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Health & Fitness

The Pros and Cons of Mental Health Diagnoses

A description of the problem can only go so far in finding a workable solution for it.

As mental health professionals gear up for the new changes to be included in the fifth version of the diagnostic & statistical manual (DSM V), I continue to wrestle with the usefulness of many mental health diagnoses. Mental health diagnoses, unlike traditional medical diagnoses, do not always have clear indicators for a disease. More clearly, when speaking of mental health, we refer to disorders. The DSM is based on observations of behavior and self-reports of a person’s thoughts and feelings. The tests that can be done are subjective to some degree and rely on the client to answer questions about their perceptions of their world. As we know, behaviors and thoughts can change at times for seemingly little reason.  We all carry around with us our own way of moving about our world. Our lenses through which we see are never crystal clear. We have distortions that can cause great difficulties for ourselves and those around us. Often these distortions arise in our youth and continue to alter the lens we see the world through in present time. As we see less clearly, we stumble and lose our way from a clear path of wellness and health.

For children, the lens is still being formed. There is more that can be done to ease some of their difficulties and empower the family to function better. As a therapist with ample experience with children and adolescents, I see the struggle parents face in understanding their child’s difficulties. On the one hand, I have seen many grateful parents who, after being given a diagnosis for their child, can now move forward with helping her in a real and productive way. A diagnosis offers validation; it points the way to appropriate supports to the child and gives a framework for the parents to better understand and cope with their child’s presentation. For these parents, the diagnosis validates their struggle to meet their child’s needs and the pain she is so clearly experiencing. In this case it is hard to consider withholding a label for their experience when it has so many immediate benefits and allows the family to move forward in an empathic, compassionate way.

On the other hand, some families clamor for a diagnosis for their child as an explanation for the child’s failure to appropriately get their needs met and this becomes the endpoint in a conversation that ought to remain open. It can become an excuse for the child's "failings" rather than an explanation of their hurdles and point to ways for them to clear those obstacles and be more successful. For the people working with these families it can be very frustrating. A diagnosis can secure additional services but the responsibility for growth shifts to the point that others – therapists and school staff – are forced to take responsibility and accountability for the child’s difficulties. A sad battle then ensues in which providers attempt to "solve" the challenges for the child and the child is robbed of the opportunity to be successful through their own actions and efforts. The benefit for the child resides in being supported by the adults around him while he figures out a workable solution. 

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What do solutions look like?

A workable solution is one in which the child continues to grow and continues to see improvements in their surroundings. I place emphasis on a child’s relationships as supportive vehicles for further growth. The quality of their relationships, especially with parents/ guardians, should continue to improve. The adults are able to see the child as capable of managing the inevitable difficulties and seeking out support as needed. The child then begins to be more confident in their abilities rather than being pulled down toward hopelessness and a lack of ability to do anything to manage those difficulties. What solutions actually look like is purposefully vague. There is no "one" solution and neither should we define solutions as either/or. In reality, the solutions are limitless. We need to recognize them as potential solutions and be informed of the consequences of each. We all strive to find workable solutions for our problems and these solutions evolve as our understanding of ourselves and our problems evolve. Again, the importance of our relationships comes to the forefront because we need to have workable solutions for both the child and the parent. One of the many goals of childhood is to figure out how to safely meet our own needs and balance them with respect and responsibility for our family and friends. This process is another layer imposed on an already challenging condition

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I typically feel that mental health diagnoses, particularly when applied to children, have more benefit to other therapists than to the clients themselves. Most therapists come to understand what to expect with certain clusters of diagnoses. I think chiefly of labels such as intermittent explosive disorder (IED) and oppositional defiant  disorder (ODD). Even the overly common attention deficit hyperactivity disorder (ADHD) becomes clinical shorthand for a general group of behavioral and cognitive challenges faced by the youngster. In the end, a diagnosis should help to guide a way to better functioning, a roadmap of sorts. 

The real journey exists for the individual. A diagnosis, in this sense, is only as good as its ability to point in a direction towards wellness and stability. With luck, skill and perseverance, it is a road all of us continue to go a little farther on.

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