Mental Health Diagnosis
The Medical Model

In our culture today, medical mental health diagnosis and medication are often considered the best treatment for the painful problems that we have in living, and in trying to get along with each other.

Even though some patients experience a reduction in symptoms being given a diagnosis and taking medication, there is plenty written about the limitations of using this approach to treat problems with relationships and unhappiness.

Limitations and problems of medication use include side effects, and the tendency to go from one drug, to a different drug, to multiple drugs as patients go up the scale of pharmacological interventions for symptom relief, and to help "manage" the symptoms from the drugs themselves. Many of these drugs are difficult to go off once started.

Often the original problems continue while the focus remains on symptoms.

For example, someone might be diagnosed with depression. The doctor gives a pill(s) hoping to fix painful feelings of loss of interest in life, yet the issues that cause the depression persist. A better approach is to follow the depression to the underlying issues, which might have to do with the person's reactions to a relationship breakup and the resulting painful beliefs about the self and future relationships, and the resulting hopelessness and inactivity. Counseling can be very helpful for resolving this type of problem.

In my opinion, seeing a mental health diagnosis as a description of symptoms only, and not take it as 'medical fact' allows other options besides the belief that medication is the best or only course of action.

Why is diagnosis used?

The main benefits of diagnosis are for insurance companies to understand the necessity for treatment (a list of known symptoms that need professional attention), for doctors to prescribe medication, and for health professionals to have a way of charting medical information for record keeping.

In fact, insurance companies will not cover treatment unless there is a specific diagnosis. For example, "Generalized Anxiety Disorder" is a diagnosis. But, "marriage counseling" is not a diagnosis. It's a form of treatment that insurance companies will cover, but not without an individual diagnosis first (see below).

What is a mental health diagnosis?

It's a list of problem feelings and behaviors (symptoms) that cause problems in functioning. In order for someone to qualify for a certain diagnosis they must meet specific criteria:

  • Symptoms must be of a certain severity.
  • There must be specific number of symptoms (feelings and behaviors that interfere with functioning in life, cause significant pain, etc.).
  • Symptoms must be present for a specified length of time.

This is the same model of how medical doctors diagnose physical disease, and the medical insurance companies are using this same model to determine if they will pay for coverage to see a counselor. There are some limitations to this model. Medical diagnosis model does not capture the actual problems and stresses that lead to the symptoms and for which people seek therapy. Relational difficulties and the stresses of everyday life are typically the most pressing concerns, and when the stress accumulates, painful symptoms emerge, eventually. Insurance will not pay for treatment until it's severe enough for an individual diagnosis.

Note: there are mental health diagnostic codes that focus on problems rather than symptoms. However, insurance companies do not accept them because they do not document how badly, or severe, the patient feels. Insurance companies only want to pay if and when the patient's functioning is declining. For example, difficulty going to work, etc.

Of course, you don't have to have a diagnosis to seek counseling. You would need to pay for it yourself in this case. Also, some people pay for counseling themselves so that insurance doesn't know about it.

People are more than a diagnosis

Also not captured in a medical diagnosis is a person's unique life story, positive characteristics, strengths, the effects of good experiences and people, cultural heritage, family, hope, and so many other things.

The primary focus should always be on the actual problems that bring a person to therapy, their strengths and resources, their growth...

The most important thing is to create a process for eliminating the reason for needing a diagnosis and medication. That's called true wellness, and it's my mission to help people find it.

See you in session.

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