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Diagnosing: The Good, The Bad, and The Ugly



What I am about to write will most likely be controversial. That has never slowed me down before…I have never been afraid to stand for what I believe in. So….here goes!! I am a therapist who has a good grasp of at least the most common diagnoses, and a fair number of those seen less often. I have experience working with a wide variety of clients with various (sometimes multiple) diagnoses. I happen to personally be somewhat anti-diagnosing, though. Yes, it is a bit of a contradiction. I just prefer, as a person AND as a therapist, to see each individual person I encounter, meet, or work with as who they are as a whole, and not assume things about them based on any kind of label. You see, I am not a fan of labels. I am, of course, analytic by nature, and I immediately start fact-gathering when I meet anyone. It’s a side of myself that developed very young (definitely pre-education) and I have not been able to shut it off….ever. I take in all information given and I use those pieces to form a whole picture, with the understanding that I will never have a complete picture of who anyone is. I don’t believe it is possible for us to fully know anyone. Some we will know much better than others, obviously, but there will always be parts of others that we cannot know. And there are parts of ourselves that no one else can know. To fully know someone you have to have been present with them from the moment of their conception, and to not only physically be present with them but to also have intimate knowledge of the inner workings of their mind and spirit for every single moment of their lives. That is impossible, and that is why I say that we cannot fully know anyone other than ourselves. I personally think the discovery process of getting to know someone else is one of the most interesting, fascinating, and fun adventures offered to us in this life. So it goes without saying that I absolutely LOVE my job!!! Yet my job requires me to accept “labels” and to sometimes “label” those I meet in ways I may not fully agree with. That is the conundrum.

When I meet someone who has already been given a diagnosis I take that in as one piece of the puzzle, and I start to explore how they may have gotten that diagnosis and if that plays a role in the current symptomology presenting in session at that time. Sometimes it is not even that relevant for the presenting issue. That may seem surprising, but it is what I have found to be true. Sometimes it is very enlightening and gives great insight into the way the person may process or react to certain situations. That always has to be explored, however, because I have encountered cases where a person was mis-diagnosed. If I were to operate solely on the diagnosis someone else has given them I would be doing them a great disservice and may be wasting both of our time in therapy. I always get to know my clients individually, within session, taking into account what another professional has noted or observed, but not accepting that as absolute or the whole of who they are, not ever.


“My experience illustrates how the drive to apply general diagnosis labels to patients’ mental health problems can be detrimental to the treatment and recovery of individuals who each have very different needs and vulnerabilities,” (Robinson 2009, 1).


Why am I anti-diagnosis if they are sometimes helpful? I personally think the potential to do harm is greater than the potential good that could come from a diagnosis. Some diagnoses prevent an individual from attaining specific types of jobs, pursuing certain careers, joining the military or law enforcement, or sometimes being accepted into society. Some diagnoses are more common and “acceptable” in society than others, but I have yet to meet one single person unworthy of love and acceptance, regardless of their diagnosis or label. People get labeled and ostracized over things I cannot even comprehend. Race. So what if they are a different color from you??? I have never and will never understand how skin color makes anyone “lesser” in the eyes of some. Economic status. Economic status is often largely determined at birth. I don’t care what anyone says about that, watch and research. It’s true. Changing your class is extremely difficult, and even more difficult for those born in poverty. Multiple research studies show that socioeconomic mobility in the United States is among the lowest in the world (see references if you are interested in reviewing the studies). How can you judge someone for something they have little control over? That is unfair, at the least. Cruel at worst. Ethnicity. Someone may have been brought up with different customs in a different culture. Different does not equal less than. Trust me on that!! Try to see things from someone else’s perspective. Good people come in all shapes, sizes, colors, and ethnicities. I know this from experience 😊. Schizophrenics. Umm….do you really think that people with that diagnosis ASK or CHOOSE to experience the things they do?? Hearing voices in your head that you can barely (or CAN’T) make sense of, seeing things other people can’t (sometimes terrifying things), believing that you are all alone in the world and everyone intends to kill you….does that sound like a good time to you? Because it sounds like torment to me. I once worked with a nine-year-old girl (who gave me permission to mention her here) diagnosed with schizophrenia. Now, it is not common for young children to be diagnosed. But she did meet all the criteria and was diagnosed, and subsequently medicated, by the age of nine. How do you think having that diagnosis affected her in school? Well, I can tell you she did not have many friends, that’s for sure. She experienced bullying and became suicidal. She battled suicidal thoughts for years because of that. I am happy to report she is a very stable adult who is now a mother, working and contributing to our society today. Why should that “label” limit her? Separate her from others? Why should she have less opportunities, or less inclusion socially? I don’t believe she should, obviously. Which is the very reason I am writing this article, if you didn’t figure that out (hahaha)!

I could continue with examples of labels people are judged by, limited by, or pigeon-holed by, unfairly in my opinion. But instead I want to ask you this…..do you have anything you could be “labeled” by? Maybe you have already been labeled….overweight? Too light-skinned? Too dark-skinned? Too short? Too big? An “average student”? An “alcoholic”? A “drop-out”? Black-sheep? Just a little “odd”? Whatever label you feel you carry, your label is no different from anyone else’s. The reality is we all have potential “labels.” Yes, people will judge us for them. Some people will “other” us. Those people may not be “our people,” as they say. Hold close the ones you meet who accept and love you unconditionally, as you are…flaws and labels and all. And remember when you meet someone, they are a person just like you who deserves to be known, accepted, and loved unconditionally just as they are. None of us are defined by our labels, our flaws, or even our past mistakes. We are defined as the whole of who we are, by our characters, our lives, our actions, by the essence of who we are. Be yourself and let that self be known. Be confident and proud of who you are, and let those labels slide right off as you walk beyond them on your journey. They may be part of who you are, but they are not WHO YOU ARE!

We all know diagnoses are a part of the mental health system and unavoidable if insurance companies are involved. But as clinicians I think it is essential for us to see our clients/patients as individuals and not fall into the trap of seeing them as cookie cutter versions of any particular diagnosis. Nor should we use cookie cutter treatment regimes based on any particular diagnosis. We still owe it to each individual to get to know them and treat them as a whole being based on their personal lives and situations. As individuals who may be diagnosed, we have to remember also that it is just a label created by society, and it may inform our understanding of ourselves to some degree, it may inform our future steps on our own healing journeys, but it never defines who we are. And that is my two cents for today! 😊


References:

Robinson, A. "Dangers of Diagnostic Labels in Patients with Mental Health Issues.” Progress in Neurology and Psychiatry. 2009.


Economic Mobility Reports:

"Pursuing the American Dream: Economic Mobility in the United States". Pew Charitable Trusts Economic Mobility Project. Retrieved 1 August 2012


Bradbury, Katherine (October 2011). Trends in U.S. family income mobility, 1969-2006 (working paper no. 11-10). Boston, Mass: Federal Reserve Bank of Boston.


Vasia Panousi; Ivan Vidangos; Shanti Ramnath; Jason DeBacker; Bradley Heim (Spring 2013). “Inequality Rising and Permanent Over Past Two Decades.” Brookings Papers on Economic Activity. Brookings Institution.


Economic Mobility: Is the American Dream Alive and Well? Economic Mobility Project, May 2007.


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