Do addict, mentally ill labels help or hurt?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Mental Health or Mental Illness

Mental Health or Mental Illness?
Photo courtesy of Pixabay.com

Do most people accept labels like “addict” or “mentally ill?”

The use of labels to identify clients keeps coming up. Does having a label, a name, for your problem help you find answers or does it stigmatize you?

The recovery movement often uses labels, usually self-applied to define the nature of their issue. Saying you are an Alcoholic helps you to understand the problem and what you need to do to overcome it. In this case, if you are really an alcoholic you should not drink.

In A.A. they don’t give out the labels. They present information and let people decide for themselves if the designation fits. This approach has a lot to recommend it.

Some people feel that giving out labels can be a barrier to recovery. If you say you are an addict then, of course, you will use drugs, the use of the label could be interpreted as a reason to stay in your problem rather than move towards a solution.

Personally, if I have a cough it makes a lot of difference to me whether I have an allergy or tuberculosis. I am frankly a lot suspicious of a doctor who wants me to take medication for my cough but does not want to tell me what is wrong with me for fear of labeling me.

People are not defined by their disorders. We should not refer to them as “the schizophrenic” or the “depressive.” We know that there are times the person with schizophrenia or another psychosis may not be experiencing symptoms or the symptoms may be milder. This sometimes is referred to as periods of lucidity. People with depression can get better.

Most people, in my experience, embrace these labels. They help define the challenge the person is facing. It is reassuring to know that you have treatable disorder rather than to think that you are crazy or that there is something so wrong with you and there is no hope. What most people find is that there are lots of other people who are struggling with the same illness.

As a professional, I feel I owe it to a client to tell them what I think they are struggling with. Knowing the problem can suggest solutions. I don’t find it useful to argue with clients overdiagnosis. Whenever possible we start by working on the things the client thinks are problems for them. Help them find a job and the depression just may go away.

Sometimes people put too much trust in a diagnosis. What if the person who gave you that one was wrong? Learn to use that information, their view of what you are struggling with, and go from there.

Now if you have been given medication, I recommend you take it as prescribed. If it is not working or you are experiencing side effects, talk with the prescribing doctor before you make a sudden change and please do not take a med only on the days you think you need it, unless the doctor prescribed it to be used that way.

Feel free to add other helpful things, like therapy, meditation and a strong support system to your medication. Medication can only take you so far. Working on your recovery includes learning and practicing the skills you will need to maintain that recovery.

So as far as diagnosis or labels go, if they help your recovery, use them. If your label is getting in the way of your recovery don’t worry about what it is called and focus on your recovery skills.

My view – for most people labeling the problem is helpful, labeling yourself is not. You are, after all, much more than any one problem you may be struggling with.

For more on this whole label-diagnosis thing see also the posts on:

What is wrong with me?

5 Axis diagnosis esoterica

Is it a medical problem or a mental health problem?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Tests for mental illness

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Mental illness.
Photo courtesy of Pixabay.com

 

 

Have you been tested for Bipolar disorder or Schizophrenia?

More and more people come in and want to be tested or have their family member tested for a specific mental illness.

We wish there was a specific test, maybe a blood test, someone could do and then we could look at the lab report and say yes, you have Depression with a touch of ADHD. Unfortunately, it doesn’t work that way.

Mental health diagnosis or mental illness if you prefer that term. is arrived at by piling up symptoms and looking at the time you have had them to see what pattern of mental, emotional and behavioral problems the client has been experiencing.

Not everyone with the same symptoms might have exactly the same disorder. Let’s illustrate this process with a physical disorder. If you are coughing and you go to the doctor and he diagnosed you with “Major Cough Disorder.” This may have been caused by a cold, asthma or a touch of Tuberculosis. While you might take some cough drops to reduce the symptoms of the cough, regardless of the cause of the cough, you would want a different treatment for Tuberculosis or Asthma over the long run.

Treating the tuberculosis cough with a cough drop could make the problem worse by letting the bacteria get a hold and as a result shorten your life.

With a Mental illness, we go the other way. We give everyone with the symptom more or less the same diagnosis regardless of what caused the symptoms. Does it matter if you are depressed because your spouse died or because you lost your job? What if you got depressed over time because your life was just not going the way you had hoped?

For each of these causes, we would diagnose depression and prescribe eventually the same treatment regardless of the cause. So you would get an anti-depressant medication and talk therapy. If you were grieving over a loss we would let you have a period of time to grieve, say 90 days and after that, if you were still grieving we would want you to get on with life.

Parents want their kid tested for ADHD. That should be simple from one point of view. The child does not pay attention when the adult wants them to. The child does not do their work – Ipso-presto they had ADHD. Not so fast loony breath.

If we look only at the symptom then yeah, sure, all kids have ADHD some of the time when they don’t pay as much attention as the adult wants them to. But it matters a whole lot if they are not paying attention because they are being bullied on the way home or if mom and dad fought all night last night or is everything in their life fine and when they try they just can’t focus.

Bipolar Disorder is another one parents want their kids tested for. One of the symptoms of bipolar is not sleeping or getting by on almost no sleep. Kids stay up all night a lot. Watching too much internet does not make you bipolar. (On second thought can I get a grant for a million-five to study that?)

This excess energy and lack of sleep are called mania or hypomania. A manic person looks a lot like someone on Methamphetamine but they get that way without the drug.

Kids also don’t get enough sleep because pound for pound elementary school kids take in more caffeine than adults. All that caffeine comes from the sodas they drink.  That much stimulant can make a five-year-old act like a drug addict on speed. Add many MG’s of an amphetamine salt to the caffeine and watch Johnny go like a cyclone. Expect that when he crashes he will get really irritable and hit someone while he is detoxing.

See why it is important to find out not just what behavioral symptom this child has but what else is going on in the family and in the kids head?

So as time passes and the facts come in the diagnosis might change, or not.

Also compounding this situation is the possibility that the client could have more than one problem. Could the Person with asthma catch a cold? Could they also catch Tuberculosis if exposed to the germ?

Someone could be depressed, have ADHD and still take in too much caffeine or do drugs. This makes unraveling the diagnosis a problem sometimes even for a professional.

So till a reliable blood test come along for Bipolar Disorder, ADHD, and the rest, we will just have to limp along counting up the symptoms and looking for other possibilities to build the correct diagnosis up over time and even then not every person responds to every treatment in the same way.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Millions about to catch a mental illness – The DSM-5

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Medical record

Diagnosis.
Photo courtesy of Pixabay.com

UPDATE – changes in the DSM-5

You can erase some of this post from your memory. Non-suicidal self-injury, Cutting did not make it and is stuck in the back – maybe section. During the process of updating the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the DSM-IV to the DSM-5 a lot of things were proposed. Some of those suggested changes were instituted and others were left out. This post includes mostly ideas that did make it to the final DSM-5. Because these ideas were included in a lot of research articles and other blog posts I have left the post up but need to tell you that some this information is now out of date.

Will you be cured or struck with a new mental illness next year?

The way we understand mental illness is about to change. When the DSM-5 is published about May of 2013, millions of people will find their mental health diagnosis suddenly shuffled. Several conditions that bring clients to therapy every day, that didn’t used to be disorders, will suddenly appear. Some old disorders will disappear or become merged with others. This happened before when Manic Depressive Disorder disappeared and the Bipolar Disorders in all their shades took its place.

We Counselors don’t write the book so we don’t get much say on these changes but in order to get our clients the help they need we have to play along with the changes the Psychiatrists make in the rule book. These new rules include the latest research and hopefully refine and improve the system we use to figure out what mental, emotional or behavior problems the client has.

The new book, DSM-5 is still under review but from the version on-line we can see a lot of the directions the new version will take. There is still time for some revisions to the new DSM, but most of these changes look pretty certain.  I have been reading the new version on-line trying to get myself mentally prepared for the changes. Here are some trends I see.

Anger becomes a Disease – sort of

We know that anger and the loss of control that comes with excess anger is a serious problem. There is a huge group of people who have been required to take an anger management class. So far anger has not been a diagnosis. We have tried to force the angry client into other existing diagnoses. Some people with anger are depressed, some are anxious some are just bad people and so on.

Cognitive therapists have been saying for years, and I agree with this, that most anger management classes fail because they seek to teach clients how to control their anger after they are already angry. Having the person who is furious count to ten only delays the explosion. The time to intervene is teaching the client not to “anger themselves” in the first place. You read that right. Others do not “make us angry” we “anger ourselves” when they don’t do what we want them to.

So we need a specific diagnosis for people who anger themselves too much and then lose control.  With kids we were calling this “Disruptive Behavior Disorder” or “Oppositional Defiant Disorder” sometimes this means blaming them as in “bad kid” diagnoses. We need to try to find ways to help kids learn new approaches. With adults they became “depressed or anti-social, or worse.

The new label for this problem will become “Disruptive Mood Dysregulation Disorder”

Cutting and Self Mutilation becomes a disorder.

Cutting and all the other self mutilating behaviors are a huge problem. Parents call or bring their kids in because of this all the time. There are hundreds of book on the subject and lots of research that says this is a distinct separate disorder. But up till the DSM-5 we had to shoehorn this into something else.

The confounding issue here is that most self mutilators do not want to die. This is most often not a suicide attempt. It is also most often, though not always, not an attention seeking behavior. Self mutilators do it repeatedly and in places where others can’t see. They use this behavior to regulate emotions.

The confounding problem, self mutilators feel bad and sometimes they do decide to commit suicide.

This problem seems destined to soon become a disorder all on its own called “Non-suicidal Self Injury.”

In the future you won’t outgrow your diagnosis

We have had separate names for the problems that children get. Sometimes the problem stays the same but every few years we change the diagnosis. We have had a whole chapter of problems that get first diagnosed in Infancy, childhood and adolescence.  This will go away. Yes kids can be depressed. I have seen video footage of a new-born in the hospital who showed significant sadness when mom and dad stopped paying attention to him. So if parents were to neglect a child, could the child become depressed? Sure they could. The more the parents neglect the more depressed the child becomes.

So rather than separating childhood depression and anxiety we can think of them as the same as grown up mental illnesses only in children the symptoms may look a little different. When they are sad the child cries and dad drinks, two different behaviors but same emotion.

Asperger’s is about to be cured.

Suddenly in one day every one with Asperger’s will stop having Asperger’s. The same thing will happen to Pervasive Developmental Disorder NOS. Don’t get too excited. Within minutes they will all have caught Autism.

Why this change? Researchers have come to doubt this pigeonhole approach. The characteristics of lots of the mental illnesses we think of as separate conditions are in fact just varying degrees of symptoms of the same disorder. So rather than splitting hairs on which name we call this we are going to think of this as a continuum and say all these people have more or less similar symptoms just some are more serious and profound than others.

So in the future all these people will have one diagnosis but we will look at the way the symptoms affect the individual. We hope this is progress. One problem though. In the past, the treatment, especially who would pay for treatment, depended on the label. Schools, insurance companies and regulators may need to figure this one out. How will they decide how severe your autism needs to be before someone will pay to get you treated? We think we know that the sooner this condition gets treated, even mild cases, the better the child will do throughout their whole life.

That’s enough of this for one post, more about the DSM-5 to come in the future.

Bottom line, the DSM-5 in mid-2013 will make some changes to the way we think about mental illnesses and possible the way they get treated.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.