Focus on Lizzie

[JSGeare]

(Note from JSGeare, who posted this):

I've stolen this from the bottom of a long thread of Angie's material; seems it deserves special attention of its own, a "fresh start." I hope you don't mind Lizzie. Here is what you wrote:

****************
Hey Angie ,

I read your post and it made me cry. I don't know why. I have been tested for almost all the mental anxiety-related conditions in the book. They came up with, so far, ADD, depression and anxiety. The anxiety disorders clinic didn't know what to make of me. They eventually decided that I don't have a typical anxiety disorder. I don't get physical panic attacks: they describe what I have as "mental attacks", alarmingly for me, because they can't think of anything more accurate to describe them as. I don't have rituals. Like you, I always thought OCD meant turning lights on and off seven times. I don't tidy compulsively, or feel the need to be excessively clean. In fact a majority of the time my room is an absolute mess. This depresses me a whole lot more than it should, though i can never find the motivation to do...well anything. This "terrifying thoughts" and "ëvil thoughts" described here, however, sound to me, disturbingly familiar. As does this circular thinking you are displaying about questioning  the diagnosis, questioning everything. I have this horrible, firm belief that nobody knows. They think they know but they don't. Whatever they decide, nomatter how good it feels to hear it at the time, the diseased, subconscious part of my mind that poisons me is too dark, to strong, and too smart to feel good about it for long. I'll think a way out of everything positive, eventually, until there's nothing but me the darkness, my terror and insanity. I don't even know if insanity is what I fear. I don't know what I'm so afraid of. All i know is thatwhat I fear is endless and empty and unbearable. I want a diagnosis but I cannot accept it. I've been given several but they only make me feel better temporarily. Nothing makes me feel better when I'm in the midst of myself: I sound like a crazy person (I'm beginning to accept that I am) but I want to know if you understand my rantings. Does this make sense to you? Is it possible that I too could have an OCD?

-Lizzie

[Angie162]

JSGeare- You have a wonderful way of putting things back into perspective.  You know, my husband has asked me several times before, "Why does it matter what 'disorder' you have?"  I don't know why.
Lizzie- Let's just try really hard to focus on healing.  It breaks my heart to hear of other's suffering with these problems.  I really do understand where you are coming from.  I know about the constant questioning of yourself.   I understand.  I guess the key is finding the "right" psychologist who will sit and listen to you, honesty, and time.  I have learned over time that honesty with your therapist will only benefit you and the situation.  Take JSGeare's advice (I have concluded that he is super smart).
Take Care.

[JSGeare]

Glad to know you read it and found it meaningful. Pass it on to anyone you think may receive a benefit.

[lizzie_e]

I'd just like to thank you for taking the time to post on my comment. Your message was brilliant, made me feel a lot better (if a little silly), and what you're saying makes a lot of sense. Of course, the thoughts have whizzed through my head at some point but it's good to hear them coming firmly and substantially from a professional's...erm, fingertips. So thanks. :-)

-Lizzie

[JSGeare]

(continued from Lizzie Part I)

THANK GOD its that way, because if everything came out of a cook book then there would be no room for individuality, no possible way to treat specific people, each of one who has a specific, unique life and set of experiences.

And so, the better way to come to terms with how well your therapist understands what's going on with you is to look at the therapy and treatment and interaction with the therapist. If the therapist presents as someone who is "catching on" to you, if you sense that therapy is getting somewhere, then the naming of your condition doesn't matter.

In fact, it seems likely to me that a disagnosis would -maybe should- change over time. Here's what I hope you will take as a good analogy. You're driving along a country road and come up on an accident that happened moments ago. There's a car crashed into a guard rail on the opposite side of the road, skid marks moving from your travel lane across the road and ending near the crash, and a dead deer lying mangled on the shoulder. The driver is unconscious in the front seat. You grab your cell and dial 911.  Now, I ask you: what happened. You say that a deer must have jumped across the road, the driver swerved to avoid it and crashed. Makes sense to me. Diagnosis: deer accident. But then, the ambulance and cops show up. The medics treat the driver and begin loading him. The cop asks what you saw, and you explain. He goes over and looks at the deer. This deer has already been dead at least a couple of days - so THIS deer was not the cause of the accident. Diagnosis is now uncertain. Cop goes over to the ambulance as they load up the driver. The driver is waking up. The cop smells liquor!  Tentative diagnosis: driving while impaired. The cop now looks at skid marks, walks around the car and looks inside of it. There's a child safety seat, empty, in the back, with some toys and toddler things. Was a child involved? The cop finds the registration and starts to call headquarters, when all of a sudden another cop car pulls up and dispenses 2 passengers -a woman holding a cold towel to her head and carrying a baby. Turns out, they were the passengers. The woman explains that a deer ran out, her husband swerved to avoid it, hit a slippery place in the road and smashed into the guard rail. She jumped out, grabbed the baby and went to a house down the road to call for help. The deer got away. They left their cell phone at the home of a friend where they had stayed the night before, and a bottle of whiskey with a loose top had drained into his clothes in his suitcase the night before -so he smelled like a drunk.

Do you see how the diagnosis was "correct" as to known facts in the story above -but was wrong in the context of all the facts? See how it changed as new facts came to light? And do you see that everyone did the right thing? The ambulance was called, people got treated, the cop was methodical and careful and the back ground explanations helped make sense of the whole thing. How like life itself is that? Now, if you can accept the above story as realistic, think of the challenges of diagnosing a mental/emotional condition! You don't have much physical evidence to investigate -you start with what a patient thinks they think! The only thing the therapist (or anyone) can do is listen, and attempt to match whatever the patient reports with whatever the therapist has heard before, and whatever the collective experience of mental health providers has seen before. The assignment of any particular diagnosis does not necessarily define an effective, one-size-fits-all treatment. And, no matter how well you or anyone may seem to fit a certain profile, you will, in the end, be your own unique "case."

Lizzie, Angie -everyone who frets over diagnosis, I hope you see that I'm not trying to argue you out of your misgivings. What I'm trying to do is demonstrate that the actual practice of mental medicine doesn't work in the way many of us believe it does -or it should. And this can be no truer than in the area of diagnosis. The guy who stained the exterior of my house said my cedar siding had held up really well over the years. This so-called expert didn't even know that my siding was red wood, not cedar. But you know what, he did a superior job staining it -a perfect job! Call it cedar, call it redwood, call it Harry - he made it look good.

And so, if your therapist is paying atttention to you, if you trust him or her, and you detect improvement (or at least, no worsening) of your sitaution, then the diagnosis probably doesn't matter. Ask to re-name it something else, as many panic patients refer to "Mr. P." Your therapist may well agree to do so.

I hope you find this commentary to be helpful.

[JSGeare]

I'm going to try a little psychic surgery here, OK? I'll do it by "picking apart" some of what you wrote.

"... circular thinking you are displaying about questioning  the diagnosis, questioning everything. I have this horrible, firm belief that nobody knows. They think they know but they don't. ..."

The horrible truth, Lizzie, Angie, and everyone, is that you are absolutely correct. They don't know. They never did know, and they never will know. Nor will you, nor I, nor anyone. Your brain knows that, and clamors for the truth to be told!

So how is it, then, that effective meds do get prescribed, effective therapy does take place, and people do actually get better? How can that happen, if no one knows what condition the patient has in the first place? Random chance? If you put that suspicious brain of yours to work on this question, you'll find that can't be the case, because people who receive treatment tend to get better faster than those who don't. Nya, nya.

It should come as no surprise, perhaps, that an OCD sufferer should be more concerned that the diagnosis be correct -as opposed to the treatment actually working. The argument, no doubt, is that if the diagnosis is bad, then it follows that the treatment can't be correct, or, at least, won't be as good as it could be. Maybe even totally wrong, maybe dangerous. And it is true that treatments can be perfectly effective -produce stunning results, really- even though the diagnosis was DEAD WRONG. Confusing, no?

Well, if the doctors really don't know what the matter is, and the wrong treatments sometimes provide good results anyway, then what's going on?

Let's start with the "big golden book" of diagnosis itself: The Diagnostic and Statistical Manual of Mental Disorders, currently in its 4th edition, I think. If you type this URL address at Amazon, you can read all about it:

http://www.amazon.com/gp/product/0890420254/ref=cm_cr_pr_product_top

Pay attention to the customer reviews, which contain such little nuggets as these:

"But people, medical students and physicians included, will insist on treating DSM-IV as a textbook in psychiatry. It's nothing of the sort - it never touches on the essential topics of etiology, prognosis, and treatment. People memorize the checklists and think they understand psychiatry, when in fact they have entirely failed to grasp the noble and great endeavor: riddling out the first causes and mechanisms of our humanity, and how those mechanisms go awry."

and this:

"Its primary function is to allow the mental health provider to accurately label a disorder based upon the number and severity of observable symptoms. It is also used to allow a common dialogue so that doctors, psychologists, psychiatrists, mental health professionals, and insurance companies can 'speak the same language.'"

and this:

"Psychiatric trainees are encouraged to use the DSM as their first approach to the patient. It is very sad to see these fledglings struggle to make diagnosis rather than to understand their patient. Do they ask whether the patient has a brother or a sister or was born rich or poor. No! Conference after conference is devoted to figuring out which DSM category the patient fits into. No one dares tells the trainee the little secret of the DSM, which is that about half of patients don't fit into any category at all. Some of us, of course, do have OCD or ADD or are narcissistic or suffer from moderate autism (Asperger's Syndrome) but most of us are not so neatly described. Most people have to be squeezed into categories that we don't fit into."

The above comments are written by MDs -psychiatrists, I suppose- so they of all people should know what they're talking about, because their association wrote the book!

But, for all the criticism, the same people who wrote such sorching reviews also seem to understand what their job is: "riddling out the first causes and mechanisms of our humanity, and how those mechanisms go awry"

Lizzie -and everyone- the whole business of diagnosis, as it relates to mental health, anyway, is terribly misunderstood. The naming, the labeling of the disorder is JUST THAT -giving it a name. You might as well call it "Harry." The name of the diagnosis may or MAY NOT suggest what treatment is appropriate. We were not put on this earth with little packages of disorders already neatly named and labeled, and with exactly right treatments that can be prescribed.