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Post-Traumatic Stress Disorder
Diagnoses: Harmful or Helpful?
What do they really tell us?
Posted April 12, 2017
Recently I read an article slamming the DSM (Diagnostic and Statistical Manual), the book of psychological diagnoses psychologist and psychiatrists use. The article argued that we shouldn’t have such a book—the book was pathologizing and created by a culturally biased culture. It cited examples of ways, in the past, we have pathologized people who were different, labeling them and calling them mentally ill, out of prejudice and/or ignorance and/or politics such as homosexuality or slaves who had a desire to be free.
First let me say: there are, no doubt, huge issues with the DSM. Some of it incredibly frustrating, some of it political, some of it just plain wrong. My colleague Elizabeth Corsale, MFT, and I even set out to change the diagnosis of kleptomania. After years of our own research and treatment with people who steal we are confident the DSM diagnosis is not research based and it's incorrect.
Also, the DSM is not a complete picture of human suffering—not even close. This is true in every science. We don't truly understand physics in its most minute or cosmic levels. As far as medicine goes, I have a daughter who had two chronic illnesses that could not be diagnosed except with "it's our best guess that she has..." and this was at the most renowned medical center in the world. I could go on and on at the limits of our current knowledge in every science—how many times nutritional recommendations have been revised based on new discoveries, or when new discoveries about plants blow open old thoughts or paradigms about evolution or the environment, etc.
But here's the bottom line: people suffer deeply and sometimes it means they can't function. It's been enough years of measuring efficacy of diagnoses and treatments to know that many of those people can be helped when we understand patterns and used fairly standardized treatments with good track records. This is why we have our (imperfect) system of diagnoses. I could give you examples of countless people who have been helped from getting a good diagnosis and the appropriate treatment.
I've worked with people with pedophilia or depression or anxiety or PTSD or schizophrenia who were deeply grateful to have a diagnosis and treatment that helped them live a life that was happier and more fulfilling (and didn't harm others). Because at the end of the day, if you are so traumatized you're destroying every relationship you have through acting out of triggers, when a therapist says you have PTSD and gives you really good therapy (and maybe you take a mood stabilizer or L-theanine) and then eventually you are able to be calm and create more loving and intimate relationships, and enjoy your life more fully, and sleep at night, you don't care what it’s called, you're just really, really grateful someone knew what was wrong with you and helped you.
I personally believe that the biggest issue with diagnoses is not the label, or that we have medication to help people, or specific types of treatment that can alleviate their suffering.
The biggest issue is that most people in the psychological profession—unless they are really good and have done their own, deeper work—see the diagnosis and symptoms and simply try to alleviate suffering. And don't get me wrong—this is hugely helpful and important.
But it's not, I think, the point of what therapy should be or what the point of being alive is, for that matter. Rather, mental illness can be a tremendous opportunity for the person (and others in their life, for that matter) to discover and learn and grow and become something bigger than who or what they were before.
When I fell into what I thought was a deep depression but ended up being diagnosed as PTSD, it was triggered by working too intensively with a patient who had severe trauma. I was secondarily traumatized by the work. But I didn't just get medication for a few months and alleviate my suffering. When I walked into my therapist's office, he said to me: this is not just a problem of today, it's an opportunity for you to change your life. We found that I got into that situation with my patient because I was putting myself aside to be who I thought was needed, which is something I was in the habit of doing. I began to see it in a lot of places, and this eventually helped me discover that I had put aside my true passion—being an artist and writer—in order to take care of what I thought needed to be taken care of. Since that time I have radically changed my life to more accurately reflect what's important to me, what's true for me. As a result, I am even more deeply happy and fulfilled than before my depression and PTSD.
So the depression and PTSD was real. I'm grateful for the diagnosis because I got a medication for several months that helped stabilize me and a therapist who specialized in mood disorders so that I could make immediate changes that allowed me to climb out of the deep hole. But from there, I became deeply grateful for the "mental illness" I had, because it allowed me to see what I needed to see about myself and to grow into a person who was more deeply happy and fulfilled in my life.
In this way, mental illness can tell us what's wrong with a person, and also with parenting, with a culture, and with society. It's bio/psycho/social—it happens in the body, in the individual's mind or psyche, and in the context of a culture or society. It may be that to heal mental illness, we have to address change on all of those levels.
So, rather than throwing out an (imperfect but useful) book of diagnoses, how about if we see those diagnoses within a larger context and address all of that? Addiction exists. It destroys bodies and lives. Having that diagnosis and treatment is hugely important. But addiction exists for a REASON—not just a personal reason, but a cultural and societal reason. Those reasons need to be addressed too.
Let's keep working on making it better. Let’s keep trying to understand in a nuanced and compassionate way, where our psyches go awry. Let’s keep learning how to address these diagnoses in effective and caring ways. And while we do so, let’s for sure keep an eye on the ways societies values influence what we think of as “pathology”—keep correcting for ignorance and prejudice.
While we’re at it, let’s keep working to create a society that has space and accommodations for the myriad of ways we end up being human. Let’s look long and hard at the ways our culture and society creates pathology and maladaptive coping with a dysfunctional world. And finally, let’s try to use the ways our psyche pulls us out of life as opportunities to grow and become something more enriched and more deeply fulfilled and connected to life.
