These chapters, yet again, have reinforced why the work we do is important. Page 138 stated, " such patients typically receive five or six different unrelated diagnoses in the course of their psychiatric treatment" and page 139 further expands by stating that " none of these diagnoses will be completely off the mark, and none of them will begin to meaningfully describe who these patients are and what they suffer from". Children with a mental diagnosis are much more than a statistic.
I both enjoyed reading about and was taken aback by the formation of the DSM and how that diagnostical instrument came into 'power'. How what once was used for insurance companies is now the means of creating a lifelong label on someone. The stigma of having a diagnosis is something that one may carry with them all through life - from childhood to adulthood. Some may even identify as their diagnoses as the book describes a patient describing themselves as bipolar. This reminded me of the importance of using person-first language. Regardless of accurate diagnosis or not (while I hope it would be correct), it's still important to use person-centered language as people are so much more than a diagnosis. I love how Van Der Kolk puts it when discussing a diagnosis, "none of these diagnoses takes into account the unusual talents that many of our patients develop or the creative energies they have mustered to survive" (Van Der Kolk, 2015, p.139). This made me smile as I think about some of my own clients - a six-year-old who knows more about dinosaurs than I ever will - and he can accurately pronounce their names! A 10-year-old who draws and writes her own comic strips using dragons.
On my current caseload, I see quite a few children who have a diagnosis of ODD, DMDD, or Intermittent Explosive Disorder. These diagnoses that I see so frequently now make me question the accuracy of such diagnoses - was there trauma taken into account? Who performed these assessments that garnered a diagnosis? What tools were used? These questions make me anxious to become a clinician someday as I continue to grow in my trauma-focused knowledge. The discussion of self-harm and a dive into the ACE study also provided useful information as to how one might come to the conclusion of a diagnosis.
Perhaps my deepest prayer is that I will somehow positively impact the children I work with. So often when it comes to trauma there is a misunderstanding as to why clients react in the way they do. I sometimes feel a sense of anger in my heart and sometimes I can't tell if I am angry that the child won't listen to me or if I am angry about the parent-child relationship and why this child has been exposed to such extreme conditions under parents care. I, again, think of Kate. She can be so lovely and yet so frustrating in a matter of minutes and yet this is not her fault. Her defiance may be seeking self-control and by all means, I want nothing more than for her to feel like she has a say. I have recently started playing music from my worship playlist when I pick her from school and daycare. I have no idea if she hears it - most of the time we are non-stop talking when I pick her up (well sometimes we are talking and sometimes she's telling me that she's gonna call the cops on me for picking her up...) but I pray that on the days when she's too tired to talk, that those words wash over her.
I often see the same diagnoses and it is troubling. I don't think that these are accurate diagnoses for the children and adults that I work with. Also, when other people hear of these diagnoses, they have a skewed or a lack of education on what these diagnoses mean. This creates unwanted judgment for families. That is a great idea to play music with Kate. What about the ride home? I know you said that her visits are less than great with mom, so does the music offer a sense of comfort or solace to her?
ReplyDeleteI think what's tricky about diagnosing is that sometimes you simply need to give them a diagnosis which matches the symptoms they are presenting with, still knowing that underlying issues likely lie in ACE's or early trauma. Still, you need to get paid and the insurance company needs to see what is currently the presenting problem. The problem certainly comes is that the diagnoses can certainly follow people and if someone isn't trauma informed, they could see a behavioral diagnosis like ODD and not look for the trauma that's likely there
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