Best diagnosis for better treatment

Diagnosing a person correctly is crucial for right treatment especially in cases involving trauma. This was discussed at the fourth biennial counselling conference in Thimphu yesterday.

Igor Pietkiewicz (PhD) said that modern psychiatry at times diagnose trauma cases with different illness. “A patient had fourteen years history of hospitalisation. He was diagnosed with schizophrenia but was definitely not schizophrenic.” He said that the patient was once diagnosed because of the voices that he heard.

He said that many patients with posttraumatic symptoms are very critical about their symptoms. “Recently, a study in Africa on possession revealed that all people who claimed that they were possessed reported having serious traumatic experiences. But none of them would associate traumatic experiences with traumatic symptoms.”

He said that social learning and cultural norms affect how one interprets reality and inform about people’s behaviour.

Psychiatrist with Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Dr Chencho Dorji, said that people with such problems are referred to hospitals and that doctors are not necessarily geared to think in a physical perspective to treat these issues. “These things keep on happening as we are not addressing the core issue and just looking at the manifestations of the issue.”

He said that the role of counselling was important and that counsellors need to try finding out what was bothering the person to behave in such a way. He said that this was a way for asking help.

In a response to a participant’s query if children in their adult lives would have the same problems their parents had, Igor Pietkiewicz said: “If you had been traumatised as a child this will affect the relationship and create a certain pattern on how you build relationship with other people.”

He said that trauma leads to fragmentation of the personality also called structural dissociation. “A part would be trying to continue living in daily life as if nothing has happened while another part would remain stuck in traumatic experiences and memories.”

He also said that talking about trauma is a taboo. “People don’t realise that the traumatising event happened to them.  As long as the patient is unable to realise what happened to him or her, there won’t be a way for working through the problem.”

Through screening tests and structured clinical interview, a traumatised person could be treated.

A participant, Sonam Yangden Tamang, said that counselling is not at all advising people. “Counselling provides clients a safe haven to vent emotions that are deepest. Often these are wounded parts in the life a person.”

She said that there are therapeutic techniques such as cognitive behaviour therapy and rational emotive behaviour therapy that would help heal a traumatised individual.

Rinchen Zangmo

2 replies
  1. irfan
    irfan says:

    At one point, I read Dr Chencho Dorji mention something like ‘manifestation of the issues’. Is that another way at looking at something like reading and coding of behaviours to record as a manual for reference! I don’t know, but I am only eager and curious to know.

    Towards the end of this post, I get to read the mention of two concepts… ‘cognitive behaviour’ and ‘rational emotive behaviour’. I have used the word concept as in the classes of human resource management, we learnt those things only like concepts in understanding organisational behaviour collectively.

    Every household, irrespective of the culture and tradition, has its own codes and manuals on behaviours decided by the elders or the seniors of the family and the tradition passes on. Even when attending a discussion or seminar where mostly psychiatrists are taking part; not usually all of them come to an agreement without discourse or a debate.

    When we mention discipline of the mind and its connection with rational thinking linking through a concept of behavioural science for any study; do we leave enough room for an option like ‘at debate or discourse with oneself’. If one is a student of literature, probably he or she thinks essay writing exercises at this point where one is reasoning to debate with one’s own ideas and concepts.

    But I have observed something here. Our present generation is not really good when it comes to all rational thinking and pure qualitative reasoning. So many times, we all like to present reasoning in percentages and percentile. Our thinking is turning more and more quantitative all the time and in a busy society; people including parents don’t have time to listen to someone reading out an essay.

    Moreover, not all of us are born painters or has that autistic ability and skill to express ourselves on the canvas of the mind with our thoughts. Is there a way to teach our young children and the youth a way to constructive, creative and meaningful expressions with thoughts where quality gets the preference! Otherwise, everyone here is at the systematic receiving end of a system involved and implied for a process in thinking. But then, it’s my personal opinion for a self diagnosis only.

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