Licensed Marriage and Family Therapist, MFT 43464
16 Years of Creative Solutions
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Many people are never even told the diagnosis that they’re given and are left in the dark as to the professional’s opinion all together. I once had a client come to me wanting to know what his doctor had diagnosed him with; having glimpsed a diagnosis number on a claim form. The sad truth, I told him, was this was simply a code for “Diagnosis Deferred” and no opinion had been formulated at all. “Diagnosis deferred” is frequently given even during a psychiatric hospitalization when people would expect a more thorough work-up.
I once had a young client who clearly had characteristics that made him “different” from others his age and had difficulty with learning, yet the diagnoses in the Diagnostic Manual (DSM-IV) gave the parents no clear direction as to how to help him. It was only upon discovery of an alternate diagnosis through my research of his case, given in Europe but not here in America, that the parents had a unifying explanation of the problem rather than a disparate list of issues and could finally understand what deficits he had, that we were able to together create a plan to remedy them. Once there was clarity, he was able to leave special education, get what he needed from the school district, and is today thriving and receiving top grades.
Some psychiatrists give diagnoses after 15 minutes of talking with a person, and sometimes in the case of a child, not even talking with the client directly, only his/her parent. I always wondered what special knowledge psychiatrists had that enabled them to make such quick diagnoses. That was before learning that research shows mental health diagnoses to be highly inconsistent and unreliable; that is that different providers will often give the same person different diagnoses. In my practice, I often solicited old reports from educational psychologists who’d completed a battery of tests on a child’s intelligence. I assumed these were standardized assessments and therefore highly objective until I started noticing that everyone coming to me was in the 1% (meaning that 99% of others taking such an exam would score higher). I started questioning how it was statistically possible that all these supposedly rare students could be coming to my office! After further learning, I discovered that these tests can also be unreliable. So people have a right to be skeptical about the diagnosis, especially one that is made quickly.
Another interesting fact about diagnosis is that the World Health Organization has found that in many undeveloped countries where there is a lack of mental health professionals and diagnoses, that people often heal from their mental health diagnosis when interviewed several years after a crisis. Here in the U.S., people are often given the message that their symptoms are static; if you’ve had one psychotic break, you will have them periodically throughout adulthood, or if you are depressed, you will likely succumb to depression again.
So what is a diagnosis in mental health? A diagnosis is simply a list of behaviors or symptoms; with a threshhold of a number of symptoms needed in order to qualify and a specific time period. For example, everyone feels depressed at times, but if the depression is said to last over a period of 14 days in a row, that qualifies as a clinical depression. The more thorough a clinician is asking questions, the more precise diagnosis they’re able to give. However, a diagnosis only describes the symptoms, it does not identify the cause. So for example, if a child has the symptoms of fidgeting and squirming in their chair, that is the symptom, but what is the cause? Is the child having trouble sitting still because he is bored, worried, excited, or has to go to the bathroom? Does the symptom indicate a reaction to a circumstance; i.e. the classroom and teacher aren’t a good “fit” for him; or his parents had a big fight last night and he feels edgy without really knowing why.
Or is the symptom reflective of his brain? Is ADHD a brain style or a problem deficit? It is very hard to change the environment to fit the kid, so we are often left to resolve the problem via brain chemistry. Medication will have immediate results, but some studies show long-term results of these medications to offer little benefit. Again, not being a medical professional, I cannot explain this but I wonder if the brain re-adjusts itself to previous functioning after a period of time.
Is a person depressed because they lack serotonin or do they lack serotonin because they are depressed?
The truth is there are many unanswered questions in the field of mental health. It can be faulty to assume that problems are all caused by the environment when science has proven that certain aspects of a person’s character are essentially identifiable in the first week of life (For more on this, see the article on Temperament)! It can also be faulty to assume that all issues relate to a person’s brain and are therefore essentially unchangeable without medication.
I am proud to have been a collaborating investigator for the latest edition of the Diagnostic Manual; the DSM-V, and always collaborate with other professionals (such as school psychologists or psychiatrists) who are treating my clients. Nevertheless, my own personal attitude is to educate myself thoroughly and apply a heavy dose of common sense to problems. What we know to be the “facts” at this time will surely be revised at a later time when science knows more. There are times when a diagnosis can be very helpful, and times when it can be wrong.
When you get down to “treating” a diagnosed condition, such as Attention Deficit Disorder, the solutions are often very pragmatic; things like waiting for eye contact before speaking and asking the child to repeat back to you what was said.
An accurate and thorough diagnosis can give everyone a common language and draw people of similar characteristics together for more insight and awareness. Yet, the important thing is to understand that a diagnosis (even an accurate one) captures only one aspect, or one dimension of a human being. It is equally important to look at a person’s strengths as a person’s deficits. It is the strengths that will carry them to success. So make sure you spend as much time investigating your assets as you do your liabilities, because analyzing problems is a circular process. Looking for strengths is where creative solutions lie.
What does this diagnosis mean? On Mental Health Diagnosis.
Many people are confused when they receive information from a psychiatrist such as a diagnosis. For some people it is a great relief to know that the issue they’ve been struggling with has a name and some potential treatments. It gives them a target to focus on in internet searches, reading, and locating professional experts.
Others question the validity of the diagnosis. Parents are unsure if “ADHD” is a “real” mental illness or if their kid simply has behavioral problems. People diagnosed with “Bipolar” may be skeptical that that label applies to them, and are hard-pressed to believe the problems they’ve been having are lifelong, as opposed to temporary reactions to circumstances.