A rose by any other name – Diagnoses and Labels

During the last couple of Mental Health First Aid Courses I have done, the subject of diagnoses and labels has come up several times in one way or another. Different angles on the same topic perhaps:

– Do we clinicise what used to be normal human emotions?
– Do people cling to / identify with a diagnosis or label and can this hinder their recovery, or make them think things are worse than they really are?

There’s something about some of this type of comment that speaks to me of mistrust. Either of the psychiatric / mental health profession, or of people with these diagnoses, or of the pharmaceutical industry perhaps. Not of all of which mistrust might be unfair or misguided.

Are we clinicising normal human emotions? Are we saying that people have a disorder that can or should be treated, when once they would have been acknowledged with a shrug – as part of the normal range of human experience. On the one hand, I don’t like the way this sounds a bit like “we didn’t get depressed in my day”. On the other – it seems obvious. Our understanding of what the full, natural range of human emotion is – why it is the way it is, what influences it – is evolving all the time. There are clearly things which once were perhaps as being unalterable – which we now understand more and have the option of seeking to resolve. You don’t see many people dismissing arthritis and refusing pain medication, saying “in my day you just accepted the aches and pains of old age”. The key to whether this is a good or a bad thing is perhaps in the word “range” – in the phrase “range of human emotions”.

MHFA (and I) explores the concept of the mental health continuum. All things in life are experienced by degrees. Stress, anxiety, sadness – there is a point at which these are normal, necessary responses to life, with positive impacts on our survival. However, if they worsen, and begin to impact on our ability to carry out the necessary tasks which keep us alive and operating in society – then they become problematic, unpleasant, and it is not unreasonable for someone to wish to find a way to alleviate those symptoms and be able to live a normal and happy life again.

What is crucial – is that it is the person experiencing the symptoms who expresses when they have reached that level of unacceptability and also that they are involved in choosing how they wish to alleviate them. It should not be for the doctors alone, or the influence of the pharmaceutical industry to say – you experience symptom x, therefore you have y, which is treated by product z. It’s fine to know that product Z may be useful – but perhaps the patient doesn’t find symptom x so bad yet, or finds some other course of action helps them instead.

Do people cling to labels? Maybe. Diagnoses can be hard to come by. If you have struggled with difficult emotions or symptoms for years and been ignored, ridiculed, felt shame or self doubt over your stupid inability to just be like everyone else – then having a “professional”, and “expert” agree with you – and say, yes, there is something going on with you, you have depression, or anxiety, or whatever, and I’ll agree that your symptoms must be causing you tremendous difficulty. That can be such a massive relief. A vindication. And if it is also the only way you can access treatment, or adjustments in the workplace, or even just respect from others who’ve previously dismissed you as faking it – then you might cling to that diagnosis.

Diagnoses on the other hand can be millstones around our necks. Especially if they prove not to be the right ones. Once a label of depression or anxiety has been attached, prescriptions prescribed, it is incredibly difficult sometimes to go back to the doctor and say – hang on. This isn’t quite working. Either – the medication isn’t working, or there are other symptoms which are not being addressed. It seems almost impossible to get a referral to someone who has the time and inclination and specialism to go through everything that is going on with you and come up with an accurate diagnosis. It’s not easy – so many conditions have overlapping symptoms. Without living with a person all day every day it is difficult to know what they are like. A doctor has only the time you are with them and what you say to judge by. And that relies on you being well enough to go, to speak, having insight into your condition, having the strength to talk about it – and overcome the inclination that your depression will give you to not want to bother other people with it. It’s nothing. I’m overreacting, I’m not worth worrying about…  If you are concerned that what is going on with you, or your loved one, is more than “simple” depression or anxiety (not that I really think there is any such thing.) – it is hard work to get the right attention if you have a reluctant (or overworked) doctor. And also to get them to recognise that not everything that goes wrong with you is to do with your depression. Granted, some things may be connected. Stress and tension may well cause back ache and headache and stomach upset – but a diagnosis of a mental health condition does not make us suddenly immune to slipped disks, brain tumours or ulcers – so it is important our doctors make as much effort to rule these possible causes out as they would with a person with good mental health.

So a label can be a good, or a bad thing. Sometimes it can be very bad. If I take my diagnosis, go away and read up on it, try various treatments / therapies / self help methods – to better understand what’s going on in my head and why – to recognise my triggers and lessen my symptoms – then my diagnosis has been valuable to me. However, if I wear it like a badge, and an excuse. I am a depressive – I always have been, always will be… I have OCD, I have a phobia… Like having it means I can give up on trying to live a normal life. That’s bad. Presumably we seek help because it has become a problem for us. Just knowing its name doesn’t make it less of a problem, and we should use the power that naming and understanding a condition gives us to help lessen its interference in our lives.

To me – my diagnosis (which I don’t think is completely accurate, but I have an inkling what might be) – is a name for a bunch of symptoms that piss me off. If I can address and challenge, and conquer each of those symptoms separately – learn techniques to keep them under control – I won’t have cured myself of depression, but I will have drained it of its power over me. However I will also know that if I stop using those techniques, the depression will most probably creep back. That is what my diagnosis means to me I suppose. Always having to look over my shoulder no matter how well I feel, because as soon as I let my guard down it will come back. And I’m not very good at keeping it up.

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