What’s the point?

From the time I first studied psychology as an undergraduate, I recall four things vividly. Likely the last to actually happen is the one that stands out most. I was ready to declare my psychology major at the end of my sophomore year when a professor told me in class that I could not be a psychologist because of my personality disorder. In 1968 I was out as a gay man at the University. Though it took an additional two decades, I proved him wrong when I earned my PhD and license to practice.

Scan_20150221 (7)There was also the psychological study in which I participated earlier in my sophomore year. I later found that it was supposed to measure frustration in a rigged card-sort activity. I vaguely recall having said the word shit a few times in that experiment. Again, it was at least two decades later before I understood shit to be considered swearing.

Then there was the time that I was sure that I had every single disorder described in our text, until a classmate told me that my belief was diagnostic of two things: anxiety and narcissism.

But perhaps the recollection that I have been having most recently is from the class in which we discussed diagnosis. I recall the room in which the class was held, the gender of the teaching assistant, and the approximate location of the desk at which I was seated. I learned that diagnosis was meant to name a disorder so that we could describe etiology, usual symptoms, course of the disorder if untreated, promising treatments, and best outcomes.

I have noticed that the meaning of diagnosis, in mental health at least, seems to have shifted since that class more than 45 years ago. It appears to me that more often than not it is used to explain our medications, functional limits, and lowered expectations. Even though the Substance Abuse and Mental Health Services Administration has repeatedly in the past five years called for us to expect cures for mental disorders – and then aim for them – we seem to be slipping further and further away from that notion of restored health and functioning.

I have also noticed the common use of the expressions OCD, panic attack, depression, bipolar disorder, and ADHD by people who have not seen a licensed clinician to make a qualified diagnosis.

Who profits from this?

4 thoughts on “What’s the point?

  1. I think sometimes people are sloppy in their self-diagnoses… If someone has trouble concentrating they think they ADHD… If someone is really clean and orderly we used to say they were “anal” and I remember saying that as a child… Now we say, “I’m really OCD.” At any rate, I think people have a general misunderstanding about different disorders and therefore apply it to themselves. When I was diagnosed with OCD, it was because my psychologist noted that it was affecting my health, my family/friend relationships, and/or my work… I was having problems with all three. To this day, i use that as a benchmark.. If something is affecting health, work, or relationships, I take note. I don’t necessarily run to the psychologist, but I note that something is off.

    Liked by 1 person

    • I am laughing about the notion of child describing himself as “anal.” This Freudian hangover points to the limited utility of diagnosis. We end up developing a view of ourselves as somehow flawed instead of remarkably resourceful in picking up tools to help cope with the stressors of life. I think your example of using the diagnosis as a benchmark to consider the limiting aspects of our survival techniques is an important one. Our problems persist until they are addressed, but at times the best we can figure out is how to avoid them — not resolve them.

      Liked by 1 person

  2. I recall an actual clinician–not an academician–exhorting us psychopathology undergrads in the mid-70s to consider whether we were observing normal behavior in an abnormal environment or vice-versa. Perhaps it is merely the foreshortening derived of an extended perspective, but in regards to both behavior and the environment I don’t think we are in Kansas anymore, Toto.

    Liked by 1 person

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