In this episode, I explore my personal observations and opinions around the topic of mental health diagnoses, and why I believe caution should be applied when seeking after a mental health diagnosis. I share my personal experience with watching my sister receive her diagnoses and feeling the need to seek after a diagnosis myself in the midst of depression and anxiety. As always, this episode is not meant to replace any professional help, but I hope to provide insight and encourage people to question if seeking out a diagnosis is helpful in their individual circumstances.
Hello and welcome to Lighting the shadows, a podcast all about mental health. I’m your host, Kristen Laursen, and today I’m going to be talking about a topic that has been on my mind a lot lately, and that is the topic of mental illness diagnoses. Are diagnoses helpful or hurtful? When can someone know if seeking out a diagnosis is the right thing to do? How can receiving a diagnosis hinder a person from growth? How can it help?
Now, I want to be clear before I dive into this topic that I am not a doctor or therapist and I haven’t personally studied or researched this topic, but I have talked with several different therapists and coaches who agree with my point of view on the topic, and I am going to speak through my personal experiences around diagnoses. My hope through this episode is to help people stop and think about why they want to receive a diagnosis for themselves or a loved one. What are they hoping receiving a diagnosis will accomplish? I hope to help others learn to see themselves and others around them first and foremost as human beings who want to be seen, understood, and treated with kindness.
So often when I delve into specific topics like this one, I like to start with a definition. So what is the definition of the word “diagnosis?” So according to Google, diagnosis means “the identification of the nature of an illness or other problem by examination of the symptoms.” So the way a diagnosis is determined is through examining the symptoms that someone is having. What are the symptoms of mental health? Patterns of thoughts, feelings, and behavior.
The greatest problem I have seen with utilizing a mental diagnosis is that when a person is given a diagnosis, they may attach their entire identity to it. And in boxing themselves into a diagnosis label, they begin to feel hopeless to change, grow, and heal.
I want to share a real life, personal example of this. My little sister, Kimber, was given the diagnosis of “Borderline Personality Disorder” and “Bipolar 2 Disorder” 1.5 years before we lost her to suicide. She underwent what was considered a comprehensive examination that looked at her patterns of thoughts, feelings, and behavior in one afternoon, and walked away with her diagnoses. Afterwards, Kimmy researched her diagnoses incessantly and determined that “A Borderline” is who she was, and “A Borderline” is who she would always be. People with BPD often share negative impulsive behavior. Kimber was participating in some of that harmful behavior before her diagnosis, but the harmful behavior definitely increased after she received her diagnosis. She would say “I’m a borderline, and this is just what borderline’s do” while at the same time battling immense shame around her actions.
I remember very clearly a heartbreaking conversation I had with Kimber soon after she received her diagnosis. We were sitting on my grandma’s floor in a bedroom we were sharing while my family was visiting and she told me that her therapist told her that if there was ever someone likely to die by suicide, it would be someone with Kimber’s diagnosis; someone like her. Hearing her say that broke my heart. I told her how much she meant to me and I asked her to promise me she would never die that way. She told me that she couldn’t promise me, because of her diagnosis, but that she would try. She said that she felt like it was a possibility she might die that way, but she didn’t want to.
Finding a therapist for Kimber was really difficult. Many therapists my parents contacted refused to see patients diagnosed with BPD and Bipolar. My mom was told that receiving that diagnosis was like receiving a diagnosis of terminal cancer…very difficult to treat and would most likely result in premature death.
In the year and a half following, I saw Kimmy change in a lot of ways. She talked about her diagnosis often. She made choices that she knew weren’t the best choices for her, and she would tell me “Well, I’m a borderline, and this is what we do.” In a letter she wrote to a boy she dated for a time, she said “you should have never dated me because I’m a borderline, and I’m manipulative. I tried to warn you in the beginning, but you didn’t listen. This is just who I am.” In her suicide note, Kimber wrote “I don’t want to live 80 more years in this much pain.”
Her hopelessness was so apparent, and from my perspective, her diagnoses only made things much more hopeless and concrete.
Since losing her, I’ve often thought back to those moments and what she said about herself regarding her diagnosis. What if her therapist never performed that diagnostic test on her? What if her therapist instead looked deeply into her patterns of thoughts, emotions, and behavior and helped Kimber realize that with work, she had the power to change? What if the goal from that very first appointment was not to diagnose, but to simply connect with Kimber and understand her? Not by slapping on a label and confining her into a borderline box, but by bringing the causes of her thoughts, feelings, and actions into the light, helping Kimber understand herself better and empower her to change in ways she desired?
The problem with labels and placing people in boxes, is that it completely undermines the complexity of humanity and stigmatizes a person or a group of people. Kimber’s diagnosis did not take into account the incredible ability she had to connect deeply with others, the pure intentions she had in most, if not all, of her relationships, the firm desire she had to serve other people and use her many talents and abilities to benefit the world around her. Instead, Kimber used her diagnoses to discredit her gifts and unique abilities, claiming that she was only manipulating others and labeling herself as “bad” and “broken.”
The truth is, we are all people. We all originated from Love, from who I perceive as God above, and we all go through hard things. Our brains react to those hard things in different ways. Going back to the definition of a diagnosis: a diagnosis is just a way to categorize the different ways people think, feel, and act. But seeing a diagnosis as a definition of identity takes away the FACT that our brains have the incredible ability to be REWIRED. Which means that WE have the POWER to CHANGE the way we think, which in turn effects the way we feel, and we have the ABILITY to change the way we BEHAVE in many cases. Which are all of the things utilized to determine a diagnosis.
So, are diagnoses final? If someone is diagnosed with something specific, will that diagnosis be lifelong? This definitely depends on the diagnosis. If someone has a broken leg, for example, we know that broken legs will heal. But if someone loses a leg or was born without a leg, it’s common knowledge that legs cannot grow back. Can someone without a leg still grow, learn, and become stronger in other ways though? Of course! While the fact that they don’t have a leg will obviously affect their life in many ways, there are endless opportunities for growth and change for the better.
I think this is true of mental illnesses as well. A person might be diagnosed with something that is like a broken leg. With time, therapy, medication, and determination, they can heal and overcome their mental illness completely, and they won’t need to rely on medication lifelong. However, someone else may have a diagnosis that is like the person without a leg. It’s not something that they will be able to fully heal or change in their lifetime, but that does not mean they can’t grow and learn and become the best version of themselves throughout their lifetime. That does not mean that life is not worth living! What’s so difficult about a mental illness versus a physical illness is that it’s very apparent if someone is missing a leg, but it’s really difficult to understand what’s going on in someone’s brain. It’s hard to understand or know the capacity that an individual has to change their thoughts, feelings, and behavior. Sometimes, like healing a broken leg, those things can be changed completely. But other times, with diagnoses such as Huntington’s Disorder, Dementia, Down Syndrome, Autism, and Alzheimer’s, like a missing leg, it cannot. But there is still a capacity for change, growth, and becoming. And I think too often we mistake a broken leg for a missing one. It’s a tricky balance because it’s important not to hinder your own or another’s ability to change and grow, but it’s also essential to understand your limits and the limits of others you love, working towards progression that is attainable and not impossible. And progression looks different for everyone. But although understanding one’s capacity for change can be immensely difficult, focusing on doing everything possible to promote positive change with compassion, patience, and understanding, is always essential for maintaining hope.
I believe that in many cases, obtaining a diagnosis is essential. Receiving a diagnosis can help mental health professionals know the best course of action to treat a mental illness. For example, it’s well known that an early diagnosis and treatment of autism can help an autistic child live a much better life than without intervention. But in seeking out the proper diagnosis, I firmly believe that the focus needs to be on treatment, growth, and healing. And I have too often seen the focus be all about finding an excuse to better determine the inability to grow and change. I have too often seen people use their diagnosis as a crutch, either intentionally or unintentionally, and that is why I think that caution and awareness should always be implemented when seeking after a diagnosis. A diagnosis should be used to provide more hope, direction, and assurance; not instill hopelessness as it did in my sister’s case.
Another benefit of receiving a diagnosis is that it can help the person being diagnosed understand themselves better and help others understand them better as well. I recently discovered that I greatly relate to being a
“highly sensitive person,” a topic I’m going to expand upon later in a future episode. As a highly sensitive person, I have the tendency to feel responsible for the emotions of others. I am learning, however, that it is not effective for me to take responsibility for the emotions of other people. My brain has developed that pattern of thinking, feeling, and behaving, but that pattern can hinder the growth of others and become overwhelming to me. I am learning how to change my behavior to be more effective for the life that I want to live.
In this case in particular, it’s been helpful for me to relate to the diagnosis of “a highly sensitive person” because it helps me understand myself better, look at my patterns of behavior, decide what is effective and ineffective, and then determine what I want to change. Now I can be mindful of my initial reaction to feel responsible if someone shows signs of anger or fear, but I can use the tools I am learning to acknowledge this reaction and choose to change it, which will become easier over time.
I love to look at emotions, thoughts, and behavior and label them not as “good” or “bad” like we so often do, but instead as “effective” or “ineffective.” Let’s look at abuse for example. Essentially, abuse is a pattern of ineffective behavior towards another human being. There are many different types and examples of abuse and it’s important to label abuse for what it is, but labeling a person as “abusive” may limit or undermine their ability to change their behavior, and automatically create the assumption that this person, the “abuser” is intrinsically bad. While abuse should never be accepted as OK or normal, it can and should be seen as an ineffective pattern of behavior, separate from a person’s identity. Separating the behavior from the person’s identity can diminish shame and encourage change for the better.
When I was struggling with severe depression and anxiety, lack of sleep and paranoia, I became obsessed with finding the right diagnosis for myself. I knew my brain was not functioning normally and I wanted to pin-point what it was that I was experiencing. I thought that maybe I was autistic, or had avoidant personality disorder, or maybe I was psychotic. I felt so completely hopeless and I wanted my family members and friends and myself to understand why I was feeling the way I was feeling. I was not looking for a diagnosis to help me change for the better, I was looking for a diagnosis to explain and excuse my behavior that I despised and felt like I could not control. I hated that I couldn’t get out of bed some days, that I couldn’t seem to form sentences, that I couldn’t connect with people, that I couldn’t even seem to make myself a peanut butter and jelly sandwich. I hated that my negative thoughts were spiraling out of control and that I was losing sense of reality. But my search for a diagnosis did nothing to help me improve, because I believed at the time that I could not improve. Seeking for a diagnosis led me further and further into the shadows. And the truth is, my depressed and anxious, sleep deprived brain, could have been falsely diagnosed with a large variety of illnesses because of my symptoms. But the answers for me did not lie in the diagnosis. It wasn’t until I decided to stop searching for a diagnosis and start looking for ways I could feel better that I started to experience healing, growth, and positive change.
When I was little, one of my favorite movies was “The Secret Garden.” When I was preparing for this episode, I kept thinking of the character Collin-the little boy in “The Secret Garden” who was convinced that he had a lump on his back and was destined for a life full of solitude inside his bed, dependent on others to fill all of his needs. It wasn’t until his cousin came to town: his stubborn Cousin Mary, who refused to believe he was as sick as he thought he was, as everyone thought he was. Mary made him, practically forced him, to transfer from his bed to a wheelchair, bringing him outside for the first time in years, and showing him the beauties of the secret garden she had discovered. While at first, Colin was very resistant to change, o;/0vertime, Collin learned to believe in himself, to believe in the way that Mary saw him, and he pushed himself to walk on his own. In the last scene of the movie, Collin runs through fields under the sunshine, strong and healthy. I am not saying we are all like Collin, but how unfortunate for the person who believes they are broken, that they cannot change, when positive change is right around the corner if they only seek after and apply the tools they need to experience hope and peace again. I relate very much to Collin, and although I can’t speak for my sister, knowing her as well as I do, I believe with all of my heart that further healing was available for her as well; that she didn’t have to live 80 more years in the pain she was experiencing.
To wrap all of this together, summarizing all of my many thoughts on this topic, I believe that diagnoses can be helpful and important in some cases, when the focus of the individual desiring a diagnosis is on finding solutions and change for the better. Diagnoses can point people in the right direction, help them find the best medical professionals, therapists, coaches, holistic approaches, etc. possible to encourage positive change. Some mental illnesses can be healed completely, while some cannot, and it is important to explore the differences, with patience, compassion, and determination. Unfortunately, I have seen too many people discount their own ability to change, including myself and my sister, and focusing on a diagnosis can often yield hopelessness and excuses for negative behavior that can be changed. It is helpful to use the terms “effective” and “ineffective” instead of “good” and “bad” when describing emotions, thoughts, and behavior, and to realize that we do have the capacity to change our thoughts, feelings, and behavior to a certain extent. Our brains have the capacity to be rewired. Placing people, especially ourselves, into limiting boxes of a diagnosis or label can be detrimental by undermining the complexity of the whole of who we are, of our divine origin and inner light, so caution should always be used when seeking out a diagnosis. Sometimes, a diagnosis is not necessary or helpful, while other times, a diagnosis is essential to determine the best treatment available. A diagnosis can also help us understand ourselves and other people better and can help us acknowledge ineffective behavior and focus on creating effective behavior. Sometimes, focusing on one effective change at a time is all that is needed. Sometimes, like Collin, we only need to believe that we can change, and determine to change for the better, until we find ourselves on our own two feet, full of peace and joy, basking in the light of truth and love.