The Dangers of Diagnosis

Today’s post is inspired by a voicemail message left for me by a client inquiring about my services. “I’m 38 years old, a GS-14 and bipolar 2” it said in part.

When I’m working with clients primarily as a psychotherapist, rather than as a career consultant, it is necessary for me to specify a diagnosis in order for reimbursement to be issued by the client’s insurance company. And although many psychotherapists enjoy the process of diagnosing their clients (to them it’s sort of like a puzzle that they’re solving), I find it both unpleasant and potentially harmful.

The moment I begin to search for the right label (which, after all, is what a diagnosis is) to attach to a client, I am limiting my view of that client. That’s because the process of diagnosing requires looking for signs of disfunction. Bipolar 2? Major Depression? Five out of nine specified symptoms must be present. Attention deficit disorder? etc.

Some insurance carriers require even more diagnostic information: is there evidence of a “personality disorder” (which is determined by the presence or absence of certain behavioral characteristics)? What is the client’s “GAF” or “Generalized…”? on a scale of 0 to 100? Are there significant social or occupational factors present (divorce, job loss). Any strictly physical illnesses (e.g. diabetes, HIV infection, etc.)

Clarifying or Complicating?

It can be very tempting to get caught up in this game: it can give the clinician a sense of certainty about an inherently fuzzy situation (i.e. what is going on with this client and what’s the best path forward to helping relieve the client of the problem/s). But in my experience diagnosis is at least as likely to complicate as it is to clarify. That’s because once a diagnostic label is attached to a client it is all too easy for both the client and the therapist to view the problem through the very lens that creates the “certainty,” a lens that is far too often either wrong or distorted.

Let’s take the example of the Bipolar 2 guy. He’s clearly viewing himself from a “here’s what’s wrong with me” perspective. What’s at least as important, though, is “what’s right with me.” Building on strengths is a surer way forward than is correcting weaknesses. Furthermore, is Bipolar 2 one of the primary issues in his life, or is it just as likely to be a cluster of factors for which there is no reimbursable diagnostic label (e.g. lack of self-confidence or overly sensitive to the expectations of family)? Even his labeling himself as a GS-14 triggers certain ways of thinking (in himself and in me) that are both helpful and limiting.

The way in which labels narrow our view is one I’ve written about fairly extensively before – see “Don’t Let a Label Determine Who You Are” and “Belated Birthday Musings – on Labeling Ourselves, Gratitude and Wonder

In brief, while characterizing oneself, or a problem or situation one is facing, has some value, it is essential to consider alternative ways of labeling what is going on so that new approaches can be used to address it, and new ways of observing it can be employed. This brings to mind one of Albert Einstein’s more famous quotes: “No problem can be solved from the same level of consciousness that created it.” More on that next time.