Why I do not Give a Psychological Diagnosis to my Teenage Patients

A psychological diagnosis is about meeting behavioral and emotional criteria, functioning like a check list.  You look at the list of symptoms - persistent sadness, trouble sleeping, constant worrying, etc – you see how many of these symptoms the teen in question displays and if they have a certain number of them you assign the diagnosis.  It is not a difficult or complicated process.  It is almost exclusively descriptive and it does not contribute to my understanding of my teenage patients or how to help them.  It is not useful clinically.  Researchers use diagnosis as a way to run studies on large groups of people who, on the surface, have similar difficulties.  Insurance companies demand the assignment of a diagnosis in order to reimburse. 

A diagnosis is assigned to teenagers based on a checklist.  It is not what teenagers “have”.  Teens cannot “have” a psychological diagnosis in the same way that people have a diagnosis of cancer, a bacterial or viral infection, or heart disease.   A diagnosis is something that a mental health professional gives to a patient.  It is not something that the patient already has and that the doctor is naming.

In medicine, the right treatment depends on an accurate diagnosis.  A bacterial infection might require an antibiotic regimen.  Appendicitis requires an appendectomy. A diagnosis of cancer may lead to radiation treatment or a transplant.  If somebody has an infection it doesn’t matter who they are or what they have been through in life.  That person will most likely be prescribed antibiotics because the bacteria inside of them are doing damage to their cells and antibiotics kills bacteria.  Psychological diagnosis gives no such guidance in treatment. 

Two teenagers that meet the same diagnostic criteria for depression can have similar symptoms for vastly different reasons.  Their treatments must be individualized to take into account these particular reasons.  The reasons why teens understand that they are depressed are useful to the psychotherapists.  Understanding these reasons is what enables a teenager with depression to heal and grow.  This understanding can liberate teens to respond in ways that are based on self-knowledge and self-acceptance instead of reacting with thoughtless impulse. 

Being psychologically diagnosed can be a dehumanizing experience to a teenager because it only considers superficial symptoms and does not take into account the complexities of unique inner thought and personal history.  A diagnosis can rob the meaning of someone’s difficulties (or “symptoms”) by separating it from their personal history and understandable, however extreme or self-defeating, reactions to it. If a teenager really buys into the idea that they “have” a psychological diagnosis they can use it as a crutch to stop trying to get better, understand themselves or take responsibility for their experience.  It can become an obstacle to treatment. 

Psychological problems are not like medical problems.  There is no “depression virus”.  There is no “anxiety parasite”.  There are no solid parts here.  These problems exist between the complex electrical connections of the brain.  They are determined by one’s personal ideas, understanding, history, environment, and emotions.  Experience and a teenager’s unique reactions to that experience produce their psychological pain.  And just as experience and reactions to it can cause suffering different experiences and an examination of the reactions can lead to recovery from suffering.  This is the goal of counseling – to provide healing and growing experiences.

My dear teenage patients, I don’t care about your assigned diagnosis.  You don’t “have” one.  It may have been given to you but it’s not helpful.  I care about understanding your suffering, your happiness, your healing, your growth and you.   

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By Miguel Brown