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Diagnosis: It's going to be OK.

My late adopted Cree uncle Louis Paquette used to say to me: “Rey your words can put you over, or they can put you under, so be careful what you say”. Uncle Louis was a wise man. He spent the better part of his latter years in pastoral ministries helping many people heal from their addictions and mental health issues. Although wheel chair bound from an accident that happened in the 70’s Louis was a man of great stature. And his words always resonated with my understanding of the power words have to determine and define our life’s course, uplift, create, heal or to inspire others. The implicit wisdom in Louis’ saying was that we each have the power to construct meaning and understanding in different situations where we find ourselves in difficulty or in triumph. How we use words to describe ourselves and situations is important in that words have the power to build us up or put us on a low trajectory towards destruction.

I began to reflect on past experiences such as a formal hospital discharge hearing and my observations of patients who were listening to the clinical notes being read to a panel, I distinctly remember the optimism and a sense of hope the female patient began with and the sense of diminishing hope as it tangibly waned she began to hear the clinical case notes been read to the entire panel as the review panel progressed. I watched hopelessly as she seemed to react to the clinical language and terminology in such a way that she was being stripped of her dignity and courage as each word seemed to be an indictment on her ability to function in a very basic manner. “Schizo-affective, delusional, hallucinatory, lack of insight and substance-induced”. I thought to myself this surely isn’t the person sitting there. In some ways I was right. She had changed. But would the panel see this in light of the case notes which seemed to pathologize her very existence? Certainly the clinicians at that table wanted the patient’s situation to improve. The notes themselves seemed quite descriptive and non-judgement, quite fact-based in their tone. However, it became clear she did not take them that way. This lady’s future rested upon these words. Every word, although descriptive was pivotal to her release and postured against all of her future hopes so it seemed. I am certain that she perceived every word in those notes as having the power to affect her life in a very real way. The discussion at the workshop brought up a bigger question for me. As a clinician/therapist, how do clients perceive our use of clinical terminology?

Some postmodern therapuetic approaches eschew the use of diagnostic labels and psycho-pharmacological interventions for fear of further disempowering clients and in fear of offending their clients or somehow thinking that the terminology itself will somehow make someone mentally ill. They further assert that some of these terms are totally made up, driven by consensus and maintained by their corporate use in the field. However, this is totally and entirely inappropriate. Clinical terminology is utilized to provide practitioners with common ground to approach symptoms or concretize legitimate states of mental health. Granted some may have more acute symptoms than others and sometimes the situation improves resulting in a loss of diagnosis. This is why individuals in mental health care are provided with follow-ups and reassessed as part of a treatment schedule/plan. This is usually a collaborative process involving individuals in the client’s circle of care.

When I have to use clinical terminology I see myself as someone who is normalizing mental health issues by applying terminology that is accurate and descriptive rather than pathologizing. Are these notions of pathologizing clients by using clinical language valid? Or is it rather buying into a paradigmatic approach that over-exaggerates the negative effect a therapist can have in a helping role? It is indeed the role of a good therapist to help their client find their voice, model the use of positive language and empower the client to reflect upon their experiences through the use of powerful, self-affirming language descriptors.

Do we have the power to help each other with our words? Yes we do. But we need to stop looking a diagnostic and clinical terminology as bad words. We do not create mental illness. Mental illness is rooted in brain biology and genetics. Elitism is much more aligned with these older etiological interpretations of mental illness. Science establishes appropriate clinical definitions to describe symptoms that endure over time. Similarly good evidence-based psycho-therapeutic practices are developed with scientific method to treat the symptoms of mental illness. These symptoms may be treated just like a hemorrhaging wound. By using a multidisciplinary approach and being fearless in our acknowledgement of mental health diagnoses and clinical descriptors counsellors may begin to truly empower people by normalizing these conditions and thereby provide a healthy and truly accepting environment for those struggling to come to terms with their illness.

We must become comfortable with hearing and using descriptive terminology in order to accurately assess and treat mental health in our communities. In this ways helpers in communities may provide much needed relief and treatment from the pain of undiagnosed mental illness. When we are able to dispassionately describe the problem we may then begin to address problems in a professional and adult manner. How effectively we address describe and treat the symptoms is directly connected to how effective we will become in employing specific targeted treatment approaches to reduce acute symptoms of mental illness. This means having the courage to do so. Clients look to mental health counsellors, social workers, psychologist, psychiatrists and health practitioners for this guidance and leadership. It would not be appropriate to shy away from describing the realities of those suffering have to deal with every day in favor of magical thinking. When we can describe the effects and symptoms with specific terminology; when we can accept these conditions and own an approach to working with those living with mental illness.

When we resolve our own tensions to describe mental health from the standpoint of adult professionals, then our clients may also begin to experience the normalcy and gain a realistic sense of the prevalence of specific disorders. Then they may rest assured that there is a pathway for treatment that in some circumstances results in effective management, resolution and even complete remission of acute symptoms. Mental health sufferers account for one in five people every year in Canada. These are family, friends and community members, brothers, sisters, mothers and fathers. We have the tools and courage to describe mental health as effective professionals who can come along side suffers with competence and the courage to help alleviate suffering and pain.

Much of our misconceptions of mental health arise from our refusal to acknowledge that mental and emotional disease are just as valid as other physical diseases. Let’s begin to recognize that mental health diagnoses involves cognitive and emotional states that are no less significant than other physical illnesses like diabetes or cancer.

Hearing more of words which reflect mastery not just our dysfunction is important in addressing our mental health. It is then that we realize that our challenges addressing one's mental health may involve more strengths than weakness. This is a much more accurate and hope-inspiring approach to bolstering client efficacy and helping people to contextualize the part of their functioning that isn’t working so well. Diagnostic language is meant strictly to be a means of categorizing and understanding the facets of mental illness. Counsellors then must encourage people to tell their story and to use their own voice in such a way that promotes the discovery of the competent self-the aspects that demonstrate health reifying behaviours as strengths.

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