Tell Me What's Wrong

It used to be Borderline Personality Disorder. Just recently it has been Bipolar Disorder. The Diagnosis of the Day seems to change without warning or direction, depending in part on the newest edition of the Diagnostic and Statistical Manual (that's DSM to you), on the differing meds the pharmaceutical companies have come up with, and on what sort of therapy is popular just now. It shows up in treatment plans, in supervisory sessions, even in the self-diagnosis made possible by the internet.
They can be what a former supervisor of mine called "garbage terms," vague categories covering damn-near anything and especially those cases where the clinician is stuck for a diagnosis. Even with the occasional second-guessing of the insurance people, no one really questions the therapist. Sure, a good therapist reviews a case every few months, revising the treatment plans and possibly coming up with a different diagnosis to add or replace. But in a time where most clinicians are scared silly of anything that might be seen as admitting a mistake, such changes are rare if not non-existent.
So the client can go along collecting different diagnoses, as he or she moves from therapist to therapist. (That's another change; people committed to therapy usually have several therapists over their lives, either because of the abomination known as "brief therapy, or because of a mistaken understanding of therapy as only meant to deal with any immediate crisis.) Lemme tell ya a secret: therapists don't always agree, and might come up with a completely different diagnosis and treatment plan for the same client. Yes, understandable; determining the exactly right thing is not always scientific, but more like chasing a black cat in an unlit room. Throwing darts blindfolded.
The insurance people insist on a diagnosis within certain parameters; they will not accept an Axis II as the primary diagnosis And the average person wants to know what's wrong right away! (Think it's something to do with our human need for certainty when things get uncertain.) But I come from a therapeutic generation that was impatient with the whole thing; something to do with reducing a human being to a clinical term. (Even today, doctors and nurses are prone to talk about the "appendectomy in room 208.") For all the need for certain forms of professional discipline, maybe we all need to learn how to live with uncertainty and focus on who is hurting, rather than exactly what is causing the pain.