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What's in a name
Posted Thursday 22 July 2010
We all belong to groups, both by choice and by chance. Some of them shape and define us more than others, but it isn’t always us who get the chance to decide which groups others choose to judge us by. Male or female, young and old, optimist or pessimist, we all try to fit ourselves and others somewhere and interpret behaviours accordingly.
What about the group you’re put into when diagnosed with a mental health condition? Read Seaneen’s post about when she was told by a psychiatrist that she didn’t have bipolar disorder but should instead have a diagnosis of borderline personality disorder. Her diagnosis had affected so many aspects of her life and had become part of the way in which she as well as others interpreted herself and her emotions and behaviours.
As Seaneen puts it:
I allowed my diagnosis to become the prism through which I explained and understood some of the stranger and more destructive/florid aspects of my personality.
Dino Girl came to an agreement with her health professionals that she shouldn’t have a diagnosis of bipolar disorder but rather a mood disorder, but it still shook her to deal with a change of diagnosis (reducing her medication literally shook her more).
Seaneen wrote about how she felt when asked in an interview to give her experience of mania:
the [diagnostic] name does not matter, not really, it’s experiences that do. But in these kind of settings [interviews], the name does matter because the name is what people will use to find information.
We have an urge to group, to classify, to simplify. If we didn’t, we’d be overwhelmed but sometimes a name can be all that we see.
Anne Marie Brian wrote in Mental Health Today that she was given a diagnosis of schizophrenia when, as she now knows, she has bipolar disorder. As a result of the first diagnosis, she was placed on antipsychotic medication that left her struggling to function and increased her depressive symptoms. She had to fight to get someone to step back and look at her and her symptoms again rather than just see things that conformed to what they expected to see, based on the group they’d put her in, the name they’d given to her condition.
It isn’t as if there is flawless categorisation by health professionals. Looking at people admitted as emergencies to hospital a study found that 27 per cent had a psychiatric diagnosis but ward staff identified 31 per cent of admitted patients as having psychiatric symptoms, identifying some patients with only mild symptoms and not identifying others with more severe symptoms.
There was only moderate agreement between psychiatrist and nursing staff about overall classification (58.8 per cent) and even less agreement about which patients were ‘cases’ (14 per cent).
Two psychiatrists working in London wrote that they have experienced an increase in people coming to them with a self diagnosis of bipolar disorder. They say that some people ‘want to be bipolar’ and might not grasp that this diagnosis comes with negative consequences and that not everyone who experiences individual symptoms of the disorder such as mood swings or chaotic behaviours may have bipolar disorder. Surely it is a good thing if, as the psychiatrists suggest, increased awareness of mental health issues means that people are recognising signs of distress and seeking support? We are encouraged to look after our physical health and report changes (appearance of moles or lumps and bumps) so why not mental health?
The implication from the psychiatrists is that no one should want to be in the ‘people with a diagnosis of bipolar disorder’ group. However that does rather miss the point that having a diagnosis and being put in a group can be a positive thing. Realising that there are explanations for your disrupted thoughts and behaviours, that you are not alone, that there might be help and support available can bring a measure of relief for many. Of course it helps to be given the right label and be placed in the right group so that you get the right support.
Is it just the alternative to being given a label (being left without explanations or support) that makes being given a diagnosis a good thing? There is also the sense of belonging that can come with being in a group. Dino Girl wrote about the sense of community that can develop with other people with the same psychiatric diagnosis, when pondering the fact that she no longer had a diagnosis of bipolar disorder:
It's a bit lonely out here, in the non-bipolar world.
Do you think that having a diagnostic label is a help or hindrance? Have you found that the quest to get the “correct” diagnosis took over from the quest to lead a healthy life? Mind is re-launching Openmind and would like to hear about your experiences. Comment below or contact us at Openmind@mind.org.uk
Bridget O'Connell, Head of Information
13 Comments
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I am really grateful for having a diagnosis of depression&anxiety. It allows me to explain to other people how things affect me, and short-cuts the miss-understanding others might have of my behavior... eg. I am very lethargic, so it takes me a long time to do housework on my bad days. Usually I would be accused of being lazy, messy or disorganised, but when I explain I am working on that pile of washing, it is just taking me a while today because of my illness, I find I get a more positive response, and I don't feel guilty.. Subsequently I feel more able to do things because I am not racing about feeling guilty that the place is not perfect, I can take my time doing each job to the right standard and the house stays tidier because I can keep it tidy better.
This works for University work, helping my child with his homework and visiting friends in much the same way. People have a better understanding that I might not be perfect, but the fact I am up, about and doing things slowly is appreciated, rather than belittled.
I do agree a wrong diagnosis, or some diagnoses can be harmful, but at the same time a correct diagnosis can help the patent, and their friends, family and colleges do a bit of research and understand some of the problems the patient faces.
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I think it's important for people to get the right diagnosis so they can find the right help. However it's difficult for doctors to measure and a lot of symptoms just overlap. For example I thought I had depression and anxiety for years but now think I have Borderline Personality Disorder after reading a book and doing research, it seems there are similarities to Bipolar as well. I'm not looking for a label that's the last thing I want! Its the help that I need and people want that and recognize people in the system can only make sense of things once they label you with a disorder, as depression and anxiety are not taken seriously.
So i believe you yourself can truly know and keep note of how you feel each symptom and to what extent so you can come to a balanced conclusion and don't let it worry you what you get labeled with, I'll just work on feeling better and dealing with each symptom
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I was wrongly diagnosed with bipolar disorder last summer. The psychiatrist examined me for a total of 2 minutes before telling me that he would have to put my medication up by 5 times the dose I was on. I fought this labelling rigorously with the help of my GP who insisted that I had had a psychotic episode as part of a nervous breakdown.
A year later I am on minimal medication and working full time again. I don't think the level of concentration required in my job would have been possible at the dose he suggested. Also there is talk of me coming off medication completely in the next year. If I had allowed this man's view to go unchallenged I would have been medicated heavily for life. -
I have suffered from certain psychotic symptoms periodically for the last 6 years. I have never really been given a definite, well-considered diagnosis despite being admitted to hospital in the past. I don't wish things upon myself but my instinct is to classify, to understand, and to recognise similarities in others - some sense of community and empathy. That's why, despite the stigma and the inaccuracy of these labels, I would choose to have something to call my experiences, something to help others understand.
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Can you get sad syndrome in summer
I seem to be the only person who gets down when the sun is hot,and brighter when it isnt. is this sad syndrome in some form.
I do take medication for depression.
or am I just strange. -
I was diagnosed with Borderline Personality Disorder and Depression last year by my psychiatrist. This was after years and years of suffering alone and a long fight to get proper treatment from inept doctors. To be honest, I was relieved. I actually said to her when she told me "I've always known I wasn't right and now you know I'm not right, so I'm pleased!" And I went on the Mind website and read the information about BPD and God, I'm like a little textbook tickbox exercise. It also explains a lot of what has happened to me in my life, my psychiatrist thinks I've been ill since I was a little girl and I also have a family history of mental illness.
I'm glad that I know what I have as it's also made my workplace take my needs seriously - I'm currently in the process of having a workplace assessment because I have targets and tasks that I find nigh on impossible because I'm ill. I feel I'm finally accepting that I am mentally ill but I am learning to live with it and to cope better.
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I knew i had depression but to be labelled with BPD has been very frustrating for me. I do feel i'm treated differently because of it, and that is a barrier to getting much needed help for my depression
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http://www.prozacville.co.uk/2010/07/dear-friend-whats-time-is-this-really.html
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Beki you are so right, being labelled BPD is frustrating. I find also that my depression is no longer taken seriously because everything is now down to my personality and its untreatable. This label is all too convenient so the mental health services can discharge people and interesting that it is mainly women who are lumbered with this label.
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I agree with Linda and Becki thet being labelled with BPD is frustrating. Although I have symptoms that come under BPD, I have others that don't . I think I also have a biological illness that runs in the family.But I am having problems getting the right medication because symtoms that don't fit the BPD theory are just dismissed.I moved recently and asked to be referred to another psychiatrist.I explained all this to him but he just said that was the way i had come to rationalise my illness.This was all within ten minutes of meeting me. I wish they wouldn't label people, but instead just treat the symptoms that each individual feels they need help with.
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Hi,
I have a diagnosis of rapid cycling bipolar disorder, and it was such a relief for me - I fought for years to get a referal to a psychiatrist, because although I visited my GP, I only went when I was depressed, not when I was manic.
Bipolar seems to be the 'in' mental health condition at the moment, it is in the media, but living with it is a little harder - I think the more people discuss mental illness in the press etc and tackle stigma the better. Stephen Fry doesn't particularly appeal to me, but my Dad loves him, so for him to admit to a mental illness is inspiring. I also like to think people see me as 'Laura' first and 'Bipolar' much much later.
Thanks, L x -
One of my concerns at the moment is the large amount of my childrens teenage friends that are having their mental health issues labelled. A lot of teenagers go through mental health problems when they are transforming into adults, but i see it as, mostly, a phase in their development just like the terrible twos. It concerns me that these teenagers introduce themselves to you & identify themselves by whatever label their issues have been given & that they dont seem to have been told that this may just be part of their growing up. Also many of them see it as something beyond their control that they cannot try & manage themselves. I am not suggesting that this is true in all cases, but that these labels can be a very negative thing for a teenager who is trying to understand themselves & where they fit into the world and to their self image.growing up & life changes are hard for us all, sometimes we do need extra help but that doesnt necessarily mean that thats how it will be forever.
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I was tentatively given a diagnosis of BPD at the age of 42 last year. This was after a lifetime of cycles of breakdowns and recoveries which resulted in a turbulent life and relationships. Although a shock at the time, the positive attitude of my GP and therapist helped me to see in the symptoms a way of understanding the more extreme reactions and behaviours which had led to problems in maintaining employment over a long period of time.
Thankfully, both my GP and therapist were open minded enough to share with me their own learning curve about what this condition would mean for me. I have been treated for depression with medication as well as being offered extensive and focused CBT sessions which were designed with my therapist to help me cope with my BPD until a more suitable treatment was available.
Although I have been on sick leave for the past seven months I am due to return to work full time in three weeks. I have developed a deeper understanding of the triggers to my more self destructive behaviour and have been equipped with some skills to help me to manage them.
At the same time I have been given the rare opportunity of becoming part of a day therapeutic community for BPD sufferers in my local area. I know I am lucky in the staff who have worked with me as they have a positive view of the long term prognosis for BPD in that they believe that I am treatable.
Any positive steps forward began with a recognition of the groups of symptoms which identified for me and those helping me the condition I am suffering from and learning to manage. It has not been a negative experience. However, among others, including my own family, there is a clear fear of a condition that is not widely understood or even recognised.
For me it has been a relief to name and face the demons that I have battled all my life.
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