Diagnosis and Symptoms: How helpful are they?
Our culture has really done an amazing job at reducing social stigma around psychological issues. Unfortunately, in that process, we have somehow traded out stigma for a medicalized, symptom-focused, shallow understanding of ourselves and our mental health. On the positive side, you won’t get a scarlet letter for a mental health challenge these days. On the negative side, people are spending way too much time in and out of therapy as they work to extinguish symptoms rather than unearth the personality and relational dynamics that fuel the presence of those symptoms. Let us explain.
As things have progressed, what use to be technical, diagnostic psychological language has become common parlance. As always, solutions breed new problems. Today, people have lost their sense of agency and uniqueness when it comes to addressing mental health issues. They see themselves as struck with an illness, burdened by a force bearing down on them, with a name like OCD, ADD, GAD, MDD, PTSD (etc). Diagnosis provides a categorical label for a cluster of symptoms that people frequently experience. However, symptoms are not descriptive of the meaning, causes, and biopsychosocial elements fueling their existence. Looked at in this way they are symptoms without a story of how they came to be.
In other words, people now struggle to connect the acronym to the rest of their life and lived experience. Conceptualizing our symptoms/issues as imposed upon us and purely biological seems exonerate us and our loved ones from responsibility and circumvents any shame we might experience. It also circumvents shame. In giving up any responsibility in creating our mental health we also forfeit a necessary sense of agency needed to make change and get better. Compounding the issue, the medical model has been forced upon psychology and psychological science. It is not a good fit. Therapy is good to be informed by science but when conducted like science is a recipe for failure. Things are infinitely more complex in human psychology and manualized, uniform approaches don’t provide the best outcomes. In many ways, just as a doctor wouldn’t equate treating a fever with treating the underlying condition, we don’t believe that aiming for relief of immediate symptoms means relief from the underlying condition.
In a recent article Gabor Mate, MD a renowned psychiatrist stated “We tend to see peoples illnesses as as isolated, accidental, and unfortunate events rather than the outcomes of lives lied in a psychological and social context; illness is the body’s expression of experiences, beliefs, and lifelong patterns of relating to the self and to the world.”
How focusing on diagnosis can impact therapy
As a result, people sometimes come in demanding specific treatment plans, expected graduation dates, and want to be loaded with techniques they can easily find on google. A diagnostic label is good for the medical model but not for symptoms that emerge from complex human life and experience. Self-diagnosis has also become increasingly popular. Frequently, people enter treatment believing that they are suffering from a particular disorder but it rarely turns out that the initially reported disorder is the only focus of clinical attention.
A caveat to this position is with psychiatrists and prescribing medications because these physicians are, in fact, treating symptoms directly. Psychotherapy would be at times impossible without the help of the stabilizing medications psychiatrists prescribe (e.g. bipolar disorder, severe depression, schizophrenia, and similar in severity). The utility of diagnosis is more obvious in approaching mental health from a biological, symptom-focused position and needing a quick frame of reference to select the appropriate medication class. Discrete categories work well to help physicians prescribe more accurately based upon symptoms, because in effect, this is all they are trying to remedy unless they have more time with patients.
Nancy McWilliams, a renowned psychoanalytic psychologist, drove this point home in a recent scientific journal, “One answer may be that viewing psychological suffering as a set of disorders that can be fixed or improved chemically can easily invite the obverse assumption that those painful experiences are ultimately caused by random or genetically based chemical differences among individuals. This a false conclusion, of course, something like saying that because marijuana improves appetite, the cause of low appetite is lack of marijuana. But it is nevertheless a frequent leap of logic – in the thinking of nonprofessionals and of some professionals as well – to ascribe much severe psychological suffering to a “chemical imbalance.” Such a construction tempts us to ignore all the painful other sources of psychological suffering, such as poverty, neglect, trauma, and the myriad ways in which human beings can injure each other psychologically.” (McWilliams, 2021)
“…It use to be that a socially avoidant woman would come for therapy saying something like, “I’m a painfully shy person, and I need help learning how to deal better with people in social situations.” Now a person with that concern is likely to tell me that she “has” social phobia – as if an alien affliction has invaded her otherwise problem-free subjective life. People talk about themselves in acronyms oddly dissociated from their lived experience: “my OCD”, “my eating disorder”, “My bipolar.” There is an odd estrangement from one’s sense of an agentic self, including one’s own behavior, body, emotional and spiritual life, and felt suffering, and consequently one’s possibilities for solving a problem. There is a passive quality in many individuals currently seeking therapy, as if they feel that the prototype for making an internal psychological change is to describe their symptoms to an expert and wait to be told what medicine to take, what exercises to do, or what self-help manual to read.” (McWilliams, 2021)
How we work with diagnosis
How does this translate into our approach? First, we will provide a comprehensive explanation of the issues you are facing, no simple one word answers or acronyms. We will provide and honor your diagnosis but we will not focus on it as a problem to be solved in and of itself. We will help you become symptom free through a meaningful understanding of yourself, finding a new way of experiencing your feelings, and connecting the dots of your life and relationships in a way you haven’t before. It is our shared responsibility not to simply focus on symptoms of psychological pain but more the larger issues that have driven you into treatment at this time. We feel it is our responsibility to provide more than temporary relief. Our goal is to use diagnosis in such a way that it allows us to target root issues and dynamics that provide lasting change. By focusing on improving overall psychological functioning your symptoms will naturally lift. Consequently, symptoms may even get worse for a short period of time before overall psychological health improves dramatically. This is a common understanding amongst seasoned therapists.
In our group, expect to be seen as a whole, full person, with agency, who is currently facing challenges not a cluster of symptoms. By honoring your personality, experiences, relational and social factors as the context of your psychological ailments you not only get better faster but learn, grow, and become more psychological deep and robust in the process. Therapy of this style tends to inoculate you against future psychological difficulties too. People often share they connect, relate, and experience the world in different ways as a result of a psychodynamic approach. Because we don’t focus solely on symptom patterns and diagnosis, we also don’t apply a one-size-fits-all manualized approach. Research shows that approaches like this tend to have poorer outcomes (Truijens et al., 2019). This philosophy and approach are one reason we believe our patients make such amazing progress.
If you are looking for a deeper and more thorough explanation of your diagnosis or searching for a psychologist who can help you really work through the issues you are facing then you have made it to the right place. Feel free to call or text us anytime, we would be happy to answer any questions you might have and get you scheduled for a first session in our group.