It’s only fair to start off this new series, one I’ve wanted to do for a year, with the broad category of diagnosis. What is a mental health condition diagnosis and why does it matter? We are going to talk about some of these ins and outs of mental health diagnoses, how they are described, and the system used with which to understand them. But first, a disclaimer is in order.
My disclaimer for this article, and one that you will often see in each new article of the series, is that I am not a mental health professional and my opinions on these matters stems only from my own experiences, of which I am an expert in, and should not be taken as medical advice. I only wish to shed light on treatments that have been beneficial for me and inspire ideas in others that they can bring to their own treatment teams and potentially incorporate into their own recoveries where applicable. What works for me may not work for you, as we are all unique individuals, so take what I say with a grain of salt.
With that out of the way, we can begin addressing the issue of diagnosis. I personally prefer the term “mental health condition” over “mental illness.” In 2016, I used the term “mental health issues” as a bridge between condition and illness and I suppose I reject the term “mental illness” as it feels too stigmatizing and I revoke the notion that I am “ill.” Even though at the same time I back the mission of Canadian Michael Landsberg’s “Sick not Weak,” a nonprofit organization.
I think my logic in that is I’d prefer being thought of as “sick” or “ill” over “weak,” as mental health conditions are not a sign of a character defect or purposeful fault of the one struggling with them.
I don’t mind thinking of the diagnoses I live with as chronic illnesses but there’s something about “mental illness” that just makes my skin crawl. A person is not inherently “anorexic” or “schizophrenic”; they are instead a person “living with” or “struggling with” a condition.
Back to diagnoses, in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are around 250 disorders with a specific, varying amount of symptoms occurring over a detailed duration of time that can explain the behaviors, thoughts, emotions, and physical symptoms a person with a mental health condition may experience. According to Grohol (2011), approximately 50 percent of people living in the U.S. will meet the criteria for a diagnosable mental health condition at some point in their lifetime, as measured back in 2004 by the CDC.
It’s been discussed before whether the DSM-5 should be approached as a medical model (as it has in the past), a categorical approach (as it is presently), or in a new direction altogether.
Having mental health conditions listed in a categorical approach has its limits (in fact, most approaches will). If I only fit the criteria for four out of nine symptoms of borderline personality disorder (BPD) I’ll meet the criteria for borderline tendencies (or ‘traits’ as it were); however, if I have five or more symptoms, I would fit the criteria for BPD as a whole.
The problem is people don’t fit so neatly into these classified boxes. And the truth is that diagnoses have the ability to change over time. A person can be initially diagnosed with depression only for years later to come to the conclusion that the true disorder behind the curtains is bipolar (either type one or type two). That’s why, although it can be instinctual to define one’s self in a diagnosis, becoming too attached and too dependent on the labeling can create a host of chaos on its own.
When I was in one of my hospitalizations in the spring of 2017, one of the mental health specialists (MHS), where I was first introduced to the BPD-tendencies diagnosis, described diagnosis as a fluid spectrum. At one point, I was to the left of the spectrum and at that present moment, I was elsewhere. And, ultimately, that’s okay because diagnoses are mainly important for insurance billing purposes and ways to direct treatment approaches.
The time when a set of symptoms begins to cause distress and impairs functioning is the biggest indicator of an underlying mental health condition. People who experience some symptoms of mental health conditions but aren’t impaired, distressed, a danger to themselves or others, or deviate from their society’s norms are not categorized as fulfilling the necessary quota to be diagnosed.
Lastly, treatment itself is an interwoven spiderweb; there will be many overlaps and connections within each treatment to be discussed in this series.
Diagnosis
By Raquel Lyons
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September 19, 2018