What’s in a diagnosis?

Sometimes I receive feedback that a diagnosis is too stigmatizing or worse, an excuse for “bad” behavior. Some folks have expressed that the diagnosis is too hurtful, or unnecessary. Why must you put a label on it? The criteria for diagnosis in the DSM-IV TR (psychology’s manual for making diagnoses) include symptoms and generally a requirement that the behaviors or symptoms are problematic in the person’s life.  Unlike biologic medicine which describes the presence or absence of a certain identifiable thing (for the most part), psychology focuses on symptoms. We know more than we used to about the origins of these symptom sets, but still have a long way to go.

What is relevant to the provider and the client is whether the proposed diagnosis is related to problems in the client’s life and if there is a known treatment associated with this pattern of symptoms that would help improve the client’s life. Most diagnoses have effective treatments associated with resolution of the symptoms. The more known about the cause of the symptoms, the more available effective treatment becomes.

In the case of a diagnosis of Attention Deficit Disorder, we know that the brain actually functions differently in true ADD (as compared with symptoms resembling ADD but a consequence of depression, modern life, or something else). For the majority of clients with this different brain activity, a combination of medication, nutrition specifically addressing the vulnerabilities of this condition, and additional changes can vastly improve their lives. It can also open the door to leveraging what they considered a weakness and turn it into strength.   

Symptoms such as impulsivity, forgetfulness, and acting out can appear selfish, passive aggressive, or irresponsible when in fact the reality is any of those behaviors can be a manifestation of chemistry and faulty memory (and it can be the manifestation of something else). The diagnosis doesn’t excuse the behavior, rather addresses physical limitations and opens the door for known treatments to reduce those behaviors, rather than blames the client for character defects.

 Because most diagnoses reflect a greater presentation of what is considered normal for humans, the odds are that under the bell curve, some of us are going to end up on one end or the other of that bell curve.  If everyone was majorly depressed, would it be a problem? Or would our world revolve around that norm? If everyone had bi-polar disorder, would we consider the person who doesn’t experience mania as someone who doesn’t feel enough?

It seems most of what we measure is connected to our perception of what is “normal” or common. When occurrences happen outside the norm, they are often labeled luck, miracles, problems, or disasters.  If your provider has given you a diagnosis, they have given you a tool to explore via known solutions connected to the diagnosis-- how to leverage the strengths of that diagnosis (assuming the diagnosis is accurate), and how to resolve as much as possible any associated challenges.