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
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