Self Diagnosis Is Not An Option

[anthony]

I am not sure why you would think that you as a counselor would not be qualified to diagnose ptsd in others.

As you outlined, Australia is vastly different with how mental health is performed.

Psychiatrists are primarily for diagnosis and medication review only. Psychologist here, requires either 3 years post grad supervised hours, or another 3 years post grad doing a Masters or such, before being a licensed psychologist.

Therapy here is vastly different, in that you must be qualified as a counsellor to perform therapy. Counsellors here do the majority of therapy work, not psychologists. A counsellor here cannot prescribe or diagnose, they can only give experienced observations... a psychologist or psychiatrist here are the only people who can make an official mental health diagnosis.

Counsellor, nurse, social worker, MD, etc, can all be therapists... but they have limitations on the type of therapy they can perform... which is pretty much everything except EMDR, which you must be a licensed psychologist / psychiatrist to perform. Psychologists are the ones who do the heavier therapy work that is outside the realm of a therapist... ie. when they have reached their limit of knowledge and/or experience, then they refer the person to a psychologist.

You can also just obtain a degree in psychology here and not do the rest for licensing, being the medication prescribing and diagnostic qualification... you can just use your degree in psychology to perform therapy.

America is all privatised and about insurance and covering your arse... Australia has legal requirements, just not as silly, nor as worrisome due to private insurance issues. Anyone who performs therapy here does have to have insurance cover obviously for liability.

I think Anthony you would make an excellent councellor/Therapist.

Thanks... though I actually have and know my limits.

I would not make a good therapist dealing with general day to day issues, ie. relationship breakdowns, my life is too hard today, etc type stuff.

I deal optimally with PTSD, and all those things can be encompassed within PTSD therapy, and I do ok with them within that sphere, but by themselves, I tend to be more male then and have a 'toughen up' approach, which isn't empathetic for what the person needs.

I can be... but I think females more often make better general counsellors, as females are more nurturing and emotional than males.

I will excel in what I do well already... PTSD. If you want to really get better and get back into life, that is when people will come looking to me for help. If they want someone to hold their hand and tell them it will all get better... then I am not that person.

My plans go beyond normal therapy... being I want to get more involved with theory and practicable aspects, not just sitting in a room telling someone how to do something, but actually going and doing it with them, so we can pull apart what they feel at that time and apply realistic solutions to them and their life in real situations.

 

[mamachick]

Anthony,
Regarding your last paragraph:

I remember reading in one of your posts Anthony-about your desire or goal of getting ;people out of the classical setting to do therapy (away from office ). With all of the ethical/legal ramifications, I wondered how and if you had any plan of how that could be done? It remeinded me of an idea thought that I had during a healthier time -pre ptsd diagnosis.

The things that I discovered to be most productive in overall health years ago, and restored and overall health was 1. exercise 2. diet and hydration 3. social/work that was congruent to beliefs. So during this healthy time, I did a lot of walking or used eiptical or treadmill machine regularly. At times talking to co-workers. (keep in mind, I have no evidence, have not researched, am making no valid claims). I had a hypothesis about therapy being done during exercise while increasing heart rate and endorphins and other brain chemicals will increase success and healing. I think it is possible for (ideas, changes of thoughts, letting go of pain, feelings of empowerment, healing, etc) for success to be escalated
during exercise-out of classical office setting.

This was my experience and what I observed in only a few others (personal not professional). It made sense because when someone is in a depressed state and changes are suggested they are often resistant. It would make sense that if the brain chemicals could be altered through exercise, and simutaniously reporting symptoms, processing feeling, etc. that the difference in brain chemistry may lead to more positive outlook. (this not limited to ptsd but for those with negative thought patterns that feel helpless). Feeling strong physically can eliminate some feelings of helplessness in itself. Obviously, it would not work for many with health issues that would not allow. Here in U.S. I know it would pose some ethical and legal dilemma's, but not sure they could not be addressed. I never pursued this because of lack of time during that period.

I would appreciate any thoughts you have on this.

 

[anthony]

Legal ramifications cease if the client signs an agreement to perform therapy whilst going for a 5 mile walk, sitting in the gardens in a quiet secluded area, going to perform practicable activities and tasks for exposure therapy, etc. As long as the client agrees to it, then there are no ethical or legal issues. Its an old adage that therapy must be performed in this stuffy little room which apparently is private, yet so uncomfortable and usually daunting for the client, that it causes as much hindrance as it does provide a perceived 'total privacy' situation.

Obviously you must factor in confidentiality... and the client must be cautioned that therapy in more social environments, people surrounding could here something, partiality of conversations, etc. I doubt anyone is going to hear anything of substance whilst talking and walking, especially if you remain cognisant of others walking around you and stop to allow others to pass, etc.

Many therapists are restricted if they work for companies... being its about how many clients you get through, not the quality of work done. Shifting outside normal concepts will impede cost. You can't just run a video or audio recorder to record the session... you would actually have to take a real interest, remember key points, etc, then record them after the session, not during. You could stil feasibly use a good audio recorder and capture the majority of conversation whilst out and about, as many have good pickup for radius nowadays, as well as clip on mics for clothing that wirelessly feedback to the recorder, etc, to cover documentation requirements for licensing, legal and such.

I would see the largest reason being $$$$ that people don't do it, because the cost would be more / you would not make as much money as a therapist doing it that way. Losing half an hour before and after a session, as example, to meet a client at a local shopping center and do their shopping with them because they have panic attacks, etc, whilst doing it and cannot control them. So doing the therapy in the environment, helping them find realistic solutions they can use within their shopping center, will quickly solve a major issue in their life, compared to talking about it and asking them to perform x,y and z within the situation. You do it with them once, then they have to learn and apply what you have just taught them in real-time, insitu, for further times. Hopefully they take onboard what is learnt and they apply it. Obviously you cannot go to the other extreme, and pay a therapist to help you do your shopping each week.

Going clothes shopping, etc... people want to do it, but get into panic attacks, dissociate, the list goes on. If they can't take what you teach them in a room and apply it, then the best trick is to go with them and teach them in the environment once, maybe twice. Someone who is afraid of crowds... you take them to a crowded event and talk them through it, teach them techniques insitu, because they love going to concerts, but are afraid of attending due to the crowd. If you get them back to concerts using specific techniques that work for them, then their goal is obtained.

 

[mamachick]

Anna,
A friend of mines wife was in a horrible car accident a few months ago and was in a coma for a few days. She had a brain bleed. She had some other bone fractures and injuries. Her husband is friends with a well known neorusurgeon who he called in . The first thing the neurosurgeon told the husband about her prognosis is this:

Anything below here (putting his hand to chin area), I can tell you about, but the brain is a mystery. Why some go into coma, shy some come out, the course of recovery, the extent of damage, etc, we do not know.

There is much truth in this -in my own opinion. For as many people that are affected by some sort of brain illness, be it mental illness, injury, organic, etc-there is a lot of theory but little proven course of treatments. I am guessing that over the next few decades that will change, because when it costs enough money-gets media attention- govt. does more, allocates funds, etc.

Ptsd has been around for ever. When I first heard of it many years ago, I thought about my uncle who went to war and was never right after that. I think they called it shell shock. Many civiliian have had this as well. I think it is when the govt starts having to pay for disability that more attention is paid to it. Altzheimer has been forever, they were just labeled crazy expecially if early onset. Head injury is getting attention because of athletes.

In the 50's, depressed people, drunks, menopausal-all got shock treatments against their will. Not so humane as today either..I am grateful to be living at this time rather than then, but there is still so much to be discovered.

 

[Gloria]

The term mental illness is probably one of the most degrading, despicable vile and derogatory label that professionals and therapists bandy around and once labelled can be used to take someones sovereignty away from them. I think this is evil.

Well it's better than crazy. Most people don't know this but that crazy is not a legal or medical term. And mental illness can be drinking, gambling, over-eating, lying, I mean just about every body has some form or type of mental illness. Do you bite your nails? - compulsive behavior and that's a mental illness. When people say I'm crazy. I just say crazy is as crazy does and since everybody does crazy things. The only normal is the cycle on the washing machine!:eek:

 

[PTSD sufferer]

Thanks for this posting Anthony and for others insightful comments. This is obviously something that concerns some people, and considering what people have been through, maybe some of the reactions are more about concerns about not being 'believed' which may correlate with individual's trauma experiences.

My original diagnosis was severe PTSD and that diagnosis came from a very qualified psychiatrist, and I had the hole spectrum of blood tests, MRI - everything - done (mainly because I was worried I had a tumor or embolism that was causing my world to erupt the way it did - I didn't by the way). That psychiatrist, sent me to a psychologist for treatment. Both concurred with the original diagnosis. I had heard of PTSD before, but did not know much about it - what I knew was mainly from poor portrayals in movies like the 'The Forth of July'! But with every diagnosis, I read extensively as I feel that the more I know the better I understand, the faster I can get well. This goes for any diagnosis I have been given since the advent of Google :) Yes, caution should be taken with any information on the internet, and I certainly don't believe everything I read - book or internet - or I'm even told. I have a brain which I like to exercise evry now and then :) But I concur with Anthony in this respect.

When diagnosed with severe PTSD, I spent a long time in denial (still am if I'm honest), questioning whether it was something else - I didn't want (and still don't want) to be going through what I am. I hope for the majority of people it is not PTSD, because for myself, if it was a lesion on my brain, great!!, take it out and let me get on with my life!! Yes, PTSD needs to be diagnosed by a professional (they are the experts), but in my mind everyone with a mental illness can benefit from therapy, treatment and support.

At the end of the day, many mental illnesses have many 'symptoms' in common (PTSD, AD, Depression, Bipolar, Psychosis come to mind). It can be difficult to fit the textbook criterion of one illness when there are so many similarities across them. Academic thinking is far from finished when it comes to disorders of the mind. Why is that? because the brain is a very complex thing and we have barely skimmed the surface when it comes to what our brains can, and do, do - let alone how we react. All options must be explored so that you can get the help you need to get well, this is part of the process or journey.

I undertook research every time that a new 'possibility' was presented to me along my journey - which has only been in the last 6 months-ish (originally diagnosed 2 years ago) - and they have largely been ruled out. And before you ask, does it bother me that I have been through all the 'possibilities', no, not at all, its called being thorough.

I would also like to point out an interesting anomaly I found during my search of academic papers on various mental illnesses through my journey. Some mental illnesses, I'm thinking of Psychosis as the example, can also be such a traumatizing experience that it can cause PTSD. Food for thought...

I think, the other thing that is quite interesting is that PTSD can have a delayed reaction. The trauma may be old, and we may not have reacted 'instantaneously' with PTSD symptoms when it happened. This is quite a fascinating idea in my mind, which has to do with how traumatic 'memories' are stored differently than 'normal' memories. There are various names for such a delayed reaction (as well as dismissal during the traumatic experience), such as dissociative amnesia, and retrograde amnesia. As I said before, something is mentioned to me, I then research the crap out of it, so thought I would share...

The other interesting academic information that I have read is on memories - clearly of relevance. Such literature talks about various distortions of memories such as false memories and confabulations. There may be truth to memories, but they can also be distorted, maybe in small ways, but also in the same respect, maybe in bigger ways. This could be due to emotions, which heightens and can even change details or just a facet of age - we all know the brain starts to degenerate as we get older. For example, a pair of scissors could be distorted to be a knife in an memory, just as a red bike might have actually been blue, and that story about falling off a horse was actually your brother not you. Interesting hu?

I am, by no means, negating individuals trauma, symptoms and diagnosis. The only (and very long winded) point I would like to make is - we still don't have all the answers. Yes, a professional diagnosis is ALWAYS better than self diagnosis, psychiatrists and psychologists are heavily trained and are the experts so, if we can, we should always defer to the experts. But could a diagnosis be wrong? - well yes it could be, because academia is by no means 'finished' when it comes to mental illnesses. Regardless of your diagnosis, do what you need to do to get better.

PS. Anthony, I am an optimist and a pragmatist at the same time (weird I know, but possible :O_o: ). I know the trauma will never go away, it is part of history and as such is an experience that can't be 'undone'. For me, reality is that, sure there is no cure, but I optimistically believe that, I can work my backside off to put it where it belongs - in history. That might be the 'illusive cure' I personally need.

 

[Lady of Longbourn]

Some mental illnesses, I'm thinking of Psychosis as the example, can also be such a traumatizing experience that it can cause PTSD. Food for thought...

Bipolar disorder can have psychosis ( Not always and not only disorder that can). I found this when I was reading about Bipolar disorder.

"About 40% of people with bipolar disorder also have PTSD."

Noticed comorbidity is not uncommon on this forum. Its still really eye opening.

REALLY makes you realize how very important it is to get a qualified person to check you out!

 

[mamachick]

Hi ptsd sufferer, many good points in your post. You've done a lot of work in understanding. I agree that you can learn to manage and be highly functional.
There is a lot of comorbidity, I do not hear a lot about dual diagnosis of ptsd and traumatic brain injury here though, and I think it is more common than reported. Having a head injury may make one more susceptable to ptsd. There is more information regarding the dual diagnosis with military than in general population. One may have a negative ct right after the trauma, and swelling occurs over the next days or weeks. During this critical time, one may find themselves making poor decisions that lead to other life threatening events and cause further trauma.

 

[PTSD sufferer]

Hi Ayesha,

Yes you are right co-morbidity is definitive something to consider and there are a great deal of academic papers on co-morbidity including PTSD and Bilpoar, PTSD and Psychosis, PTSD and Skitzo-effective, PTSD and Anxiety Disorder, PTSD and Despression, PTSD and Substance Abuse, PTSD and Schizophrenia, PTSD and MDD, PTSD and Chronic Pain.....

Agree that it is so important to get a professional to check you out, at the same time, don't be hard on them, let them do their job and go through all the 'possibilities' so that you can get the help you need. Psychology is not an 'exact' science and this is simply part of the journey.

Hi Brat, I do try my best to gather knowledge. I get a lot of 'personal power' from the application of knowledge (working memory) and thinking (cognition). Sometimes I get it right, sometimes I get it wrong, and I am still in the process of gathering knowledge. My next step is a chit chat with a small list of academics who's papers I have read, so that I can pick their brains too :p Yes, I do the extra mile and a half :geek:

Traumatic brain injury may not be talked about a lot in this forum, but it is certainly written about by academia. Trauma does not necessarily need to be psychological to cause PTSD. Although you mention that the trauma to your brain caused you to take risks which were traumatic, there are also a lot of academic papers on physical factors creating PTSD such as post operative trauma. Yes, traumatic experiences such as anesthesia not working, but also the use of drugs in surgeries (such as transplants) causing hallucinations which causes trauma = PTSD and biological factors that might work in the same way. You are right, the majority of academic papers I have seen on brain injury and PTSD have been written about using samples of VETs. I guess, VETs are as good a place as any to start when it comes to finding people who have experienced trauma and injury.

Also interesting, prior exposure to interpersonal violence can increase the risk of PTSD (durrr) but we could also be genetically predisposed to PTSD (interesting :cautious:)...

On the other hand what you are experiencing may not be PTSD at all. Don't know about you guys, but I'd want to know either way. If you can, talk to the experts and begin your personal journey. Listen to what they have to say, question everything (including yourself :O_o:) and be open to all possibilities. Just go out of your way to get the help you need to get better. That's my 2 pence anyway.

 

[Girl3]

Currently there are a number of clinical trials either in progress or analysing data looking at TBI and PTSD. While they are events that can happen comorbidly - PTSD patients often get into "scrapes", it would seem thus far that traumatic brain injury might even be protective against PTSD.

Having had many beatings in which I suffered loss of conciousness, I am not certain I subscribe to that - but I could see where in some cases, losing conciousness prevents certain aspects of enmeshing with the trauma. Perhaps they will find that a subset of patients - those who have a certain environment or genetic predisposition will be PTSD prone with TBI.

 

[mamachick]

Girl13-yes unconsciousness may be a protective factor for ptsd, but that is regarding severity such as coma and amnesia from injury. If I close my eyes and think, I can remeber everything in very slow motion, going down during a fall, I am aware during the entire event and only out for 5 minutes. Obviously, perceptions are skewed-but having no control over the situation, being unable to help myself, feeling death is inevitable, were all present. This happened in a supermarket-I cannot go to supermarket, particularly alone, and it has been 5 years.

ptsd sufferer-I admire you in your learning (was that way when brain absorbed more). I think you do really well in sorting this stuff out and teasing out the possibilities. Right or wrong can change-you deserve a lot of credit as you are IMHO pretty objective and on target.

Prior to accident-neglected as child, married at 17, was physically, mentally, and sexually abused for 5 years. Survived and moved on. After remarrying, during calmer time, experienced symtoms of ptsd along with CFID, fibromyalgia, IBS (somatic) all following minor car accident. Over years, regained health. No symptom of depression, anxiety, nothing.
Healthy as horse. While in grad school, seperated from husband. Dated a man that was intellegent, charming good looking, but sociopath. I think anyone could have been tricked by this man. He kept me off balance. He reinacted stalking events. Ended that and was resolving events.
Working very hard, finished school, passed exam, good job, excellent pay, kids well, etc. Growing up, my mother was alcoholic, father not present, first young husband bi polar and addict. All of my life I have been very cautious, I have never socialized with addicts, friends into health and fitness, many activities around my kids events, learning , etc. Not a risk taker.Very much of a conformist, I was always able to seperate myself from situations and people that might not be real safe. Even relatives that have been in trouble-able to practice tough love easily.

A year later had accident. Back of head hit floor several times, coup countercoup injury. No bleed or anything so that was good. Over the next weeks, things got worse, sleep disorder, extreme anxiety, irritable, anger, personality changes, which of course was not accepted or understood my 2 teen daughters. Now things that daughters would say would make me cry, so I guess I was extremely sensative. Within a month, a friend introduced me to her friend who was a recovering alcoholic. I knew this guy in high school and met him again at a steak fry in our 30's. He was a hot mess. I had politely removed myself in past situation. Not now, I listened to his problems and felt sorry for him, I became his best friend. Over the next year, he left me at a restaurant in strange town. He tried to joke me. He was not really recovering. He verbally assaulted a friend of mine (police officer), and others, friends were getting upset with me. He pestered me, dropping my with flowers etc. Something emotional in me changed in that accident. He was an accident waiting to happen.My daughters car was set on fire, dog was poisoned, and he would threaten me after discontinuing all contact. I began drinking heavily during this time to calm myself. The relatives that were a mess, I got right in there and tried to save them. These people will drag you down, and they did. When you hang out with people like this, things happen that could be traumatic to an already fragile brain. This is what I meant when I say I put myself there.

Is it one or the other or both? The best I can conclude is that it is both. In healing and managing ptsd, I think it is mandatory that we put ourselves in a safe place and that we are not feeling threatened. Then after repeated exeriences that are safe, symptoms decrease or even are absent, as in my case. However, if you introduce threats again to a person who has a history of ptsd, for me anyway, the symtoms were almost immediate and intesity fierce. (it takes less of a threat to create severe symtoms when ptsd is in a remission). I know remission is not the right word, but that is my tbi.

I have read that the same part of the brain is effected in ptsd and tbi. Whatever the case, I know that there is no cure for ptsd, and once you have this, we can heal and we can learn to manage it. I cannot see that being possible if we are in an unsafe environment or in constant conflict. We create a safe and stable environment for the best possible outcome. However, I do believe, something can happen that may seem minor or moderate to a non ptsd, and can launch the ptsd person back in time. The more support systems in place and the safer and stable environment, the better they can move past and get back on track. Just my opinion.

 

[Girl3]

Brat17 - you are so right about so many things - you had prior "priming" in PTSD, repeatedly - and yes people with PTSD are susceptible to again relapsing into PTSD under certain circumstances.
When I stated that TBI may protect against PTSD - that is strictly based on current data/study schema: and studies are based on populations - me personally - I AM NOT A POPULATION. I am a person. You are a person, not a population.

Statistics are wonderful. But when something happens to you - it is 100% for you - regardless of the statistics.

So TBI - PTSD -symptoms - it all boils down to you needing help so that you can go to get your groceries. PTSD and whatever made you a PTSD person leaves you a setup for sociopaths and brutal, antagonistic, abusive others. You need help to overcome these things. No shame - no questions about validity. Get help so you can heal.

It is so hard to help yourself when you life has designed to make you 'helpless'. I have a hard time going to the store, to go run, to go out to eat, to go anywhere - even though I know it is my right.

I pray you get what you need. many hugs.