What I’ve learned about using diagnostic labels

by Debbie Quackenbush, PhD on March 18, 2011 · 1 comment

in diagnostics

Once I decided I was going to try to quit using diagnostic language. My head was swimming with diagnostic labels and, when I started working at Menninger, I came to find out that there were new labels to be learned! For example, I found out that one can be addicted to “love.” Who knew?

I became convinced that I stopped seeing “people” at some point, and started seeing boxes and symptom lists and other forms of academic short cuts that are often used to describe a  complex human who sits across the room from us.

In my role as a psychologist, I often get called upon to use diagnostic language when describing people. I’ve been trained in psychopathology and assessment, and there have been times when, within 15 minutes, I had to come up with a formulation about a person’s innermost self. I knew it was too much when I went home and started thinking of my dog as “avoidant” and “masochistic.” She deserved better, I thought.

A new viewpoint

I became determined to look at people contextually. At this time, I started wearing a rubber band on my wrist, and every time I uttered a diagnosis (or defense mechanism or similar psychobabble) in a meeting, I would snap it. I found that I was snapping it every five minutes or so!

It seemed that diagnostic language was everywhere and that even patients were hungry for a word, or set of words, that pulled their experience together into a cohesive and unified idea. For about two weeks, I succeeded.  Interestingly, I found my thoughts to be more poetic and my stream of consciousness about the folks I was working with to read, on paper, more like a rich and detailed novel. My patients were coming to life!

And then I forgot the rubber band and sank back into my old habits. Perhaps I’m a “label addict.”

What happened to mentalizing?

It struck me that in forming a diagnosis we were doing the opposite of mentalizing. Instead of staying curious and continuing to ask questions, we were arriving at conclusions — sometimes far too soon in a person’s treatment. I believed that a diagnosis was an end point and could lead, quite possibly, to the cessation of curiosity. However, in a poignant moment dealing with a relative who was struggling with a mental illness, it dawned on me that the diagnosis gave the family, at least, a community. It allowed them to look online and join groups for relatives of people struggling with bipolar illness, for example. It simplified complexities in an already demanding world.

In sum, I’m back to my old habits. I like what I discovered, however, when attempting to let go of a world view that was instilled in me many years ago:  that human problems can be distilled and diluted into medical terms. In doing so, I discovered a richer language in myself, and I find that I’m thankfully still able to access that language.

I also learned something about some peoples’ quest for meaning and understanding, and how diagnostic language can assist in that quest and can even help people form supportive networks. As always, the answer is not an “either/or” but a “both/and.” Or, perhaps I’m just projecting.

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{ 1 comment… read it below or add one }

Jim Webster March 27, 2011 at 11:31 pm

Thanks Dr Q for sharing that you tried a new approach. Us patients do appreciate that you docs pull “our stuff” together into a cohesive and unified idea given that time in a meeting spent with you all is very short. I agree also on the “both/and.” Rev DelMundo used that too.


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