Diagnosis and Direction

The following blog was co-authored by my colleague Timothy Nelson, L.Ac (for an introduction, see "Eastern Medicine meets Western Psychology). Tim's sections will be in in bold font.

I want to start this conversation, Michael, by talking about where exactly our philosophies meet. I want to start with a basic framework of how Western Medicine is working. In this system of medicine, having a physical health problem means you schedule a visit with a physician. Psychiatrists and psychologists treat the mental sphere. Osteopaths, dentists, naturopaths, etc. all have their own spheres and there is overlap. One absolute across all Western medical fields is that a patient needs a diagnosis. A medical evaluation must take into account the patient’s entire situation and place it neatly into a code. This code, basically, tells everyone what to start doing. This code tells insurance companies what treatments to pay for, and which not to. This code tells all other health care practitioners what “standard of care” treatments options are available and what your likely course is. If Western Medicine were a giant map, the diagnosis code would be a big “YOU ARE HERE!” sign.

Getting a diagnosis can be a relief for someone who has been suffering. Moving forward is possible for the doctors and the patient because there is already a clear map of what is next. Your treatment plans, the medicine you will take, drugs you will need, surgery to alter your body, and therapies that help you rebuild. This map of Western Medicine also has a thousand red pins in it that show what happened to other people who have had your diagnosis. This is the structure of Western Medicine. It is a “map” and “location” medicine.

When we talk about patients and the healing process, we have a different type of conversation. It isn’t so much about figuring out that diagnosis, but more about figuring out what the next step is. If a patient is standing at a location on our Map of Medicine, we are both working intimately with the patient to figure out what their next step is. In a certain sense, this next step IS the diagnosis! This is a “compass” and “direction” based medicine.

Go back to that image where you are going to your doctor, you have your initial exam, and you are about to get your diagnosis. Right at this moment, a Chinese Medicine practitioner will give you a diagnosis, but they will hand you a compass, rather than a map. They will tell you actions to take immediately. To help your condition, they will give you acupuncture/moxibustion/herbs/etc. that are intended to immediately alter the direction your body is going. They will put you in touch with the sights, sounds, and sensations of the immediate moment and these can tell you and your acupuncturist what is going on. There is a lot of searching in people nowadays to “be in the moment” and “just breathe” and meditate, etc. I think people are searching for that compass that will tell them, right now, which direction to go in.

Thank you Tim – I like your comparison of a diagnosis as a “you-are-here” indicator. Our views on treatment definitely align. We want to give clients more of a direction to follow and things they can apply to their daily living to help alleviate their suffering. The diagnosis is not the end-point of treatment – if it were, we would be pinning our clients to the map! I also agree that giving a client a diagnosis can provide them with some relief, as it can give them a name to describe their lived experience. It is a label that helps affirm that, “This is a known thing, others also have this thing (you are not alone), and there are actions you can take that help.” However, there is a potential danger in giving someone a diagnosis, wherein they may take the label on as a nametag for themselves and begin ‘acting the part.’ Therefore, the meaning clients take from a diagnosis is extremely important.

Take, for example, the difference between someone saying, “I am a depressed person” versus “I am a person with depression.” If you are a depressed person there isn’t much you can do about it and everything you do – or don’t do – is ascribed to being a depressed person. On the other hand if you are a person with depression, then depression is another of the multitude of things you experience in life, not a central defining characteristic of who you are. This is a subtle shift of language, but a very important point. If a person believes they are a depressed person they may give up on doing things that can help, such as spending time with friends or exercising. However, if they believe they are a person with depression this shifts the focus from what they can’t control to what they can.

As practitioners, it is important to be clear about what a diagnosis is and what it isn’t. One of the best definitions I have encountered is “a cluster of symptoms that tend to hang out together.” I like this description because it implies that a diagnosis isn’t an absolute thing, and that someone doesn’t necessarily need to have All the symptoms of a depressive episode (for example) to be diagnosed with Major Depressive Disorder. Not everyone’s depression is going to look the same, and therefore treatment should be individualized as much as possible. Another point to stress while we are on the top of diagnosis, is the core criteria for ALL mental health diagnoses: it must cause significant distress or impairment in daily functioning. For example, Anxiety itself is not a disorder – we all become anxious at some point and it serves an important purpose; however anxiety crosses the threshold into an Anxiety Disorder when the anxiety is too great over too long a period of time such that it impedes someone’s ability to function at work, succeed at school, socialize, or causes other maladaptive behaviors.

I love that phrase, “a cluster of symptoms that tend to hang out together” because it ties this whole conversation together. Most of my patients come to me because they have a diagnosable condition, like anxiety or pain, and they have a cluster of symptoms related to it. The cluster is somewhat foggy by nature, and can vary with their activities and intake of substances. Chinese Medicine takes all those activities and substances and clusters of symptoms and paints one complete picture. You will see how everything works together. Developing this complex painting of our symptoms, our medicines, our virtues and vices is my passion. This is treating the individual, not the diagnosis, and when I paint an accurate picture, the patient recognizes it like and old forgotten friend they used to know, just haven’t kept in touch with.

Thank you Tim. Our approaches to treatment definitely have a lot in common in terms of diagnosis and treating the person as a whole. It will be interesting to see what other similarities emerge in our next blog topic!