Friday, October 02, 2009

It's never one thing at a time

The Guilford Press catalogue came to my office again. I get them quarterly. It is full of books for therapists about how to deal with what faces us. Psychotherapy has moved far away from the time when grand theories of psychology, psychotherapy or psychopathology ruled the field.

Now everything is specialized. Each book is 450 pages about a sub-specialty. ADHD in the work-place. ADHD in Jr. High. Anxiety disorders in soc ail situations. Anxiety disorders in young women with abusive histories. Depression in older males. Depression in young mothers. Depression in Jr. High boys. Alcohol dependence in women, in families, in teens, in teens with alcoholic parents.

On and on two, three, four hundred titles. All of them are well thought out approaches. Some are well researched by very capable groups at major universities. All of them seem like useful and necessary additions to our knowledge and skill base.

Except they're not. Yes, it can be useful to learn what other people are thinking and doing, but really. My nine o'clock appointment was the depressed son of an alcoholic with a depressed mother, who was having anxiety attacks at work because his company is going out of business and his anxious, formerly addicted, wife, who is grieving for her recently departed mother is pregnant.

My ten o'clock appointment is a cancer survivor who has seizures, who lost her son in a motorcycle accident, and has a father who was alcoholic and a mother who is bipolar.

So, to be able to keep up with the latest theory and research I need to read at least a dozen books before my eleven o'clock shows up.

We, those of us here working the front lines, have to deal with the whole package. That's what makes psychiatric diagnoses a joke. Bipolar disorder isn't one thing in he brain, it is probably hundred of variations. Every body's brain is different and they have all been shaped by every one's life, all of which have been very different.

This kind of stuff doesn't come out of a manual -- despite what the insurance companies want.

So, it's surgery on Monday. And my figurative model of the Sydney Harbor Bridge has been partially knocked over by the tide. I will have to begin building most of it over again after my eyes recover. Perhaps then I will look at things differently.

1 comment:

Lena said...

I like how you look at things. You always make sense.