It’s a Diagnosis, Not a Merit Badge

Finally, there was a explanation for Emma’s moodiness, temper tantrums and inconsistent performance in school. At age 12, her exasperated parents took her to a psychologist and she received a diagnosis: Bipolar. Although saying that she or her parents were happy to receive the news wouldn’t be quite right — however, it did provide a certain level of relief knowing that there was a name for what had been a significant concern in the Smith household for several years.

Although diagnosing mental disorders is commonplace, it’s still surprisingly controversial. While having a name for a problem can provide hope and reassurance that a return to normal is possible with a treatment plan, it is a two-sided coin. On the brighter side side is hope and treatment; on the other is excuse and apathy. A diagnosis should inform treatment, but it should not be an excuse for poor performance or behavior — or for expecting less of someone.

A well-known phenomenon has been studied by educators for years in which the danger of a diagnosis is illustrated. For example, a child may have a difficult time paying attention in first grade and may be diagnosed with ADHD — or perhaps a note is made on his permanent record regarding his attention problems. Consequently, every teacher he has from that point forward is likely to look for evidence of ADHD — and likely will find it. After all, it’s what other teachers have said to be on the lookout for.

It’s one of those situations where you see what you want to see. Eventually, even the diagnosed individual starts looking for symptoms of mental disease. This heightened awareness can actually cause a loss of hope, rather than a sense of empowerment. “Oh, I feel depressed. I always feel depressed. I was diagnosed with depression, so I guess that’s just who I am. I will have to live with it.” In fact, I have heard of some individuals using their diagnoses as an excuse to tell someone off, have wreckless sexual encounters that put them or their other partners at risk, or to quit jobs with no plans for the future. A diagnosis is not something to be ashamed of; however, it is not something to wear like a merit badge as a license for behavior that is ultimately destructive.

The problem with diagnosing mental disorders is that it forces an individual into a box. Anything outside of that box is disregarded as an anomaly. It attempts to apply the scientific method to explain someone’s entire way of being, just like a scientist looking through a microsocope counting cells. The fact is, however, that a person’s soul and psyche can never be understood using the medical model. It’s similar to trying to explain the essense of a butterfly after it has been pinned to a board and labeled. Certainly I can see the butterfly’s color and composition — but does that label really tell me how it flies? The rhythm of its wings? The feelings that watching a butterfly in motion evokes in the observer? So it is with psyche or soul. It cannot be pinned down, analyzed and labeled.

Unfortunately, insurance companies require a diagnosis for payment. Most therapists and counselors who would otherwise prefer not to issue a diagnosis are forced to in order to secure payment. This is one reason why many therapists have chosen not to accept insurance. The medical diagnosis model as advocated by the American Psychiatric Association is being rejected by many therapists as its flaws are becoming more and more evident. Instead, some therapists are opting for a model that allows for describing the quality of the individual’s personality traits without the judgment that a diagnosis can have. (One such author at the forefront of this movement is Nancy McWilliams, author of Psychoanalytic Diagnosis.)

Diagnoses are helpful when they are used to give clues to the therapist and client about what might be occurring. It can help to create an individualized plan for each client, and also bring a sense that what someone is experiencing is understood and treatable. However, diagnoses should be used only as clues that inform — and never used as a weapon, excuse, or merit badge. Doing so diminishes the unique qualities that comprise every person’s personality and actually limits the possibility for individual growth. Refraining from using a diagnosis to capture the entire essense of self or others encourage growths, peace of mind, and personal empowerment. And, that’s something that everyone wants — including client and therapist.

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