What's Your Label?

 It was the first year I was working at an outpatient clinic in Zürich, I was seeing a patient for the first time. I didn’t have much of an idea of what it was about, just that this 40-something year old woman, a mother, was going through a rough time. We were sitting opposite each other, and with my pleasant, but not too off-putting therapist smile, I was about to start my usual first-encounter questions. But she turned around and rummaged through her bag, pulling out a folder of papers and laid them out on the table. “I found these questionnaires online; they are very relevant to what I think I have and I’ve already filled them in for you”. This woman had diagnosed herself with light autism and ADHD before I’d asked her if she had managed to find our office easily enough. She continued: “you see, my daughter just got the Asperger diagnosis and since its hereditary, it probably also explains why I’m having issues.” I was baffled, I did not know which words to push from my mouth.

But honestly, what are you going to say as a therapist? I’ve listened in on several very experienced therapists dealing with ridiculous situations like these in exceedingly elegant ways, the patient never getting offended or even feeling a little rejected and I remember thinking: “how the heck am I going to become such a smooth talker?” It would cause me a decent amount of anxiety. An easy and not infrequent way out I think, is to grant every request and say: “you are probably absolutely right, let me write a long letter to the social insurance to have you reduce your weekly work hours, and then let’s get you started on Ritalin (Methylphenidate, stimulant with dependence and tolerance potential similar to amphetamine) this instant”. I didn’t study this long, to become some guard dog for tax money and reason.

Another diagnosis that has increased its prevalence significantly over the last 30 years is PTSD (post-traumatic stress disorder), so much so that the new diagnostic manuals are tightening the criteria to receive the diagnosis [1]. The most interesting change I think, has been the definition of what constitutes a traumatic event. It used to be quite clear that the traumatic event in question “is likely to have the same effect on anyone experiencing it”, examples being concentration camps and slavery. In this recent study, they found that [2] 30% of the traumas are “interpersonal network experienced trauma”, whatever that is. Then I ask myself, who am I to put someone’s experienced trauma in doubt? However, what happens if I don’t?

A study that is relevant here states that: “Attention-deficit/hyperactivity disorder (ADHD) has tripled in rates in the past twenty years; bipolar disorder has doubled overall, with childhood diagnosis increasing forty-fold; and rates of autistic disorder have increased by more than twenty-fold. In the US, the yearly prevalence of a mental disorder is reported at 20–25%, with a 50% lifetime rate, and Europe is not far behind [3]”. The line between truly mentally ill and troubled “normal” person has become so blurred, it is overloading not just the psychiatric institutions but all the other doctors’ offices. Decreasing the accessibility for those who are truly dependent on them. But that is just a byproduct. The true problem is with these specific labels that are getting so popular, Asperger syndrome, Autism, ADHD, PTSD, Bipolar and now also Dissociative disorders; they don’t come off. They will follow the person for life, it will define them, and given early enough kids and teens will form their identity around them. The “treatment” consists mostly of restructuring your environment to better accommodate whatever this illness may be. 

What we see now in the generation entering adulthood, is the search for a victim status. It has become how they set themselves apart from their peers. You’d be surprised at how many young people have neglectful or abusive parents. It often makes me question what I’m being told in the session, but even to me, summoning a patient’s whole family to verify their reports seems a little excessive. So, in this widespread trend of “what is your victim status”, I wonder if we (both therapists and patients) aren’t being set up to fail? It goes without saying, that these disorders are terrible for the sufferers, and they should be treated to the best of our abilities. But the numbers above are telling a story different than discovering the previously undiscovered sufferers. I suggest, when in doubt, aside from filling in the questionnaires, to help people look past their victimhood, and approach life with courage.

[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168808/

[2] https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis/print

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683254/