It’s easy to get caught up on your mental health diagnosis. When we feel bad, we want to know what’s wrong with us! I think it’s Human nature to classify and explain things, so i don’t really find it surprising. But, there are ways I believe diagnostic labels can hinder our mental health journey, and many counselors (including myself) go gently with diagnosing and sharing those terms with clients.
- What is a mental health diagnosis?
- How are diagnoses used?
- Are there times it’s better not to know my diagnosis?
- What if I suspect I have a mental health condition?
What is a mental health diagnosis?
When you go to a doctor, your medical diagnosis is often pretty clear-cut and crucial for treatment. You have a broken bone – set the break and immobilize it until it heals. You have Type 1 Diabetes – you need Insulin. While it’s not always that simple, it’s often a straight line between a clear diagnosis and a treatment plan.
In mental health, it’s often a bit more hazy. Because mental health concerns grow out of a complex system of physiology, relationships, personal life conditions, individual trauma histories, and an array of other contributors, it’s substantially less clear than a broken bone or condition that can be identified with lab tests.
How are mental health concerns diagnosed?
Think of mental health diagnosis, as a cluster of symptoms we give a name to for easy reference. These clusters and labels are outlined in the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5).
For example, consider a patient who presents with several symptoms.
- Trouble sustaining tasks
- Easily distracted
- Fidgety, can’t sit still
- Unable to relax quietly
- Talks excessively
They may receive a diagnosis of Attention Deficit Disorder. The clinician looks at a collection of behaviors, sees what label best seems to match that cluster, and offers a diagnostic label. (Best is the operative term there – see below.)
Seems pretty simple, right? Read on…
It’s often not an exact science.
Consider some of the conditions that contribute to a Generalized Anxiety Disorder (GAD) diagnosis.
- Difficulty concentrating
- Sleep disturbance
Do you see the potential overlaps between ADHD and GAD? Given how complex Human behavior is, it can be very easy to attach these symptoms to one condition or another!
The DSM is clear that is symptoms are better indicators of another diagnosis, the first must be ruled out. But, given the limited time we get to spend with patients before being required to assign a label, it can be a challenge!
I have a particular concern for the possibility of conflating ADHD diagnoses with anxiety disorders in children. I think it’s really important that we take our time to get this right. While I don’t see children in my practice, I take great care to only refer families to providers who are extremely careful in the diagnostic process. You can read more about my practice and who I see here. Also, if you have a child you’re seeking help for, you can still feel free to contact me for a referral to a qualified clinician who specializes in working with children.
How are diagnoses used?
There are a few primary ways a diagnosis is used. Typically, you will have to sign a consent for your counselor to share this information with others.
If you’re using insurance to pay for counseling, the clinician will have to assign a diagnosis to bill them for services. The insurance companies want to know there’s a clinically important reason to pay for services.
When referring you to other providers, especially medical doctors, a diagnosis can be very helpful. For example, an LPC can not prescribe medication. So, if it seems you would benefit from medication for your condition, it will be important for your medical doctor to have a clear picture of what’s going on. Rather than going through the whole diagnostic process again, it will help them to have the opinion of a trained mental health professional in deciding what medication is best for you.
Some cases, such as Schizophrenia and other related conditions, require a clear diagnostic picture for proper treatment and management. Such cases have profound implications for the patient and their families, and comprehensive treatments that include medication are often the best way to manage symptoms.
Are there times it’s better not to know my diagnosis?
I believe there are often reasons not to focus on the diagnostic label. While your insurance company may need that label, the way I work with people embraces the complexity of the Human condition. While severe conditions often require a clear diagnosis as part of the conversation, the anxieties of everyday life often transcend these clear-cut labels. In fact, I have seen instances where knowing the label can make it harder to move forward.
Living into the diagnosis
It’s not uncommon to make subtle (or even overt) changes to our behavior based on the label that’s attached to us. When we do this, we actually increase our symptomatic behaviors because we live into that label.
I saw this clearly in a non-clinical setting, at a workshop for a bunch of university professors. The presenters used a version of the Myers-Briggs Personality Type Indicator (a popular personality assessment for team-building exercises). Once facilitators organized this room of highly intelligent, PhD trained academics into personality groups, I saw the professors increase the degree and frequency of the behaviors that put them in those groups to begin with. These highly intelligent people gave into the manipulation of the label, and it wasn’t a subtle effect.
I think we can all be prone to this. If a doctor tells us we’re likely to be forgetful or disorganized, we can echo this evaluation in our daily lives without realizing we’re doing it.
Mental health difficulties are real and are just as valid as medical conditions. Period.
It’s easy to beat ourselves up over our mental health symptoms and the ways they make life more difficult. We think mental health makes us less than others. I believe it’s crucial to normalize mental health difficulties so we can meet them head-on and heal properly.
It’s usually far more productive to discuss symptoms and experiences than labels. I see labels functioning as shame triggers far too often. Having depression or anxiety doesn’t make you any less valuable as a person than someone with a broken arm or inflamed appendix. They’re just conditions that need to be addressed to improve our lives.
When a mental health diagnosis a) may cause you to feel worse about yourself, and b) won’t really help us treat your symptoms, why should we focus on it? I like to focus on what it’s like to be you. What does it feel like for you to walk in the world, interact with others, work, play, and love? Even people with the same diagnosis will have dramatically different experiences, so focusing on the label just doesn’t make sense in make cases.
Failing to “own our stuff”
It’s not uncommon for people to come to me with concerns that their mental health concerns are causing difficulties in their relationships at home or work. While self-compassion is often a part of therapy with me, I firmly believe that owning our actions is an important part of true self-compassion.
A hypothetical example… Let’s say someone has chronic difficulties managing their life. They struggle to meet friends on-time for social events, have trouble remembering household responsibilities, and fail to pay bills on-time, even though they make plenty of money. If this person receives an ADHD diagnosis, this may help explain the behaviors.
However, there can still be consequences. Friends may get tired of being left wondering what’s going on. A spouse may not be willing to take up all the slack on housework. If the person calls the electric company and says “I have ADHD, so you shouldn’t charge me a late fee for paying my bill late,” that’s an example of not owning their behavior. No matter what one’s opinion about ADHD and the resulting behaviors, the request to waive the late fee, or expecting others to just deal with the fallout of the condition isn’t likely to go very well.
Focusing on the label can cause a new round of problems that can harm relationships and even create additional consequences for us. If the patient and therapist can focus on managing the symptoms effectively, that may lead to far better results in therapy.
What if I suspect I have a mental health condition?
If you’re having difficulties that may be related to mental health or relational difficulties, I would be happy to meet with you to discuss how I can help. To be clear, symptoms don’t have to be completely debilitating for therapy to help. In fact, the majority of my clients are completely functional, and just want to live a better life.
Your reasons for seeking therapy are as unique as you are. If you want to talk about what’s going on, I’m here to help. I hope to hear from you.