It’s a funny thing because it can be so concretely appreciated in everyday encounters. But the outcomes are highly variable. For example in one instance a female patient will come in reporting that she has bipolar disorder and needs medication in addition to the five she is already taking, to control her anxiety. If I tell her she “does not have bipolar disorder”, perhaps as a predicate to suggest more medication (for example a highly advertised antipsychotic or more alprazolam), is likely to do more harm than good, she might become outraged that I disagreed with her self-knowledge.
In another (just as likely) scenario, a woman of color might come to me complaining that her previous prescriber, a (male) nurse practitioner prescribed her multiple antipsychotics and mood stabilizers for “bipolar disorder” the np was sure she had due to her insomnia and sexual promiscuity (two-timing her boyfriend). I tell her she does not have bipolar disorder and she is relieved. I also tell her that her behavior is not what clinicians typically call “sexual promiscuity”.
I just want to add the first instance is a sort of imagined amalgam of multiple encounters, don't take my part too seriously (for example diagnosis relating to choice of sixth medication). The second instance is an actual case. A nice demonstration of why the DSM "method" is so flawed due to few symptoms' being unique to any diagnosis.
We humans get anxious about things we don’t have an explanation for. It’s more important to have one than to be sure it’s “correct,” regardless of how we determine correctness.
What goes for “diagnosis “ has long been applied to delusional ideas; they do explain and thereby reduce anxiety. Wish I could recall who first talked about that, but it’s been decades.
I really liked your article on the Rumpelstiltskin effect and was actually in the process of writing something reflecting on the connection with Levi-Strauss's ‘Effectiveness of symbols’ (I’m an anthropology PhD student). So cool someone’s already pointed it out!
Much of the psychological anthropology literature I’ve come across, set in very culturally varied (and often non-clinical) settings, shows that evoking the right names for distress can be powerful in itself.
You may have seen it already, but there’s a rich article by James Dow (1986) titled “Universal Aspects of Symbolic Healing: A Theoretical Synthesis”. It uses Levi-Strauss’s descriptions as well as many other accounts of clinical (e.g. Western psychoanalysis) and non-clinical (e.g. shamanic) healing to theorize the following universal structure for healing through the manipulation of symbols:
* "The experiences of healers and healed are generalized with culture-specific symbols in cultural myth.
* A suffering patient comes to a healer who persuades the patient that the problem can be defined in terms of the myth.
* The healer attaches the patient’s emotions to transactional symbols particularized from the general myth.
* The healer manipulates the transactional symbols to help the patient transact his or her own emotions."
(Dow frames psychoanalysis as another type of cultural myth, but an effective one)
First, I don't think providing a patient diagnosis is necessarily therapeutic. I think you should remain alert to the fact that what some may experience as recognition, others will experience as labeling and/or reductionism.
Second, I think you are talking about two distinct forms of empathic communication. Torrey emphasizes that the patient is heard, while you emphasize that the patient is described. The only thing in common is to the two approaches is that it involves speech. Perhaps one can relate the two by hoping that by being described the patient will also feel heard.
3rd, mental health professionals are not the only people who seek to help the vulnerable by giving them the opportunity to be heard. A cop talking a suicidal person down from a ledge is offering anxiety reduction from the realization that "someone understands, that he is not alone with his sickness, and implicitly that there is a way to get well.”
The same is true of nurses, pastors, and other empathic professionals.
Thank you for naming this phenomenon and shedding light on the history. I've been curious about the impact of diagnosis and the clinician's responsibility in the case that certain diagnoses create stigma within the clinical community (specifically, BPD- or referring to a patient as having "Cluster B traits").
I wonder about the downstream impact on the patient's likelihood of recovery when their behaviors or traits are attributed to personality, mood disorder, and/or trauma without ruling out undiscovered neurodevelopmental differences (specifically, ADHD and autism).
I also wonder why clinicians are reluctant to look at ADHD and autism specifically. With ADHD, I suppose there is a hesitancy on the part of many to prescribe stimulants. With autism, I suspect its because there is a knowledge gap regarding the evidence of the benefit of a late-diagnosis when a patient is engaged in appropriate support for identity integration, community building, and psychoeducation- as well as a paucity of providers available to facilitate that support.
It’s a funny thing because it can be so concretely appreciated in everyday encounters. But the outcomes are highly variable. For example in one instance a female patient will come in reporting that she has bipolar disorder and needs medication in addition to the five she is already taking, to control her anxiety. If I tell her she “does not have bipolar disorder”, perhaps as a predicate to suggest more medication (for example a highly advertised antipsychotic or more alprazolam), is likely to do more harm than good, she might become outraged that I disagreed with her self-knowledge.
In another (just as likely) scenario, a woman of color might come to me complaining that her previous prescriber, a (male) nurse practitioner prescribed her multiple antipsychotics and mood stabilizers for “bipolar disorder” the np was sure she had due to her insomnia and sexual promiscuity (two-timing her boyfriend). I tell her she does not have bipolar disorder and she is relieved. I also tell her that her behavior is not what clinicians typically call “sexual promiscuity”.
I just want to add the first instance is a sort of imagined amalgam of multiple encounters, don't take my part too seriously (for example diagnosis relating to choice of sixth medication). The second instance is an actual case. A nice demonstration of why the DSM "method" is so flawed due to few symptoms' being unique to any diagnosis.
We humans get anxious about things we don’t have an explanation for. It’s more important to have one than to be sure it’s “correct,” regardless of how we determine correctness.
What goes for “diagnosis “ has long been applied to delusional ideas; they do explain and thereby reduce anxiety. Wish I could recall who first talked about that, but it’s been decades.
Nice. I like how you elicit the differences between Torrey and yourselves. Very helpful. Thanks for the shout out my friend. ❤️
I really liked your article on the Rumpelstiltskin effect and was actually in the process of writing something reflecting on the connection with Levi-Strauss's ‘Effectiveness of symbols’ (I’m an anthropology PhD student). So cool someone’s already pointed it out!
Much of the psychological anthropology literature I’ve come across, set in very culturally varied (and often non-clinical) settings, shows that evoking the right names for distress can be powerful in itself.
You may have seen it already, but there’s a rich article by James Dow (1986) titled “Universal Aspects of Symbolic Healing: A Theoretical Synthesis”. It uses Levi-Strauss’s descriptions as well as many other accounts of clinical (e.g. Western psychoanalysis) and non-clinical (e.g. shamanic) healing to theorize the following universal structure for healing through the manipulation of symbols:
* "The experiences of healers and healed are generalized with culture-specific symbols in cultural myth.
* A suffering patient comes to a healer who persuades the patient that the problem can be defined in terms of the myth.
* The healer attaches the patient’s emotions to transactional symbols particularized from the general myth.
* The healer manipulates the transactional symbols to help the patient transact his or her own emotions."
(Dow frames psychoanalysis as another type of cultural myth, but an effective one)
3 points
First, I don't think providing a patient diagnosis is necessarily therapeutic. I think you should remain alert to the fact that what some may experience as recognition, others will experience as labeling and/or reductionism.
Second, I think you are talking about two distinct forms of empathic communication. Torrey emphasizes that the patient is heard, while you emphasize that the patient is described. The only thing in common is to the two approaches is that it involves speech. Perhaps one can relate the two by hoping that by being described the patient will also feel heard.
3rd, mental health professionals are not the only people who seek to help the vulnerable by giving them the opportunity to be heard. A cop talking a suicidal person down from a ledge is offering anxiety reduction from the realization that "someone understands, that he is not alone with his sickness, and implicitly that there is a way to get well.”
The same is true of nurses, pastors, and other empathic professionals.
Thank you for naming this phenomenon and shedding light on the history. I've been curious about the impact of diagnosis and the clinician's responsibility in the case that certain diagnoses create stigma within the clinical community (specifically, BPD- or referring to a patient as having "Cluster B traits").
I wonder about the downstream impact on the patient's likelihood of recovery when their behaviors or traits are attributed to personality, mood disorder, and/or trauma without ruling out undiscovered neurodevelopmental differences (specifically, ADHD and autism).
I also wonder why clinicians are reluctant to look at ADHD and autism specifically. With ADHD, I suppose there is a hesitancy on the part of many to prescribe stimulants. With autism, I suspect its because there is a knowledge gap regarding the evidence of the benefit of a late-diagnosis when a patient is engaged in appropriate support for identity integration, community building, and psychoeducation- as well as a paucity of providers available to facilitate that support.