and social interactions. Even the law might help more…

    A clear view of what is normal and what is to be expected, even of something apparently as simple as a diagnostic process might preempt further medicalization, further psychologization.

    Philosophy, science, epistemics, logic, outcomes, probabilities, instead of mere concepts that refer only to the subjective, even if objectively pain is undeniable.

    I left with the impression of anomia, the sense of lack of rules, possibly, me biased, on the loss of old religious rules. Sinful turned into psychological abnormalities. Without psychological normality being established scientifically, at least in a manner that can be summarized as knowledge provided to minors. Even adults.

    A situation, even a problem, that the refered article seems not to address. The educational effort from good sources for self education, a goal to be guiding when minors in educational contexts are cared for, not only educated.

    Instead, for me what is provided is a Guru model, more of the same, even if sometimes a bouncer Guru, at least in my mind. Self discovery guided even when apparently the Guru seems to disagree with the method in the case in question. Constraints on the freedom of speach of the Guru?.

    “No human is perfect, as no human is spheric, cubic, linear, sigmoidal, flat, etc.”. Same as saying we are all flawed, they seem analogous statements to me…

    Some statements are devoid of useful relevant meaning, in popular term they are trivial statements. Seem to me more like cliches that reinforce the paradigm that is taken as starting point, “as good as any”, really?.

    There was a classroom of kids, each took turns: I have ADHD, I have autism spectrum, I have enuresis (to kids laughters), etc.

    The smartest kid said: I have problems, some are parts of me, some are part of the world, some are part of someone else.

    Some I can solve on my own, some are to be solved by someone else, and the world is not going to solve anything. Some I can only think about and do nothing about them. Some are thought a lot, and they are still there, last time I checked.

    And that is also a problem for me, because everyone is making all those problems mine by calling me crazy…

    Question: Was the kid, he or she, being selfish?.

    Hint: Being alone, not lonely, is not necessarily selfish…

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  2. Most of this diagnostic BS is for the psychiatric community and drug companies to make money/push agendas, for insurance companies to fight with providers about justifying care, and for people to have a diagnosis to take away responsibility for their behaviors (i.e., it’s not me, it’s my bipolar disorder). I believe there are only a few diagnosable conditions in the realm of psychiatry that can be diagnosed with the same fidelity that MDs can diagnose physical health concerns.

    So many therapists try to treat depression or anxiety in the same way for every client just because they diagnosed them with it. Unless a client is dealing with something that has a real biological/neurological or developmental root, instead of diagnosing, we should be focusing on how the presenting concerned developed and how it’s being maintained to address it as therapists. This allows for both trauma and biological/neurological situations to be addressed while allowing the client to take responsibility for addressing it to whatever extent is in their power.

    Problem solved

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  3. Even people who have had huge issues in the past might also have a condition that would explain why they reacted the way they did. I was diagnosed at 40. That’s about 35 years of maladaptive reactions to things that weren’t happening or that were totally different than perceived later. My life would have been totally different, and a lot easier, if I’d been medicated a lot sooner. So yeah, I do think we should be rushing into diagnoses. A lot of my former friends and family members and teachers and employers probably do too.

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    • i.) If what you were “diagnosed” with is a psychiatric categorisation (MDD, ADHD, BPD etc.), it is as much a diagnosis as Fever Disorder is a diagnosis for why one has a fever. What was your actual problem? Depression? Delusions? Hallucinations? Drinking? Mood issues? Inattention? Or was it a physical problem?

      ii.) What prevented you from getting psychiatrically categorised and given drugs? Psychiatrists and psychologists are very willing to accept new patients. Is it that you did not know there was some problem that would get better by taking a drug or that such drugs were available? 35 years is an awfully long time to not recognise that something is problematic. Until 16-19? I get that. But I can’t see why a human being cannot recognise that there’s a problem for that long unless they have an issue like severe cognitive deficiency (very low IQ or “mental retardation” which I find hard to believe given that you write reasonably well) or a person is delusional or he/she grows up so isolated that they do not know the resources the modern world has (like spending your entire life in a small rural area with no knowledge of the outside world). If it is other reasons, what are they?

      iii.) What are some examples of things which happened (that were different than your initial perception) and what were your initial perceptions of them? What was the actual truth and how was it different than your initial perception? Why do you think you could not perceive reality?

      iv.) I wouldn’t say we should rushing into diagnosing anything in terms of applying psychiatric categorisations to people. But in terms of identifying problems for which there is some solution? Sure. The faster, the more accurate, the better.

      v.) As far as “I’d been medicated sooner”, that verbiage potentially implies someone should have forced you, even subtly, into taking meds. If you say “I wish I knew there were drugs that would help me”, I can understand. But if it’s the former, please let that be limited to you and others like you. That mentality from clients of psychiatrists drags other people who want to get out of the mental health nexus, into it. It is a “you should have told me it was for my own good because I do not have the intelligence to discern right from wrong” mentality. In other words “please be my master”.

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  4. This commentary is at once understandable and confused.

    This therapist, and many of us, see things going on with the people around us that are very real yet not readily understandable.

    In going for a medical model focusing on diagnoses and “treatments,” the mental health academics and practitioners have shot themselves in the foot, putting them decades behind those who are actually increasing our understanding of the human condition and how to treat it.

    While it goes without saying that life experiences can trigger mental health episodes, there is no way we can simply eliminate all challenges in life and hope that will work to keep everyone happy. Some practitioners and patients feel that meds have worked for them, yet this approach seeks to effect the mind and emotions in some sort of mysterious way by treating the body. We know meds have an effect on cognition and emotion, but that’s so indirect. Why not deal with these factors more directly?

    Most current practitioners think they ARE dealing directly, because they think consciousness is a brain or neurological process. The fact that it isn’t hardly even gets covered here, as this possibility is relegated to the subject of “parapsychology” which is considered a “pseudoscience.” Until someone with some skin in the game starts challenging this entrenched and enforced ignorance, we will not have bright and shiny practitioners, nor bright and shiny patients, nor a bright and shiny society.

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