Mental health diagnoses: what are they (and aren’t they) good for?

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Diagnoses can be tricky. 

They can be useful; they can be complicated; they can be helpful or unhelpful. 

Mental health diagnoses are a tool; and like any tool, they can be productively used or destructively misused. 

One of the important things to understand about a diagnosis is that it’s not a “thing” that exists independently of anyone’s behavior or neuropsychology. 

You can’t see, feel, hold, or physically measure an “eating disorder” or “PTSD.” 

These are all descriptions of patterns of feeling and behavior. No less, but no more. 

Many people get in trouble when they over-assign importance to a diagnosis, or when they begin to think of a diagnosis as a “thing” unto itself. (There’s actually even a name for this problem— it’s called “reification,” after the Latin word for “thing.”)

It’s true that a diagnosis can be helpful in understanding what’s going on with someone. It can even leave some people feeling relieved that their pain has a name, and that it’s more than just someone choosing to act destructively or think negatively or feel terrible. 

But it’s also true that if we get it in our heads that simply naming our pain will always lead to a straightforward path to a cure, we’re going to be in for frustration and heartache. 

When you’re facing the issue of a mental health diagnosis, keep in mind that the labels and numbers we mental health professionals assign to your symptoms serve various functions. 

Sometimes they serve a “place holder” function while we gather more information. 

Sometimes they open up opportunities to work with different kinds of professionals (there is a subset of specialists, for example, whose services are unavailable unless people are diagnosed with specific conditions). 

Sometimes a diagnosis is necessary to procure payment for the kind of professional services necessary, even if the specifics of that diagnosis aren’t particularly well-established. 

Don’t get married to a diagnosis. 

Don’t fall into the trap of thinking that a mental health diagnosis necessarily means what is “wrong” with you has been determined with the specificity of a CAT scan or a blood test. 

And always, always, always remember that a diagnosis can, at best, DESCRIBE what’s going on with you…but it often can’t EXPLAIN what’s going on with you. 

So, if there are all these caveats, what good is a mental health diagnosis at all? 

There is a subset of conditions for which accurate diagnoses are absolute lifesavers, when it comes to choosing treatment modalities. Post traumatic and dissociative conditions are like this. Very often PTSD and dissociative disorders get diagnosed as mood, anxiety, or psychotic disorders, and treatment functionally grinds to a halt because it is not accounting for the core symptomatology that trauma presents. 

Another good example of this is certain eating disorders. There are known patterns to how people with anorexia and bulimia tend to think, and labeling these conditions accurately can give the provider a clue on how to treat them psychotherapeutically. 

Most mental health diagnoses, however, are not like this. 

Major depressive disorder, for example, is a condition that is frequently diagnosed (accurately enough, according to its diagnostic criteria), but which doesn’t, on its surface, give a provider much to work with in terms of the thought patterns and life events that are contributing to it. 

Most disorders that are diagnosed with a caveat of “not otherwise specified” (NOS) are also examples of this. The “NOS” designation is usually employed as a sort of “place holder” diagnosis when someone’s difficulty is clearly related to a type of diagnosis— is clearly a mood problem, or clearly has elements of an eating problem, or clearly has aspects of a dissociative problem— but the specific diagnostic criteria necessary to nail down a firm diagnosis are not present. As a rule “NOS” diagnoses don’t contain an awful lot of useful information for a treating therapist— or a suffering patient. 

Something else we need to remember about mental health diagnoses is that, most often, they essentially offer “snapshots” of someone’s symptoms and functioning at the time of assessment. While this can be useful, it is also necessary for therapists (and patients, and family members) to think about this “snapshot” in the context of everything we know about this person— including their past behavior, their past diagnoses, and their past treatment (both successful and less than successful treatment). 

All of which is to say: treat mental health diagnoses as the provisional tools that they are. 

They do contain information, and that information is often useful. 

But they are not tools that are designed to be used in the absence of other information; they are not tools that should be considered infallible or unchangeable; and they are limited by the imperfect procedures and perceptions of the human beings who assign them. 

Remember what I always say about any tool: you need hammers to build houses. It’s hard to build a house WITHOUT hammers. 

But hammers can also crush your thumb if you’re not paying attention. 

Book Review: “Making Friends With Your Unconscious Mind” by Patricia O’Hanlon Hudson

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In “Making Friends With Your Unconscious Mind: A User Friendly Guide,” Patricia O’Hanlon Hudson wants us to think of our unconscious mind as a computer. It is a tremendous tool…if we know how to access its functions and use it judiciously.

Hudson makes the case that our unconscious mind knows things we don’t about why we do what we do; what we need; and how we can function better. She advocates learning to access our unconscious minds through self-hypnosis, dream interpretation, and intentional dream programming, and she lays out simple techniques for familiarizing ourselves with and harnessing the abilities of our unconscious mind.

Her techniques for inducing self-hypnosis are fairly straightforward; they would be recognizable to anyone who read the book I reviewed a couple weeks ago, Goldberg’s “Self-Hypnosis.” Hudson touches on progressive relaxation and visualizing relaxing places and situations; however, unlike Goldberg, she stresses that hypnosis is optimally induced via permissive “possibility” language, rather than directive, “you-will-now-feel/think/do-this” language.

(Students of psychotherapy will appreciate the fact that this emphasis on “possibility” language is, in fact, linked to the fact that Hudson is married to one of the pioneers of solution-focused psychotherapy, Bill O’Hanlon.)

Something that I like about Hudson’s book is that she treats the unconscious generally with gentleness and respect. Unlike Goldberg, who was fond of giving our unconscious commands to follow, Hudson’s interventions mostly focus on asking for our unconscious’s cooperation in telling us things it wants us to know anyway.

Examples of things we can ask our unconscious to elucidate for us include reasons why our behavior is blocked or why we’re behaving in self-sabotaging ways; clarifications of fears or anxieties; and assistance with shifting our emotions and behavior with less pain and internal struggle.

A unique feature of Hudson’s book is the focus on proactively working with dreams. There are reams and reams and REAMS of books on dream interpretation, many of which approach the subject from involved Freudian viewpoints.

Hudson here doesn’t do a deep dive into dream theory; rather, she advocates doing as much conscious thinking and writing about the problem as is practical, then intentionally asking our unconscious mind to keep working on the problem via dream states. Then, when we wake up, Hudson advises immediately jotting down what we can remember of our dreams (a widely advocated technique that has been shown to progressively improve how much of our dreams we can recall), and reviewing our dreams for “answers” our conscious might have provided (either obviously or symbolically).

Hudson goes on to elaborate on how we can use self-induced trance states to mentally “rehearse” dealing with difficult situations, or mentally prepare ourselves for life events or tasks.

Again and again, Hudson asserts that the key to effectively engaging our unconscious mind is to treat it with curiosity, respect, and deference. She emphatically states that becoming familiar with how the unconscious mind “talks” to us, and intentionally setting out to communicate with and draw upon the unconscious mind can provide us with perspective and resourcefulness we may not have even suspected.

Overall, I like Hudson’s approach to the mind. It fits well with my own therapeutic philosophy, which prioritizes forming a supportive relationship with one’s self (long-time followers of my work will remember my repeated assertions that you simply cannot bully  or shame yourself into feeling or behaving better– it just doesn’t work).

Likewise, I like the way she recommends thinking of the mind– as a computer that will work better and better the more familiar you become with it. I cannot tell you how much of my own work with patience centers around getting them to be less afraid and reluctant to look at and explore their own minds. We cannot, as it turns out, change something that we don’t understand well and/or are reluctant to engage.

The only glitch I have with this book is, we still don’t know– not really– what the unconscious mind actually IS.

We don’t know if it functions the same for everyone.

We don’t know how it works, or interacts with the physical nervous systems we human beings have.

Yes, it’s a great thing to become familiar with the workings of your mind; yes, human beings are responsive to suggestion and it’s important to learn how to frame and introduce suggestions to your mind in a way that will get results; but I think it’s also important to remember that, when it comes to “the unconscious mind,” we’re all just taking shots in the dark.

We don’t REALLY understand it all that much better than Freud did.

(I’m acquainted with at least one personal development teacher who claims, over and over and OVER again in his social media posts, that psychology “proves” that “90 percent” of what motivates us is driven by our “unconscious mind.” It drives me up a goddamn wall. Psychology “proves” no such thing. Either he doesn’t understand how psychological research works, or he doesn’t understand what “the unconscious mind” suggests to psychologists; either way, I’m pretty sure he only says it because he thinks it makes him sound smart.)

Overall, this is an incredibly accessible, constructive little book. Hudson’s suggestions on how to nurture concentration and relaxation skills are solid, and her suggestions for imaging and journaling exercises are well-thought out. Most people can benefit tremendously from developing the skills she discusses.

Just don’t expect your “unconscious” mind to do work that can, and should, be done consciously.

You can make any change in your life you want…IF…

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You can make any change in your life you want. 

Adopt any habit. Give up any habit. Pursue any goal. 

(You may not ACHIEVE every goal you pursue, but that’s a different matter.) 

Truly, you can make any change you want…but there’s a catch. 

The catch is, you have to decide— and then frequently remind yourself— that the UPSIDE of making the change is worth the DOWNSIDE you’ll incur in the process. 

Our brains and behavior really aren’t that hard to figure out. They operate on a principle that B.F. Skinner called the Balance of Consequences: we do (and think, and feel) things that we think will lead to pleasure or gratification; and we avoid doing (and thinking, and feeling) things that we think will lead to pain or punishment. 

Yes, yes, it seems that we sometimes get our wires crossed— that is, we sometimes think, do, and feel things that seem certain to sabotage us or lead us to painful outcomes— but usually that’s a glitch. We can often understand self-sabotaging behavior if we look for how our brains have construed those choices as more pleasurable or less painful than the alternatives.

(Usually this boils down to, a decision that might be painful in the long term is seen as less painful or more pleasurable in the short term. Our brains aren’t good at thinking long-term; they tend to prefer immediate gratification to playing the long game.) 

If you want to get yourself to do something that you’re not doing, or to stop yourself from doing something that you’re already doing, what needs to happen is, you need to convince yourself that one path is more pleasurable and less painful than the other path. 

That’s one way to go about it, anyway. 

The other way to go about it is to acknowledge, up front, that you’re asking your body and brain to embark upon a project that’s going to lead to some pain, it’s going to involve some forfeiture of pleasure…BUT, those downsides are worth it, because there is a compelling upside here. 

Sounds simple. And it is simple— but, as anyone who has ever tried to change a habit can tell you, it’s not particularly easy. 

How can we make it easier? 

First thing’s first: we have to get super clear on the UPSIDE you’re chasing. 

There has to be an actual benefit to the change you’re looking to make, and it helps if that benefit can be quantified and expressed in clear, emphatic terms. 

For example: if you’re looking to give up smoking, it’s not enough to characterize the benefit of that as “I’ll be smoke free.” You need to be able to list multiple benefits of giving up smoking, that really resonate with you. You need to be able to make a convincing list, a list that includes upside after upside, benefit after benefit, to giving up that habit. 

The good news is, our brains will respond to our attempts to condition them. 

As you seek to make long, clear, emphatic lists of the UPSIDES of the changes you’re looking to make, your brain will work with you. The more you look for these upsides, the easier it will be to find these upsides. 

Not only that: the more you look for those upsides, and the more you review your list of upsides, the more emphatically your brain will imprint and reinforce those upsides. 

The more you think about them, the easier it’ll be to think about them, in other words. 

The end goal here is to make it super, super easy to think about the many clear, emphatic, important upsides to making the change you want to make…because in many cases, the downsides, or the costs, are going to be in your face. 

This is especially true if you’re looking to quit a habit you’ve been engaged in for awhile. 

The brain doesn’t like giving up patterns. Even patterns that seem to be self-harming or self-defeating— your brain likes patterns. 

Giving up patterns is a pain in its butt. 

So you need to give it reasons to give up those habits and patterns. 

Those reasons need to be clear. They need to be real. They need to be things you can review, things you can memorize, things you can pull up on a moment’s notice when your resolve begins to weaken. 

You can make any change you want. 

But you have to work WITH your brain…not against it. 

We are what we repeatedly do and think– no more, but no less.

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We are what we repeatedly do and what we repeatedly think. 

We literally create who we are based on the patterns that reinforce and allow to continue. 

This may seem obvious— but there seems to be an epidemic of people who think they are somehow something OTHER than what they repeatedly think and repeatedly do. 

They seem to think that they are nothing more than the sum of their past. 

Or they think they are nothing more than the sum of what others think about them. 

Or they think that they are destined to carry on, for ever and ever, the legacies of their family members. 

We get these ideas in our heads because we want our human existence here to mean something. Some people really like the idea that they are more than the sum of their patterns of thought and behavior; whereas other people are quite dismayed by that thought. 

I’m here to tell you that there is no need to complicate it— and there is no benefit to doing so. 

The fact that we are what we repeatedly do and what we repeatedly think means we are in the driver’s seat. 

It means that we can change who and what we are. 

It means we are not beholden to the past, to our family legacies, or to anyone else’s opinions or viewpoints. 

If we don’t like who we are or what we’ve become, there is one way out of it: change our patterns of thinking, and change our patterns of behavior. 

Unless and until we change what we do and what we think, we do not change who and what we are. 

What this means is, no label or diagnosis has control over you. 

No genetic predisposition has any control over you. 

No court ruling has control over your fundamental identity. 

All of these things can INFLUENCE who and what you are— but I would encourage you, strongly, to look deeper at this equation. 

How and why do these things influence who and what you are? 

The ONLY extent to which ANYTHING can influence who and what you are is by influencing what you DO and what you THINK on a REGULAR BASIS. 

You do not need to be held captive to your influences. 

Because you can (and will) be influenced does not mean that you do not control your choices. 

Because you can (and will) be influenced does not relieve you from responsibility for choosing who you are and what you’re all about. 

Think about the fact that anybody who wants to influence us— what do they want to influence, specifically? 

That’s right: your thoughts and behavior. 

Why? 

Because of exactly what I am saying: your regular thoughts and behavior are literally what defines you. 

Do you want to change your life? Start simple. 

Make a list of things that you regularly DO and regularly THINK. 

Look not at isolated thoughts and behaviors; look at PATTERNS. 

You’ll quickly come to find that when people refer to their “personality,” all they are really talking about are their predicable PATTERNS of thinking and behaving. 

The good news is: patterns can be interrupted. 

The better news is: patterns can be replaced by different patterns. 

Your current patterns didn’t evolve overnight; your new patterns won’t develop and solidify overnight. 

But if you’re capable of developing the patterns you already have— you’re capable of developing different patterns. 

Patterns you choose. 

Patterns that align with your goals and values. 

But first thing’s first: get real about accepting that we are what we repeatedly do and think. 

No more; but no less. 

Book Review: “The Power of Focusing: A Practical Guide to Emotional Self-Healing.”

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In “The Power of Focusing,” Anne Wesier Cornell wants to get us out of our analytical minds, away from our thoughts, and into our bodies. 

This book describes a technique of working with our emotions through the sensations we experience in our bodies. Cornell observes that, in personal development work, we often lead with our logical minds and emphasize what we’re thinking…at the expense of what we are feeling in our bodies. 

According to Cornell, learning to tune in to the “felt sense” of how our emotions are cropping up in our physical bodies— a process called “Focusing”— can help us get in touch with emotions, fears, instincts, wisdom, and programming that might otherwise remain inaccessible to our logical, analytical minds. 

Focusing isn’t hard to learn— but it can be challenging to practice. 

It entails doing an attentional body scan, focusing on the central structures of our bodies— our abdomen, throat, and chest— and asking, inwardly, what’s going on in there. 

In Focusing, we invite our body to yield information to us— we don’t aggressively seek it out or demand that our body give it up. 

We focus in on what we’re physically feeling in our body— tension, heaviness, lightness, uneasiness, sturdiness— and we go through a process of acknowledging it (“saying hello to it”), attempting to put words to it, and asking questions of it…all with an attitude of gentle, unconditional acceptance. 

The idea is, when we approach whatever we’re feeling in our bodies with curiosity and respect, not insisting it be anything other than what it is, we’ll have a better chance of it softening and telling us what it’s all about…and, if we take the trouble to listen, we might be surprised. 

Much of “The Power of Focusing” is spent on emphasizing the importance of acknowledging that we are not our feelings. There are PARTS of us that feel various things— but we can, and do, exist independently of whatever parts of us feel whatever ways. 

(This is a key concept in one of my areas of specialty treatment as a therapist, Dissociative Identity Disorder. Cornell’s technique here mirrors tactics found in Internal Family Systems theory, which also emphasizes empathic, supportive communication between “parts” of the self.) 

In Focusing in on what we’re feeling in our bodies, Cornell stresses that our job is to sit with our feelings, give them space to be what they are, acknowledge them, and invite them to tell us what we need to know. 

This is in contrast to how many well meaning patients— as well as therapists— go about conducting therapy— many go into therapy assuming that the idea is to grill ourselves about why we feel what we feel and do what we do, and/or to strong-arm ourselves into behaving differently. 

The best thing about this book is how straightforwardly Cornell lays out her technique, then goes on to discuss its practical applications (using just enough case studies, in contrast to similar books which devolve into anecdote after anecdote about how awesome the technique is). Cornell doesn’t attempt to overreach in her claims of what her technique can do; she acknowledges it as essentially a starting point or deepening tactic, which is exactly what it is. 

Students of psychology will note similarities in “Focusing” to both object relations theory and person-centered psychotherapy. Cornell emphasizes strongly that the key to personal development is forming a supportive, accepting relationship with one’s self first and foremost— and when one is using Focusing as a tool of self-knowledge, it’s almost impossible NOT to develop such a relationship. 

The only limitation that occurs to me about Cornell’s technique might be when readers assume that Focusing, in itself, is the end-all, be-all of personal development. To my mind, Focusing is best thought of as a tool, not a comprehensive theory of how healing happens. Just like any tool, it can be instrumental in healing…but there is more to emotional regulation and behavior change than supportively exploring one’s emotions through the body. 

That said, Cornell seems to go to pains not to oversell her technique. I’m appreciative of how readable and concise her book is, and how practical her focus is. 

“The Power of Focusing” is a useful introduction not only to listening to and honoring one’s self…but the very basis of self-esteem in general. 

We can– and must– choose who we become.

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We can choose who we become. 

Who we are, what we value, what we like, what we do…it doesn’t have to be left at the mercy of the things that have happened to us. 

It doesn’t need to be left at the mercy of our genetics. 

We can consciously, intentionally choose not only what our life is going to look like and include, but literally who we are. 

And what’s more: if we’re going to have high, healthy self-esteem, it’s vitally important that we do choose who we are. 

Consciously. Purposefully. Intentionally. 

Why is this so important? 

Because high, healthy self-esteem necessitates, above anything else, a sense of autonomy. 

In order to have and maintain healthy self-esteem, we need to proactively create our lives, rather than reactively live our lives. 

To just sit back and live our lives— to accept who we are and what we like and what we ARE like— is to accept a passive identity that, ultimately, can make us feel very vulnerable. 

If the very basics of who we are is left up to forces outside of our control…why should we believe that we can meaningfully control anything at all? 

Don’t get me wrong: the world will do its very best to convince you that you cannot choose who you are. 

The world will work VERY hard to make you believe that who you are and what you like is entirely out of your control— that you cannot fundamentally choose or change who you are. 

The reason the world will work so hard to help you think and believe these things is because it emphatically does NOT want you choosing who you are and how you behave. 

The world wants you to THINK you are at the mercy of powerful, mysterious forces outside of your control…because if you truly think and believe this, YOU are easier to control. 

Being passive makes you easier to sell stuff to. 

Being passive makes you easier to bully into voting for who they tell you to. 

Being passive makes you more predictable and controllable. 

Don’t make any of that easier for “them.” 

Why do we resist the idea that we can— and, indeed, must— choose who we are? 

Often, we resist it because it’s a tall order. It’s intimidating to face the prospect of choosing who we are, what we value, what we want, what our goals are. 

What if we get it wrong? 

What if we can’t live up to our own expectations? 

Fear keeps a lot of people from actively, aggressively pursuing and exploring who they are and what they want. 

Then there’s all that conditioning we got growing up. 

If you haven’t noticed there is a strong undercurrent of fatalism in our culture. 

Many, many people think that things like personality characteristics, character traits, and even the size and shape of our physical bodies are mostly, if not wholly, created by the interplay of genetics we didn’t choose and early life environments we didn’t choose. 

We’re saturated in this worldview as we grow up. 

Why wouldn’t we believe it? 

I’m here to tell you: you are not at the mercy of forces outside of yourself. 

I’m here to tell you: it’s not too late— never too late— to choose and create who you are. 

I’m here to tell you: you can choose who you are…and you must. 

Self-esteem can tolerate “no.”

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Healthy self-esteem can stand dissent. 

When we’re emotionally healthy, we can handle someone being wrong. 

We can tolerate it when someone disagrees with us. 

Why? Because someone disagreeing with us, or even being objectively wrong as we perceive it, doesn’t threaten what we know. 
When we have healthy self-esteem, we know reality exists, and we know we are committed to perceiving and understanding reality to the best of our ability; and we know that commitment is not dependent upon anyone else’s point of view. 

(Or anyone else’s opinion about OUR point of view.) 

Have you ever noticed how rattled people with low self-esteem become when someone disagrees with them? 

They get all uncomfortable. They lash out. They try to silence the dastardly dissenter. 

Why? Because people with low self-esteem have usually NOT made the commitment to perceive and understand reality to the best of their ability. 

Usually people with low self-esteem HAVE low self-esteem specifically BECAUSE they are basing their understanding of reality on somebody else’s ideas or approval. 

There is a strong connection between reality orientation and self-esteem. 

It’s not that people with high self-esteem always “know” or assume they are right about what reality entails. To the contrary, most people with high self-esteem are more open than most to the shocking idea that they may in fact be very WRONG about what the world is all about. 

But it doesn’t threaten who they are. 

Their sense of self and worth exist independent of whether they’re right. 

Their sense of self and worth exist independently of whether they’re smart. 

People who have low self-esteem don’t identify with that. 

They figure if they’re wrong, it must be because they’re terrible, incompetent, silly people; and if THAT’S true, then dear Lord, we can’t let anybody KNOW that, right? 

Observe how you react to people disagreeing with you. 

Observe how you react to the prospect of being mistaken. 

Now observe how the people around you react to disagreement or mistakes. 

Have you been sold a bill of goods about how your worth depends on being RIGHT? 

Have the people around you bought into the idea that to disagree with an opinion of theirs is to attack them as a person? 

You can tell a lot about a person’s self-esteem by how they respond to being criticized or corrected. 

High self-esteem tends to meet such instances with humor and curiosity. 

Low self-esteem tends to meet them with defensiveness and anger. 

The good news is, we can change how we react to people disagreeing with us and correcting us. 

We don’t have to stay in a defensive, low self-esteem position. 

The thing is, we need to be able to accept the idea that we are not our “rightness.” 

We are not our opinions. 

We are not even our performances, flawless or otherwise. 

We can cultivate our tolerance of being wrong, mistaken, silly, or even disagreed with…if we are patient and compassionate with ourselves. 

You know. If we do those things that cultivate high self-esteem.