Diagnostic Labels

I am frequently astonished by the diagnostic labels that get slapped on people all too often by an uninformed "professional". I've encoutered a school speech pathologist diagnosing autism, a massage therapist declaring a patient has fibromyalgia, or an occupational therapist telling a mother her child was bipolar. And don't even get me started on nurse practitioners dispensing psychotropic drugs. What is this nonsense?

One of my patients was told he was depressed by a mental health counselor. He sees his depression as something external that once he sheds it, like a heavy overcoat, all will be well. I had him tested by Mecte, my esteemed colleague to the east, who is very skilled at such things. He does the standard intelligence tests and the MMPI but also administered the TAT, which looks at emotional themes and psychodynamic underpinnings. Well, this gentleman tested highest on anxiety and far lower on depression. I decided to use this to my advantage in treating him, by pointing out his worst difficulty was his fear not his depression. But he doesn't like that one bit. Being afraid is a lot different than being depressed. And he knows, because some counselor told him, that depression is his problem. He is depressed in the same way someone else is diabetic. He, like so many people, doesn't quite get the idea that the labels they wear might be wrong or that they might no longer be valid. In treatment, people change and with time and work, they get better.

But what would it mean if he were not that depressed any more? Well, it would mean his family is going to expect a lot more out of him and there will be fewer concessions made on his behalf. Being sick in the mind, as he calls it, does have its pay-off. If he's sick, he doesn't have to work, be responsible and be a grownup. The crazy person always wins and that's often tougher to treat than the presenting problem itself. I used an automobile assembly line illustration with him. At the beginning of the line, there is a chassis. Then the engine, the brakes, the seats, the doors, side panels are added. As the car moves down the line, more and more things get put on. Like an assembly line, his treatment is dynamic. He does not stay the same and will continue to change as we move on down the line.