Well, there’s inherent confirmation bias in what brings us to the psychiatrist/psychologist in the first place. Someone, somehow, thought there was a problem and sought advice. Until we get objective tests or scans, diagnosis is inherently subjective. And that’s precisely why you shouldn’t bind yourself up equating diagnosis with identity. You or your loved one might have a disease, but aren’t that disease. And the course of that disease or even the diagnosis is uncertain, so why burden yourself.
Labels only have power if you let them, or people ‘believe’ in or ‘need’ them. They serve utilitarian purposes for insurance companies, or drug manufacturers, or doctors, or researchers or lawyers, legislators and judges, and most of these professionals know their limitations and methodology with assigning them. When they get into the hands of lay-people or people with axes to grind, things tend to go awry, and they can get misused in stigmatizing or otherwise limiting ways.
My diagnosis was handed to me on paper and discussed by the head psychiatrist when I was discharged from a state mental hospital. Maybe it was a legal requirement, or maybe this was the first time I ‘paid’ for services, I don’t know. Prior to this, I’d seen a psychologist for a year without diagnosis. I also had one visit to a psychiatrist and wasn’t told a diagnosis, my mother might have received mine, but she didn’t share it with me.
Insurance was not involved for most mental health services I’ve received for various reasons: at first I didn’t have health insurance; then my employer was self-insured and the ADA was not yet in force, so filing a claim was risky; Then there were limitations on the number of sessions per year I could claim, and psychotherapy was a hard sell for medical necessity; My present psychiatrist refuses to file paperwork and play the insurance company game (this isn’t uncommon in the US). So I generally only file for prescription coverage and the rest has come as tax deductions or out of my HSA accounts. It’s just not worth it for me hassle-wise and risk-wise as long as the medication is paid for.
So with no insurance companies involved and various psychiatrists and psychologists rarely even mentioning a DX, the focus was on my symptoms and problems and what I might do to overcome them. That’s all a DX is in the end, a bag of symptoms that are sort of like other people’s bag of symptoms. And treatment and recovery is trying various tricks and techniques to see if the load can be lightened, or new strengths developed so it can be more easily carried. I don’t think I ever even got or asked for a prognosis. Perhaps they didn’t want to limit or discourage me by expectations, or maybe more realistically they didn’t know.
I forget the exact sequence of events, it may have been before I was hospitalized or before I decided to ask for a referral to a new psychiatrist for neuroleptic treatment, but I had a session with my first Jungian therapist where I declared myself as having SZ and accepting it. I guess it was similar to LGBTQ+ folks saying they identify as such. Without professional comment or confirmation she acknowledged it and effectively said if this had value for me then fine. She avoided labeling at all turns, and at a time I spoke to her on the phone about finding a new psychotherapist upon moving, she pointed me to a list of Jungians and said to be careful of disciplines with preconceived biases of pathologies, etiologies and prognoses.
This was a bit of a phase where I tried to spin my disease and myself as something ‘special’, but at the same time picking the various symptoms apart and trying to make them appear more normal. Sort of a lemonade out of lemons approach. Over time, I became less self conscious about things and realized that ‘normal/neurotypical’ people had many of the same problems, it was more a question of degree and awareness. So recovery for me was a process of losing that feeling of specialness while retaining the self-awareness (which is a hard thing to shake once you have it). And with that came thoughts of where does my illness end, and I begin. My mantra was largely, “you aren’t special, everybody has problems and are more concerned with their own, not yours.” I’m reminded of the quote of Ian Maclaren sometimes attributed to Plato or Philo, “be kind, for everyone you meet is fighting a hard battle.”
I don’t really think about it much any more, accept to post here and take a pill along with various others in the morning. I haven’t had appreciable symptoms in the past two or three years and even if I did, I’m confident I can overcome them. This is after 30 years or so of this, and it wasn’t cheap or easy or pain-free. I recently asked my sister what she thought about my illness and some advocacy efforts I’m working on, and she said she doesn’t think of me as my illness or acting like I have an illness or with or in spite of my illness. To her I’m just me, no label or bag of symptoms, just me.
I see people coming here expecting a quick fix, the perfect P-doc an exact DX and a miracle RX that makes the pain go away. Unfortunately the world and our brains don’t work that way. We have to learn to deal with and embrace imperfections— starting with ourselves.