Taking Diagnoses with a Large Grain of Salt

It's only in the last 50 years that we've had so many names for the ailments of our psyches. If we go back a couple of hundred years, there were very few diagnoses available: you were sane or you were insane. If you were insane and had money, you might be called "eccentric."
A hundred years ago, if you were a woman, you might be diagnosed, whatever your symptoms, with "hysteria". This was a fascinating condition, in which, the doctors beliueved, the uterus somehow became detached from its regular surroundings and wandered about the body, causing emotional troubles. A woman who was depressed, anxious or upset about something could be showing signs of this important if fictional, condition. Reading and thinking could make it worse. Women were told to rest, prevented from reading and cautioned about the harm that could come from trying to use their minds. 

I think it's important to remember the origins of hysteria when we think about diagnosis today.  We should  take into account trends, knowledge and cultural conditions. In the 1970's and '80s, many unhappy women were medicated with a highly addictive drug (still in use today), called Valium. Valium (aloso called Diazapam)) is a muscle relaxant, a potent sedative. Women who were upset, tearful, anxious, depressed and self-harming were given Valium to "calm them down. " Doctors didn't know what to do with these women, and some of them were annoyingly emotional (often diagnosed with borderline personality). Trauma-informed practitioners would now recognize many of these women as suffering from post-traumatic stress.

Until quite recently, there was no recognition of the effects of unresolved trauma, and no established treatment for it. Battleground fatigue was the only recognised trauma, and soldiers were hospitalised and drugged for it. Sometimes they got better; many times they went home to face a lifetime of nightmares, rages, depression and daytime triggers. Many committed suicide, and many still do. Their families also suffered the consequences of their trauma.

The problem with being a man is that men aren't expected (or allowed)  to experience or express emotions: little boys are taught before they can even read to feel ashamed and unmanly if they feel something. Creative and artistic impulses are stifled; expressions of delight or curiosity shut down. Showing sadness can be met with adult mockery or anger--the only emotion boys and men are expected, even rewarded, for showing in a world that still somehow believes that men and women have divided up the human traits with no overlap. In a culture that enforces gendered stereotypes and behaviours, we are all harmed.

Although women have suffered greatly at the hands of the medical model of mental illness, men have suffered  as well--part of that suffering comes from the fact that the medical establishment too often doesn't recognise men's emotional pain. When they need help, too often it isnt there. When you can't help yourself and no one else will help, shame and despair (labled as "unmanly") can make life seem not worth living. 

These days, the trend is towards diagnosing not only children, but adults, with autism spectrum disorders and ADHD. There is an interesting overlap between a traumatic past and behaviours that look like autism or ADHD. Scattered attention is a common sign of post-traumatic stress, and being unable to get close to people is another sign. Communication problems and a strong need for control are also common. It's important to understand that diagnoses change as culture changes, and as we come to know different things about how the body/mind/brain works. It's not a fixed thing, and we're never going to be 100% right, because we will likely never come to the end of everything there is to know about bodies, brains and minds. 

A doctor who's being asked to consider an autism or ADHD diagnosis may not take the time to discover whether the sufferer also has experienced traumatic events. The effects of trauma may be overlooked, and someone may be given medication intended for ADHD and which will not help resolve trauma---and may even worsen the post-trauma symptoms. With all the attention given to ADHD and autism specrtum disorders in the media, patients may appear in front of the doctor asking for confirmation of what they think they're experiencing, without having considered other possibilities. A good diagnosis doesn't just ask, "what are the symptoms?" It also asks, "are there things going on that don't fit into those symptoms? Could this be something else?" A good diagnosis doesn't just run down a checklist: it also should rule things out.

For example, if someone comes to me saying they're anxious and they don't know why, the not knowing why is a big clue. They might say there's nothing in their life that shold be creating anxiety, yet there it is. First, I want to know what they mean by anxiety. What does it feel like, how does it manifest? Do we have the same understanding of anxiety? Sometimes people use a word without really knowing what it means. So, first we agree on terms and describe the symptoms, and when, where and how they manifest (and around whom).

Usually, when people are anxious, they have an idea of what might be behind it. If they don't, I want to start by ruling out the possibility that it's a chemical, not a psychological, problem. I ask about caffeine intake, about sugar. I ask when the anxiety started and has anything else been happening-headaches for example. If someone tells me they're anxious and they've been drinking 6 cups of coffee a day, I'm going to recommend they start by reducing their coffee. If you're wound up on caffeine, all the therapy in the world isn't going to help your anxiety. Forget therapy; switch to decaf!

Sometimes a set of symptoms points to a potential physical problem. A good therapist, when faced by symptoms and a client who has no idea why they're there, will ask the patient to see a physician and rule out the possibility of a physical ailment. A racing heart can be a symptom of anxiety, but it might be a heart problem. 

Many times, anxiety can be eased by looking at lifestyle choices. If you watch the news every night before bed and then you can't sleep, please stop doing that. No, really--the adrenalin and cortisol that course through your poor body when you see and hear about war, violence, injustice, economics--the fear, anger and frustration that attends every thinking person who watches the news, is bad for your entire body. And make no mistake-- your body is intimately connected to your mind. Our chemistry, the chemicals that move through our body also influence the workings of our brains, which exist in close relationship to our minds. If you're anxious, if your blood pressure is high, if you have bad dreams, give up watching the news for a month and see what happens. If you can't give up the news, therapy may help you find out what's behind the feeling that keeps you doing something that harms you.

There's so much to write about diagnoses, I barely know where to start. Maybe I'll just make a bulleted list. But I want you to know this. A diagnosis of a mental health condition doesn't mean it's necessarily  lifelong. I meet a lot of people who talk about "my mental health" as though having once had a major bout of depression, or even years of anxiety, means they'll never recover; that they'll always be damaged somehow, or fragile. It's not true. You can be diagnosed with all sorts of mental health conditions that can improve and disappear, leaving you as healthy as anyone else. You can change, and walk away from a diagnosis. (There are very few conditions that tend not to change, that require ongoing treatment, such as bipolar disorder--there are a few, but not many.)

It takes so little to tip us off the balance beam. Think about it this way: there's a really easy way to make someone psychotic: don't let them sleep for a couple of days. That's all it takes to turn a perfectly sane (umm, if anyone could be said to be perfectly sane!) person into someone who doesn't know where they are, what day it is, or what's going on.  Their emotions are all over the map. But they don't stay insane--once they get some sleep, their mental health is restored. We are that delicate, and that resilient.

One more thing: if you know someone who has been diagnosed with a mental "illness", don't think they're all that different from you. We are all one bad chemical, one traumatic event, one disappointing love affair, one sleepless night on a flight to Thailand, away from "crazy". In fact, a great contemporary philosopher named Alain de Botton says that on a first date, we should ask each other, "How are you crazy?" and if the other person says, "I'm not!" run away briskly, because either they're totally unaware, or they're lying.

​When someone has a serious mental health condition, it's worsened by being ignored or treated with suspicion, or fear, or being patronized by other people. The philosophers call it being "othered": as in, one person thinks the other is somehow less human than they are. It's a horribly isolating thing, to be othered.

Being socially isolated is a common problem for people who experience mental illness, Loneliness is one of the worst crazy-making life conditions, and it's one that people with mental health conditions may endure simply because other people are fearful. The vast majority of people with even very serious mental illnesses are utterly harmless: they might act strange sometimes, (and often not!)  but they're not dangerous. What is dangerous is being treated like you're less than human by people who are afraid and who don't know any better. So if you know someone whose mental health is currently in a fragile state, you don't have to go to extremes to help: just be kind. Kindness is balm to the soul, not just for those who are fragile at this moment, but for all of us. 

The Bullet Points
1. Diagnoses are based on on time, place and culture. They change as times change.
2. Diagnoses should not only match symptoms,  but rule out other possible conditions
3. Physical symptoms can look like a mental health symptoms (and vice versa)
4. A diagnosis is rarely a lifelong issue
5. We're all one bad chemical, one bad experience, one sleepless night away from a mental health problem
6. Most mental health problems are fixable
7. We shouldn't think of people with mental health problems as different from us: they're not
8. Loneliness creates or contributes to bad mental health
9. Our bodies, brains and minds are interconnected and affect each other
9. Giving and receiving kindness treats many of life's ills; physical, mental and spiritual

If you're feeling fragile, take heart. Sometimes just talking over your problems with someone who's really listening can make all the difference. Don't be afraid to each out, and if you don't find help right away, keep on reaching out until you connect with a trustworthy someone who wants to help. They don't have to be a "helping professional": they might be a friend or acquaintence, a work colleague, your doctor, your hairdresser. Don't let pride stop you and throw away the unhelpful notion that we're supposed to be able to handle life's slings and arrows on our own. We are built for connection: we need each other. And the friend you reach out to today will one day need you to listen to them. We are made to help each other: it's that simple.