The Problem with Counseling

Those of us in the psychiatry/psychology world know there is a unifying standard used country-wide for classifying mental disorders and other mental health issues -- the Diagnostic and Statistical Manual of Mental Disorders (DSM). The manual changes periodically; the current version in use is the DSM-V.

There have been a couple of newsworthy differences between the DSM-V and its predecessor such as enveloping what was known as Asperger's into the high end of Autism Spectrum Disorder. The issue I was curious about today, which lead to this article, was the change from Gender Identity Disorder (GID) to Gender Dysphoria. This change is not simple terminology, along the lines of the difference between manic-depression and bipolar disorder, but it marks a complete change in substance, in diagnosis.

In my curiosity as to why this change had taken place I took to Google. I didn't find a solid reason, nothing like what I was expecting or hoping to find. Instead, the reasoning behind the swap had to do with experience, including stigma and healthcare insurance reporting.

We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize. 1

And therein lies the problem I have with counseling. It isn't objective.

In counseling the doctor, social worker, or other mental health professional asks you, the patient, for a goal. Actually, in my experience, they don't usually call you a patient. They say client.

This is completely different from any other medical setting. First, if I tell my doctor I am in pain, he never asks me if I would like to have no pain. He assumes that I'd like to experience as little pain as possible. My level of wellness would be in proportion to the amount of pain I felt. Second, if I tell my doctor that my ankle hurts, he checks my ankle, sure, but he also gets my weight, blood pressure, checks my nose. I might leave that appointment without the percocet I wanted but with a prescription for follow-up blood work at LabCorp. Every time I've had my first prenatal appointment, my OB has also performed an unrelated pap smear. When I take my children to the doctor for a sick visit, I explain what I think is wrong. The doctor then examines the patient and draws his own conclusion -- which may agree with mine or not. Treatment, though, is almost always solely determined by the doctor's conclusions and not mine.

Do I have a disorder or don't I?
It is hard to convince people that you have a mental illness, but it is just as hard to convince yourself that you have a mental illness. The excuses abound. So, the thought that the definitions and categories upon which your own diagnosis depends are constantly in flux is not helpful in any way.

Well, how do you feel and how do you want to feel? Do you really expect me to be capable of answering that?

If I tell my doctor that my ankle hurts, he checks my ankle, sure, but he also gets my weight, blood pressure, checks my nose.


I do have a hard time figuring out how much time to spend on trying to understand and control my mind in the light of other things I must do. I generally publish an article each Tuesday, and sometimes that comes at the cost of our school day and balanced meals and the like.

Essentially this is part of self care and caring for my own health is part of serving my husband and children. My husband can say the same thing about going to work. There must be a balance. It isn't set in stone; some days require longer hours of focused writing than others. But, sometimes I lose sight of my real, day job.

One way I've combatted this is through having some parts of a schedule. We aren't so organized that we can plan a time for each daily activity, but there are a few things I can pencil in for a particular time (well, usually it's a time range). School begins at 10:30AM (that is, between 10:30 and 10:45) each weekday, for instance. What time we end can change from day to day.

Even on days I'm not that well, I like to stick with school if I can. Sometimes, I just can't, and it has to be a sick day. But, usually, I can push through. The trick is not letting myself wonder about it -- ifs will kill you.

It's not really about homeschooling or housecleaning or any other tasks. Our school lessons have served as a way to connect with my children, even when I don't want to. School or no school, I'm still Mom, and having lessons that we must do, gives us something to talk about and do together.

One thing that has helped this year is the family subjects we've done. Last year everything was individual; now, we do Geography and Writing altogether. This prevents me from being disengaged, handing out assignments and then not interacting with anyone.

Our school lessons have served as a way to connect with my children, even when I don't want to. School or no school, I'm still Mom.


Maybe I'm fine. Maybe you are too. Maybe I'm not. Maybe you're not either.

That's the thing. We can tell what the body is supposed to be like and do. It's usually quite clear. The mind on the other hand isn't. Will, emotions, heart, it's hard to say with much certainty what is the proper functioning.

So, my diagnoses, just as any diagnosis, are imperfect and subject to possible changes. And will be indefinitely.

And that is life in a cursed world.

Will, emotions, heart, it's hard to say with much certainty what is the proper functioning.


A note on form. I'm struggling through a (hypo)manic phase at the moment. I think my writing is probably more disconnected than usual. It's going to be like that.

  1. Jack Drescher of the American Psychiatric Association quoted from "DSM-V To Rename Gender Identity Disorder 'Gender Dysphoria'" by Camille Beredjick Advocate.com accessed April 19, 2016.