Chapter 1079 - 811: Appears Minor, But Cannot Be Cured
Everyone took a moment to digest.
Director He looked at the auditing students and was just about to say something when her phone suddenly started vibrating.
"Hello? Dean."
Hearing Director He address the person on the other end like that, everyone immediately fell silent, thinking it might be something important.
But then they heard Director He say, "I’m in clinic today, it’s not very convenient to talk. How about I call you back at noon?"
Nan Zhubin blinked.
"Mm, mm... I know, but I’m seeing patients right now."
"Okay, okay."
Director He decisively hung up the phone and turned her gaze back.
"Where were we just now?"
Nan Zhubin reminded her, "You were saying that after considering everything, you’d let the patient drop out of school."
Director He patted her own head. "Right, a new brain really is useful."
She gave Nan Zhubin a word of praise, then looked at the auditing students, whose eyes still seemed a bit cloudy.
"Alright, let’s take it step by step. You all try doing a case conceptualization for this patient first."
Director He said, "Happens to be, although today is a follow-up, this girl actually gave a fairly complete account of her situation."
As she spoke, Director He turned sideways to block the computer screen so they couldn’t see the electronic medical record on it.
"Tell me, based only on what you just heard, what do you think is going on with this girl?"
The teaching session suddenly turning into a quiz session made everyone react like students who’ve just been cold-called in class.
After one breath of silence, a trainee consultant ventured, "Is it... school refusal?"
Director He gave him a glance and didn’t respond. To her, that answer was quite amateurish—at a Psychological Consultation company outside the hospital, they really might pull out a category like "school refusal problems."
But in Psychiatry, phrasing it that way really wasn’t appropriate.
Nan Zhubin was still thinking, frantically combining the information he’d just heard in his mind.
After seeing Director He’s reaction, the others didn’t dare to be the second person to speak. In the end, the garrulous senior tried, "It feels like... a Somatic Symptom Disorder?"
The other auditing students slightly nodded when they heard that.
The girl’s symptoms did look like that; the most obvious thing was a psychological problem of Somatization.
Director He neither confirmed nor denied it, and asked, "Anything else?"
No one answered.
Director He sighed, skipping over the initial "school refusal" answer and addressing the garrulous senior’s response:
"Somatic Symptom Disorder does indeed involve real physical discomfort, but its core feature is that the patient is excessively focused on the bodily symptoms themselves—constantly worrying they have a serious illness, repeatedly going for checkups, spending huge amounts of energy on wondering whether they’ve got some major disease."
"But with this girl, her headache and nausea are situationally specific. They only occur at school and disappear once she leaves school. Her attention is consistently directed at the school environment, not at her body itself."
"She doesn’t suspect that her body might have some other serious disease."
The garrulous senior went quiet. Lacking in skill, he felt he’d made a rookie mistake.
And now that a brick had been thrown to attract jade, for the sake of saving time, Dr. He finally displayed the content on the electronic medical record.
The answer was different from what everyone had imagined.
"Behavioral and emotional disorders with onset usually occurring in childhood and adolescence."
Everyone froze when they saw it. That string of words looked... oddly unprofessional.
Hadn’t they been expecting something like "XX Disorder" or "XX Syndrome" to appear?
But the moment Nan Zhubin saw the answer, his thoughts fully opened up.
He recalled diagnostic reports he’d read before; there really was a diagnostic category with a name that long.
It just wasn’t commonly seen.
Seeing their expressions, Director He didn’t elaborate much. Time was limited, so she began stuffing knowledge directly into their heads.
"This girl’s symptoms are widely distributed and diffuse."
Director He recited as if counting her own treasures: "She has school-situation-triggered anxiety, she has depression, she has an ’if I don’t go to school I’m doomed’ obsessive cognition, she has headaches and nausea as Somatization responses, and she has obvious avoidance behavior—"
"—but none of these alone constitute a complete, sufficiently clear core diagnosis." Director He spread her hands.
Exactly.
Whether it’s "Anxiety Disorder," "Depressive Disorder," or anything else, it’s never enough to just have anxiety or depression present.
Every psychiatric disorder has a series of diagnostic criteria, and to make a diagnosis, several of those criteria have to be met.
Director He clicked her tongue. "When, in outpatient, we find that a child or adolescent has certain symptoms that seriously impair functioning, but we can’t clearly classify them under a specific disorder, we’ll fill in this diagnosis."
Like a big basket you can throw anything into.
"But this is often what doctors hate to see the most," Director He said. "In the child and adolescent field, a lot of the time we just can’t give a definite core diagnosis."
"A child might simultaneously have elements of anxiety, elements of depression, elements of obsession, elements of social avoidance. Each of these is enough to meet part of some diagnostic criteria, but none of them can fully capture all of the child’s problems."
She paused. "At times like that, we write this diagnosis. It means that the child’s problem is not one-dimensional, not something you can precisely intervene in with a single particular therapeutic modality."
In other words—this diagnosis, to a certain extent, stands in for ’unknown.’
The auditing students drew in a sharp breath, picturing the scene of themselves as Psychological Consultants receiving a visitor referred from an outpatient doctor bearing the diagnosis of "Behavioral and emotional disorders with onset usually occurring in childhood and adolescence."