Psychological diagnosis is not as reliable as our profession would hope. More than a few times, clients have shown up for counseling with a long list of prior, and periodically contradictory, diagnoses.
I have found that there are problems with a tendency to over-diagnose or under-diagnose due to inaccurate information, insufficient information, and assessor bias. For example, women tend to be diagnosed borderline personality disorder more often than what is warranted, while men who present for treatment are not diagnosed borderline personality disorder as often as it is warranted.
It is possible for art therapy to illicit information that can help correct or adjust problems with diagnosis and therefore enable the establishment a more effective treatment plan.
When a client arrives with a prior diagnosis of schizophrenia, with an attending presentation list of paranoia, hallucinations, delusions, inactivity, flat affect or little emotion, tangential thought, poverty of speech, difficulty connecting and relating to others, plus problems with memory, and at times odd in their presentation – these symptoms would appear to be a slam dunk as a diagnostic confirmation.
Chemical abuse or dependency complicates the above problem because the use of non-prescribed psychoactive drugs can trigger short-term and/or sadly long-term mental illness, sustain mental illness, and mask mental illness.
It is also risky, in fact dangerous, for an uneducated, undereducated, unlicensed and/or uncertified art therapist to challenge any diagnosis at any time due to an image produced in a session. In addition, no one, anywhere, except a licensed medical doctor, can tell a client to reduce or quit their psychotropic medication(s).
All of this said, it can be very powerful to ask a client, who is stable (and with team approval), to paint what the voices are saying, (or have said in the past). This serves to check on the current level of mental health, and/or open the door to new and possibly useful clinical information, and it may also help bypass family rules for keeping secrets.
Once when helping a client paint a life-sized silhouette mandala, I asked about the voices in his head. He was reluctant to say, I imagine, for a myriad of reasons. I asked, “Can you paint them?” He said slowly, “Yes.” I sat silently as he painted, “Shhh, just relax,” and “No one will believe you,” and “This is our secret”.
This question, “Can you paint the voices?” has been, in more than a few cases, a very important power point of nexus,… the beginning of positive change and transformation.
Childhood trauma, is always tragic information to hear. Even so, in this case, I felt a sigh of relief because trauma is treatable to a point of resolution.
Interesting isn’t it how signs and symptoms for one or more diagnoses might be explained by normative or at least understandable responses to profound childhood trauma. How many adult survivors of childhood trauma have experienced, 1) periods of feeling frozen and flat, 2) periods of difficulty speaking in a way that might look like mutism, 3) problems of attachment, especially an avoidance of or difficulty with connecting to other people, 4) intrusive traumatic memory seeming and feeling like a hallucination, 5) moments of severe anxiety, terror, or paranoia, 6) problems with attention and memory and, 7) having an odd presentation or dress such as wearing too many clothes in summer in an effort to hide.
Many people with schizophrenia do not have childhood trauma, but for those who do, identification of trauma is a possible gateway for improvement.
Schizophrenia has a poor trajectory,… those with the diagnosis tend to have a much shorter lifespan than that of the general public. In addition, those with schizophrenia have lives that are chaotic and difficult.
Therefore, if there is a chance for a small window of hope and change, however small, let’s do our best as a profession to find it.
NOTE: All art submissions are posted with a signed authorization to release confidential information. The cases are disguised. This means that they are a conglomerate of several cases, from three decades of work, and from a variety of locations across the United States and abroad.
The art piece above is by a person, well on his way to a better recovery, who was previously misdiagnosed as schizophrenic.