i've been writing up my first solo mental health assessments at internship, which essentially means i'm the lead clinician looking at the appropriate axis I mental health disorder. we're a community outpatient mental health clinic, and insurance will only pay for treatment if there does, indeed, exist an axis I disorder.
i have a really hard time diagnosing children. i know much of the dsm criteria for childhood disorders upside down and inside out - i use it every stinking day at my job in psychiatry research at ohsu. it's not that. it's a tricky process with minute details and differential considerations, but i don't get turned off emotionally by its trickiness.
rather, i have a hard time putting the onus of responsibility on kids because kids come from families and families interact. and some of the kids i see are very, very young. (some are 17, but some are 6.)
diagnoses mean different things to different people. some parents are relieved to hear that a group of professionals agreed that the set of sxs their child is experiencing warrants a clinical name. some parents accept the label for treatment purposes, but prefer to think of their child without the label. as many different perspectives as there are stars in the sky.
and it goes back to power. shoes and i have many, many conversations about the incredibly odd and almost unwanted power we have in certain situations. shoes sent juveniles to kid prison. he sent adults to adult prison. i've provided countless episodes of court testimony re: my professional opinions about parents' ability to parent their children. now i'm the one giving people labels that tend to stick around for long periods of time. it's an alternate universe. you do the best you can with the training, graduate education, best of your common sense and qualifications the state gives you.
and in the end, you're still putting a label on another human being. still saying, "this is what's wrong with you."
my group supervisor shared this excerpt from Alice Walker a few days ago. it fits in many ways -- especially around my work with teens. especially around my work with children who are brought into the clinic for "behavioral problems." it fits better with who i am. i return again and again to it. i remind myself that the dx is a means to an end ... and the end is a loving, hopeful connection with a human being.
"In the Baemba tribe of South Africa, when a person acts irresponsibly or unjustly, he is placed in the center of the village, alone and unfettered. All work ceases, and every man, woman and child in the village gathers around the accused individual. Then each person in the tribe speaks to the accused, one at a time, about all the good things the person has done in his lifetime. All his positive attributes, good deeds, strengths and kindnesses are recited carefully and at length. The tribal ceremony often lasts several days. At the end, the tribal circle is broken, a joyous celebration takes place, and the person is symbolically and literally welcomed back in the tribe."
if i can just remember my passionate desire to work with people in remembering their own strengths, their giftings, their preferred ways of being ... maybe, maybe i can balance the therapeutic process with the task of diagnosing.
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It's just plain hard and challenging...but your heart is big. Writing your feelings like you do in your blog will give you some reference to refer to later. It is a system of "what is WRONG" and for all the talk of strengths, it is often just that. Lordy how I love that African tradition. I wonder how things would be if we have more community...more tribe. Us Europeans who found tribes to be "heathen" and "uncivilized". Sometimes our "civility" is worthless and useless...
It's hard to play the game that is in vogue...but that's the game that IS. Always knowing while you put on the label...just always knowing and explaining...this is what we have to do to get the "goodies" (extra help, insurance coverage, programs...), and remember the people...and their strengths.
If anybody can accomplish that, it would be you. I'm so glad you will be in "the system". For however long your heart can stand it...it will be a better place because you were there.