Evaluation and Diagnosis

RU SSW Psychopathology

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What is diagnosis? We live in an era of quick fixes. And the search for solutions often leads to equally quick attempts at diagnosis, assessment, or evaluation. Many believe that diagnosis of a mental illness or concern can be done in minutes, much like we diagnosis a bacterial infection or a problem with our motorcars. And hasty diagnoses can have lifelong consequences, especially for children and adolescents, who come to see themselves as “diseased, disabled, disordered”; and sometimes others (e.g., teachers, peers) label and treat them as disordered. Many practitioners in our quick fix mental health system, seek answers to complex questions by resorting to a series of simple questions (i.e., tick off boxes on a checklist). Then they consult the increasingly controversial diagnostic manual of the American Psychiatric Association (DSM) and by some magic a diagnosis emerges. And remember, this is a symptom checklist. It does not produce an understanding of the cause of our symptoms. We all have symptoms throughout our lives: depressive symptoms, anxious symptoms. And the causes of these symptoms are so specific for each one of us, unlike a fever caused by a virus, that we must seek the answers, not from checklists, but by learning together what the symptoms mean.

We believe that because our deepest longings and most troubling problems are not produced over the short-term, there are no easy ways to understand or evaluate our problems. Unfortunately, our mental lives are not like bacteria and they don’t lend themselves to simple understandings or solutions. There is no litmus test for our complex and sometimes troubled thinking, feeling, or action. There is no blood test or thermometer. And as hard as we’ve tried, we can’t look into the brain and find a place where it all happens. It’s just too complex and determined by so many factors.

And often, as we begin to understand our problems, our perspectives begin to change and the problems themselves change. And because we do not believe in a check-list approach to diagnosis, our approach to diagnosis is guided by caution, deeper understanding, often over longer periods of time. We will spend several sessions with you and together evolve an understanding of the issues and concerns you bring. After this period of evaluation, we will offer some suggestions as to the best approach and the best person to help you. Finally, evaluation, like therapy, requires a trusting relationship, grounded in our capacity for careful listening. This is a kind of listening defined not by listening for (if we listen for, we’ll hear what we expect to hear) but by our capacity to listen to. See recent New Times Article by Dr. Jerome Groopman.