What Are Diagnoses For?
I remember early on in my education hearing that diagnosing was not as important as maybe the general public might believe. So then you hear cases where someone Googles their symptoms and determines they meet some criteria for some condition and they start saying that is what they have. So how do we as therapists reconcile that?
One part of the debate is whether or not we, as therapists, should use a medical model to our treatment approach. What this means is are we looking at clusters of symptoms and assuming that everyone with this cluster meets this diagnosis? And if we are, then I can take someone that says “Oh I have major depressive disorder” and infer precisely what their symptoms could. Has good predictive validity, to use a fancy research term, no? And maybe we’re getting our predictions right most of the time. So what is the problem with that model?
Well, several therapists feel as though that model goes in the face of what psychotherapy can be as a holistic treatment. If we focus too much on symptoms, then do we end up missing some existential journey to finding purpose or do we look over them as valuable persons? And don’t get me wrong, several people have reason to stand by both of these remarks. It has been the case that individuals perceived their healthcare professionals have focused too much on their symptoms and not listened. So when it comes to us as therapists, how should we focus on diagnosing? And the bigger question, is why should the general public care how we diagnose??
I’ll give three cases where I believe diagnoses can be beneficial to professionals and the public alike. And I believe each of these can be true whether your healthcare professional uses a medical model or a humanistic approach:
1. Diagnosis gives a common language and a common people group. So now we are talking about what having a diagnosis can do for how you relate to others in similar cases. Of course it is tremendous to have others around to support you. But more than that, knowing what community to look for (i.e., a postpartum depression group) gives you access to not only the unique experiences of those around you, but it puts you in the vicinity of those that are likely to going to empathize with you. And more than that, it can give you the chance that they offer an incredibly insightful take on your situation.
2. Diagnosis gives access. Whether you need a diagnosis for school accommodations or you need to have a diagnosis in order to get an emotional support animal, these descriptions hold validity – and for good reason. They say you have a unique take to how you operate that should not be discouraged or shamed, but embraced by making equitable adjustments to everyday demands.
3. Diagnoses advocate for you. This last one is my own take, and albeit an odd description, is one I love. Otto Kernberg, psychoanalyst and psychiatrist, was once reported saying ‘Diagnoses are for the analyst’s anxieties’ (source unknown). Perhaps what he meant by this is that we, as therapists/analysts, encounter people every day that require our help. And that help entails a certain expertise into the human psyche, human condition, and fundamentals of how the psyche heals itself all while listening intently to how our patients navigate their minds. And so, we hear conflicting emotions, thoughts, and beliefs as patients attempt to make sense of their minds. So when we hear something as a symptom, perhaps me giving you a diagnosis is really just to let me know to expect a, b, c to show up as I’m relating to you. Perhaps diagnosing just helps me manage my own mind and curiosity as I get to know you as a human being. And so while it is important, it is not the end-all-be-all. Instead, it gives credence for how your mind is working right now. And that is what I mean by diagnoses advocate for patients – they become a useful metric for me to embrace so that I can better relate to you in sessions.
I hope that these perspectives are helpful in you finding what treatment is best for you. Of course, feel free to reach out if you ever have any questions about these. One of my passions is to conduct research that expands on our ability conceptualize symptoms, right now in the arena of posttraumatic stress disorder (PTSD).
For more resources that take a critical lens to what we mean by diagnosing and symptoms, I invite you to look at these two books:
1) The WEIRDest People in the World: How the West Became Psychologically Peculiar and Particularly Prosperous by Joseph Henrich (2020) (The acronym WEIRD stands for White, Educated, Industrial, Rich, and Democratic)
2) Crazy Like Us: The Globalization of the American Psyche by Ethan Watters (2010)
A Thoughtful New Year Goal
New Year’s always gives us an opportunity to reflect and imagine what we want to be different. And it offers a bit of hope, right? The optimistic spirit, the celebrations and traditions, and the camaraderie from everyone else having the same perspective. In fact, I’d say New Year’s might be one of the few times in which people are that collectively optimistic.
When looking at what you want to be different, I want you to think about that perspective and belief in yourself. Many of us have experienced that high for the start of January and the somewhat-quick decline as we set into our new routine. Ironically, and perhaps sadly enough, we may even preface a change in behavior that’s occurring at the beginning of the year with that it’s not a resolution. Why do we do that? Surely that comes from somewhere, but it also squashes the hopeful environment the New Year affords us. So, how do we set goals that help you believe in yourself?
Well, we know from research that if you set too high and specific of a goal, and someone fails it, their emotional tone (affect), motivation, and self-esteem take a hit. And those three are reportedly key values one needs to make lasting change (Höpfner & Keith, 2021). Therapists know from our training that one of the best approaches to changing behavior is through SMART goals. These stand for
Specific,
Measurable,
Achievable,
Relevant, and
Time-bound.
My hope is that by using this model for goal-setting, you can think about the New Year in a fresh way. Let these goals be something that already align with your normal self and those parts of you you’ve already seen the value in changing. There’s a sense of humility in this model and I want you to take that to heart. If not so as to not squash the hopeful feeling this time of year, but to encourage a constant stance of reflecting on your goals. Make them ones that encourage further change, that build up momentum, and don’t let them run away from you.
Happy New Year and I look forward to your hearing about your journey.
-Jeremy Cooper, LPC
December 29th, 2022