Diagnosis: Wounded Spirit


“I can tell you she’s a borderline–watch out for drama, Cynthia. Be careful, just calmly back off when she gets hysterical.” Trina peruses the inside of the staff refrigerator and pushes aside my lunch and her leftovers from last week.

“No, more narcissistic, I suspect.” Henry pauses with an out-sized bear mug in his hand, staring at the wall. “At the least, sadly.”

Mary strides in, hair disheveled, face a bit pale. “And I have yet another Asperger’s with severe social anxiety waiting in my office. Two the last week. I need a drink…just kidding, I need cheddar and crackers and pass me that apple juice.”

“Anyone want the leftover salad? Vegetables are critical to the positive progression of my jam-packed day. Could we get more emergencies, you think?” Trina doesn’t wait for a response and pours on balsamic dressing.

Henry emits a snarky bark of a laugh and mutters to himself, “For me, another sociopathic sex–and meth, of course–addict, so away we go.”

I’m exiting to my own office with my cracked blue and white mug of peppermint tea, wondering when this day will end. When, in fact, I will no longer be working here. It’s not that I don’t give some credence to my co-workers’ professional diagnoses. It’s not that I do not care about my clients. I’ve been doing this work for years and though I am not a psychologist and provide basic mental health counseling within a context of intensive addictions treatment–even though I cannot argue effectively against their specific education and insights, I am long past weary of the diagnostic web.

So finally, I retired three years ago, and this is partly why. I saw too often that the people I was trying to help had become caught up in defeatist mode, the standard cures often complicating their lives. And I also have always wondered why the health of the spirit is not addressed as part of treatment. It seems a no-brainer to me, whether it is addressed outright or, at the very least, considered an influence upon well being.

Once cast into the sticky weaving together of mental health services, clients can have a very hard time extricating themselves from it. Anyone would, likely, if you consider how die-hard labeling of people casts them in a certain mold, right or wrong, with its attendant interventions, secondary diagnoses and uncertain prognoses. Once on record–the DSM-V Diagnostic and Statistical Manual tagging you as having a certain disorder, say–it lasts a very long while if not always. And people carry this with them secretly or fearfully (due to worry of stigma) or with a certain pride: this underlies who I am, this is what happened, this is what can be fixed now. It’s an identity, an explanation, a cause for thinking and behaving certain ways. But people too frequently become inured to an insidious helplessness that accompanies such labels. It’s powerful stuff–it keeps one stuck within a point of view that shapes an entire vision of his or her life. It also can become an excuse or a burden: “I can’t help it; it’s haywire neurology; it was imprinted on me by environmental factors; it’s genetic; it’s just how I learned to cope. And I sure can’t change now.” Worst of all, it becomes a convenient identity card: “I am anxious and OCD” or “I am traumatized, have ongoing PTSD” or “I am on the autism spectrum so I’m of course really different.”

I heard hundreds of histories of uniqueness for decades. It was the common threads that interested me, for each of these persons shared underlying similarities.

And all those years I sat across from people sent to me for their alcoholism or opiate dependence or methamphetamine addiction and so on. But what I really saw were persons who had had profound harm visited upon their spirits. Not their egos, not their minds, not their bodies–though all those were also impacted. Their very spirits.

I wanted to set up my own shop with a sign hanging outside my window: “Spiritual Self-Healing/ Support Services Available/No Fee Charged.”

I realize I’m going out on a limb here. I’m not going to write a research-based treatise decrying current mental health practices. But I am suggesting rather strongly that people who need or want help sit down for intake and within a couple of hours are given a diagnosis, They then can walk out and more fully live out that diagnosis. They are anxious. They are delusional. They are reactive. Rather get better or even recover, they name the symptoms and perhaps it does bring some comfort in the naming. But if one is vulnerable, any sort of intelligent-seeming explanation looks like a fluorescent life jacket. And perhaps it is a real beginning, the way to extend a helping hand.

But then what happens? After the medications are adjusted and readjusted and deleted and started again, after the therapy sessions are extended a year or two or more, when groups multiply and become mandatory…well, what of the person who walked in that door desperately looking for better control of her own life? For freedom from confusion, a burden, the dependence on a substance to try to govern his mood or behaviors, his seeming destiny? At home again, sitting in their rooms, what do they see in the mirror then? They see trouble and sorrow, a loneliness that permeates all else as they are deemed sick people now, not struggling people trying to become stronger and wiser.

Only a small percentage of the emotionally challenged are chronically unable to function daily or to learn how to carry out a better balanced life. And the majority of substance abusers are not doomed to a fatal addiction. But they do need an emotional and spiritual overhaul, a goodly change of direction, and lots of support along the way. Not a label that tells them they are one thing and that is how it is and it will never be different. What has happened to a guided transformative process in the diagnosis- and pill-driven therapeutic process? People who are looking for happiness or peace want to participate in their rediscovery of both. To gradually take responsibility for the search and finding. They need a mirror to show them what’s still good and hopeful inside so they can begin, then sustain the work. I could (and can) do that.

I understand why mental health providers–myself included at times–like to identify, categorize, organize their caseloads into neat diagnostic slots. This one needs that, that one needs this, and these few cannot be in the same room together for more than fifteen minutes. It makes matters more manageable for providers and can seem helpful to the clients. Such sorting and tagging aids treatment planning and points us all toward a direction. It takes on the semblance of cogent action. It targets an outcome. We humans do like explanations, and if they sound and look like science, so much the better–whether in truth they are effective or not.

But what is the science of personal suffering, the significant bio-neurology of it notwithstanding? We know it erodes health, from the arterial inflammation to  dodgy digestion to restless sleep. We know it creates cognition deficits and emotional lability. We further know it can lead to breakdown, bit by bit, of one’s common functionality. Diagnostic criteria can aid in this information tabulating, yes. Yet the spirit of the person–what of that? How can that science go deep enough to find and heal the devastated soul of a human being–that is what I asked every day. That is what has me all these years in and out of the field.

I have not forgotten a great many of my clients’ therapy sessions and groups. They stay with me, perhaps, because long before I decided to retire I had begun to see the majority of people had a very hard time recovering–from grief and loss, from abuses of all sorts, from failures to love and be loved. Seeing diagnoses of post traumatic stress disorder or general anxiety, acute depression with psychotic features or schizophrenia did not tell me nearly the whole story, however. Barely any of it.

What spoke to me was how they sat, how they did not speak of what mattered most, of how they sought or avoided my eyes as the pain rushed in the chinks in the armor we had discovered or made together. Their anger toward some omnipresent but blurry God for feeling forgotten and left behind. Their bitterness toward the ones they had once loved and now blamed. The pain that they had swallowed year after year because no one wanted to know of it. They were truly sick at heart. Broken of spirit. Or had had so much overload, diminished by months or perhaps years of substance abuse, that they could note very little as an authentic feeling. The identity they had been given was addict or alcoholic or crazy person.

How does a counselor propose hope as a tool to those who do not embrace it’s value? How is the path forged that helps them find their way back to some semblance of wholeness? We didn’t so much talk about their symptoms. We didn’t study weekly assignments. They didn’t have to enjoy being there or even like me. They just had to show up and I needed to be utterly present with them. To listen not only to the words but the undercurrents, the shadow of feeling, the ghost of the past that kept showing itself despite complex camouflage. Slowly, the masks designed to keep the world at bay would begin to fall away. Even the criminally active. Even those who heard odd voices. Even street-savvy heroin lovers. What they choose to do when that reveal was up to them. It mattered far less that I had to send a family services report or call their psychiatrist or probation officer. What I looked for was the barest resurfacing of who they were and could be. What they needed to stay alive without such regrets.

First and last I offered compassion. That is all. Because people who are in pain need the balm of kindness and those who rail against the world’s inequities and cruelties need steady, non-judgmental caring. Just as we all do. Love. It comes down to that. When someone is ready to accept an outflow of love, then spiritual and emotional healing can initiate and a lifelong, rich adventure unfolds–with less harm and more good being done by the very one who came in for help. Hurting persons, hungry for relief and finding love supplies that, are far more apt to pass it along. We –counselor and client–can work with each other in familiar ways even if it seems foreign at first to the client. Common denominators include being human, and we all suffer and we all are also spirit. Or so I, and so many others, do believe.

Blaise Pascal, a French philosopher, inventor and physicist alive in the 1600s, wrote that humans are restless, want to fill our craving with things that are of no real help, when the “infinite abyss can be filled with only an infinite and immutable object, in other words by God himself.” (from Pensees VII) We can be cognizant of the God-shaped void, yet dismiss or forget it’s importance when all is well. When it is not, people once more to reconsider. And an even partly honest reckoning is hard.

“It must take such emotional and mental energy, I admire that you can do this. I surely could not,” I heard over and over.

Or: “Well over twenty years in this field? How do you do that? I burned out after five (or ten or fifteen)  helping people.”

Yes, to be of hopefully good use to other humans can be taxing. I think the power source makes the difference. It’s not veggies or tea or rest and exercise that fuel me. There was a primary source of my commitment and stamina but not my stubborn will or that I’ve always felt called to be of some help to others. It was God’s love of me. Every time before I met with another client (or groups) I prayed for more guidance and mercy, the strength to be a witness; also for good humor and patience; for my own petty ego to step aside and let God use me. Each hour of every day was nowhere close to any sort of perfection. I wasn’t looking for a mark of success. But I knew from my conviction as well as experience that with Divine Love to empower me, I would do what was needed or discern what other options would be good.

How much separates us from one another, the ones who become diagnosed and treated and the ones who pride themselves on doing just fine, thank you, true or not? A very thin line. No one knows what might happen that can tilt the balance, upend gravity so that your life starts seesawing and you cannot keep all in orderly balance. And I can assure you, it won’t strictly be a diagnosis or pills that will delineate your path and empower your life. That will be your seeker’s soul and whoever can hear its cry. It will be seizing the opportunity to avail yourself of compassion given, then learning how to plant the tiniest seeds of hope and faith in its fertile sustenance. I assure you, it happens. Life changes us but we, too, can effect great change.