Last night, my husband and I watched the movie “The Soloist”, starring Jamie Foxx. It is a movie about an unlikely friendship and the power of music in shaping and re-shaping lives. It addresses issues of politics. It addresses issues of social justice. And it addresses issues of mental illness.
As an Occupational Therapy (OT) student, I am learning about the role that diagnosis plays in therapeutic treatment. Namely, I am learning that a diagnosis does not define a person. As OT’s, this is a battle that it seems we will be fighting within the healthcare system for years to come: you are treating people, not diagnoses. They have a history. They do not live in a box, nor should they be treated as such. There is no linear path upon which they have traveled to reach their diagnoses, nor will they continue down a predictable road of recovery. One size does not fit all. We provide therapy for people. And people are unique. Yes, of course, we have established trends of behavior and intervention through research and experience. Definitely, there is protocol for therapeutic intervention. We want to give the best care possible. We don’t want to throw the facts and the framework out the window. But neither should we discard the fact that people are people, not simply diagnoses. Period.
When I was a Psych major at UCLA, it “ruined” my ability to consume popular media without relating it to what I was learning in my classes about human cognition and behavior. Similarly, and maybe even more so, my nine short weeks as an OT student have already “ruined” my ability to experience life without noticing just how much we like to put people into boxes and categories.
Partway through “The Soloist”, I observed an interesting scene in which the LA Times reporter is talking with the LAMP Community worker, a man who helps people who are living with mental illness on the streets of Downtown Los Angeles. The reporter is trying to persuade the worker into getting The Soloist on medication in order to improve his condition, all the while asking what his diagnosis is. This is the conversation that follows:
(Worker): I don’t get too hung up on diagnoses.
(Reporter): How do you help somebody if you don’t know what they have?
(Worker): Everyone one of them (LAMP Community members) have been diagnosed more than you can imagine, and as far as I can tell, it hasn’t done any of them any good.
Maybe that doesn’t seem profound to you. But it did to me. You see, just the previous day, the professor for my Psychosocial (i.e., “Mental Health”) class talked about why she would not do this one thing in our class. And she was very firm in her belief about not doing this one thing. She said that she would not teach us about working as OT’s in the Mental Health field by saying, “This is what you should do for a person with Schizophrenia” or “This is what you should do for a person with Depression” or “This is what you should do for a person with Post Traumatic Stress Disorder (PTSD).”
That’s not how it works.
For one thing, mental illnesses have a tendency to be co-morbid (i.e., occur together). A person who presents with Schizophrenia may also present with Depression or with a Generalized Anxiety Disorder. A person who presents with PTSD may also present with Depression or with Obssessive Compulsive Disorder. There is no guarantee that we will be asked to treat only one set of symptoms, so why should we be taught it that way?
For another thing – and this has been pounded into our heads from what seems like day one – every person you work with is different. No two people have exactly the same treatment plan. Everybody responds differently. Their biomechanics and neurological makeups are different. Their occupational and family histories are different. Their fears and passions are different. And their relationship with you, as the therapist, is different.
And so we, as developing Occupational Therapists, must remember that we are working with people. People who have fallen onto hard times and who need our help. And people are not simply diagnoses. They are unique individuals who want to be known, and not just “treated” like some disease that needs to be cured. They are people who will continually remind us.
That one size does not fit all.
Occupational Therapy 