Jenna Anne Unmaksed: I Have Generalized Anxiety Disorder
How important is my actual diagnosis in determining the kind of treatment I get for myself?
Your diagnosis is crucial. As illustrated in various vignettes throughout the Faces of Anxiety section, we make mistakes when we do not make the right diagnosis. While it may take several months or years to know with certainty what any given individual’s diagnosis may or may not be, it is always important to rule out the most severe diagnoses. This process usually begins with a careful medical workup, perhaps including a trip to the neurologist for an EEG or a CT scan of the head. It always begins with a detailed, careful life and psychiatric history. If your doctor believes that you suffer primarily from an anxiety disorder, he or she will have ruled out depression, manic depression, and substance abuse diagnoses as primary. If you are solidly within the anxiety spectrum, then it may be less important to determine if you have pure panic disorder, social phobia, or both, for example. You will have a chance in your treatment to discern what most troubles you, the ways in which it appears, and whether you would be willing to consider the use of medication as a tool to manage your symptoms.
If you clearly have obsessive compulsive disorder (OCD) or panic disorder with agoraphobia, the diagnosis helps your doctor to know that you would most likely benefit from a trial of medication and some version of cognitive, behavioral, and exposure therapy. If you clearly have posttraumatic stress disorder, then you will most benefit if in treatment with someone experienced in that field. Otherwise, you can refine your diagnosis as treatment unfolds. Most patients do not fit neatly into the boxes of the DSM and suffer from an overlap of symptoms. Finding a treatment that places the focus on you as an individual and your life history and symptoms rather than on your diagnosis per se
will allow for the real story, whatever it might be, to unfold safely.
Rick’s comments:
While I have a long-term diagnosis of depression, it is relatively recently that I have been diagnosed as having OCD. This is not the fault of any of the people I have seen in treatment. My OCD mostly takes place internally, with thoughts that hinder me, yet are not really observable to others. My clinical workers are not psychic, and since I found it very difficult and embarrassing to talk about the nonsense phrases, word and number avoidances, and repetitive thoughts whose origins I either can’t explain or wouldn’t want to, I was not considered to have this illness until I began to talk openly about these symptoms. I am currently looking to find a psychiatrist in my neighborhood with whom I can work by taking medication and participating in talk therapy, in addition to seeing my current therapist.
I would urge anyone who is reading this and is not getting the help that they need-and deserve!-because of any misguided shame they may be feeling about the nature of their symptoms: don’t lose valuable time the way I did by concealing things a clinician can aid you with. There is nothing “bad” or “silly” about what you are dealing with. There are reasons OCD occurs and there are ways OCD can be treated. There is no reason that that treatment can’t begin soon, or now.
Why is being listened to and feeling understood so important to any good treatment?
Patients do not return to see us because of our choice of medication or because of our ability to make a correct diagnosis quickly, though those aspects of care may factor significantly into that decision. Patients return because they feel listened to and taken seriously. A patient may kick and scream, tell us how much they hate us and how unsafe they feel in our hands, only to sign up immediately when a regular hour opens. Patients vote with their feet rather than their words. Feeling truly understood by another individual with your most honest feelings-comfortable or uncomfortable-is perhaps the most powerful force between humans, and that feeling may well draw on the healthiest aspects of early mother-infant interaction. As humans, we crave to be understood, and finding a doctor or therapist who makes you feel understood is essential. If you know that your doctor takes you and your story seriously, then you can feel comfortable delaying the need for a diagnosis until your doctor has the data she needs to make one correctly, even if that takes a couple of years working closely with her and allowing her to experience with you the ups and downs of your particular life.
Finally, being listened to and taken seriously in and of itself reduces anxiety. Knowing that there is a person and a place to help contain and understand your feelings makes the feelings more manageable. Learning to understand the origins of these feelings can only occur with someone who listens to you closely enough to understand some aspect of what you go through. Good listening is the flip side of the talking cure coin.
“If I had 100 tongues in my head, I couldn’t completely tell you all the thoughts I have nor the different attitudes I have to those thoughts,” I said to my analyst. I didn’t know where to start or what topic to choose. So I started with the one that just seemed to need to be spoken the most, without knowing the certain digressions I would make or where I would end up with this free association process. I can be pretty funny, or quite down on myself, or very dramatic. In truth, I used a good deal of these styles convincingly to deflect what I really felt at the time. Growing up with very needy, unhappy parents, I had become competent and sophisticated in smoothing over any rough material. It became my second nature to push away growing, gnawing, upsetting thought patterns which brought on anxiety. I didn’t even have to plan it, as my thinking style just dealt with anxiety that way.
Somehow my analyst listened carefully for the main thread of what I tried to say but which at the same time got negated or circumvented. He listened for my need or the feeling in the moment. I was never too aware of this, as I kept talking and would get caught up in the immediacy of my thoughts. Then he might say something, something I might think was off the wall. Or, maybe he would hit home, leaving me feeling deeply understood in a way I didn’t realize even existed. I was not sure if he was using some kind of magical insight, or maybe it was that he was picking up on something in my tone of voice that shocked me. How could he have heard that, when, surely, that couldn’t possibly have come from any message of my own. But one way or another, we have moved to a different position and to another viewpoint that has a lot of meaning for me, whether I can accept it at the moment or not. And my life has changed; I can’t go back. And there it is. If he were to listen as my good friends do on the phone or at a party, or even as a best friend might listen, this change would not happen. In those circumstances I might feel vastly better through the socialization with people I know and like. But I would not have changed in the same way. The analysis moves forward because the analyst listens. No listening, no development. Maybe this is one way for you to check if yours is the right health-care provider. If nothing happens, maybe you are not being heard. I was.
Term:
EEG – Electroencephalogram – This is a kind of brain imaging technique, involving electrodes placed around the scalp, that measures brain waves and can detect abnormalities like seizures.
