On the Tragedy of Labels
- Undiagnosed
- I Am Sowellian
- Capitalism Didn’t Create Human Nature
- What Identity is Not
- A Man Without Guardrails
Recently, I had the honor of telling a young man that he had no mental health diagnosis.
Backstory
A new client comes to my office for court-ordered alcohol and drug counseling. We begin with the usual intake questions. As we move through the process, I’m doubting the validity of the claim that he has a substance problem. Upon further inquiry in subsequent sessions, this young man, indeed, does not have a substance problem. He has a stress problem. He showed zero signs of substance use disorder (SUD) but was very stressed about recent events.
This young man (let’s call him Jim) has had a run of recent troubles involving his ex-wife and their shared 5-year-old son. He’s been accused of many things that he maintains never happened, along with everyone that knows Jim, including his new wife. Regardless of where the truth appears in those situations, I’m here to help him with his “diagnoses.” Jim was told he had certain problems and that this was now who he is. He was virtually told to accept his new identity, his new label.
Jim told me a great deal of the stress he is under because he is trying to raise a family as the sole provider so his wife can simply raise the children at home, something both agreed is beneficial and desired. He tends to cope with alcohol, though he does not display any addictive behaviors, as confirmed by his wife.
As Jim and I continue to meet, we find areas in his childhood and early adulthood that have caused him the most trouble. Among them are his diagnoses of general anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). How he escaped an ADHD diagnosis in this climate of psychiatric cocktail mixers leaves me baffled.
I began treating him as if he indeed had those diagnoses. The problem was, the more questions I asked, the less I saw symptoms consistent with such diagnoses. I went as far as to administer several screeners to help me determine the level of each diagnosis. The conclusion to which I arrived was that he did not have any of the diagnoses.
Unwanted Good News
Here’s the trick, this isn’t the first time I’ve delivered news that someone either
- no longer has such diagnoses or
- never had such diagnoses.
And was usually met with reluctance and disbelief.
A couple of years ago, I wrote about a client who was upset:
- Her: I’m upset because my child isn’t being treated like everyone just because he has autism.
- Me: How would you feel if he had no diagnosis at all?
- Her: (quickly recanting her sentiment) Oh I know he has it.
- Me: Why is it important that he has a diagnosis?
- Her: It makes him special.
- Me: To whom?
- Her: I guess to me
- Me: So the diagnosis isn’t about him, it’s about you?
- Her: (speechless)
So I was prepared for whatever Jim was about to dish out as I said, “Jim, you have no current diagnosis.” To my slight surprise (I don’t get surprised anymore), he had a look of relief on his face. I called the expression out and asked why. He stated that he never wanted the label and over the last 10 years he had feared he would be stuck with this for his entire life. I explained to him what I did to arrive at such conclusions and how he did not even come close to meeting any of the diagnoses. I also admitted that I did not know him when he was diagnosed, so it may have been valid at the time (other than PTSD, he’s never possessed such symptoms. This was a misdiagnosis), but that it no longer appears applicable.
Presumptuous Diagnosing
Jim had been living in both:
- Fear of being “stained goods” his entire life
- while simultaneously trying to live up to the label he was given.
When I proposed the idea of removing the label altogether, he smiled. Big smile.
I won’t presume I know the circumstances surrounding this man’s trip to the head doctor. But it truly appears someone was eager to diagnose. As if when a new patient enters their office, they shift into
- Cognitive bias- where they see symptoms they want to see to ensure diagnosis and ignore those which don’t line up with preconceived ideas, and
- Motivational reasoning- where they are actively searching for such symptoms just in case they don’t easily present themselves.
Freedom
Whatever the state of affairs, this man had a restful sleep that night. I know because he sent me a text the next day to tell me so.
Don’t settle for a quick diagnosis. And even if you receive one, don’t run to medicine. At least not right away. I hope and pray we return to medicine and diagnosis as last resort rather than first solution. There’s nothing noble, beneficial, moral, or efficacious about slapping labels on individuals that will follow them the rest of their lives. If a diagnosis is necessary, this should be found, not assumed.
I’m grateful to have undiagnosed this young man. I look forward to many more.
Stay Classy GP!
Grainger