Dilbert’s The Fact

James: Thank you so much for sharing that, Regina!  That’s great… I forget how funny that comic/cartoon was/is.  I am going to share this link with the group I talk with down here.

After reading Chris’s article, I had some other thoughts.  Chris wrote “It is interesting to think about what would happen to the practice of psychiatric therapy without diagnostic boxes in which to put patients” and how diagnosis can contribute to the social process of treatment.  I thought it was quite nice what he wrote: “A successfully negotiated and agreed-upon diagnosis, coming out of this process, externalizes the problem, defines what means will be used to attack it, and so re-moralizes not only the patient but the others…. a diagnosis is not only a box, it can also be a battle plan.”  So well put…

I saw a young man yesterday for assessment on entry to our program.  He had experienced a psychotic break in the past week or so (atleast as far as his family understands it), and had been taken by his mother from Florida (where he resided) to live with her here in North Carolina.  He presented with some very interesting behaviors: very friendly… almost expansive and consuming, immediately shook my hand and proceeded to give me some sort of secret handshake and then winked and stuck his tongue out at me as if to play with me, and led me to my office (went down the hallway with me in tow reading all of the office placards until we got to mine office) and then asked me to go in ahead of him.  He was convinced that his mother had taken him from Florida because she was anxious about him, the hospital down there had held him because his father talked them into believing he was psychologically troubled (“I went there on my own to get hydrated after using Adderall”), and related his present psychological stress to not being home, being a “straight” man in “gay porn,” and that his girlfriend hung herself after realizing he was impotent from the psychiatric medications the hospital put him on last week.  The client’s mother was very distressed by what she characterized as his delusions and his expansive affect… she said he was usually so mild, “tame,” and that she investigated his life in Florida to see what truth there was to what he said, and none of it was “real.”  The young man is not going back to his old apartment in Florida, and is likely stuck here with mom, but he believes he does not have “psychosis” or any other mental illness.  What a tough situation for all parties!  The psychiatrists here are likely to diagnosis him with schizoaffective disorder which he will likely disagree with and try to convince him to take medications for which he sees no reason to take.  Situations like this I think fit nicely with the idea that Chris wrote about… that more important than slapping a label on him is finding a diagnosis that fits for all parties so that a proper battle plan can be drawn up to help this young man get his life back, and his mother feel more assured about his life and their relationship.

Got to run now, but I also wanted to recommend an article:  “A proposal to classify happiness as a psychiatric disorder” by Richard Bentall (Journal of medical ethics, 1992, 18, 94-98).  It is certainly a bit satirical, but he ends with a poignant statement: “Indeed, only a psychopathology that openly declares the relevance of values to classification could persist in excluding happiness from the psychiatric disorders.”  Quite a piece of commentary on the state of our mental health paradigm in Western medicine.

Regina Jardim: November 8, 2010

Dear Peggy and James

Yesterday I wrote quite a large post to you both but for some reason when I clicked on post button I lost it. I will try to rewrite it. First, thank you very much for your comments. I am very happy that you liked the cartoon and I hope you find it as useful as I do to work with my students.
On the topic of diagnosis, I tell you what I have been trying lately. I have been inspired by Michael White saying on his book about narrative therapy maps: “Jeffrey, What colour is your TDAH?” What I mean is that although very difficult I try to use externalization to manage the diagnostic. I know this helps with the managing of the patient but we still have the question of dealing with our pairs.
I promise to write more on this topic later but for now just sending my greetings.
Best regards, Regina Jardim