Meme of the week: the problem of interpretation

This is a meme about interpretation. It points out that when we misinterpret information that is coming from our own bodies, it can land us in real trouble. It turns out that it is critically important to know the difference between existential despair and hunger. Existential despair requires a huge outlay of resources: talking with your family members and partner, meeting with religious leaders if you’re a religious person, meeting with a mental health provider, and the list goes on. Despair requires a person to marshall resources and take a series of steps towards feeling well. But if it’s the case that your blood glucose has dropped below 3.9 mmol/L and you are suffering from hypoglycemia… then it is literally true that you can solve that problem with half a glass of apple juice. This is why good interpretations matter.

The kind of information we get from the inside of our bodies has a special name: interoception. We’re much more familiar with information we get from outside our bodies, which is technically called exteroception. Exteroception is more regularly known as our five senses: taste, touch, smell, sight, and hearing.

Insight

In the meme above, the joke is that we’re such dumb animals that we confuse the feeling of rejection and fears of impending isolation with being a bit peckish. But this is a critically important discussion in the context of psychotherapy, because as a client it is important to work on the right problem. And this isn’t simply an issue about wrong or improper diagnoses, though, of course, this is a common problem too.

Let me give an example: a client I met with recently told me that they have been struggling with panic attacks. The short version of the story is that they have a condition called reflux. Reflux is the condition whereby a valve at the top of your stomach and the bottom of your esophagus doesn’t function properly. This valve—the lower esophageal sphincter—doesn’t close the way it should and, as a result, acid from your stomach finds it way up your esophagus. This causes all sorts of issues, from heartburn to pain to loss of voice and a host of other effects. For my client, it causes an ongoing problem of interpretation, because it is hard to know whether what they are experiencing is something related to reflux or whether it is the beginning of a serious cardiac event. If it’s the former, it may respond to Gaviscon. If it is the latter, it requires immediate emergency interventions. The panic is a manifestation of uncertainty: “I know I have reflux and maybe that’s what it is, but… what if it’s something more serious?”

signals

The problem of interpretation isn’t one that only involves an individual’s misinterpretation of signals from their body. As someone who sees almost exclusively clients with adhd, I can report that the overwhelming majority of people who get diagnosed with adhd as adults have had medical professionals misinterpret their problem—sometimes for decades. This is particularly likely to happen with women. I can’t tell you the number of women I have seen over the years as clients who have a lifetime of anxiety diagnoses without any real success with either counselling or medication for anxiety. Their doctors and psychiatrists and counsellors simply got  it wrong. They misinterpreted their symptomology.

Just to complicate things a little more, this is the reason it’s important to see a person who can offer you the proper interpretation for the problem you’re having. If you’re feeling blue over an extended period and go see your doctor, the likelihood is that you will receive a diagnosis—a diagnosis is a special kind of interpretation—of depression. Once the interpretation is given, the intervention follows. The intervention that doctors offer patients they interpret as depressed is typically medication, most commonly selective serotonin reuptake inhibitors (SSRIs). These medications can be effective, but no moreso than other interventions. And unlike some other inteventions, medications like SSRIs can cause other physical and psychological ailments.

If you go to see a psychotherapist with the very same blue feeling, that therapist will spend time asking about the context in which your feeling arose. If you are feeling poorly due to the death of a parent, and it turns out that you had a strained relationship with that parent… it may be the case that the proper—and best—interpretation of your symptoms is that you are both grieving for and furious at that now dead parent. If it is possible to solve your melancholic feelings by working with a therapist who helps you through the grieving process and helps you to express your fury at your parent towards forgiveness or whatever other endpoint feels therapeutically appropriate… then you have courageously worked through one of the most daunting existential tasks there is. If you went to see your doctor because your interpretation was that you were suffering from a medical problem, you may end up with a lifetime diagnosis of Major Depressive Disorder (MDD), which will then greatly increase the likelihood that future medical professionals will reinterpret your future symptomology as the same.

Interpretations matter!