What's in (and under) a diagnosis?

what is the use of alleviating symptoms if we are not also addressing the complex patterns that brought those symptoms to the forefront?

Have you ever experienced the world as chaotic and unpredictable? When we are children, it is: when we are born, we are completely dependent on a world over which we have no control. We learn over time to navigate this world, and develop agency and accomplishment as we grow into our bodies and our brains. If any of this is thwarted or impeded- either, the capacity for making meaning of our world, or the capacity to live as fully ourselves rather than projections of our parents (as in developmental trauma) and society (as in racism and poverty) and all of this unprocessed grief and pain- we do not get to fully experience ourselves and live our own lives. We take on what Winnicott has called a “false self” and live with what Atwood calls “the ghost of the interrupted life.” This is one of the grains of sand at the root of pathology and disorder.

When Western medicine requests a diagnosis from me to determine whether my work and your pain deserves treatment, it becomes a strange translation. The diagnoses in the DSM-V can seem problematic and limiting: a challenging way to distill psychic and emotional pain into something digestible and clean. On the other hand, diagnoses provide a method of communicating to the system what your internal experience is. Psychotherapy in and of itself is a process of translating, of making meaning, of finding the thread and allowing for some kind of shape to be taken throughout the chaos of disconnected experiences. The thread is your identity, and we weave it together through the therapeutic relationship. And sometimes, we need the help of doctors, medication, and treatment teams to help you get to a place where you can start to make meaning in your life, and help you in the process of becoming more fully you.

I am generally asked by insurance companies to diagnose someone who is seeking treatment from me in order for the person to get reimbursed. When this happens, I always have a conversation with the person beforehand. It's important to understand how the observable and reportable symptoms are often just the tip of the iceberg. Most of us in pain wish for fast and direct treatment, and alleviating critical symptoms is a huge part of that. But, what is the use of alleviating symptoms if we are not also addressing the complex patterns that brought those symptoms to the forefront? If we consider symptoms as our body's and brain's way of telling us something is wrong, it's important to honor this message and do the work to get down to the roots. Everything is interconnected, and when we push parts of our self away, we lose contact. We do our work so that you can feel contact with all parts of you. The process of talk psychotherapy, mixed with somatic awareness and mindfulness and other interventions as ways of titrating or mitigating intense and chaotic emotional experiences, can allow for a paced exploration of this internal thread.

If we have a desire to get to know ourselves, we are always excavating. Sometimes, there is light underground; sometimes, we need the darkness to allow for feeling our way through. A diagnosis is a starting point to systemically “validate” pain that you know you feel. It can be relieving to have a diagnosis; it can help inform your treatment and care, as well as your relationship to yourself and the world; it can help you have access to treatment you want and need. However, the diagnosis is not the totality of your identity. That is an ongoing exploration into who and why you are. And it is impossible to know yourself completely without reflections and intersubjective interactions with another person- such as, for example, your psychotherapist.