Sunday, May 20, 2012

Time to Heal: Developmental and Medical Models of Service

Ty Cobb was once asked to describe baseball.  After a moment's pause he said "It's something like a war."  There is something like a war occurring in professional mental health communities, most recently rekindled through the debates on the development of the DSM-V, a diagnostic manual.  See a Scientific American blog series on this issue for more information.  This war has many facets, from economic if not downright mercenary (involving the coding of disorders and therefore billing of encounters), to treatment - given connections to the pharmaceutical industry, to, perhaps most broadly, a starkly contrasting view of human beings and their problems.  In this humble writer's view, nowhere is this contrast more palpable or consequential than in college mental health settings.

Late adolescents and early adults exist in the throes of a volatile period of human development.  As I have mentioned in previous posts, their psyches are roiling with energy, literally bubbling over as they experiment with identity in their search to find authenticity and manifest the real self in the world.  Anyone who remembers those years can resonate with this time marked by fear, various forms of aggression, behavioral instability, relationship turmoil, and academic or career missteps.  This volatility is quite simply inherent in, and in fact necessary to, their growth.  And as any parent knows, it takes a lot of patience for outsiders to see this process through, to support but also avoid negatively contaminating it in some way.  Contaminating development can send youth off onto an unintended and unneeded life trajectory, and this may be quite harmful indeed.  Forces which discourage or abort patience in work with youth stoke the flames of warfare between developmentally- and medically-oriented disciplines.

To address any temptation toward dichotomous thinking or polarization, which seems so rife in society today, let me be clear.  Medicine as a thoughtful profession and considered practice is a wonderful thing, capable of using its many massive powers to alleviate human suffering and facilitate human growth.  No one in their right mind can rationally argue otherwise.  But any thoughtless or unconsidered practice is capable of great harm, no matter the profession.

Recently, the former chair of the DSM-IV Task Force, Allen Francis, who is himself a physician, wrote a brief essay on the harm caused by misdiagnosing and mislabeling.  He counsels us to use caution and patience in this process, a very wise statement indeed.  Unfortunately, those individuals and entities who stand to make a great deal of money from the industry are working in the opposite direction.  Their apparent purpose is to transform medicine's grand promise into a ghastly and speedy intervention delivery system, which may result in incorrectly pathologizing, hospitalizing and/or medicating consumers.  Or worse.  In a rather breathtaking development, one vendor is advocating for the utilization of instruments to render diagnoses in three minutes, and reducing one's mental health status to a single number!

Given the complexities of college student life and development, I simply don't know how anyone, with any tool or level of experience, can accurately diagnose youth in three minutes.  Or in 10 to 15 minutes, the average duration of many medical encounters.  It takes time to understand the bubbling psyches of young and old alike.  Susie and Johnnie may meet "the criteria" others establish for disorder X, but that may not in any but the most cursory way capture the essence of what is happening with them.  This hypothesis does not compute in those who want fast and efficient delivery of products.  Susie may be caught in a cycle of fear and anger based in years of psychological torment in family dynamics, which she cannot even articulate in hours and hours of encounters.  Johnnie may have difficulty focusing due to years of exposure to video games and substance use, the latter of which he hides from others, and the anger he feels toward his father who abandoned him.

Susie and Johnnie deserve our time and attention, our best effort in creating environments which encourage them to tell their stories and be healed.  Let's support and fund those that provide such environments.