Correct Diagnosis?
My personal, professional experience, and community experience is that we often misdiagnose the problem and then spend time, energy and money attempting to solve the wrong problem.
For example, I just have responded to an email in the past hour which illustrate this issue. A friend wanted to know how to help a friend who is considering suicide. He is willing to get help but has no insurance and no money. His wife has cleaned out the bank account. The presenting problem was that he has no money. In fact, I am more than happy to see him for what he can afford which, at the moment is nothing. Now the issue is whether he will accept this gift or if he will let his embarrassment about having no money determine what he does.
Another person I know defines anxiety as the issue which is keeping them from moving on with their life. I suggested that the issue is not the anxiety but his relationship with the anxiety. I have often written about how we can establish a healthier relationship with anxiety or other such conditions.
Often, when one has an addiction one blames other people, places, things, and events for their continuing use. The truth is that when one is ready to quit using, one will avail themselves of all the resources available to make that change. The further truth is that the recovery process may be very emotionally and physically uncomfortable. If one has the habit of telling oneself that one cannot deal with the discomfort – that one is too fragile – than if one truly wants to quit using they will have to give themselves a more accurate message that they are not fragile.
Often lawmaker and others say that the problem with poor people is that they do not want to work, that they are lazy, and that even if they had money they would just waste it. Thus, they may then recommend that one end “entitlement” programs and force people to be responsible. Yet, when researchers have experimented with giving everyone in community a guaranteed income which is high enough to live decently, crime rates go down, people manage their money well and in all respects, everyone who is physically and emotionally able (sans acute mental illness) functions as productive, law abiding healthy individuals, partners, parents, and community members. These experiments clearly show that the correct diagnosis is often poverty and not irresponsible users of other people.
This morning, while at the gym, I was listening to a Ted Talk by neuroscientist Medhi Ordikhani-Seyedlar. He is working on computer models which might be able to be used to treat ADD and those who have lost their ability to communicate. He and his colleagues have been able to demonstrate and track how the person without ADHD processes incoming stimuli and how that differs for those with ADHD. If two stimuli are shown to a person without ADHD, that person’s brain will automatically primarily focus on one of those stimuli whereas the person with ADHD does not have a brain function which selects a point of focus. By understanding what is happening neuroscientists such as Dr. Ordikhani-Seyedlar may be able to design computer programs to help train the brain of the person with ADHD to filter and focus. By being able to test the functioning of the brain eventually we can more accurately diagnose conditions such as ADHD. A child (or adult) who is dealing with emotional trauma or an unusually intelligent person might appear to have ADHD and be incorrectly diagnosed. When they do not respond to treatment they or their parents might be blamed when in fact the problem is the incorrect diagnosis.
I recall one case of a woman with a history of depression suddenly getting much worse. She was finally hospitalized for acute depression. Both the woman and I kept saying that there was something else going on. This was not just clinical depression. The doctor got very angry at the woman and accused her of not wanting to get better. Finally, after prodding from the family, the patient and they did further testing and discovered that she had fluid on the brain. When a drainage tube was surgically installed her depression returned to its normal treatable level.
With another patient, it was discovered that he had a tumor hiding behind a bone which was putting pressure on part of the brain resulting in his presenting symptoms.
The Ted Talk once again reminded me that on a personal, professional and community level I must constantly stay open to the possibility that my initial diagnosis is incorrect. Whether I am attempting to diagnose a client’s presenting symptoms, a mechanical problem, a computer issue or a relationship issues I want to remind myself that the most I can do is to make an educated guess. With some issues, I can sometimes make reasonable educated guesses. With other issues, which require knowledge or skills I do not possess I need to always be open to seeking help.
Once again I am reminded that as a social scientist I need to remember to begin with the null hypothesis. Ignoring, for the moment, academic arguments about different approaches to the use of the null hypothesis, I want to remind myself to begin with the assumption that there is no relationship between x symptoms and y diagnosis. Careful research might, at times, then show that in fact there is not only a correlation between x and y but a direct link. If, however, I start with the assumption that there is a direct link between x and y I am likely to look for evidence to support my assumption and ignores important evidence which does not support my assumption.
Written July 13, 2017
My personal, professional experience, and community experience is that we often misdiagnose the problem and then spend time, energy and money attempting to solve the wrong problem.
For example, I just have responded to an email in the past hour which illustrate this issue. A friend wanted to know how to help a friend who is considering suicide. He is willing to get help but has no insurance and no money. His wife has cleaned out the bank account. The presenting problem was that he has no money. In fact, I am more than happy to see him for what he can afford which, at the moment is nothing. Now the issue is whether he will accept this gift or if he will let his embarrassment about having no money determine what he does.
Another person I know defines anxiety as the issue which is keeping them from moving on with their life. I suggested that the issue is not the anxiety but his relationship with the anxiety. I have often written about how we can establish a healthier relationship with anxiety or other such conditions.
Often, when one has an addiction one blames other people, places, things, and events for their continuing use. The truth is that when one is ready to quit using, one will avail themselves of all the resources available to make that change. The further truth is that the recovery process may be very emotionally and physically uncomfortable. If one has the habit of telling oneself that one cannot deal with the discomfort – that one is too fragile – than if one truly wants to quit using they will have to give themselves a more accurate message that they are not fragile.
Often lawmaker and others say that the problem with poor people is that they do not want to work, that they are lazy, and that even if they had money they would just waste it. Thus, they may then recommend that one end “entitlement” programs and force people to be responsible. Yet, when researchers have experimented with giving everyone in community a guaranteed income which is high enough to live decently, crime rates go down, people manage their money well and in all respects, everyone who is physically and emotionally able (sans acute mental illness) functions as productive, law abiding healthy individuals, partners, parents, and community members. These experiments clearly show that the correct diagnosis is often poverty and not irresponsible users of other people.
This morning, while at the gym, I was listening to a Ted Talk by neuroscientist Medhi Ordikhani-Seyedlar. He is working on computer models which might be able to be used to treat ADD and those who have lost their ability to communicate. He and his colleagues have been able to demonstrate and track how the person without ADHD processes incoming stimuli and how that differs for those with ADHD. If two stimuli are shown to a person without ADHD, that person’s brain will automatically primarily focus on one of those stimuli whereas the person with ADHD does not have a brain function which selects a point of focus. By understanding what is happening neuroscientists such as Dr. Ordikhani-Seyedlar may be able to design computer programs to help train the brain of the person with ADHD to filter and focus. By being able to test the functioning of the brain eventually we can more accurately diagnose conditions such as ADHD. A child (or adult) who is dealing with emotional trauma or an unusually intelligent person might appear to have ADHD and be incorrectly diagnosed. When they do not respond to treatment they or their parents might be blamed when in fact the problem is the incorrect diagnosis.
I recall one case of a woman with a history of depression suddenly getting much worse. She was finally hospitalized for acute depression. Both the woman and I kept saying that there was something else going on. This was not just clinical depression. The doctor got very angry at the woman and accused her of not wanting to get better. Finally, after prodding from the family, the patient and they did further testing and discovered that she had fluid on the brain. When a drainage tube was surgically installed her depression returned to its normal treatable level.
With another patient, it was discovered that he had a tumor hiding behind a bone which was putting pressure on part of the brain resulting in his presenting symptoms.
The Ted Talk once again reminded me that on a personal, professional and community level I must constantly stay open to the possibility that my initial diagnosis is incorrect. Whether I am attempting to diagnose a client’s presenting symptoms, a mechanical problem, a computer issue or a relationship issues I want to remind myself that the most I can do is to make an educated guess. With some issues, I can sometimes make reasonable educated guesses. With other issues, which require knowledge or skills I do not possess I need to always be open to seeking help.
Once again I am reminded that as a social scientist I need to remember to begin with the null hypothesis. Ignoring, for the moment, academic arguments about different approaches to the use of the null hypothesis, I want to remind myself to begin with the assumption that there is no relationship between x symptoms and y diagnosis. Careful research might, at times, then show that in fact there is not only a correlation between x and y but a direct link. If, however, I start with the assumption that there is a direct link between x and y I am likely to look for evidence to support my assumption and ignores important evidence which does not support my assumption.
Written July 13, 2017
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