Diagnoses

When I first went to the psychiatrist with Dave, I saw that the psychiatrist had all of Dave's information on the computer screen behind him, and I read it all.  My eyes seemed to fixate on the line "GAF - 50."  I couldn't stop staring at it throughout the session.

GAF is a global assessment of functioning, and a 50 means he has serious symptoms or serious impairment in  functioning.  It is also the kind of score inpatients had to have at a local psychiatric hospital before they could be discharged.  I remember thinking, "Really?  Really, is that what we're living with?  A level of functioning that would barely get you discharged from an inpatient facility?"  I thought about it all the rest of the day.  I tried to think of reasons it wasn't true.  Somehow I was double bound, wanting it to be higher, to have some kind of confirmation that things weren't so bad and would get better - I also wanted it to be low, to have confirmation that my feelings were valid, but I felt like I would much rather have been told my emotions were off-base and things were going to be fine.

Now that I've learned more about the GAF, I realize that Dave really should've had a score closer to 30-40.  And I feel angry it wasn't assigned to him.

Later in the year, when things had gotten a little better, we had another appointment with the psychiatrist.  We mentioned that Dave had failed nearly all of his classes that semester, and the psychiatrist said 3 or 4 times, "Really?  Really, that was your GPA?  Wow."  It was like he was shocked at how poorly David had been functioning.  And even though the double-really was very similar to my original reaction, I felt angry.  I felt angry that he would keep asking, when Dave already felt bad about it, and I felt even more angry that he hadn't asked about it sooner, when it would have actually benefited us.  I bet he left that session thinking, "Wow, I had him pegged for a little higher functioning than he was.  I'm glad he's doing better now," and went on to meet his next student for their 15-minute session.  But I left the session agonizing over what resources we might have been able to have if he had realized the extent of Dave's situation sooner.

Now that I know Dave probably should've had a lower GAF (it's subjective and there's quite a large range of scores you can choose, but I'm still very confident in that assessment), I wish I could go back in time to that first session and wave it in the psychiatrist's face, saying, "LOOK!  This is what we are dealing with.  Now please, help us find the resources we need."

In terms of actual diagnoses, rather than GAF scores, Dave thinks he probably had dysthymia throughout high school and certainly on his mission (dysthymia means that for at least 2 years, you feel depressed more days than you don't), and the episode from this past year was an episode of Major Depressive Disorder - Severe.  Early onset dysthymia means that you're likely to have a major depressive episode later, and if you have one episode after dysthymia, you're likely to have more episodes later.  We were counting on that anyway, but somehow...  it actually makes me feel better to be told it's much more likely than not that we'll have another episode.  It's like, rather than spending my life worrying about whether or not another one will come our way, we can spend our time preparing.  It feels much less haunting and uncertain that way.

Diagnoses have historically been harmful in my family, and left people feeling both labeled and hopeless.  But somehow it's comforting for me to know exactly what box someone would put Dave's symptoms in.  It's comforting to me to know what we should expect.