Everybody has Something: The Problems of Diagnosis Creep

When I was first studying psychology, I read and pretty much had to memorize a tome called the "DSM IV". This stands for "Diagnostic and statistical manual". The title is important--it is NOT a compendium of measurable diseases and symptoms and treatments such as the _Merck Manual_ I grew up with. It is, indeed, a book of statistics and symptom clusters--by which we really mean sets of moods and behaviors. I recall feeling as if, at any given moment, I could qualify for any number of these diagnoses, absent only a phrase such as  "clinically significant stress or impairment." So these diagnoses require a determination of clinical significance prior to being diagnosed, unlike a cold, which is still a cold regardless of whether it keeps you in bed.   

These days, we see more and more diagnoses, both of psychological ills and medical ones. Too many school children are taking one or more psychiatric drugs. Too many adults are, as well. But too many adults and children are also taking drugs for medical conditions. This would not be a such problem except for diagnosis creep. How many medical patients realize that what constitutes hypertension these days is not the same as what used to be hypertension? The criteria have gotten lower. The same goes for diabetes and high cholesterol. Results can also vary by doctor, as I discovered to my horror when a now-fired optometrist diagnosed me with macular degeneration and had me frantic that I was going blind. The specialist to whom  I went running said I had no such, but a small particle of what my grandmother would have called "schmutz" on my retina, that was unlikely to affect my vision soon if ever.  Diagnosis creep. Whether the reason is a surplus of caution on the part of a doc, a mistake, or a new set of rules from the AMA, more people have more diagnoses these days and it is NOT a good thing.

Is a Psychiatric Diagnosis Just Another Name for What You're Feeling? A Rose by Any Other Name.....

The concept of mental illness is at its core about control. When someone is labeled mentally ill, a system including physicians, social workers, and government authorities begins to gain access to her life. People have problems. People have mental or psychological problems. The practice of calling these problems by names reflecting illness and thus putting them into the purview of physicians has been doing harm for decades. It is also demeaning, taking ultimate control from the individual and placing it within their genes or their parents.

I have said it many times and shall say it for as long as I can: there is not a pill for that. Make no mistake, your brain is a biological entity--YOU are a biological entity--thus distress of the mind and emotions are also biological entities, but this does not imply that the only or even the best or even a viable way to solve problems of the mind and emotions is with a pill. The overused "chemical imbalance" theory is dead. On the contrary, psychoactive pills cause chemical imbalances--they change your brain in ways science does not understand, sometimes they alleviate symptoms, but they do not CURE distress.

Thus one danger of calling mental distress a "disease" is that it is then treated as such--you become a patient and you look to a doctor to fix something. This works with appendicitis and broken legs and cancer. It is a fact, however, that not all things clearly within the realm of medical disorders are treatable by medical doctors. In general, there is no treatment for the flu or even the common cold, and physicians are stymied by irritable bowel and migraine. Medical science certainly does not work with depression, anxiety, phobia, PTSD, and the many variations of psychological distress delineated in the various manuals of disease such as the DSM and the ICD, because these are not diseases in the once-commonly understood meaning of the term. These problems do not show demonstrable tissue damage such as a cancer or a stroke, nor do they have symptoms that represent the body fighting a foreign invader, such as cough, fever, runny nose. Rather they have emotions and behaviors as their hallmarks.

Is there a Pill for That?

I'll start by admitting something; medications scare me. Not all medications and not in all cases, but many. Perhaps this diminishes my credibility as a psychologist who fancies herself quite scientific, but there are reasons for my atypical stance. Allow me to state for the record that I am not a prescribing physician, and what follows is my opinion, which mostly consists of: "Buyer beware".

 In the years since I have been practicing psychology, I have seen a startling number of serious, damaging reactions to medications. In addition, I have also seen no small number of similarly bad reactions to street drugs. Years of observing and reading have thus led me to a very conservative stance regarding attempts to pharmaceutically solve health problems, both physical and psychological, as well as the ones sitting on the border thereof. Some examples follow, after which I'll provide some details about how I work with my clients in light of my observations.

Is Mental Illness a Myth?

Have I piqued your interest or accidentally insulted you? I did not make this question up. Thinkers and physicians for many years have wondered the same thing. Mental illness is confusing. It is not diagnosed as is physical illness via tests for microbes, probing for damaged or diseased tissue, nor compiling a list of objectively measurable symptoms. Mental illness is diagnosed via a system of symptom clusters published in one or another manual, the contents of which are agreed upon by scholars in the field. The problems arise when the contents of those manuals change over time, because mental issues are not clear-cut diseases as are physical illnesses. Things are added and subtracted over time--but we could not imagine a time when influenza would stop being called a disease!

Science tries, year after year, to isolate specific markers for mental illness. Tests come and go, but the construct remains elusive. We can objectively test for the flu or cancer or diabetes or a broken leg, but we cannot test in a way that never changes, for depression, schizophrenia, or anxiety. This does not mean that you are not suffering with your problem. It only means in this context, that your problem is mislabeled by being lumped in with physical illness. This is important for many reasons. I hope you are still with me as I elucidate why I, and others like me, believe calling mental problems "diseases" hurts those who suffer with them.

The Myth of Mental Illness and the Late, Great Thomas Szasz

For those who know me, you know that I dislike diagnoses. My clients have to specially request a diagnostic code to put in the little box their insurance demands in order to reimburse them. I treat people, not diseases. I treat people, not disorders. I treat people, not symptoms. I work at treating them with respect--respect for the ultimate fact they while I guide a healing process, it is the client who cures herself. Or to use words Dr. Szasz might use, it is the client who solves her own "problem in living".

People come to me with vexing life problems. They have chronic pain that has mystified a handful of competent physicians. They have had anxiety since grade school, and it has now blossomed into panic attacks. They feel depressed and unmotivated. They have failed to lose weight despite having tried a score of conventional means. My job is to look at the individual in front of me, and learn what ails her and how it may have come to be so. I apply a kind of scientific method where I form hypotheses with the help of the individual in my office, and we challenge the hypothesis with a treatment plan--if it works, it was likely true, or at least close enough to true to solve the problem.

Dr. Szasz and I have had our differences on some delicate points--can some of this material I help to discover and interrelate be hidden in the unconscious, and my client not know about it? Can historical events cause strange symptoms today that the client has not chosen as a solution, but rather that seem to have chosen her? Can my client essentially develop symptoms that solve a problem in an unfortunate way that she is consciously, directly, unable to alter? Is there a scientific way to apply psychotherapy? Dr. Szasz was quite clear that the answer to all of these questions was no. I, on the other hand, am clear that the answer is yes.

Those minor differences aside, the legacy of Dr. Thomas Szasz is immeasurable. He championed the human mind. He fought the psychiatric state--the ability of the government to control individuals by means of their mental state. He fought the medicalization of psychology, thus attempting to empower the individual to change himself rather then being at the mercy of a physician. Dr. Szasz did not believe in "helpful coercion" --a phrase that chills the blood. For me, reestablishing or maintaining the power of my client to change is the essence of good therapy.

Center for Conscious Living.......a name with a meaning. I see my task as helping you, the client, my employer, to improve the quality of your life by guiding you to discover and use your personal power to change. Yes, I guide and you do the rest of the work. Sorry, but there is no magic pill. What there is is power--the power you discover to help yourself! The joy of my work comes from seeing clients find and utilize their power and--um--get me off the payroll (not that I would mind if they gratefully paid me forever.....). Stop therapy because you are better, not because you are bored! Contact Dr. Low at the Center via e-mail: drlow@pobox.com, or phone. 630-249-1983. I look forward to hearing from you!