Differential Diagnosis and JC Therapy
The DSM, and the labeling process itself can, for various reasons, hinder the psychologist or mental health practitioner in how he/she sees and responds to his/her patient, but it does, at the very least, provide a basic structure that is useful in organizing ones caseload, developing a symptom-specific treatment plan, and in getting paid for the rendering of services by 3rd party payers.
How does the story of 6-String Therapy challenge traditional notions of therapy?
Six-string Therapy
Given the symptoms expressed by the character in this song, how would you diagnosis him/her?
JC Therapy
Dr BLT
words and music by Dr BLT copyright 2009
Posted by Bruce L Thiessen Ph D at 11/13/2009 3:41 PM 
Categories: differential diagnosis
Tags: differential diagnosis psychology rock music and psychology country music and psychology psychoanalysis music and psychology
Categories: differential diagnosis
Tags: differential diagnosis psychology rock music and psychology country music and psychology psychoanalysis music and psychology
November 17, 2009
Cathy Lazarus
A patient may be expressing many of the behaviors outlined by the DSM-1V for a particular diagnosis; however, by assigning a label to that person with a particular disorder it doesn’t take into consideration any other combined disorder that may be present nor what has caused these behaviors. Are they physiological or environmental in nature? Additionally, this labeling may encourage a self-fulfilling prophecy and the patient may act out the diagnosis. The medication prescribed for the labeled patient may be effective for the labeled condition but fail to treat the whole patient due to other unrecognized conditions and the cause for these conditions.
The six-string therapy targets the emotions of the patient making them feel that there are those who understand and empathize with what they are going through no matter what they may have done, for whatever reason, providing the patient a brief escape from their dilemma and comfort by way of melodious medicine.
The patient exhibits criteria for Panic Attack with Agoraphobia as per the DSM-IV-TR Manual, Axis1, GAF Scale 60-51: Anxiety about being in places from which escape might be difficult/ embarrassing, tightness in chest, short of breath, fear of going crazy, etc.
Alfred Adler defected from the psychoanalytic viewpoint of Sigmund Freud, focusing on the social and cultural forces rather than inner instincts as determinants to behavior. Adler believed people are inherently social beings motivated primarily by the desire to belong to and participate in a group. With this perspective in mind, it is no wonder that a striving, talented musician would dream about becoming part of the revered, idolized, and profitable music culture. Our society values individual success and we often pattern our success with those who have demonstrated what that success entails (in this case): adoring fans, seemingly unlimited wealth, and personal achievement. We think we want what “they have” (on the surface at least) and that this accomplishment will bring us acceptability within a particular group and happiness. I believe achieving the outlined success of our culture, or the dream of becoming a famous musician, satisfies a great need for others to accept and validate one’s personal talents. If others feel we are worthy of their praise then we feel satisfied we have accomplished our goal, we have succeeded and are accepted into that particular genre. We all value our own success and achievements on different scales and levels depending on our personal dreams.
Freud believed the fulfillment of a wish was the essential motive of a dream. I have been able to relate to Freud’s Theory of Repression by past dreams. Many years ago I had a very aggressive, socially challenged, and verbally abusive boss. Now before I go any further, I want you to know that I am not a violet person, but I would dream of blowing his brains out with a “big” gun. The dream was very vivid even down to the rich,
Reply to this
Still working on that succinct thing! Here’s the rest of the dream, sorry. Cathy Lazarus.
Freud believed the fulfillment of a wish was the essential motive of a dream. I have been able to relate to Freud’s Theory of Repression by past dreams. Many years ago I had a very aggressive, socially challenged, and verbally abusive boss. Now before I go any further, I want you to know that I am not a violet person, but I would dream of blowing his brains out with a “big”gun. The dream was very vivid even down to the rich, red blood splattered on my office wall. For some strange reason, this dramatization in my sleep helped me get up every morning and report to work with a different outlook giving me the strength needed to accomplish the tasks of my normal work schedule by feeling that I had a secret weapon against my tyrannical boss. Rather than allowing my subconscious to become the victim of workplace abuse, my dream assured me that I could remain strong and victorious throughout the day because my secretive, inner self had an arsenal of thoughts protecting me from the enemy outside.
Reply to this
The purpose of the study of the 6-String Therapy is to incorporate the music and the poetry into a therapy. Each individual responds differently depending on his or her harnesses. The purpose of the 6-String Therapy is to incorporate the music and the poetry to the treatment of psychological health. ”Johnny's method shortened years, dried tears, stilled fears, and shifted psychological gears, even as it incited rowdy cheers. “
It does not have to be a traditional method in order to help people who have psychological problems. In the song the Psychological help that the prisoners received from the traditional therapy was not affective as a 6-string therapy. Many of these people suffered different type of metal disorders. Most of them because of the surrounding environmental experience depression, and sometimes suicide.
Reply to this
Six string therapy challenges traditional notions of therapy by simply being unconventional. I’m sure in some psychology circles using anything but conventional methods is considered rogue and probably frowned upon. Using “six string therapy” as a way to break through to prisoners is probably a highly effective method as it discards the typical “psycho babble” most prison inmates are used to hearing, and provides a voice of understanding through lyric and rhythm. Johnny Cash made a name for himself through the prison population; it’s possible that his lyrics help to provide credibility to the therapist by the inmates. That credibility may be the first step toward improved mental health among inmates.
As for the person described in, “JC Therapy” I would consider a diagnosis of Agoraphobia Panic Disorder.
Reply to this
Traditional therapy is usually conducted in a clinical setting, with the therapist following a structured format which entails a standard question and answer approach, where as, six-string therapy aka music therapy interjects a stimuli (music) into the therapy session. I believe six-string therapy could be of great benefit to patients. We have all witnessed the profound effect music has on us; it can make us feel sad, happy, energetic or relaxed. According to The American Music Therapy Association: music can help with physical, emotional, cognitive, and social needs of individuals of all ages. Music therapy improves the quality of life for persons who are well and meets the needs of children and adults with disabilities or illnesses
JC Therapy:
According the symptoms of the person in the song, I would give a multi diagnosis of Panic Disorder with Agoraphobia and Bipolar Disorder.
Reply to this
The story of Six String Therapy challenges traditional notions of therapy by taking therapy in a whole new direction. Like you said, the “traditional” methodologies and tools didn’t seem to be working with the prison population (even if the inmates bothered to show up for their sessions.) You can plug along with the same ole same ole which is ineffective and beginning to seem like a waste of time and effort—or you can try something new, something that might actually help. By playing and singing for the inmates, you can “trick” them into actually listening, instead of the usual reflexive action of automatically “toning the shrink out.” The message is the same, except for the single most important aspect—it is actually received. Additionally, outside of the whole “message” aspect, entertainment is a proven morale booster, and effective therapy in its own right.
The character in the song JC Therapy (which I loved, by the way,) seems to be suffering from Panic Disorder with Agoraphobia, and I would say also a comorbidity of Bipolar I Disorder. He shows several classic symptoms of Panic Disorder—feelings of anxiety, impending doom, panic, “freaking out,” tightness in chest, shortness of breath (also choking and coughing while describing the shortness of breath), and going “crazy.” He also shows indication of Agoraphobia with his statements of, “my travel is restricted or endured with marked distress,” “I am anxious in this place, in a place I can’t escape,” “it’s embarrassing...,” and “smothering, shrinking room.” Depression is indicated by statements such as, “nothing touches my misery,” “depressed for quite a while,” “a long time since I’ve smiled,” “chronic for a year,” and of course he is pleading to be rescued. I went with Bipolar I instead of another mood disorder because the character is currently having a Major Depressive Episode, but also indicated one or more previous manic episodes, which disqualifies Major Depressive Disorder as a diagnosis.
Reply to this
I forgot to include that the diagnosis is under Axis 1, and I would put the GAF score somewhere between the moderate (60-51) and serious (50-41) levels because although he did not mention suicidal tendencies, he did indicate serious impairment in social situations and it seemed that his panic attacks were more than just "occasional." Without further details, I would approximate his score at about 51 or 52.
Reply to this
The 6-String Therapy challenges traditional notions of therapy in several ways. The difference between traditional and music therapy is the structure. With traditional structure each patient is treated individually, but with music therapy treatment is simple. Music can have a profound effect ones body and psych. Research has found that a prescription of music can alter brainwaves leaving a beneficial lasting state of mind. Faster beats brining sharper concentration and more alert thinking, and slower tempo promoting a clam, meditative state. This dose of music can lead to a patient having a more positive and optimistic look at life, keeping depression and anxiety at bay.
Awesome Song… Given the symptoms I would definitely diagnose the patient with Bipolar Disorder I with Panic Disorder with Agoraphobia.
Reply to this
just to comment on 6 string therapy over conventional approaches is not so unconventional music has always had theraputic values when it comes to human beings. I think it was a better approach to the prison population because those people probably be exposed to or forced to deal with conventional methods against there wills and any thing u try is meaning less in that sense.
I think the symptoms in the song describe someone suffering from panic disorders with agoraphobia.
Reply to this
I believe 6 string therapy helps the inmates rather than conventional due to the origination of the therapy. Johnny Cash started this in the 60’S after recording a record in Foslom prison in Ca. This allowed the inmates to be part of something special, not matter what their sentences were. This was a way to make them part of the outside world. Johnny Cash was a common man from a hard working family that loved music. With little training he was able to make it big. Inmates can relate to such artist. Six string therapy give them hope in a hopeless environment as the guitar reminds them that they are not forgotten.
In accordance with DSM IV axis one, the character suffers from the following symptoms: Depression, Manic at least once but "may be more", it is chronic (at least a year), anxiety, panic, and tightness of the chest.
I believe it would be a Bipolar 1 Disorder with possible panic attack and panic attack with agoraphobia.
I don’t think it would be the bipolar 2 due to the needed major depressive episode and at least one Hypomanic (Elevated irritable mood)
He has a possible delusional disorder (“Takes my demons!”)
Reply to this
oh yes in accordance with the GAF i would also give him a 51-60... but i would say closer to 60.
Reply to this
"Six String Therapy"
According to the text DSM-IV-TR can involve a lot of the symptoms described in the song. The patient is suffering from Manic Depression, panic attacks, shortness of breath, tightness in chest, the mood swings could also include "Bipolar Disease". In addition to the obvious emotional symtoms, these symptoms also include cognitive symptoms such as feelings of worthlessness or guilt, and thoughts of suicide. Behavioral symptoms such as fatigue or physical agitation and physical symptoms such as changes in appetite and sleep patterns. Aside from the traditional/clinical methods of treatment. Using the 'Six String Therapy" for the patient has got to be the most refreshing approach. Aiding in connecting with the feelings,emotions, inner struggles,tormenting thoughts, and challenging misconceptions going on inside of the patient, not everything can be expressed in words. This is what makes Music so powerful it is a tool that can reach across, race, age,and religion. I view the "Six String Therapy" as being the most effective. "Johnny Cash" just might be able to reach the pure heart and soul of a person, exploring the deep dark things that maybe the root cause of why this person is suffering, believe or not, something that years of psychological treatment cannot do.
Reply to this