{"id":96,"date":"2014-06-01T19:46:21","date_gmt":"2014-06-01T19:46:21","guid":{"rendered":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/?p=96"},"modified":"2014-06-01T19:46:21","modified_gmt":"2014-06-01T19:46:21","slug":"again-beware-diagnoses","status":"publish","type":"post","link":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/again-beware-diagnoses\/","title":{"rendered":"again beware diagnoses"},"content":{"rendered":"

I’ve been talking recently the dangers of diagnosis<\/a>, (also here<\/a>, here<\/a>, here<\/a>, and I especially like this one<\/a>), and I heard a case on public radio that illustrates this perfectly.\u00a0 A preadolescent girl named Maia was struggling with some developmental problems, possibly Asberger\u2019s, and had difficulty making friends.\u00a0 She yearned for play dates but her intensity and oddness made her peers uncomfortable and they shunned her.\u00a0 The story was heartbreaking particularly as Maia herself \u2013 in her childlike and slightly awkward speech \u2013 described how she spent recess at school.\u00a0 Her mother then took up the story and recounted an episode in which in a fit of extreme boredom Maia knocked on a neighbor’s door near the school and asked if the boys could come out and play.\u00a0 The boys were busy, she was told.\u00a0 Maia sat down and began to sob, eventually wailing “no one will play with me”.<\/p>\n

She subsequently became more difficult.\u00a0 She was unresponsive, made little eye contact, frequently had tantrums.\u00a0 She was even hospitalized.\u00a0 There she was given the diagnosis of Conduct Disorder; other practitioners and facilities diagnosed other things.\u00a0 Conduct Disorder is a serious diagnosis.\u00a0 The American Academy of Child and Adolescent Psychiatry notes that \u201ctreatment of children with conduct disorder can be complex and challenging”.\u00a0 Such children may grow up to be psychopathic \u2013 i.e. criminally violent, chronically unable to form relationships, dangerous, impulsive, lacking in basic connection (empathy) to other people.\u00a0 In desperation, but by now with little optimism that Maia would ever be remotely happy, her parents tried a new summer camp for her.<\/p>\n

On her first day, Maia met Charlotte, a girl free from any developmental problems or social awkwardness.\u00a0 In their first meeting, in the company of Charlotte\u2019s other friends, Maia said something that made Charlotte laugh.\u00a0 Charlotte later recalled that she found Maia \u201cperfect\u201d in this moment.\u00a0 The two went on to a wonderful summer together and then regular play dates back home.\u00a0 They sat on the floor of Maia\u2019s home with her toy horses joking and role-playing for hours, like any other children.\u00a0 Meanwhile in the rest of her life Maia began responding to adults and children she\u2019d previously ignored, tolerating activities and conversations in which she had less than perfect interest, tolerating frustration and limits, complying with rules, making eye contact, and in all other ways becoming much more like a normal child.\u00a0 She still had occasional tantrums, but the change was dramatic.\u00a0 One day, for example, the school bus driver left his seat to come outside and introduce himself to Maia’s mother, just to share with her the change he\u2019d observed in Maia.<\/p>\n

If Maia had not met Charlotte, she would have to have lucked into a good child therapist.\u00a0 They do exist.\u00a0 But I can tell you as a practitioner that the world \u2013 courts, schools, insurance companies of course, and sometimes even parents \u2013 are more and more interested in my providing a label for the child, and a carefully outlined treatment plan which I am supposed to know from my first or second meeting with her, one based on addressing her symptoms directly.\u00a0 And of course insurance companies want her cured in about 15 sessions.\u00a0 Unless I am incredibly lucky and Maia takes to me as she did to Charlotte \u2013 quite a shot in the dark \u2013 this is nigh impossible.<\/p>\n

As we see from Maia\u2019s symptoms, the real problem is not described by her diagnosis.\u00a0 Maia was acting like a child with Conduct Disorder but what she wasn\u2019t one.\u00a0 Basing treatment on such a diagnosis would probably not work (unless she happened on a psychoanalyst who sees through the symptoms to the attachment problems beneath).\u00a0 It might even make the problem worse!\u00a0 Forced, pressured, cajoled, or otherwise badgered about her symptoms, Maia might become further isolated from the genuine relationships which so clearly were the cure here.<\/p>\n

In our world sometimes when the cure doesn’t come within 10 or 15 sessions, more labels start flying \u2013 Oppositional Defiant Disorder, Asperger’s syndrome, autistic spectrum disorder, personality disorders, on and on.\u00a0 This has happened with other people I’ve described in the website (Ron<\/a> as a child was diagnosed with attention problems, conduct disorder, and later OCD; see also\u00a0Ed<\/a>, George<\/a>, and there are others); these people weren’t fortunate enough to be touched early on by a Charlotte.<\/p>\n

Such diagnostic labels and probably any resultant treatments would, I\u2019d bet, have had little effect on Maia.\u00a0 What she really needed was a special friend.<\/p>\n

I hope this story has illustrated a point I have tried to make many times in this blog and in the website:\u00a0 Diagnoses in the land of mental\/emotional issues are more often than not painfully superficial.\u00a0 This is especially true with children. \u00a0For the courts, I evaluate children and families involved in custody\/visitation disputes.\u00a0 In the process I often review prior psychiatric and psychological evaluations.\u00a0 You might be astonished at the range of diagnoses that are given to a child as she goes from one difficult phase to another.\u00a0 The reason the diagnoses vary so much is that they are based on the most apparent but superficial and even misleading aspects of the person \u2013 outward behavior.\u00a0 Obviously behavior is important, especially when a child or adult must function in the world.\u00a0 Behavior is, however, very far from the whole story and it may tell you little about what the person in question needs, and about what will help .\u00a0 Take a look at the bully<\/a> and especially the\u00a0flincher<\/a> as a very simple example of how the same issues and history can produce drastically different outward behavior and conscious attitudes, yet both these characters are the same, just under the surface; and their therapies will be quite similar as well.\u00a0 No need for bully or flincher specialists; what\u2019s needed is a person specialist.<\/p>\n

Quick disclaimer:\u00a0 Of course there are children with more complex problems than Maia \u2013 children with serious autistic spectrum disorders, or with conduct problems that are indeed precursors to adult psychopathy.\u00a0 I don\u2019t mean to oversimplify the entire realm of developmental problems by reference to this one case; they aren’t all like Maia and some need much more than the remarkably good friend Charlotte.\u00a0 But again be sure you know what you\u2019re dealing with and have considered all options.\u00a0 Be wary of rushing to the diagnostic labels and specialists. \u00a0More about this here<\/a> and in the other links above.<\/p>\n","protected":false},"excerpt":{"rendered":"

I’ve been talking recently the dangers of diagnosis, (also here, here, here, and I especially like this one), and I heard a case on public radio that illustrates this perfectly.\u00a0 A preadolescent girl named Maia was struggling with some developmental … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/96"}],"collection":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/comments?post=96"}],"version-history":[{"count":2,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/96\/revisions"}],"predecessor-version":[{"id":98,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/96\/revisions\/98"}],"wp:attachment":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/media?parent=96"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/categories?post=96"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/tags?post=96"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}