The Importance of an Accurate Diagnosis
Every two years, in order to renew our licenses, health professionals are required to take a 2-hour course on medical errors, the third leading cause of death in the United States behind heart disease and cancer. One of the significant errors made has been misdiagnosis. Obviously, if the diagnosis is wrong, the treatment based on that assessment can prove to be disastrous and even deadly. As a mental health professional, I am not pumping medications into the veins of my patients, of course, but a correct diagnosis is essential in my line of work as well. What looks like depression may have underlying physiological factors contributing to it, and I must consider those factors.
I see a number of patients who were wrongly diagnosed by other mental health professionals, usually in hospital settings, often with Bipolar Disorder. It seems to many psychologists who pick up the pieces after such traumatic experiences that some providers give hurried diagnoses without taking into consideration the whole context of a person’s life. Not long ago, Dr. Annita Sawyer, a fellow psychoanalyst and author of Smoking Cigarettes, Eating Glass, spoke to our local analytic society about her horrendous treatment by the psychiatric community. She was just in her late teens and early twenties when she was wrongly diagnosed with schizophrenia and treated with electroconvulsive therapy 89 times. Years later, in a much more humane setting, it became clear that her symptoms had been the result of significant childhood trauma. Then she had been treated by the medical community with more trauma! Quick and simple diagnoses can do much harm.
When working with couples, it can take me several weeks to gather enough data about the pair sitting before me. Most of the time, the diagnoses are complex. Acute symptoms are the first to spot. These are the matters that hurt so badly, driving the couple to seek treatment in the first place. Beneath the acute symptoms, however, are almost always the chronic ones, longstanding issues that may have been there in nascent form from the earliest days of the relationship. Both must be addressed, but the acute pain must be acknowledged first. In other words, the inflammation must be treated before we are able to consider deeper matters.
I am not a sociologist, a cultural anthropologist, nor a political scientist, but for a living, I work with the complexities and conflicts within the wonderful people I see. Lately I have wondered what it would look like to put America, as a patient, “on the couch?” I ask myself, how could anyone attempting to understand and empathize with all the painful conflict within America NOT be impacted by individual perspectives (we often call this as therapists our countertransference)? We must first own our unique histories, biases, and triggers before we will be of any help. So, if we might be brave enough, or foolish enough, to attempt such a task, what might we notice?
First, I believe we would see the inflammation. Recently we have seen a nation outraged by an act of police brutality that has evoked incredibly painful feelings. If that were the first and only such act, likely we collectively would not have reacted with such deep sorrow and frustration and anger. But it was, by far, not the first, and has a deep history. Anytime power is abused we cry out for justice! Often the poorer communities and many of the minority populations feel the abuse of power most deeply, and often feel such pain first and longer than the rest of society. These people are part of the national “body.” When part of the body hurts, it should cause pain to the entire body unless the rest of the body is in some way numbed or anesthetized so as not to register the sensation. In such situations it would seem essential to restore feeling to the rest of the body: to discover what is blocking sensation and relieve it.
I wonder just how we might address such inflammation. In our bodies, fever and swelling are essential natural reactions against processes that might further compromise our health. If we simply reduce fever we may not always be doing ourselves a favor; sometimes fever is necessary. But prolonged inflammation damages the body in countless ways. In our bodies as well as our nation, there is a time to heat up and a time to cool down.
Often times in couples therapy I hear a spouse admit to being afraid of cooling down: “If I stop being angry and just forgive, I’m just afraid it will happen all over again!” Staying hot is a way of requiring the other not to forget, not to slack off, not to slide back into the destructive pattern all over again.
Second, it is essential that we explore the underlying causes of the trouble that may have existed long before any inflammation set in. Many in our nation today have highly refined ideas of what the disease is, but often they seem to be at odds with one another. These are some of the ideas that I have heard:
1. Institutional racism that is embedded in the DNA of America itself.
2. Intergenerational trauma that psychologically impairs whole sections of our nation from being able to take advantage of the opportunities available to it.
3. Well-intended policies meant to address poverty and prejudice that have gone awry.
4. Spiritual disconnection and the increasing secularization of America that seeks division as opposed to unity in our world.
5. Evil that exists in this world from demonic and Satanic sources, intent on killing, stealing, destroying, and deceiving.
6. Philosophies that encourage people to look at the world solely through the lens of differences as opposed to similarities (similar to #4 above), such as political correctness or identity politics.
7. Corporate greed that enriches a few over the many (i.e., the private sector out of control).
8. Governmental rules and regulations that hamper true freedom (i.e., the government out of control).
9. The indifference of the majority.
These are but a few theories about what is wrong with America. Currently, legislative and executive task forces are at work trying to get a handle on the problems. I pray for accurate diagnoses, for all sides of the issues to find a fair hearing, for this to be a time of bipartisanship and healing, a time when politicians would seek not to inflame or posture for political gain.
Recently, the idea of being “woke” has entered into the vernacular of our speech. “Woke” people have become alert to societal injustices, especially regarding racism. Indeed, we as a society want to root out all vestiges of racial injustice wherever they are found. But, I wonder if more is at play here than the evil of racism.
I think about the Prayer of St. Francis in such moments as these:
Lord, make me an instrument of Thy peace;
Where there is hatred, let me sow love;
Where there is injury, pardon;
Where there is error, truth;
Where there is doubt, faith;
Where there is despair, hope;
Where there is darkness, light;
And where there is sadness, joy.
O Divine Master, Grant that I may not so much seek to be consoled as to console;
To be understood as to understand;
To be loved as to love.
For it is in giving that we receive;
It is in pardoning that we are pardoned;
And it is in dying that we are born to eternal life.
More recently, in Seven Habits of Highly Successful People, Stephen Covey’s habit number five states: “Seek first to understand, then to be understood.”
Seek First to Understand
Right now, many good people are talking past each other. We are living in a world of offense-taking in which many do not even attempt to understand … at all. If you find yourself hypervigilant, looking for words or phrases or optics about which you may find offense, please allow me to say a couple things: 1) that is ultimately an unhealthy way to live, psychologically, spiritually, and physiologically; and 2) if you want to encourage those who differ from you to hear you, hypervigilance is the wrong way to go about it. I know that you may be incredibly frustrated with others who seem to stonewall you. But if your goal is for the other to hear you, then make it easy for them to hear you. In baseball parlance, try lobbing the ball across the plate rather than firing a brush-back pitch that knocks the batter to the ground! Do you want to destroy the other or get the other to understand you?
And, to those who feel deeply offended by voices that may come off as shrill and accusatory to you, may I invite you to move past your initial reaction to find at least a kernel of truth to what is being said. Please do not ignore the perspectives of these voices simply because of the style of delivery. You need not abandon your worldview in order to hear the perspective of another. The fact is that you may have been so overwhelmed by your own life that you may not have had the time or the space to imagine the world through the eyes of those quite different from you. Do not allow this moment to pass you by simply because of your own busyness. Please come to the table.
Are any of the nine diagnoses above comprehensive and detailed enough to explain adequately what is wrong with our nation? I don’t think so. Does each contain and important truth or perspective? Probably. Would everyone agree with each one of those perspectives? Unlikely. It may be too early to diagnose. We may need to gather more information, to listen more carefully, to search in places we may have overlooked, to open our minds and proceed with humility, and to pray for wisdom. After all, we have a precious patient before us.