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In Our Quest for the Right Diagnosis, What Are We Missing?

By Joan Normandy–Dolberg, LPC, Chair, Public Awareness, Advocacy, and Marketing Committee

I recently saw a funny cartoon entitled “Brain Doctor.” The cartoon shows a doctor, having flipped open the top of his patient’s head, using a flashlight to peer at the patient’s brain. The doctor is wearing a big smile while the patient looks very worried. 

The cartoon started me thinking about something therapists and psychiatrists know but seldom address … the fact that the brain is the only organ we treat without looking at it. If we have a heart problem, the doctor orders a cardiogram; if we break an ankle, the orthopedist X-rays the leg; if we have digestive problems, the gastroenterologist orders an endoscopy or a CAT scan or any of about 30 possible tests to diagnose the problem. But with the brain, we just use self-report by an individual who may have a mental health diagnosis that requires treatment. Is there a better way?

Unfortunately there is no quick test for mental illness. According to NIMH’s article, “Neuroimaging and Mental Illness: A Window Into the Brain,”  brain imaging can be used to help detect and diagnose a number of medical disorders and can be used to rule out a physical problem such as a tumor that might cause symptoms similar to depression, but it cannot be used alone to diagnose mental disorders. 

So that leaves it up to us, the clinicians, to use our academic knowledge and experience to determine a diagnosis and create an appropriate treatment plan. We have been trained to take a complete psychosocial case history, to observe, to discuss, to ask skillful questions to unearth stressors and traumas, addictions, and family history … but are there things we are missing? 

Research taking place today suggests that genetics and biology play major roles in many mental disorders, along with a combination of environmental and psychological factors. Though scientists have not yet tied specific biological markers and tests to specific disorders, a course on neuroscience with an emphasis on neurotherapy and neurofeedback could help keep us from “dancing in the dark” as we diagnose psychological illnesses.

So how can we improve what we do? How can we be sure we integrate the latest information into our work? It is up to us to keep up with new research in our field … to attend conferences, read books, join list-servs, and confer with colleagues, so we can utilize new information as it becomes available. 

I recently took a university class on psychopharmacology, which helped me better understand the structure and biology of the brain and provided me with new research-based information on the latest treatment protocols. I was unaware that research being conducted ties diagnosis of personality disorders to the size of the cerebellum, in addition to other factors. These findings made me wonder what other changes in our field have taken place since I graduated that I could and should incorporate into my work. I only wish this course had been required in my master’s program, and I encourage you to keep up with the latest information to inform our work.