The Challenges of Diagnostic Labeling

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This reposts an article recently published on Where the Light Gets In. The conventional pathographic model of mental health focuses on the diagnosis rather than the individual, which reduces us to a label. It is crucial to impress upon the client that they are not defined by their diagnoses but by their character strengths, virtues, and attributes. The Wellness Model of Mental Health recognizes that we do not recover from distress by focusing on our defects and deficiencies but on our strengths and assets. 

When we label individuals or groups, we reduce them to a single, usually negative, characteristic or descriptor based on an event or behavior. As a result, we view them (or ourselves) through the label and filter out evidence that contradicts that stereotype. Labeling by diagnoses has a similar outcome.

Arbitrarily evaluating someone based on an isolated incidents or behavior is likely an inaccurate representation of that individual. One negative behavior or incident does not define someone’s character. Rather than focus on a label, it is more authentic to value the positive contributions of the person or group. We can then relate with compassionate insight, recognizing the diversity of human thought and experience.

Additionally, attempting to distinguish symptoms and identifying specific etiological and risk factors in emotional malfunction leads to speculation, errors, and misdiagnosis. This likely results in faulty treatment programs and adverse medications.

It is important to recognize that the person experiencing an emotional malfunction knows more about its personal impact than their diagnostician or therapist. This does not imply that error is inevitable, although it happens often with social anxiety disorder. It just posits the possibility. A healthy collaboration of client awareness and a doctor patient mutual dynamic is crucial to proper evaluation. In the wise words of Hippocrates, the pioneer of modern medicine. “If you are not your own doctor, you are a fool.” 

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Five to one, one in five. No one here gets out alive…

November 3, 2023
Where the Light Gets In

The good days are finally outweighing the bad. And it’s been a long time coming.

I don’t doubt the role medication plays in this… in fact, I’d go as far as to say they’re probably the only reason my mood remains relatively stable. In a pre-emptive strike, my medication was increased recently.

I say “pre-emptive,” but in truth, I’d noticed the beginnings of a wobble. I’ve essentially re-entered the world as an actual adulting adult again. That’s not without its pressures. I didn’t really want to hang around and find out if weebles wobble enough that they eventually do fall down, so I did the only sensible thing and went back to my psych team to tell them that I was under a bit more stress than I’d previously been and I’d like to protect myself against the impact of that and the upcoming winter months. I had enough niggly signs that they agreed it was best to up the dose and add in some extra support.

To some, that might seem cowardly or lazy. Why should I think that just because I’m dealing with normal life stressors, that warrants upping my medication? Well, because I know my own limits. I know that whilst my mood wasn’t deteriorating, there is absolutely the potential for it to do so as I emerge into the world again.

Am I under any more pressure than anyone else? No. Am I, for whatever reason, less able to cope with those pressures than most people… yes. I recognize that. I accept it. And for the sake of my family, I have to be accountable for my own emotional and mental wellbeing.

I have deliberately shied away from talking about labels and diagnoses. This is the one area I really struggle with because it feels like I have more letters after my name than I can even count.

The one I struggle most with is “bipolar.” That’s a hefty label to carry around.

When you’re given a diagnosis, most psychiatrists are so risk-averse that nobody ever actually removes a previous diagnosis from your notes, even if there are questions over it.

When you’re given a diagnosis, most psychiatrists are so risk-averse that nobody ever actually removes a previous diagnosis from your notes, even if there are questions over it. Even if they don’t believe it fits. Even if there isn’t enough evidence for it to stand anymore.

Bipolar is the one I hate with a fervour matched only by my hatred of Nigel Farage. In the same breath that I was given the diagnosis, I was told that the condition has a one in five mortality rate, and that’s why I was being kept such a close eye on.

That’s a terrifying statistic to live with. I have a higher chance of dying from the illness I have than if I’d been diagnosed with some cancers.

True to form, this diagnosis simply fuelled my fear and anxiety. And when I’m anxious, I obsess. The intrusive thoughts ramp up and become harder to manage.

In the wake of being told those figures, I became sure that The Doors song “Five to One” was prophetic. That the lyrics (I refer you to this cleverly titled blog…) were a precursor to a fate that I was powerless to avoid. Despite the fact that being one of the four in five is statistically more likely, I convinced myself I’d been given a death sentence. And so, that one line in the song played on a loop in my head. It went round and round so often in my head that there was barely any room for anything else.

I cursed the doctor for their thoughtless delivery. I cursed a God I didn’t even believe in for his cruelty. I grieved for a life I was now sure would be cut short. I was waiting for the death knell to sound, and yet, somehow, it felt as though it was ringing in my ears every single day. Except that the death knell was clearly Jim Morrison in this case.

Why do I hate the label of “bipolar” so much? Well, because I feel like it doesn’t fit. It feels like a lazy way of neatly packaging up a whole truckload of trauma into one nice, neat little word, It feels like a medical cop-out.

The same doctor who delivered the death knell also told me that “bipolar disorder is the closest thing the psychiatric world has to high blood pressure. They know what medications work, the know how to control it and what works without exception” – except that’s pure bollocks.

I say it’s bollocks because there is no clinical test for the disorder… nothing in your blood that can be measured, nothing in a brain scan that will be evident. There is not a single medical marker other than your psychiatric evaluation – which isn’t so much an evaluation as a run through your life history.

I’ve never met a male with the diagnosis, although I’m aware they do exist. What I have seen, however, are scores of women with histories of sexual, physical, or emotional abuse with the diagnosis. I’ve seen dozens of women who are untreated peri or full-blown menopausal with the diagnosis.

And it leaves me wondering if the label is a cop-out for writing a woman off without actually hearing her.

I’ve variously been told in my life that I suffer from psychotic depression, that I have Emotionally Unstable Personality Disorder (having someone tell you that your personality is a disorder is pretty shit too by the way…), that I have OCD traits, anxiety (okay, this one I agree with). I don’t know that any of these labels are helpful for anything other than permitting me to access mental health support.

The thing is, those labels are all over my medical notes. So now I have to practically be dying before I’ll se a GP for a physical ailment, lest they put it down to my mental health…

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WHY IS YOUR SUPPORT SO IMPORTANT?  ReChanneling develops and implements programs to (1) moderate symptoms of emotional malfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing neuroscience and psychology including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to regenerate self-esteem. All donations support scholarships for groups, workshops, and practicums.

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