What’s Really Wrong With Me?

WWWM

For the past decade I have been conducting psychological testing for various reasons. Sometimes a person wants to know if they have ADHD or a learning disorder. Sometimes we are looking at career options and want to determine if college is a good choice, or maybe if a specific job fits their knowledge, skills, and abilities (KSA’s). Maybe it’s about a legal matter and making recommendations that are useful to an attorney or a probation department. Most often what I do is a diagnostic study to understand whatever is happening and make appropriate treatment recommendations. It’s the answer to the “what’s really wrong with me and what can I do about it” question.

In the course of hundreds of evaluations, something I’ve noticed is a lack of consistency and sometimes an outright lack of agreement among clinicians. Just this month I was beginning a therapy relationship with someone who disclosed every diagnosis along the Autism spectrum. Last month a client presented with “bipolar, major depression, anxiety, ADHD, PTSD, ADD, generalized anxiety, panic attacks, learning disorder.” What a laundry list! How is it possible for one person to have so many labels? How can one person run the gamut of an entire spectrum like Autism or psychosis? It’s more common than you think, and here are a few reasons why.

Point in Timesign
Any psychological evaluation represents a brief moment in time. Hopefully an evaluator thoroughly reviews your history, including medical and mental health records and prior evaluations. That’s certainly a best practice. It does give us more information (data points) to consider for diagnostic purposes. But even then, your evaluation a single slice in time of what that clinician observed or recorded (testing) on a specific day. Having a bad day? Testing might underestimate your best abilities. Forget your medication? Your mood might be a little more off kilter than usual. Or paying attention might be pretty hard. Leave your glasses at home? Probably going to make it hard to complete testing with speed and accuracy. Or the biggie…did you hold back some information? Sharing all the details is important for an accurate diagnosis.

Even if everything goes just as it should, it’s still entirely possible that a diagnosis can be right in that moment but not really accurate for your daily functioning. Or it might be accurate for problems lasting a few weeks or a few months, but not forever.

bullseyeMoving Targets
Another consideration is that diagnoses can be “moving targets.” There is a lot of overlap in symptoms for various disorders. For example, problems with attention and concretion can be related to ADHD, depression, psychosis, intellectual disability, learning disability, dementia….and on and on. Having mood swings? Could be a bipolar disorder, but it also could be a normal variation of depression or even personality traits. Behavior problems? Might be ADHD, depression, anxiety, Autism Spectrum Disorder, psychosis, personality-related, or a bona fide conduct disorder. See how easily this can all be confused? Yes, we get lots of training in diagnostics (psychopathology), but it takes good rapport and good investigative skills to understand what’s really going on.

This is never more true than with children and adolescents. Symptoms can look very different in young folks. Depression in a teenager often includes irritability, hostility, and acting out. Which can look like an oppositional defiant disorder. Some behaviors could be the result of medications affecting the developing brain. And, quite often, children and teens simply cannot verbalize what is going on the same way you and I can. They try, but they themselves might not understand it in order to explain it coherently.

Treatment = Change (hopefully)
Another consideration is that appropriate treatment really should change diagnostic labels over time. If you are taking medication and engaging in weekly therapy, your depression should get better and eventually that label should go away. Or perhaps your Major Depressive Disorder transitions to a Depressive Disorder NOS and then to nothing at all. ADHD frequently abates over time as the adolescent brain develops into adulthood. But not always, and more and more adults are given a label that traditionally had to be first diagnosed in children.improving together

The biggie here is Autism Spectrum Disorder. With appropriate and consistent treatment (social skills training, therapy, and possibly medication), it is very common for the more severe symptoms related to communication and social interaction to greatly improve to the point it really can be hard to see that a label is appropriate. The same is true for learning disorders. The schools refer to this as “response to intervention” and is now formally measured for those receiving special education services.

Arriving at the right diagnosis can sometimes be pretty straightforward. Other times it feels like I am a detective solving a mystery. The end result will depend on the available information, how willing people are to be open and honest, and the skills of the clinician. It is vitally important that you feel comfortable with the person evaluating you. You are far more likely to be open and honest if you feel safe and secure.

Feel free to contact my office if you keep asking “what’s wrong with me” and it seems like nobody can understand you.

Owning Ourselves

As we progress through life, we meet people and sometimes have no idea what role they will play in our story. Nearly two decades ago I met  a teenage girl in Starkville, Mississippi. Her family is very near and dear to my ex, and once I spent some time in their home I understood why. They are a crazy mess of love and laughter, support and affirmations, success and struggle, hope and faith. Angie struck me as an awkward teenager. Pretty. Amazing vocalist. Witty (which I value more than funny). Smart. But there was a lot of teen angst when I met her. She was struggling to define who she was and what she wanted for her life.

I’d like to say that two decades later I know why Angie came into my life. I don’t. We aren’t at all close. She lives in New York and I am in Texas. I have not actually been in a room with her in more than ten years. We reconnected via Facebook, as is becoming a ubiquitous story. We’ve chatted a bit online. Exchanged messages and emails. And yet I feel I understand her much more now. Certainly distance lends perspective, but so does the maturation process. Hers and mine.

In fact, I will freely admit that Angie has become a source of inspiration for me. Perhaps that’s why she came into my life. I’m not going to tell her story. It’s an interesting one, but it’s not mine to tell. Much of it comes through in her music (Check her out here ). What I will say is that she is living the artist’s dream in NYC. We all know that dream. We’ve seen it in countless movies. Starving artist perfecting her craft on the gritty city streets, singing in clubs and doing odd jobs to make the ends meet. Waiting for that big break that might never happen. And if there is no break that’s okay because at least she’s being true to her craft and her dream. It’s a great plot line for a Lifetime or Oprah movie of the week. And, like most works in progress, her last chapters have not yet been written. We get to all hold out hope she does get her big break, whatever that turns out to be.

In the meantime, Angie posted on her Facebook this statement that stopped me midway to raising a much needed cup of coffee to an eager mouth craving a caffeine infusion:

I could be wrong, but I feel like folks’d be a lot happier if we approached adulthood less about owning property and more about owning ourselves.

Could be wrong? I doubt it. I think she couldn’t be more right. This is a woman who gave up so much to follow her dreams. She really puts herself out there with her music and her live performances. Following the progression of her songs, you can see moments in her life where she is gaining true insight. I’m not sure that’s really her goal, but it comes across regardless.

“Living within your means, but knowing that, no matter what your means, you always have YOU. Prince or pauper, unless you know and love yourself, the rest is all bullpoop.”

 I think of the growing Tiny House Movement (http://thetinylife.com and http://tinyhouseblog.com , I think about simplification and focusing on what matters in life. Believe me when I say I’ve spent just as much time as anybody trying to amass the perfectly curated collection of possessions. The right car, designer labels, house full of enviable decor (which is easier when your partner is a designer…double-edged sword), photos of great travel, and on and on and on. It’s pretty easy to do with enough money and time. To the point I’ve actually lived in a home and had TWO large storage units full of “stuff.” I don’t even remember what all the stuff is anymore. So clearly it was important! 🙂

What Angie’s describing is the quintessential existential crisis. Who are we? What is our place in the world? What do we want? What will fulfill us? Self-actualization. It’s the end-game of the human experience. And she’s sharing that insight most of us get at some point: it’s about the living and not the things.

Consider Maslow’s Hierarchy of Needs. We start with the most basic of survival need and build upward. Once we have food, clothing, and shelter and a physically safe space to live, we can focus on love and connecting with others. Self-esteem and self-respect develops when we are accepting and valued by others. Self-actaulization is the top of Maslow’s pyramid and represents a state of realizing our full potential and reaching it. If we miss a step, we never get to the top and slide back down. Each level is built on the one before it. Later in life, Maslow actually argued for a stage beyond self-actualization that he called self-transendence. He came to realize that self-actualization is only possible in conjunction with self-transendence based on having a higher goal beyond ourselves that we can reach through altruism and spiritualism.

Do we need the trappings of life to reach the top of the pyramid? Can we be happy living in a tiny home? A cramped fifth-floor walk-up? Is that five-star restaurant so much better than a candlelight dinner at home? Are designer labels necessary for self-esteem? Angie’s right. We spend way to much time focused on finding stuff and not near enough time finding ourselves. We lead over scheduled lives trying to acquire all the things we think we’re supposed to have to be happy, and we don’t take enough time to enjoy what we do have. We work too many hours to make more money for the next purchase or experience. We spend too much time trying to impress each other with status symbols or social media-worthy happenings. And then crash into bed, exhausted and unsatisfied, wishing there were another way.

There is another way. A simpler way. A more emotionally and spiritually satisfying way. Stop chasing things and start chasing life. Stop living through cars and houses and wardrobes and exotic destinations. Start living in this moment. Start by accepting yourself just as you are, regardless of what you may or may not have, and believe that it is enough. Because it is enough if you let it be enough. YOU get to choose what is right for YOUR life. YOU get to set YOUR priorities. Not me. Not the neighbors. Not the snarky church lady two pews in front of you. No the other soccer moms. Not the guy in the next cubicle. You. It’s all on you to decide just how happy you will be with what you have.

Now…it’s time for me to start clearing out some storage space with a donation to the thrift store. I’m letting go of things, and in doing so I’m letting go of the mindset that led me to the things. Ready to join me? Ready to walk another path? One less travelled and far less littered? Hand in hand we go.