Recently, I heard from a client who I hadn't spoken to for two years. So when he left a message saying he was "struggling with anxiety," I was quick to get back to him. When we connected, the first words I heard were, "I'm depressed Jeff, I found out that I am ADD (attention deficit disorder) ... and the meds I've been taking just seem to make the situation worse."
"Whoa," I replied, "What do you mean you are ADD?"
He continued, "Well, I hired a professional organizer and when I showed her my routine and environment, she declared that I 'probably' had ADD. She recommended a psychiatrist, whom I met for about 20 minutes. He asked me a series of questions, agreed that I had symptoms of ADD [or ADHD--attention deficit hyperactivity disorder] and prescribed a cocktail of drugs for me to take. I've been on the meds for a couple of months but they don't seem to be working. I always feel uptight and wired. I do get more work done than before but I'm more irritable and edgy. I don't know if I should go off the meds or what. Help!"
I wish I could say that I rarely hear this kind of story. But the opposite is true. More and more often, people come to me already burdened with a "diagnosis" -- some form of label ascribed to them by a well-meaning doctor who must place them in a diagnostic "category" in order to satisfy the insurance company and prescribe medications.
Yet, as helpful as it may be to know your affliction by giving it a label, I'm highly suspect of this tendency to dumb down our symptoms to a simple (and rather artificially constructed) diagnostic category. Too often, we fall into a sort of trance, marching to doctor's orders, and "I am unfocused or anxious at times" becomes, "I AM ADD."
My client -- and I think most people in similar circumstances -- are much more complex than a simple one word label. This is why I appreciate the work of forward thinking psychologists who use innovative tools to help patients see through their diagnosis and reconnect to their deeper selves.
In a book called "Mindfulness and Psychotherapy," clinical psychologists show how mindfulness practices derived from the Eastern contemplative traditions may be helpful for depression, anxiety and other psychological maladies. In one chapter, there is a wonderful anecdote about how one therapist used the power of one single raisin to break through the all-powerful diagnostic label, "clinical depression."
A patient comes to the therapist saying that he has been depressed for years, and knows "no other state of being." After a few sessions in which they build rapport, the therapist asks him if he is willing to do an experiment with mindfulness. In the experiment, the therapist has the patient practice 10 minutes of silence, breathing deeply, focusing attention on the breath, all while guiding him into a state of deep relaxation, so that he gains awareness of his thoughts and his physical body.
The therapist then takes a single raisin and asks the patient to put it in his mouth and slowly roll it around, to feel the sensations in his mouth, and to focus all his attention on the experience of flavor, texture and movement of the fruit. After experiencing the raisin for a few moments, the patient swallows it (we assume the patient liked raisins) and is brought back gently into a state of present awareness.
The therapist then asks the patient to describe the encounter with the raisin. The patient uses words like pleasurable, sensuous, tasty and delicious. The therapist asks the patient, "While you were savoring the raisin so intently, did you feel depressed?" The patient reflects for a moment and says, "Of course, I am always depressed." Yet, when asked again to reflect a bit more deeply, the patient acknowledges that during the meditative moment with the raisin, he experienced pleasure, not depression. It was as if the raisin shone a light -- of hope -- on this patient's overidentification with the label, "depressed."
I love this story because it illustrates one of the foundational principles of my approach to healing and self-renewal: We are not our labels. So much of our self-worth is wrapped up in how we identify ourselves -- our titles, our possessions, our jobs, even in some cases, our diagnoses! Yet, it is only when we wake up and realize that we are much more than our surface identifications that we become open to possibility and free to choose other options.
In that same call, my client with the ADD diagnosis shared that over the past two years, in spite of downsizing and a merger, he had managed to keep his job, and even finished going to night school to complete his bachelor's degree. Perhaps, he had reason to feel anxious, scattered, even unfocused at times. Surely, he could use help with grounding and balance. But by smacking the label of "ADD" on him, and sending him off to the doctor, his personal narrative suddenly became suffused with a sense of dread, and he saw himself as "sick."
Now don't get me wrong. I'm all for helping people with medications when the pain is severe and it is truly difficult to function. But, here's the rub: by fostering a strict bio-medical approach to mental health in which we quickly pathologize our symptoms as a clinical disorder, we risk losing touch with a deeper truth: Human beings are much more than machines of malady.
We are adaptable, flexible, bountiful sources of creative energy--mental, emotional and physical--with the freedom to reinvent our "story" at any time. The solar energy that miraculously produces a raisin runs through our veins as well.
Sometimes all it takes is a tiny, wrinkled nugget of golden sunshine to provide an opening, a space--a glimmer of hope--reminding us WHO WE REALLY ARE.
Dr J
Follow Jeffrey Hull, Ph.D. on Twitter: www.twitter.com/DrjUSA
Dr. Harold Koplewicz: Child Mental Health: 7 Common Myths
Judith Warner: 'We've Got Issues': The Myth Of The Overmedicated Child
Kaitlin Bell Barnett: Generation Rx Grows Up: A Response to Judith Warner
Overselling Overmedication - NYTimes.com
Is your parent overmedicated? - Health - Health care - msnbc.com
The most damaging byproduct of a society of labels is self-labelling.
I recommend that everyone survey the literature, review the latest research on giving children drugs, examine who is doing the drug research & their side effects, and search the net or NYT's articles related to the BigPharmas and their corrupt practices with all of the helping professions.
That said, the reported anecdotal 20 minute psychiatric exam is either a description of a poorly trained psychiatrist, a rushed psychiatrist in an bad HMO, or a biased invention of the writer's mind. There are some poor psychiatrists, but the majority are not. In any case, "Dr. J" is dosing hyperbolic inflammation.
ADHD is not cancer, but it is a real disability with life-long consequences in work, play, and love. Any failure to recognize this is flat earth. Search "Barkley ADHD" at youTube. Check the ones where he is in the dark coat at his presentation in Canada. E.g., http://www.youtube.com/watch#!v=qguNB4b36Vo
The NIMH Mutimodal Study is another useful search.
Also...just fyi. I didn't mean to be "hyperbolic" -- and the anecdote is based on how the story was passed on the me by my client. I have spoken though, with a number of psychiatrists -- and they are often the first ones to note that due to patient overload and insurance payment limits, they often do "patient in-take" screenings and evals in 15-20 minutes. I don't think this is so much a reflection of the quality of the psychiatrist--it is just that their job as changed. They no longer view themselves as in the 'therapy' business...but rather in the medication distribution business. At least many do. Unfortunately.
At the annual meeting of the Michigan Sociological Association, at Thomas Aquinas College, there was a presentation that talked about doctors (especially in the mental health field) seeing their patients as "the broken object."
You don't consult a broken object about symptoms. You don't listen to a broken object. You do what you think is right to fix it.
Humans are not broken objects. Patients are able to describe their symptoms, and they can participate in their treatment.
I know a lot of psychiatrists who can not comprehend that people living with severe depression have suicidal ideation. It happens, and it happens every day. Yet, if you tell the psychiatrist that, they immediately try to admit you into a Psych Unit.
Suicidal ideation happens. It's only thoughts of suicide. I've been coping with those ideas for a long time, and will probably continue to do so for a long time.
I would like to see some kidn of review board at mental health practices and clinics. Every time a psychiatrist "diagnoses" whatever the issue of the week is (gleaned from talk shows, journals, magazine articles, etc.), the patient is re-evaluated before medication is prescribed. It seems every time I see a mental health professional, I get a new diagnosis pulled from the latest fad.
"We are not our labels. So much of our self-worth is wrapped up in how we identify ourselves -- our titles, our possessions, our jobs, even in some cases, our diagnoses! Yet, it is only when we wake up and realize that we are much more than our surface identifications that we become open to possibility and free to choose other options."
Unfortunately many around us think we are weird and into "new age" thinking, when we begin to understand there is so much more than the labels and stuff.
I can take a roomful of arguing theists and atheists and unite them in thirty seconds. They have become their labels. I choose mine. When they ask me what I believe. I say it changes every day.
A lot of the new age is cooky, but it is needed so that we can rediscover the past. For thousands of years all humankind was eco-pantheistic. But we call it primitive animism.
Believe exactly what you want and change it as you so desire. Good fortune. here is a tune:
http://www.youtube.com/watch?v=QiYqYPEXsJU&feature=related
In civil society we have achieved a kind of democracy, so there grows in our children an awareness of equality - preached to them in many ways. 'We are equals. Sit down. Listen to me.'
The staggering cognitive dissonance between preaching equality and subjection of children to rules or, if they fail, to coercion results in the aggravation of mental conditions which would otherwise be entirely manageable. There is no cognitive dissonance in schools in premodern cultures which still utilise a culture of subordination and in these places there is almost no occurrence of ADHD.
We cannot revert to subordination. We cannot restore the shattered compliance system. We must democratise our schools. The very absurdity of the statement reveals the nature of radicalism. It is not what liberals want but what they fear. Once it was the slaves. Lower class men. Women. Gays. Each in turn gained rights as gradually we create a society of equals. The children's turn comes and adults cry that cry of old,'It will bring anarchy.' But in their hearts they know the truth - there is anarchy already. Feeling conflicted they act out, get angry and tell me I must be crazy.
A tune:
http://www.youtube.com/watch?v=86nzp0_Hafo
Do not confuse a diagnosis with a label or vice-versa. When one assumes a diagnosis is nothing more than a label, it prevents those who would otherwise be helped from a correct diagnosis from getting the help they need.