Saturday, July 30, 2016

Behind the Magnifying Glass: Categorizing Vast Human Experience

Current models of diagnostic systems are woefully imprecise. But their use continues and is embedded in the economics of mental health care. One is not paid or reimbursed for the cost of services by an insurance company without a DSM-5 diagnosis, even though there is wide acknowledgement of its shortcomings. The coin of the realm is depending on runes. Even the NIMH has changed its reliance on the DSM-5 in funded research projects, and has begun looking elsewhere for diagnostic constructs. Incidentally, as of this writing the United States is the only country not mainly relying on the ICD-10 for its diagnostic rubrics, though that may change soon. One wonders what this says about America.

This has thrust the discipline of psychiatry into some disarray; it is after all the author of the DSM-5. But it is not alone. All mental health professionals are flummoxed when they try to reconcile the height, width, and depth of human problems with rigid, confining, and just plain silly diagnostic tools. The situation results in working with folks who technically "meet criteria" for a disorder but don't have it, and vice versa. It also means that some folks have a disorder but do not resemble each other in the least, except for a handful of "criteria".

It is even the case that many who "have" common disorders such as depression, anxiety, and substance abuse, may need no "treatment" at all. A great many such persons have issues which remit on their own, and to a greater degree than those who were in treatment! This must partly be because we may not know what we're aiming at as we shoehorn complex human beings into simplistic pigeon holes. This phenomena comports with my own clinical experience. Most of those I work with might have intense periods of distress or crisis, but these are essentially transient as they are borne of developmentally- or contextually-based predicaments in their lives. And most of the time, a few sessions focused on understanding these predicaments plus some problem-solving results in demonstrably positive outcomes. This takes profound listening and respect on the part of the helper, not one who is guided by a manual.

Think about it. Remember how you felt on your worst days, and those parts of your past and present which were the ingredients for such times. Remember if you ever felt understood, and if you did, by whom. It might have been a therapist who did. I hope it was, because I know there are many of us who can. But it might have been a minister, a friend, a family member, or a stranger on the street. And chances are good they didn't follow a manual.