What's in a Diagnosis?

A new era began last week, when the new edition of the Diagnostic and Statistical Manual was published.  With the catchy nickname DSM-IV, the book categorizes symptoms of mental and emotional disorder, and codes them by number.

The DSM-IV is like the Bible, only the contents changes in every edition, as psychiatrists and consultants update and refine what’s normal and what’s not. Every time a new edition comes out, new controversies emerge. Why it matters is that insurance benefits and disability payments are based on these DSM codes, and it's the best we've got as a guide to diagnosis.  

But in mental health, diagnosis is controversial, because it's based more on interpretation than on measurement. If there’s something wrong with you physically, your doctor can send you out for blood work, cat scans, MRIs or other tests to determine what’s ailing you.   

But if there’s something bothering you emotionally, your diagnosis will be determined by what you say and what the provider observes about you. No blood work, cat scans or MRI’s. You can’t go for a brain scan to determine whether it’s bi-polar disorder or Post-Traumatic Stress Disorder, for example—two disorders with similar symptoms requiring very different treatment.  

Researchers in the field of neuroscience are now mapping how the brain functions, and studying what combinations of symptoms correspond with which chemicals. Beginning in the sixties, this research has led to the development of medications to combat extreme symptoms—like hallucinations and suicidal depression.  Over time, clinical trials have shown that medication combined with therapy is the most effective way to address serious mental disorders.  

But not everyone who’s stressed or overwhelmed has a DSM diagnosis or requires medication. So the question is, how can you tell if what you have is a situation, or whether it’s is a syndrome?  Try a little self-diagnosis.  It’s a situation…if something happened that caused it.  For example, people going through a crisis—the death of a loved one, the loss of a job or any major life change—do experience many conflicting feelings. It may even feel like you’re losing your mind.

Sometimes what seems to be a break-down could actually be a break-through.  

But what if this kind of thing is constantly happening to you, and it’s been like this for as long as you can remember?  If your life is a constant drama, that’s the sign of a syndrome.  Therapy can make a difference.  

Any situation that challenges us can be an opportunity for growth. Therapy can be the empowering conversation that helps us face the challenges, and discover well-being practices to enhance self-worth, creativity and joy.  

Susan Dingle LCSW CASAC is a therapist on the North Fork providing counseling for tweens, adolescents and adults. She is currently accepting new clients, and can be reached at 631/734-8658.