Diagnosis

"The Agnew Clinic" by Thomas Eakins
“The Agnew Clinic” by Thomas Eakins

Diagnosis

I’ve never been depressed, not officially.
Maybe not at all except the once, at age 15; might have been depression
what my mother called “adolescence” and “defiance”—

there was an eating disorder back then too,
an anorexia nervosa, that got missed; named instead “late blooming”
(which won my skinny bones a lead in the spring musical
whatever one called it, so clearly nobody minded, not even me).

But I wasn’t depressed anytime/everytime the diagnosis got counted.

Among the moods I have [not] had:
‎‎         depressive disorder–unipolar
‎‎         dysthymia
‎‎         bipolar depression
‎‎        
generalized anxiety disorder
‎‎         anxiety-Not Otherwise Specified
‎‎         hypomania and 
‎‎         anhedonia.

It wasn’t depression when I filled out forms for the therapist
who said, “I think you’ve undergone a major depression”—
and although I told him “no,
I don’t think that’s it,” major depressive episode
was what got sent to the insurance.

When the shrink that therapist recommends, asked that I guess
his diagnosis for my head, and I told him “one week ago
dude-down-the-hall called it major depression” —the new doc beamed
in diagnostic triumph, laughed “guess again!” before giving in
and telling me borderline personality disorder,
which wasn’t it either.

I almost prefer therapists who never tell you
what they’ve put in your file—though you then must battle against
the unknown definitions in their minds
as well as the unknown crazies in your own.
It grows tedious after a time:
navigating what specimen of disorder a professional classifies you as
when he squints at you under his microscope.

My least favorite was the shrink who, after I sat in his office and told him
I was afraid the switch in my head was about to turn off,
lectured me on what a poor choice of metaphor a lightswitch was.
Because “depression is so much more complicated” and “psychiatry
is so much more skilled” and “this is not wax on/wax off for brain chemistry”
and among all the things he said, none of them was
“can you tell me more about that?”

Which I wish he’d asked, because I might have told him how one episode
STARTED between the 16th and 18th of August
and
ENDED Monday, October 1st, around 7pm
which really doesn’t sound to me like how I’ve heard depressions described.

Maybe if he’d asked and I’d answered, we both would have understood:
if a lightswitch is the wrong metaphor for depression,
then depression is the wrong metaphor for a lightswitch
(and I’ve never been one for using metaphors carelessly).

Last summer a therapist passed me a recommendation—not a diagnosis
intentionally, just a “this term sounds like what you’re describing
and I know you like reading this stuff” kind of thing—but

under that psychiatric label, behind that peer-reviewed language

I found—wholly unexpected—people who
feel different
in exactly the ways I feel different

which is not, I realize, a proper diagnosis. It’s not even clear
if the nosology is dissociative or anxiety-based
when I describe it like that—
‎‎            ‎          ‎‎            ‎          ‎‎            ‎          (and I would offer to tell you the name except
that’s a bit like handing someone a dictionary when what they asked for
was a guide book and when what they really need
is a guided tour.)

Reading
“No treatment known to be effective”
and
“Most severe cases have onset by age 16”
freaked me out at first (especially as I recognized my own age-14 self)
until I realized
“Criteria C: Experiences clinically significant distress”
no longer applies if I choose to refuse it.

‎‎            ‎          ‎‎            ‎          ‎‎            ‎           ‎              And why not refuse distress
risen from decades of shouting into headwinds, wondering if my voice
carries only stillborn sound? What other choice—
with no known treatment
and no other known ways-of-being?

What you call a diagnosis, I will call a dialect of self

and I will translate your inflections into my own tongue and reply
with enunciation common and precise
enough for anyone to follow
‎‎            ‎          ‎‎            ‎          ‎‎            ‎          ‎‎            ‎  ‎‎           even headshrink docs,
who tend to be hard of hearing, and slower than your average joe.

~a.i.


“Diagnosis” is part of an ongoing memory project.
Additional installments can be found here.

Image credit: Licensed under Public Domain via Wikimedia Commons 

10 thoughts on “Diagnosis

    1. Thanks! (oh, and welcome back from holiday! Nice to be seeing new posts from you again. 🙂 )

      The thing I find troubling about psychiatry in general — what sets it apart from most other medical specialties, seems to me — is that there is already an agreement, by the moment a patient steps into the office, that there will be a medication-based solution. Regardless of the issue. It’s a bit like a doctor who specializes in bones (broken and otherwise), but one you only go to see when you’ve already determined on your own that you need a cast.

      For people who genuinely need casts (or psychotropic meds) that’s an invaluable service. For lots of other folks, though, it means the initial diagnostic burden lies with the patient, not the M.D.

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  1. Diagnoses have their uses, mostly benefting research and insurance coders. They’re all clearly works in progress, likely to be replaced soon enough by more specific categories as the research findings continue to pour in. Goiven that we still have only the vaguest notion as to how the brain works normally, it’s really rather ridiculous to place such confidence in diagnoses. They’re ideas.

    I always counsel all my patients to forget about diagnoses: they cause more harm than good, especially in that very different people with very different presentations can easily fit the same diagnosis, as they’re set up today. Instead, I encourage them to focus on their symptoms, and on ways to address them. Focus on treametns choices, pros and cons, and find a way to feel and do as well as you wish. That’s what it’s all about for me: helping.

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    1. Greg,

      Agreed! These diagnoses are very much works in progress and, like all labels, they serve to bring certain elements into high relief while disguising others. The map is never the territory, and it’s important for all parties to keep that strongly in mind. The same “disorder” can present very differently in different people, as you point out — and I would add that sometimes what presents as very similar symptoms to an observer can be experienced as radically different phenomena by the people living them.

      I certainly understand the advice to “forget about the diagnosis” and would agree that’s a better alternative than ossifying any conception of yourself (or someone else) as being fully contained and explained by any psychiatric category. (Though I also understand — and have on occasion succumbed to — the desire to hold out a diagnosis as a shield, as “I have [X], my doctor says so!” Which is itself a better alternative than simply feeling morally or mentally weak, as so many cultural messages make mental illness out as being.)

      My one reservation comes down to this: focusing on the symptoms — as either client or health care professional — still requires language. Without mental health equivalents for x-rays or blood tests, what my symptoms “are” is constrained by the concepts I have available for understanding and expressing them, as well as by what concepts the listener uses to interpret, filter, and understand in turn. (Which is, at the end of the day, much of what drives me to write about any of this — and with such a to-do about my metaphors…)

      Thank you so much for reading, and for sharing your thoughts!
      alice

      Liked by 1 person

      1. Language, of course, is crucial. We must keep in mind, though, that defined words do not amount to knowledge of reality. Just ideas with labels, and perhaps more, sometimes. Thanks for taking so much effort and thought to respond! – Greg

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  2. Have to be honest, I had to look some of these diagnoses up and what I read leads me to conclude that each one is just a fancier term for the one before, and these professionals just keep adding more and more diagnoses to their book, I suspect for reimbursement rather than anything else.
    You are functioning, and living, and moving through your trauma each day, but where in hell do those who can’t even begin to see any hope or future or wellness ever find a professional who has a clue…the answer is that they most likely don’t, or they find alternatives to their issues that we read about on the evening news.
    I’ve considered counseling, mostly to try to get my own life and plans into some sort of reasonable shape, a sounding board if you will, yet it’s frightening what one might encounter out there. So I blog instead, hoping one day something timely and profound will appear in a comment so that I may seize the advice and run with it.

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    1. Yeah, the written definitions do end up sounding quite generic and similar! I see the issue less as something sinister or profit-motivated — and more as a problem inherent in any effort to take a massive amount of data about lived experiences and to condense it all into a single, comprehensive concept map.

      How to find the right person for your needs/experiences/personality to work with…is not a nut I’ve ever learned how to crack. I’m working with two great therapists right now, who have both helped immeasurably in saving my bacon over these past few terrible years, but the way I got connected with each of them was more luck than anything else. I’ve certainly not always been so fortunate, even with therapists who I fully believe had the best intentions. Psychiatrists…are another matter altogether. I’ve got a lot of anger when it comes to shrinks — as well as a strong desire to stab them all in the eye with a fork. It’s an issue. I’m working on it. 😉

      My feeling about going into therapy (if that’s still something you ever consider) is that if someone’s coming to it with a base of self-awareness and a pretty clear sense of where s/he wants to work further, then finding a good person to work with is a doable, if annoying, process. If you start therapy only in a moment of crisis, everything’s a lot harder and the stakes are all much higher: a person in crisis may have great difficulty assessing the actual therapeutic fit, and a person in crisis also can’t afford to not find anyone.

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      1. Thank you for leaving me with an image of you carrying around a supply of forks, as well as you, attempting to explain some aspect of yourself to a person with a fork bobbing about in their eye as they take notes on your progress… 😉

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        1. Haha!! Oh, by the time the forks come out, I’m pretty much done talking! But I may hold onto your image, for something to visualize while the talking is still in progress…

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