Understanding Mental Health Diagnoses

MYM Diagnosis; June 2021

Episode Description

Diagnosing children with a mental health-related condition can be controversial. Many worry this gives children a label that is set in stone and will follow them around their entire lives. In this episode of Mind Your Mind, Dr. Wayne Martinsen talks about the role of diagnosis in getting children the help they need. Martinsen encourages us to think about mental health diagnoses the same as we do any health diagnosis. If you go the doctor and they diagnose you with strep throat, that doesn’t mean you’ll have strep throat forever, or that you are a strep throat victim. It just means that you have a collection of symptoms that point to strep throat, and the doctor will use that diagnose to provide the appropriate treatment.

What to Expect

  • Learn why diagnosis is important to effective treatment.
  • Discover how therapy, medication, and lifestyle can help you adapt to, or overcome, a mental health diagnosis.
  • Understand that a diagnosis does not define you.


Things to Think About

  • Is mental health stigma keeping you from getting the help you need?
  • How might your lifestyle be affecting your mental health?
  • Did you know that a psychiatric diagnosis can change or resolve over time?

About the Guest

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Dr. Wayne Martinsen, Medical Director and Psychiatrist at Dakota Family Services diagnoses psychiatric and behavioral health conditions, makes treatment recommendations, and provides medication management for clients of all ages. He is also the Clinical Clerkship Director for the University of North Dakota Department of Psychiatry and Behavioral Science. Dr. Martinsen received his doctorate degree from the University of North Dakota.

Dr. Martinsen provides telehealth and in-person services in our Minot and Fargo locations. 

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Transcript
Understanding Mental Health Diagnoses

Featuring Dr. Wayne Martinsen, Medical Director/Psychiatrist, Dakota Family Services

Tim Unsinn:   Welcome to Mind Your Mind, a podcast presented by Dakota Family Services, an outpatient behavioral health clinic located in Minot and Fargo North Dakota. In this podcast, I will talk with our experts about understanding and nurturing our mental health and wellness. I'm your host, Tim Unsinn. Join me each episode as we explore the intricacies of our minds, decrease the stigma of mental illness, learn practical tips for managing our mental health and well-being, and recognize when it's time to ask for help. Join me now to mind your mind. In this episode of mind your mind I'll be talking with Dr. Wayne Martinsen.

Tim Unsinn: Dr. Martinsen is the medical director and psychiatrist in Fargo and Minot. Dr. Martinsen diagnoses psychiatric and behavioral health conditions makes treatment recommendations and provides medication management for clients of all ages. Again, this is really a great opportunity to talk with you, Dr. Martinsen. Today our topic is psychiatric diagnosis, but before we get to today's topic, you know, the question is coming, why do you do what you do?

Dr. Martinsen: As we've talked before Tim my intention was not to go into mental health. I ended up with a job at group home in Minnesota so that I could pay the bills to pursue a career in architectural drafting. And I just became fascinated with people. I was working with angry adolescents, and I was one of the people who just like that population. And I like trying to help them and trying to find ways to connect and solve problems.

Dr. Martinsen: So I switched my major to get a degree in social work, went on to get a master's in social work so that I could do therapy, went on from there to medical school to go into psychiatry. And in the last few years have been teaching. I'm the clinical provider for psychiatric training for our third year medical students on the Minot campus of the UND School of Medicine. So, I got pulled into it by this lure of both people and a fascination by their problems and sort of an enjoyment of helping.

Tim Unsinn: And you've made it more than a career. You've made it a lifelong ambition to help people. And that is really, it comes through in everything you do. Today's topic I'm really, really intrigued by the topic—psychiatric diagnosis. So what is the purpose of a psychiatric diagnosis?

Dr. Martinsen: The purpose of the diagnosis is to take the symptoms and help us understand how to help. So for example, probably two thirds to three fourths of all my work psychiatrically is with children and adolescents. Especially with a ten-year-old child, the most common symptom that brings them in is anger. But anger is like a fever. It doesn't tell you if you have cancer, or if you have a hormonal problem, or if you have a bacterial infection, or if you have a viral infection. It just says something is wrong. And that's the way a lot of our psychiatric symptoms are. So you can be suicidal because you're being abused. You can be angry because you're being abused. And the treatment for that would be very different than if you're angry because you have bipolar disorder; if you're angry and hurt because you're being humiliated or bullied in school; or if you're being angry because you have a personality disorder and can't cope.

Dr. Martinsen: So what the diagnosis does is it helps us sort of collect symptoms, and see how they fit together, so that we can understand what's giving rise to the symptom on the surface, for which somebody says, I need help. Now, a lot of people are really concerned about a diagnosis or about feeling pigeon holed. And you really want to sort of back that off and compare us to other parts of medicine. So if you go in to your primary care doc, and he says, "Oh, you have strep throat. I've done the test. I've diagnosed you with strep throat." It doesn't mean that you are a strep throat victim. You know, you still have an identity bigger than "the person with strep throat." What it does is it says that's what the doctor is going to treat you for.

Tim Unsinn: How does that then drive the treatment you're talking about is you, you find you know, you, you hone in on what you feel is the diagnosis. And then how do you, how does that drive the treatment approach?

Dr. Martinsen: And then you can share that with the patient. You can talk about what it means. You can look at where it came from, and then you can thoughtfully decide with the client what it is that they want to do to manage that. So my role largely is medication management. And that's one option. If somebody comes in with depression or with anxiety or with ADHD. The other thing that could be done is a lot of times, lifestyle changes can be made, or there might be times when somebody just needs to be reassured that they're safe, that there has to be an intervention because there's violence in the home or somebody who has violated a child. There are times when really the treatment of choice and the one that's most acceptable is psychotherapy. And so you talk through new ways to think about your life, or you talk through a trauma, or you look at what you say to yourself in a frustrating, stressful situation. But once you have the diagnosis, once you understand why the presenting symptom—whether that's anger or anxiety or depression—once you understand why that is going on, you have the diagnosis. Then you can talk with somebody about what approach makes the most sense to treat this.

Tim Unsinn: As I talk with and hear other people talk about psychiatric diagnosis. You know, they often think or often hear, well, if I get set in and diagnosed with something, well, that's set in stone. So is a psychiatric diagnosis set in stone for life or can it change?

Dr. Martinsen:  It can change. It changes the most with kids who are, who are sort of delightfully. They're going to mature out of a lot of problems they have no matter what we do which is kinda nice. But if you have anxiety and you can take a look at it in a couple of ways, you can either say, this anxiety gets in the way of my life. I like who I am. I like my relationships. I like my work, but this anxiety gets in the way. And I want to go to see Dr. Martinsen and get a pill. And you can also say, no, I'm not. I'm not satisfied. I think that having the anxiety is something I want to change about myself. I want to be different than I am. And you might go to Dr. Spencer or Dr. Weberthe psychologist or one of the therapists and look at how do I change my automatic response to anxiety.

Dr. Martinsen: So even if the anxiety or the depression is genetically predisposed, because it runs in your family, you can find ways to change it. So when you have a diagnosis, it is not set in stone. The things that tend to be sort of set in stone are IQ. Our ability to learn, tends to be pretty much preset. For some people, ADHD will be preset and they won't outgrow it. Say half to two thirds, don't outgrow it. But even there, you can decide "I'm going to change my lifestyle. I'm going to live in a way that's really interesting so that if I have a short attention span and I have to read reports all day long, maybe that's really not where I should be. You know, maybe I should do something that I find innately interesting." Whether that's working with people or working with numbers or teaching or working with your hands, it's like, you can change your lifestyle to be a better fit for who you are. So at the end of life, the dementias are, you know, there's a lot of research on how we avoid getting a dementia, but once that's happened, that's something that once diagnosed is probably not changeable, but the vast majority of our mental health diagnoses either can be changed, or lifestyle and therapy can adapt so that they are not significant.

Tim Unsinn:  You are listening to Mind Your Mind. And on this episode, Dr. Wayne Martinsen's with us, and we're talking about psychiatric diagnosis and who decides what the criteria are for a particular diagnosis?

Dr. Martinsen: Well, there, there are a couple of ways that it's done. The basic symptoms that cluster together to make a diagnosis are sort of organized and researched by the American Psychiatric Association. And they put out a manual called the Diagnostic Statistical Manual that will list every accepted diagnoses and all of the symptoms that go into that diagnosis. Now, depending on what questions I ask or what I'm aware of, how comfortable my client is with me, I may be able to elicit a really full, balanced interview and information, but there are times when, you know, I or other providers think we have the diagnosis, but boy, the patient just doesn't seem to be responding to treatment. Or the patient doesn't resonate with what we're saying about them. And one of the things that is really very helpful is the use of a psychologist. A psychologist is a doctoral level provider. They have their PhD or their PsyD, and they have psychological tests that look at the whole person. And they look at factors of personality and lifestyle and stress and brain processing and emotional responding. And they can either confirm or refute a diagnosis. And again, they're not perfect either, but the more you dig into it, the more likely you are to get it right.

Tim Unsinn: He's got the psychiatric diagnosis. What if they disagree with it? What are their options?

Dr. Martinsen:  I think it's really, really important that, that you and the person you're seeing agree with what's going on. And I really encourage people, whether they're seeing me or any other provider, if what the doctor, what the psychologist or the therapist is saying, doesn't fit. I really think you need to both take a look at, "Am I wrong?" But you have to be willing to see a different provider. You know, not every auto mechanic can fix your car. And similarly, not every provider is going to resonate with the kinds of problems that you're presenting and all of us have areas that we're stronger in and areas that we're weaker in. And so I think at the drop of a hat, if it doesn't feel right, and you can't come to an agreement with your provider, I think you get a second opinion, or you ask to see a psychologist and do some testing.

Tim Unsinn: Oh, great information as always. Psychiatric diagnosis information with Dr. Wayne Martinsen, Dr. Martinsen, always a pleasure talking with you. We appreciate your time. And as you know, you've done this before. It's not your first rodeo. We have another question before you go. You get a prize. What do you do personally, to mind your mind?

Dr. Martinsen: Well, you know, I'm luckier than most people in that I find my work by and large invigorating, but nonetheless, I work on those things that positive psychology is really defined as being helpful. I meditate. I take my dog for a walk every day. I try to connect with people. I eat a largely fresh fruit and vegetable diet because we know those things matter. I try to protect my sleep in those things, lifestyle, really lifestyle and relationships really matter.

Tim Unsinn:  As always thank you for your time. We appreciate hearing from you. And on this episode of mind your mind talking about psychiatric diagnosis. Loving the podcast. The opportunity to pause, rewind relisten, relearn. Thank you, Dr. Martinsen.

Tim Unsinn: Thank you for joining us for Mind Your Mind, a podcast presented by Dakota Family Services. You can't have health without behavioral health. Remember to mind your mind. For more information, links to additional resources, contact information, and much more go to Dakota, family services.org.

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