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.

Hello, Ashland

Goodbye to Bend and all the great people, clients, professionals, and friends and acquaintances, I met and helped or was helped by. It is time to move on, though. While we felt as if, after 3 growing seasons, we had finally mastered small greenhouse gardening in an  inhospitable climate with no soil,  what we really wanted was a place to grow food and watch nature thrive.

Hello Ashland! Up here in the woods, amazingly only 15 minutes from town, clients will be invited to see me in a private space, with the sounds of nature to add to the ambiance. It was gratifying to see our garden immediately begin to thrive as it never had in Bend, and I know the beautiful environment will enhance the healing that occurs for my clients. In-person sessions will begin Sept. 1 in this new space.

I also welcome intensive clients starting Sept. 1: Medford is 30 minutes away and Ashland less than 15, and both have a variety of hotels, motels, B&Bs, and hostels, as well as a fine selection of eateries and groceries. We are 30 minutes from the Medford airport. While a therapy intensive is hardly a vacation, traveling to a beautiful spot far from your daily environment offers a unique opportunity to break old patterns and create new ones. Follow-up in person or via video-chat assists you in maintaining your new learnings in your home environment. 

It has been stressful to move many miles for the second time in 2 years, and perhaps I have learned some new things about managing stress and the ways in which change affects me and others as well. Stress is always both good and bad: it forces new ways of seeing things and behaving, but it can cause strain on the system. Moving changes one's relationship to others, to resources, and to oneself. Out with the old, in with the new, to coin a phrase!

The new incarnation of the Center for Conscious Living will offer individual and family therapy, Rational Emotive Therapy, which is the elegant, effective precursor to CBT,  Sensorimotor Trauma Therapy, and clinical hypnosis. I will continue to focus on physical symptoms that bridge the mind-body gap such as gut issues (irritable bowel, cyclic vomiting), headache (migraine, cluster headache), and chronic pain (RSD, CRPS 1, fibromyalgia); those difficult-to-treat issues that often defy medical treatment. Call for a free phone consultation.

Meanwhile, I shall be learning about my new environment and preparing a new space for seeing clients.

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.

When should you see a psychologist for a physical illness?

I have been writing on the topic of mind/body medicine for over 20 years, and I continue to learn and be amazed by the human mind/brain. Long years ago, a brilliant scholar named Ernest Rossi began to write about hypnosis and neuroplasticity. He was, of course, not alone in this, but he was my first formal contact with the fascinating world of brain changing body. Despite my psychological training, I began to see the mindbody connection everywhere. A client with diabetes who suffered from severe psychological distress after an amputation presented with uncontrollable vomiting and raging fevers rather than diagnosible psychological problems. People with intransigent chronic pain ran from doctor to doctor and were accused of faking or drug-seeking, but with good psychological exploration and insight, their trauma could be found and they could heal themselves. Clients with autoimmune disorders such as rheumatoid arthritis and multiple sclerosis found improvement, often dramatic, with the application of psychological techniques. A client who had attempted suicide with a .38 to the head showed NO brain damage on MRI, demonstrated no physical disabilities from the shot, but had significant amnesia for his entire life prior to the incident! The amnesia remitted with psychological treatment.

These extreme examples of the intricate mindbody connection led me to view my clients with a much more open mind. Things I had diligently learned in graduate school held less sway versus the real experiences of my clients. Medications did not appear to work miracles despite being used in ways even our textbooks said were dangerous. Diagnostic criteria and diagnosible disorders from the _DSM_ changed over time, which confused me if those listed problems were diseases. Does the definition of influenza or diabetes change with each new edition of a manual? Do they sometimes disappear from the text? And despite modern times labeling many problems as diseases in what appeared to be both an attempt to put them in the bailiwick of physicians and to remove the stigma of causality from patients and their families, suffering seemed to be getting worse, not better, and reliance on medications increasing as well. Additionally, the number of clients coming to me already taking three or more psychoactive medications appalled me. Why, after all, were they still suffering if these medications work? I began to wonder about many things I had been taught and to question common treatment practices of people seeking mental health treatment as well as physical medical treatment.

Whose Pain Is It?

Having recently arrived in Oregon, studied diligently for (and yes, passed) my ethics exam, and at long last, received my license, I had a few months in which to explore the clinical issues prevalent in my new environment. Chronic pain kept popping up in conversation, sometimes right after "oh, you do hypnosis," and sometimes before.

What I gleaned from my participation in clinical groups and meetings was that the chronic pain treatment pendulum has swung once more. In short, and without citation: Long ago, MDs prescribed heavy doses of medication for pain patients, chronic or acute. The pendulum then swung to a fear of creating addicts. This was not entirely unfounded, as overprescribing of serious pain medication was rampant, and addiction was up. (When my children left a dentist with Vicodin for the removal of wisdom teeth, I knew something was not right). So docs lived in fear of government repercussions for overprescribing, and, as with most pendulums, now it had swung too far, and even deathly ill patients were constrained from receiving comfort, by over-regulation. Back it went, and back came too many addicted patients along with, guess what? too much chronic pain.

Flexible Bodies, Flexible Minds, Guest post by Julie Francis

Emotions are expressed through your body as a series of muscular contractions. When emotional states become chronic, your body learns that the corresponding contractions are "normal". In other words, the muscles develop a habit of contraction that equate to an emotional state. When this happens, it becomes difficult to tell if your emotional state is caused by an actual event or if it is the remnant of muscular contractions leftover from an habitual pattern learned during a time of significant stress. And, it's not just your emotions that are involved. When muscles are chronically contracted, they affect everything from digestion to posture to back pain. The same muscles that help you stand up are involved in breathing and digestion. When they are tightly held, your body can't function as it was designed to, and you start to develop symptoms of dis-ease -- headache, indigestion, low back pain, etc., etc. Working with a clinical psychologist can be extraordinarily helpful in identifying the cause of symptoms and in clearing the way for new healthier choices. To move things along more quickly, it can be very helpful to approach issues from a body perspective as well.

That's where the Feldenkrais Method® comes it. It is a powerful neuromuscular approach that uses gentle movement and touch to help your brain relearn its responses to life. As Dr. Low helps you to become aware of and shift your responses and reactions, I help you become aware of your movement patterns so you can get out of the movement rut you are stuck in. As your movement patterns change, you learn to let go of the excess contractions; movements become more supple, balance improves, and your muscles re-learn the ease and flexibility you were born with. Together we work to teach your nervous system (which includes your brain) that it has choices and help you get back on track to health and comfort.

Julie Francis is a Guild Certified Feldenkrais Practitioner and Assistant Trainer of the Method. She maintains an office in Glen Ellyn and is now in her 21st year of helping people learn to shift unhelpful patterns of moving and being. To learn more about the Feldenkrais Method® and Julie Francis, check out www.Optionsforease.com.

Vexing Illnesses!

I am just back from presenting at the American Society of Clinical Hypnosis Annual Meeting with my colleagues, Julie H. Francis, GCFP, and David C Flemming, MD. We presented our fascinating workshop on uncovering the reasons for puzzling medical problems such as intractable chronic pain, migraine, IBS, interstitial cystitis, and autoimmune disease. The blanket term I use for these problems is "medical disorders of dysregulation."

These illnesses are vexing to physicians because they do not follow the rules. Medications tend not to work, there is no surgery that fixes them, and even the cause is elusive.

These problems are even more vexing to those of you suffering with such a condition for those same reasons. No one seems to be able to help. Now and then something seems as if it is helping and then you are let down when your symptoms return.

The work I have done in my office, and the work I have shared with various colleagues, leads to some interesting conclusions with the potential to help many of you. First and foremost, we know that you are not pretending, faking, or, worse, crazy. You have symptoms, some of which are visible or measurable, others of which are subjective--you hurt, but it cannot be seen by others.

Trauma, Pain, and the Freeze

I get many questions about the link between pain and trauma.......for a start, chronic progressive pain syndromes like "complex regional pain syndrome type I" (formerly known as "RSD") have their basis, not in organic injury (though they often start with an injury), but in the flight, fight, freeze syndrome. In a moment of shock or fear, the system goes into auto-pilot and cuts off certain self-healing behaviors to assure safety. Sometimes, even after the injury heals and the moment of fear (auto accident, fall down the stairs, etc.) is over, the brain does not kick into recovery mode, and continues to perceive the limb as injured. We call this dissociation--in this case a divergence between perception and reality causing faulty operation of a system. This has the effect of rendering medication, surgery, and physical therapy ineffective (sometimes even harmful), as the key to healing is actually changing the perception! The freeze mode is an endorphergically charged pattern, which prevents even the strongest pain medications from breaking through, and represents wild oscillations of the autonomic nervous system, which can cause anxiety, insomnia, digestive difficulties, memory and concentration deficits, and, of course, PAIN. The key is in the brain--getting the perceptions in line with reality and exiting the freeze. RSD? Call for more information--you can learn to feel well!