Separating the Mind and the Body – Mental Health Assessments

Chronic pain/ health conditions and personality disorders often get mixed up in medical and psychological assessments. By people who should know better. There are common aspects of each: lack of energy, self esteem, self image and trust issues, changing social supports/withdrawal from society, difficulty sustaining social supports and activities, and career or education tracks, mood control issues (feeling sad, angry, worried, hopeless, alone), lack of concentration, brain fog…..

The difference is often distinguishable by chronic pain having some beginning; an illness or injury, or a genetic history. Personality disorders do too, but they aren’t necessarily within the lifetime of the person who is being currently evaluated. Since they begin for this person when they are being reared (bonding, intimacy, trust, self esteem, mood control), it can often be understood that someone (how many?) else in the family also has them. Due to a genetic issue &/or a common family crisis. ie death of a parent, alcoholism of a parent, jailing of an older sibling or parent, GBV in the family group…..Or a common social/environmental issue; ie. war, poverty.

And to turn that around, there are chronic health issues such as fibromyalgia, endometriosis that are linked to family distress. Esp incest and battery.

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So knowing that, how do you challenge the tests? What does it take to separate what is going on with this person? I haven’t seen anything that leads me to believe you can separate them. Which makes me question if inventories are the best way to assess someone? Esp considering what the stakes are (long term incarceration, in some places death sentences, loss of custody of children) and that the people doing them aren’t medically trained. They also often side with social workers &/or cops with an agenda/biases. Which affects the reading of the inventories’ results. Even if they send them out for a computer reading. Yet this is the standard of care that courts rely on.

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Would there be a better method? No matter which assessment you are involved with someone has to do the work, and they all have their own agenda. Some are better educated than others, unequal. And all tests need to be read, interpreted.

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Plus contrary to popular opinion, not all psychiatric/psychological issues have biological markers that a test would pick up. Though there are quite a few that do. So maybe it’s a matter of ruling them out?

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And contrary to popular opinion, malingering to get out of trouble isn’t a frequent thing. Neither are things like hypochondriasis, or Munchausen’s syndrome. People lie and try to fluff their presentation when in the presence of authority. But that isn’t the same as a pathological lying display. Yet many assessors believe that is what they’re looking at. Despite all evidence to the contrary.

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So it’s confusing. And oh so needed to figure this out.