Dear Therapist:

My sister has a difficult time with her 2 of her children. They are socially awkward, struggle in school and seem to me to be very anxious. Whenever they go through something difficult, she seems to quickly find a "medical" related reason why whatever is happening is happening. One time it's strep, one time PANDAS, or Lyme disease or whatever else. She runs around from doctor to doctor getting all sorts of treatments for them.  None of the treatments are familiar to me as "standard." She does not "believe" in therapy or psychiatric medications. I understand that these things I mentioned are real illnesses, but I wonder how common they really are and why they seem so much more common in our community. I think she is overlooking the standard options for something more exotic. I don't know that mine or anyone else's opinion will make a difference to her but am hoping the panel could provide some education as to some of these rarer diseases that seem to me to have become very popular in our community. Why are things that are supposedly rare seemingly common in the community? What are some guidelines that parents, and educators can use to see if someone is pursuing a correct path for psychological diagnosis or are going down a long windy road that ends up nowhere good?



I am not an expert on medical ailments, so I can only speak to them in a broad sense. Certainly, there are diseases and conditions that have only been recently identified. Others were known largely only to the medical community until it became clear that their incidence was more prevalent than previously believed. PANDAS is an example that falls into both of these categories. It was only identified in 1998, and its popularity appears to have significantly increased over the past ten or fifteen years. Although it is still considered controversial by many and it is likely over-diagnosed by many practitioners, it is now accepted by the mainstream medical community.

On an individual basis, it makes sense to consider both medical and psychological causes for symptoms that can be related to both. When a patient presents with symptoms that I believe can be easily explained by a medical condition, I ask them to have a full physical done to rule out physical causes. Focusing specifically on possible medical causes while ignoring psychological ones (or vice-versa) can lead to misdiagnosis and continuation or exacerbation of symptoms.

I’m not sure what you mean when you state that your sister doesn’t “believe” in therapy or psychiatric medications. Does she not agree that psychological disorders exist or that they can be treated via medication and therapy? Or does she refuse to believe that her children have such problems? If the former is true, it will be very difficult for her to change her perspective on her children’s issues. She would first need to acknowledge the existence of mental disorders, then she would need to recognize that her children may have psychological issues.

Occam's razor is the principle that the simplest (or most obvious) explanation is more likely to be the correct one. To some extent, this helps explain the reason that I will ask people to be tested for things like Lyme disease, PANDAS, or an under- or over-active thyroid (especially for sudden onset symptoms without a clear cause). Similarly, when someone has ongoing symptoms that can most easily be explained by psychological factors, the most obvious cause is the single mental disorder (like an anxiety disorder). This would appear a more likely cause than multiple medical issues.

Naturally, we assume that the medical and psychological experts with whom we consult are aware of possible causes outside of their field of expertise—and that they will guide their patients toward exploring other possibilities. However, this is not always the case. It is our job as health providers and as parents to research and understand the issues with which we deal. Open-mindedness and an objective viewpoint are paramount in allowing us to accept new concepts and their possible application to our loved ones.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer / 718-258-5317