Patients invariably want to know what diagnosis I’ve given them or the papers from somewhere else say they’ve been given. Some don’t ask. Many do. To those who do I’m really, really tempted to say, “What’s it to ya?” but I’d just be dismissed as being flip or, even worse, that I’m with holding some secret that will help do something, though I’m not sure what. Most of the time patients don’t know what that information is going to help either. I do tell patients that I’ll tell them but first I’d like to know what having that information is going to do for them. Most of the time the answer is something vague, like, “I just want to know what you’re writing about me,” or “I want to know what I’ve got.”
I know, you’re looking for an answer. You want to be told you’ve got Bi-Polar Disorder or Schizophrenia, or something, anything, as long as it has a name. Giving your condition a name explains what you have and then explains a course of treatment, right? That’s how it works when you go to the doctor. He says you’ve got Bronchitis, you take this prescription for antibiotic to the pharmacy, take a pill x number of times a day for y number of days and “you should feel better. If not, call me. Be sure to take all the pills.” OK, the doctor doesn’t say most of that, it’s written on the bottle the pills come in but it’s doctor (some doctor) who tells the druggist to put those labels on the bottle.
OK – you don’t really want to know you’ve been diagnosed with Schizophrenia or Bi-Polar Disorder because those are serious problems. So how about some depression or anxiety? Better? OK. Still, what does that tell you? There are clinical interpretations of those two words but I don’t really think that’s what you’re looking for because: there’s no antibiotic that you take for y number of days and it goes away. Medication can bring some relief, or so the pharmaceutical companies claim (more on that another time – I’m not anti-medication, just anti-miracle drug,) psychotherapy/psychoanalysis can bring some relief, the combination of psychotherapy/psychoanalysis and medication can bring more relief but, if you want real relief from what’s troublin’ ya (“What’s the matter bunkie? You say your brother hid your homework in the washing machine and now you algebra stuff is all over your underwear and the teacher is asking you to hand it in….”) you’ve got to change the things that are causing the condition, because that’s what your condition is a reaction to and a defense against.
We diagnose across five Axes (that’s acksees, not the things that have strings and make music), I-Clinical Disorders; Other Disorders That May Be a Focus of Clinical Attention II. Personality Disorders; Mental Retardation III – General Medical Conditions IV – Psychosocial and Environmental Problems and V – Global Assessment of Functioning.
When you ask me what is your diagnosis you’re usually asking me for the top item on the list. I hesitate to tell you because it doesn’t tell you anything about what’s going on. It barely tells me what’s going on. What it tells me is that your symptoms, your reactions to your General Medical Condition added to your Psychosocial and Environmental Problems, have been given this or that name and number by the taxonomists who need to track these things for statistical and other informational purposes, like whether you can have coverage under the new parity law or not (another post another time.) Same thing about Axis II except that’s more pervasive, more of a character style, than just a bunch of symptoms.
What you’d be asking if you knew what to ask is what do I see as the things that are pushing and pulling on you that are causing you to be this way. You’d be asking me ” How do I increase my GAF (Global Assessment of Functioning) so I can _____ (insert desired result here.)
Doesn’t matter. I’m still going to hear “What’s my diagnosis” or its variant “I took a test (looked it up, whatever) online. I’ve got this. Do you agree?”
I don’t know. Please tell me more about it.
I was really angry when my therapist didnt give me my diagnosis. but i tend to keep anger to myself. I asked him what he puts on my insurance code – i ddint want to be direct but i hoped that he would tell me what my diagnosis is. He said adjustment disorder. Which is all good but I was expecting that he would tell me a diagnosis. I guess I just want to know whats wrong with me. Maybe then I wouldn’t be so confused about why im so messed up up. I was furious. Do they know or do they just not want to tell you? Its very confusing. I tend not to show my anger or to confront.
Anonymous,
Thank you for your reply. I’m not sure what you mean by “…he would tell me what my diagnosis is.” Adjustment Disorder is a diagnosis but to the average person it really doesn’t mean a whole lot or brings up an image that’s unpleasant.
The problem with “diagnosis” is not that we don’t know. The problem with “diagnosis” is that, unlike medical problems, having a name to something doesn’t indicate a definite course of treatment that leads to a cure (or says the condition is chronic, etc.) The diagnosis of “Adjustment Disorder” is exactly what you asked him for: What he tells the insurance company based on what he sees as the behaviors/symptoms you manifest and matched against the differential diagnoses contained in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (the DSM-IV.)
The reason I say that this is a problem is that the diagnosis isn’t you. It’s not even exactly how your particular difficulty with the world plays out in your day-to-day life, and certainly doesn’t describe what the course of cure is. We can’t say that “two weeks of this pill will wipe out the infection” or anything like that.
I’m sure this sounds evasive. It’s not meant to. I have a client who reminds me (weekly) that psychotherapy is an imprecise science (he actually says it’s not a science because it can’t stand up to rigorous scientific method.) I don’t disagree. The “diagnosis” of what’s “wrong” with you is what you tell us is your difficulty in your interface with the world (and there’s nothing “wrong” with you, it’s just a rough spot that gives you discomfort & difficulty.) The “medical diagnosis” is jargon that allows us to communicate succinctly, but not totally accurately, with other clinicians and your insurance company.
Having a name to a problem is not always the road to the cure. Knowing where the difficulty lies and what roads lead to easing the difficulty is more important than what to call it.
I hope that helps & doesn’t seem too much like trying to muddy the waters.
Peace through plain talk & clear understanding,
Jay