Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Friday, January 27, 2012

Diagnosing vs Careful Listening

"A diagnosis tells that there is a reason for that other than that they are bad."

This quote is from a blog post written in criticism of my most recent post about the controversy over the autism diagnosis. The intense and widely varied response to that post has prompted me to further explore this complex and highly emotionally charged issue.

The wish to be recognized and understood by those who love us is an essential human quality. We want to have our experience validated. In my work with parents, my main objective is to listen and validate their experience, with the hope that they will be more free to do the same for their child. For parents whose child is struggling in a variety of ways, a diagnosis may say to them "You are not a bad parent." In this way, I understand that a diagnosis is of value.

Speaking from the child's perspective, there is a similar wish to have his experience validated and understood. When, in that previous post, I describe an occupational therapist "giving words to his experience' I did not mean teaching the child to talk. I meant literally giving words to his experience, as in saying "I know its hard for you when its so loud and other kids are too close to you." This kind of giving voice can go a long way in helping a child make sense of his experience. The aim is to avoid having him feel that there is something "wrong with him."

The same blog post goes on to say:

"Dr. Gold simply does not understand that autism is not a psychiatric disorder."

It took me some time to wrap my mind around this criticism. The autism diagnosis or preschool depression or any other psychiatric diagnoses are in the DSM, the Diagnostic and Statistical Manual of Mental Disorders (italics mine.) In essence, you can't have a diagnosis without having a disorder, because it is by definition a diagnosis of a disorder.

So the question becomes: Can we validate a child's or a parent's experience, recognize that there is nothing "wrong with him," that his experiences are "real", without giving it a label?

Psychotherapists run in to a similar challenge when they work with adults whose primary caregivers had significant depression. These adults have often, over the years, internalized a sense that they are bad, that there is something wrong with them. Helping them to recognize that their caregiver was in some way emotionally unavailable to them can validate their experience. It can be enormously helpful in shaking that crippling sense of being damaged in some way. In this setting, the "diagnosis" may only be relevant for the insurance company, and has no real meaning in terms of helping the person to feel better about himself.

While I don't have an answer to this dilemma, I do, thanks to the responses of my readers, have a clearer sense of what the problem is. We don't listen to each other enough. Careful listening, and with that the ability to understand another perspective, is one of the qualities that makes us human. Cultivating this skill will be good for everyone.

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