What Do You Think Of T's Who Don't Like To Diagnose?

[Cool Cat]

i suppose it is worth noting that my T though accredited is not a doctor, and cannot diagnose. But tbh I hate how they loosely use words like traumatised, depressed, addicted, schizoid etc etc and then when you refer to yourself like that they almost backtrack.

I have a lot of ambivalence to not having a diagnosis...

 

[seedling]

I don't think about my diagnosis that much but I count on it being there. I like being able to think/say "I have..." No if's, and's, or but's.
It doesn't change the work I do in therapy but it does give me some kind of foundational reference to go from.

Is there anyone else who could do the diagnosis part for you?

 

[Kintsugi]

My Ts have always had the authority to diagnose, but they all say something about how talking strictly in terms of diagnostics is limited, probably because I'm a bit preoccupied with the wonderful, crisp clarity diagnoses hold for me.

In short, these ladies are frustratingly well-intentioned. That's how I feel. :shifty:

 

[Suzetig]

Mine doesn't diagnose and I'm quite happy with that in all honesty. I think diagnosis has its place but I know for me having a label wouldn't be helpful because I would obsess about it.

 

[Cool Cat]

I suppose like maybe I'm wrong but imagine if they wouldn't diagnose dyslexics and they just said "We're not gonna say you're dyslexic as it will bring you down" when in fact it can be key to people understanding and it makes it feel like something separate to you

 

[scout86]

I suppose like maybe I'm wrong

I don't think you're wrong. I do think that different people might feel differently about this. My T's not a big fan of labels either. He says he'll only be happy with the DSM when they have one label for each person on the planet. Because everyone is unique and everyone has greater or lesser amounts of ALL of those traits. He doesn't see the diagnostic labels as being real useful because "mental illnesses" don't exist in the same, discrete way that physical diseases do. He'd rather focus on "what's the problem and what do we do about it?" without worrying about what category (or categories) a particular client fits in to. But, I can also see how having a label might make your situation seem more "real" and more understandable.

Having said that, I just reread your original post. I'd have to say my T DOESN'T use those words much, definitely not loosely. If he does use them, at some point there's going to be a conversation about how he's defining them, so we know we're defining them the same way.

 

[DogwoodTree]

when in fact it can be key to people understanding and it makes it feel like something separate to you

This is the way I feel about Asperger's, but not about PTSD, depression, anxiety, what-have-you.

With AS, it's an underlying, neurological wiring that can affect how therapy should be administered and what expectations we can have regarding outcome. That's why I'd really like to get a formal assessment for it. But for the other issues...PTSD, depression, dissociation, whatever...trying to fit it into a box seems like a waste of time when we could instead focus on addressing issues at a symptomatic level (understanding that trauma is the underlying cause for those).

 

[seedling]

For me, having the diagnosis of PTSD helps me accept that I have something that needs treatment. It also helps me to focus on the fact that the trauma is the cause and that is what I need to address in my search for treatment. I guess it gives me a starting point. I think without the diagnosis it would have been even easier to fall in to the "it's not that bad" frame of mind.

 

[Friday]

trying to fit it into a box seems like a waste of time when we could instead focus on addressing issues at a symptomatic level (understanding that trauma is the underlying cause for those).

This is one of the things that makes diagnosis super important to me.

Anxiety, for example? Is a symptom that exists across who whole LOT of disorders. But you tell someone who has been kidnapped & raped that "that's never going to happen"? Um. It already has. It's not an irrational fear, or a delusion/imagination, or a chemically induced bout of paranoia. It's a very real fear based off of past history. But if you take a PTSD tack, and treat fear of kidnap as a real thing with someone who is delusional? All it does it make them even more solid in their delusion, and even more freaked out. Take the PTSD retraining response track with someone whose not responding to outside stimulus, but internal chemical push? Might as well tell a diabetic to retrain their pancreas, by eating more cake! Bad juju.

PTSD symptoms have a basis in reality.

That's one of the huge differences between this disorder, and other disorders where the basis is imaginary, or chemical, or structural, or some combo of the above.

Our anger? Our fears? Fight/flight response is something that can seriously be messed with (positively). We can learn to temper our responses to situations. To take a step back. To train the 0-60 response to slow down. But someone who is bipolar? It doesn't matter if they have the best grounding skills in the world. The chemical imbalance isn't based in reality or imagination. It's like trying to get someone under anesthesia to go about their daily business. They can't. It's not something anyone can learn to do. Their bodies aren't flooding with chemicals in response to something else (triggered). Their bodies are flooding with chemicals, because that's how their bodies work.

But it's only one of the differences.

Each disorder, even though symptoms may be near identical, has it's own unique thing. What is the absolute best treatment of SymptomA for 1 disorder? Is the absolute worst treatment for SymptomA for a different disorder.

Knowing where symptoms come from... Let's the symptom be addressed in a useful way.

 

[Chava]

Well I think seeing a therapist if we have really challenging symptoms, even without getting a diagnosis, is more helpful than diagnosing ourselves and doing our own self-help for PTSD or other major issues.

I had gone through all the major assessments many years ago...diagnosed anorexia and PTSD and alcoholic (chemical dependency or whatever they'd call it officially). The "T" of the PTSD at the time was an assault, but I didn't link all my previous self-destructive behavior to earlier trauma (the assault just put me over the edge and suicidal).

Anyway, after several years out of therapy and falling apart in new ways I found my new therapist. After a particularly bad meltdown I asked if she thought I might have BPD or if I should go do the MMPI again, or whatever assessment. I don't remember her actually saying she didn't think I had BPD but she reminded me that all of my symptoms are really well explained through the lens of complex trauma, so she didn't think more labels were necessary. She knew what we were treating and how (for me it manifests as a lot of somatic symptoms, disconnection from my body, the regular old nervous system dysregulation that flips between hyper and numb, some dissociation, and disconnection between myself and others).

If someone is having disruptive symptoms and has no idea what is going on, or has a vague idea but is not sure which treatment would make sense, a diagnosis is helpful to get you in the ballpark. All of my previous diagnosis, along with a thorough intake with my current therapist, put me right in the CPTSD ball park. Another therapist might also find a way to throw in some somaticization disorder that keeps changing in the DSM, or some other stuff. My current therapist cares more about the therapy than the labels, but she and I know we are treating complex trauma (not an official DSM diagnosis, but it doesn't matter).

On the other hand, I have never felt satisfied with my chronic pain diagnosis and wish it was more clear so I could clue friends in better. I worry they just think I'm a crazy f*cking wimp. Diagnosis helps direct treatment, but it also offers validation. But the whole process can be misguided too, especially with incompetent therapists who meddle more in labels than the individual's set of symptoms and treatment process.

 

[ghotiff]

I think without the diagnosis it would have been even easier to fall in to the "it's not that bad" frame of mind

This is the problem for me. My T doesn't like labels but is that because I'm not "bad" enough and should suck it up better...or does she just not like labels.

I'm currently unable to work etc and I keep going through loops of "am I just being lazy" or "am I struggling/suffering".

 

[Anarchy]

Following on from Scout,

Even with the well known psychoses, like schizophrenia, and under ideal conditions, such as field trials for the DSM, with highly trained clinicians...

Once random overlap is corrected for, it is difficult to get more than 60% agreement in diagnoses between different clinicians looking at the same patients.

I can see how certainty could be comforting, or at least reassuring.

Unfortunately the certainty is not there, especially with things like early trauma and attachment problems.

The proponents of physical or chemical causes of problems in functioning in work, relationships and other areas of life... Have still to come up with something to match say an xray for diagnosing broken bones, or antibody tests for diagnosing whic specific bacterial and viral infections people have.

Those kind of the tests might come someday. But until then, however earnist and confident a diagnosing clinician might appear, once random chance (think of diagnosing by tossing a coin) is removed, there's probably at best a sixty percent chance a subsequent clinician will agree with the first.

There's a good, well referenced discussion of this in Benthall's book, "madness explained".