As a therapist, I work with people who have varying degrees of mental illness. I spend a lot of time thinking about what exactly it means to be “mentally ill.”
The idea of “mental illness” isn’t as black-and-white as it seems on the surface. For better or for worse, we use a medical model in treating mental illness. We diagnose people by comparing their symptoms to a checklist of symptoms that research has shown tend to cluster together and are linked to a measurable disturbance in functioning. The Diagnostic and Statistical Manual (DSM) is a book published by the American Psychiatric Association that defines what they consider a “mental illness:” significant disturbance in thoughts, emotions, or behavior that stems from a dysfunction in psychological, biological, or developmental processes that contribute to mental functioning.
Insurance companies use these definitions to decide what human feelings or conditions warrant “medical treatment”. If you have symptoms that reflect a disorder as defined by the DSM, and that disorder is causing you to struggle to function, then they will (sometimes) pay for the treatment.
In my experience, mental health is a lot more nuanced than these definitions. The medical model checklist style of diagnosis makes it seem very black-and-white: you “have” this illness or you don’t. I think this is misleading, lends itself to stigmatizing mental illness, and discourages people getting help when they need it.
For example, let’s say you are really sad and think you may be depressed. You go to a therapist, and you meet all the criteria for depression except two: you’re not irritable and you are sleeping okay. So strictly speaking, you’re not depressed (as in Major Depressive Disorder (F34.8)). But you are “depressed” as in feeling really sad, struggling with managing your feelings, and could use some help.
So does that make your problem invalid? Does it make you not “mentally ill?” Should you just “get over it” because you’re “not sick enough?”
I’m over simplifying, of course, but I’m trying to make a point. If we think of mental illness the same way we think about physical illness, we are going to miss people who need help. We are going to invalidate people’s pain because we are trying to objectively evaluate and label a subjective, personal experience.
People want certainty about what’s going on with them, and a lot of the time feel relief when they get that certainty. They equate certainty to a clinical diagnosis. I don’t begrudge them that relief–it can really reduce anxiety to know, “I’m not broken or lazy, I have X”. But I think we should validate “I’m really struggling with this sadness” at the same or similar levels as we validate, “Oh, you’re clinically depressed.”
This is why I tend to respond with support when someone comes to me self-diagnosed with a mental illness. Whether or not they hit the specific criteria, they have found a way to label their subjective experience in life in a way that gives me insight into how they are viewing themselves and experiencing the world. Sometimes it’s how they’ve made sense of how they move through the world, and it’s given them some relief to think of themselves that way. To the degree that it’s helpful and not causing harm, I think that’s great.
Sometimes I have to explain that they don’t actually hit the diagnostic criteria, or that we need another person’s evaluation or input before we can “officially diagnose” them with something, and that can be a difficult conversation. However, I always try to do that while affirming that what they have discovered about themselves is valid, that what they are experiencing is difficult, and that the help they are looking for should be provided, even if it doesn’t meet exactly what the DSM says it “should” in order to be diagnosed.
I’m not saying that there’s no danger in self-diagnosing, or that we don’t need psychological testing or psychiatric evaluations to clarify symptoms or guide treatment. I just think that we need to also account for human experiences outside of the statistical norms, and that there should be room for people who are “a little depressed” or “a little ADHD” to be taken seriously.
Sometimes it’s hard to be a human with a brain, and sometimes those difficulties don’t match up perfectly with what’s in the text books. It’s okay to still need help, and it’s okay to still get help.
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