The Pleasure & Pain of a Diagnosis

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by: Jamie Rautenberg

As someone who holds a license to practice psychotherapy, many may find what I’m about to write strange.

When I first studied the DSM(the Diagnostic and Statistical Manual of Mental Disorders),I remember being super excited to learn about all the different clusters of symptoms & behavioral patterns people possessed and how they related to various disorders. I longed to know the why behind the what.

For a newbie therapist, there can be a certain kind of relief to know that if someone exhibited 4 out of the 6 listed symptoms, a code could be written in their treatment plan & we’d have a clear place from which to guide our work.

When it came to the how of treatment, my graduate school education trained me in the importance of something called “Evidence Based Practice”. Meaning that the most responsible way I could act as a clinician is to follow a researched protocol that proves a certain treatment works for any given diagnosis. The evidence is published in various journals further solidifying the proof.

When it comes to treating depression, I learned that research has proven a combination of talk therapy & meds is most effective.

But, what happens when a client is not interested in medication or talk therapy?

What happens if they try therapy and/or medication, and don’t respond as expected?

Are they destined to remain depressed because the evidence shows so?

The further I dove into the research & methods of treatment, the more questions I had about it.

Yes, there is a trend we see when it comes to certain situations resulting in a particular set of emotional & psychological symptoms that manifest specific behaviors.

Yes, this information is very useful to help light the our way down the darkness into the root of the issue.

Yes, there is a relief for both therapist & client to know that there is an “answer”.

But, what if we’re wrong?

Something as small as a speck of bacteria like, Borrelia Burgdorferi(Lyme Disease) or a myriad of other medical conditions, can present as a laundry list of psychological diagnoses.

So can a significant trauma that’s remained repressed for a lifetime.

We don’t always know the cause of what we experience, but the labels we put on them can be just as damaging as the cause itself.

Just as I committed to finding the cause of my physical ailments, I sought out psychotherapy to heal my mind.

I worked with a gifted social worker for the good majority of my 20’s processing my moodiness. She, along with several other therapists, came to the same conclusion. I had Dysthymic Disorder (aka chronic low grade depression).

The label made sense to me at the time, so I gladly accepted it.

So, a few years back, I went to my first session with a new social worker who specialized in chronic pain. By the end of the hour, we vibed so well that it felt like I was discussing my glorious mess with a peer. When it came time to place a diagnostic code on the invoice for my insurance, she turned to me and said, “What do you think?”

In unison, we said, “300.4”, DSM speak for Dysthymic Disorder.

We laughed and went on to have what I believe was a beautiful & mutually therapeutic relationship.

But, looking back on that moment, I can’t help but be slightly disturbed by my rote response. It was as if I carried the code with me in my back pocket. I kept it tucked away in my subconscious, only to come out during times of vulnerability. It was clearly a relief for me to wave that flag rather than actually consider the more muddled issue which had yet to be uncovered.

My attachment to the Dysthymic code wouldn’t come to an end until I waged a war on Lyme Disease, another label which invaded my body long before I ever knew what a therapist was.

In the midst of fighting so hard to kill what I thought was killing me, I realized that all of my sadness went way deeper than Dysthymia symptoms would ever suggest.

My experience was not a cluster of symptoms tied up neatly in one label.

My mind was the visual representation of a Jackson Pollock painting-clusters of splatters.

This wasn’t anything a textbook or another person could decipher. To be honest, I’m not even sure any of us can ever fully know what lies underneath all of those splatters. But, what I do know is that it’s not completely necessary to know in order to deal with them.

This meant intentionally swan diving into a pool of all the discomforts, emotional & physical, I ever held onto throughout my entire life. I had to allow myself to feel the pain that my body stored.

Every label, every diagnosis, every harsh word I ever believed about myself wrapped around every muscle, every joint, every part of me, constricting my being.

The way out of this pain was not another diagnosis or pill to cover the symptoms of constriction. My only way out was allowing it to exist as it is, without the judgement of another or myself.

I’m still very much processing the experience of living in the uncertainty of this very human body, but isn’t everyone else?

There is pleasure & pain involved with every diagnosis doled out, on multiple levels. But, ultimately, it’s up to us to recognize that the root of all of these labels basically comes down to how effectively we can process our feelings, thoughts & behaviors.

We all struggle with these 3 areas at different points in our lives for an infinite variety of reasons, which is why I’m finding it less possible to classify what seems to infinitely subjective.

We could have microorganisms in our brain. We could have been abused. We could have been bullied. We could have lost our parent at a young age. We could have grown up homeless. We could have a switch flipped on a specific gene and it expressed itself as physical disability.

It’s vital to note that each of these hypothetical situations can produce exactly the same emotional symptoms, and therefore a similar diagnosis. And yet, the treatments required can vary greatly.

And so, I decided to practice as a holistic life coach where I can operate from a fuller, more whole picture.

I’m grateful to incorporate the knowledge I’ve received from my educational training and experience working in various mental health clinics throughout New York City. However, I’m only now feeling the freedom that comes with acknowledging all possible aspects a person brings with them into a session.

I believe that ideally, coaching & psychotherapy is a process of learning how we can face our own reflection without judgement. Over time, it can be difficult to separate between the judgements & the diagnoses.

So, I’d rather operate from a place of consistent curiosity. No one can know us better than us, I believe this to be true of all humans, especially my clients.


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