Thursday, November 15, 2012

Depression, etc.: How important is a diagnosis?

At my second therapy session three-ish years ago - right after Therapy Guy finished my intake questionnaire - I asked him what was wrong with me. I wanted a diagnosis. I'd already done my research and had narrowed down the possibilities, so I was quite prepared to handle whatever answer he gave.

"There is nothing wrong with you," he responded. 

Except that answer.

It pissed me off. A lot. How did he know? Had he lived inside my head for the past two decades? Nope. I knew something was not right. He simply didn't know me well enough. Because if he did, he would surely see that there was something very, very, very wrong.

Now that I am familiar with him and his compassionate, kind nature, I know that what he didn't mean was, You're making all this up. You're just some thirtysomething suburbanite with too much time on her hands, and you don't need to be here. Instead, what he meant was, You are perfectly fine and worthy just as you are - you just don't believe it yet. You may be struggling but you can make your life better. 

For a long time, he would give some version of the "There's nothing wrong with you" statement every time I asked him what my problem was. Even when I brought in journal entries that made me sound insane. Even when I cut myself. Even when I called him really late at night from two time zones away, crying into his voicemail. He always insisted that I was an acceptable person, deserving of concern and care, and that there was nothing innately wrong or bad about me.

Therapy Guy is not a big fan of the psychiatric diagnostic manual. He views it as a collection of symptoms ("experiences," he calls them) packaged in a variety of convenient ways. Patients in the mental health system are typically labeled with one of these "experience packages," even though everyone's set of experiences is unique, and even though the labels are often given for the primary purpose of appeasing insurance providers. That is why Therapy Guy doesn't deal with insurance companies, and why he treats the individual, not a diagnosis. I see what he means: looking at the diagnostic manual, I could probably give myself a whole slew of labels, and yet none of them would really fit exactly what I deal with.

On the other hand, his reluctance to offer a diagnosis has always bothered me a little, and when I finally did receive one from my psychiatrist early this year, it was kind of a relief. I deal with symptoms of depression. I deal with symptoms of PTSD. And while that doesn't mean I equate them with who I am or the change I am capable of, yes, it's really nice to have a framework of reference from which to work. (I now realize that Therapy Guy was already working within that general framework, so it's not as if I was totally off track in terms of trying to get better.) My psychiatrist's choice of antidepressant - Zoloft - was based on research indicating that it is effective for PTSD. That's why she picked it as a starting point for me. Pharmaceutically, it gave us a place to begin.

Moreover, it's nice to feel that I am not alone. When I hear someone say that they struggle with depression or PTSD, I know that even though our experiences aren't exactly the same, we share some common ground. I can relate to the challenge. It's comforting. The label - while limiting in some ways, and inadequate - creates a sense of community, and for people like me who often feel isolated and different, that sense of community is meaningful to me.

The important thing to realize about mental health diagnoses (as with many physical health diagnoses) is that they aren't necessarily permanent. Mental health is a fluid thing, and our personal choices play a big role in it. Most psychiatric conditions are treatable. Doesn't mean treatment is easy, but it's possible. So even though I was diagnosed with PTSD in February, I may not always have PTSD (there are many, many excellent treatments for PTSD; with enough time and support, people do recover). And even though I may have a genetic predisposition to depression, I may be able - with help and vigilance - to avoid the worst relapses. 

As Therapy Guy likes to say, People have an immense capacity for change.

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