Few people outside the psychiatric and pharmaceutical communities know how common the practice of stretching and bending the meaning of words is in medical files. That practice is influenced quite strongly by the bias of the clinician. I have personally had client files sent to me that clearly were based on a liberal and intentional misuse of words. This misuse served the purpose of identifying an otherwise understandable behavior into a symptom. I am confident in saying this because many of the files referred to me included dissociative behaviors and events. In fact, the files actually used the term dissociation but failed to include any primary or even secondary dissociative diagnosis. Further, those files usually indicated pharmaceutical treatment failures and no application of psychotherapy.
For example, patients were referred to me that were experiencing agitation related to a flashback of abuse. In the files, agitation was interpreted as “a variant of hypomanic behavior.” Such misuse of language completely shocked me. Those patients had often lost years on a wild goose chase, with therapists trying to find the right pharmaceutical agent for “a variant of hypomanic behavior.” The correct approach should all along have been trauma therapy as it was their trauma that was being displayed in the symptoms.
It is common to see patients that are kept on antidepressant for years yet remain depressed. Although they are labeled as suffering from “treatment resistant depression”, it is more appropriate that they be labeled as suffering from Antidepressant-resistant depression!
If a patient on antidepressant(s) has not improved as expected, the correct procedure is to review the diagnosis, not just to persist in trying different dosages or a newer drug. There is no logical reason or peer reviewed study that would indicate that the depression symptom is part of a disorder that justifies the exclusive use of medication. In reality, that is the common practice – to increase the dosage or change of antidepressants. Instead, try listening to the patient. Or, at least, continue with the medication and try listening to the patient.
In Volume 1 of Engaging Multiple Personalities, there are several examples of patients I had referred to me that were labeled as having treatment resistant depression who made progress in their healing journey through psychotherapy. With psychotherapy, those patients were treated. Their traumas were acknowledged and often successfully processed. During the psychotherapy, there were weaned away from antidepressants successfully and fairly quickly. I only remember a very few DID patients who required antidepressants as adjunct to being treated with psychotherapy.
