Incorrect Diagnosis

Through higher education, via television and print media, and in direct application in practice, psychology and psychiatry have disseminated a misleading understanding of diagnosis to the public. The notion that most people, from the least to the most highly educated, have is that the key element in understanding and treating psychological problems is by attaching a concrete diagnostic label that essentially “defines” the problem, and, in practice, then determines the correct pharmaceutical “solution” to the problem. An important consequence of this diagnostic labeling is that a great many people walk around defining themselves by diagnostic labels they’ve been given by someone: a family doctor, a psychiatrist, a counselor at school. “I’m bi-polar,” a student tells me, as though this were the most salient fact I could know, as though it explains everything about the student. When asked to turn off a cell phone or close down a laptop during class, another student says, “I’m ADHD,” as though no further justification were necessary.

It’s now nearly half a century since the “medical model,” — the model that analogizes psychological problems with physical ailments — was severely criticized as fundamentally flawed and detrimentally misleading. It isn’t that these arguments were effectively refuted. It is still evident that terms and implications drawn from this model are misplaced when applied to problems in living. Making active healthy choices, while relevant in medicine are generally secondary to medicines that affect diseases directly, such as antibiotics for infections, while they are often primary in psychological areas. Even the most ardent supporters of pharmaceutical approaches rarely dare call psychoactive drugs “cures.” Etiology – the process of seeking the direct cause of a medical ailment – is a far different matter when applied to human problems as relations of cause to effect are far more complex than determining that a person has been exposed to a particular.

Rather than refuting the argument that the medical model is misapplied when extended to problems in living, the medical model has dominated largely through the mechanism of insurance companies insisting diagnoses as a condition of payment, their success in requiring endless paperwork and denying payment for psychotherapy beyond a few sessions; and the pharmaceutical industry’s brilliant capacity to produce a chemical concoction to match every diagnosis.

There’s no denying that some psychoactive drugs help some of the people some of the time and only sometimes have horrendous side-effects. The problem isn’t the use of the drugs themselves, although the price tag is enormous, but the psychological “side-effect.” Chief among these is that the use of pharmaceuticals and diagnostic labeling as the primary tools is that they increase the tendency for people to externalize their problems, the tendency to see their problems as beyond their own control, their own choice. While there’s nothing wrong with alleviating the guilt of most therapy clients have about their difficulty, helping them to see that they have come by their problems through a variety of factors, many of which they don’t control (e.g. being raised in abusive environments), part of what most good therapists do is to help patients see that they need to be very actively engaged in changing the patterns that are causing their misery. The pharmaceutical solution along with the psycho-chemical explanation of problems directly undermines helping people take responsibility for improving their personalities, their relationships, their lives.

Explaining problems as chemical imbalances with pharmacological solutions undermines a thorough exploration of the quality of a people’s relationships, their ability to connect to another person and their ability to let go. At its best, psychotherapy explores the impediments to intimacy and the clients roles in improving their relationships. What does the client understand or fail to understand about passion, about feeling able to share one’s deepest feelings, about feeling understood by another or others, about personal integrity and self-respect. Is one miserably alone? Desperately dependent? Hopelessly inadequate? Suffocated and claustrophobic? How can one become excitedly connected? Comfortable in one’s own skin? Willing to extend beyond one’s current limitations to achieve a richer, fuller life?

Psychotherapy has never been a simple matter. The ability to attract and hold clients has never had a perfect correlation with actually helping them lead better lives. Many therapists, with or without formal training, manage their clients dependencies to keep them as paying customers more effectively than they help them to lead better lives. No clear and direct solution has yet been evolved to evaluate the “success” of a particular course of therapy and it must be admitted that some therapists are either unscrupulous or self-deluding in offering “treatment” that does not truly benefit their clients. But these deficits do not justify giving up on trying to learn how to help people through talking with them, nor, moreover, on trying to understand the human condition, particularly when it’s going awry.

Essays on creativity, community, social change, and the search for meaning