Dear Therapist:

My daughter, who is a young adult and therefore has the autonomy to make her own decisions regarding medication, opted to take medication for depression.  This in spite of the fact that as her mother I know her better than a doctor who spent 10-12 minutes interviewing her and over 40 minutes interviewing me at the initial appointment (after having been told the opposite is what would happen).  Said doctor diagnosed my daughter as being anxious, defiant (ODD), depressed, and manipulative.  I explained that she was not depressed and is jumping on someone else's planted suggestion because she is in fact manipulative and as such takes no responsibility and plays on people's sympathies to wiggle out of any responsibility, including ANY school work (and then complains about her poor grades, got her teachers to modify her responsibilities and then complained that the improved scores were worthless as they hadn't been earned -and she was RIGHT). 

My question is how is a (very) brief interview a solid basis for a diagnosis? 

How is a mother, who knows her daughter for decades, so easily dismissed in lieu of the opinion of someone who met my daughter for a few minutes?  Whatever happened to "a mother knows best"?   

Response:

I am not a psychiatrist, so I can only speak generally to psychiatric matters. This situation is clearly very frustrating for you. As you say, how could someone—degree and experience notwithstanding—know your daughter better than you do in just a few minutes?

The doctor obviously does not know your daughter better than you do. However, you ostensibly chose this doctor based on their qualifications and experience. Psychiatrists are trained to identify symptoms that can be treated with psychiatric medications. The assessment process is designed, in part, to ascertain the possible efficacy of medication. Just as a doctor treating headaches will identify symptoms and try to treat their underlying causes, so will a psychiatrist attempt treatment based on symptomatology.

Granted, psychiatry is different than most other fields of medicine. There are few medical tests that can help determine the existence of mental illness. Most psychiatrists do not utilize medical testing in the diagnosis process. Diagnosis and treatment are based on self-reporting and information obtained from significant others, parents, and the like.  

I obviously cannot speak for the doctor, but the assumption is that the diagnosis was based on the information that was collected. Doctors are trained to make objective decisions. You are concerned about the fact that this doctor could not possibly know your daughter as well as you do. Though this is true, it also means that emotions and subjectivity are much less likely to inform their decision.

The initial intake session should certainly be more extensive than that which can be accomplished in 10-12 minutes, but I don’t know to what extent the doctor based the assessment and decision on the 40-minute conversation with you. You stated that you were told that the opposite of what occurred would, in fact, occur. I assume that you were told that your daughter would not be diagnosed with depression, and that she would not have medication prescribed.

I don’t know what the doctor heard in his conversation with your daughter, and I don’t know how his impression of your daughter changed from after he spoke with you to now. The fact that medication was prescribed clearly seems to indicate that the belief is that your daughter has feelings of depression. Remember that medication does not treat diagnoses; it treats symptoms. Your daughter may not truly have a specific depressive disorder. However, if she feels depressed, this is a symptom that a therapist or psychiatrist will attempt to treat.

You seem to believe that your daughter’s issues are more deeply rooted than what can be codified by a diagnosis of depression. If this is the case, she needs help learning to manage her emotions and her relationships. Although this help will typically come from a mental health professional other than a psychiatrist, the process can be a long one. I don’t know if your daughter is currently seeing a therapist, or if the doctor understands that she will be seeing one. Perhaps the doctor believes that your daughter needs medication to help manage her feelings of depression in the short run until she learns to properly navigate her relationships and regulate her emotions.

At times, any doctor needs to make judgement calls based on the information that they have. You were involved in the assessment process. Do you feel dismissed because of the direction in which the doctor chose to go, or will they not discuss their decision with you. If the latter is true, this may be due to your daughter’s age and her decision not to allow coordination of care with you. If you feel like your input is being ignored, but you are included in the treatment process, you can certainly ask the doctor any questions that you have, and air any concerns.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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