BIG READ: Is your mental illness diagnosis helping or hurting you?
Don't read this if you want a simple answer.
Now, hate for the DSM's frequently weird takes on mental illness is a genre in itself; I have also contributed to the circus. Still, you cannot ignore the manual's cultural clout, which hinges on the most influential idea in psychiatry, and indeed all of medicine: the idea of diagnosis.
Personally, I've had a complicated relationship with diagnosis. While I've usually not believed in collecting labels, I've just been advised by my new psychiatrist that I might have been living with multiple conditions that never got diagnosed and hence treated properly. It made me feel a twinge of grief for my lost years. I have to wait for my hypomanic state to settle before I can be 'reliably assessed'. Which makes this a great time to revisit one of Sanity's most popular pieces ever: a deconstruction of psychiatric diagnosis.
Does a diagnosis of mental illness, based as it is on the patient's self-reported symptoms and no 'objective' biomarker, help or hurt? Who does it help and who does it hurt? Read and decide.
PS: Have you noticed the new Sanity logo? It reflects my plan for some time now to amplify Sanity and shrink my name as part of the logo. Waddya think? Also, the current design of Sanity, much loved as it is, has been around for 4 years. Is it time for a refresh? Lemme know.
I usually dread the question with which Anamika, my therapist of many years, starts every session.
"So, what's on your mind?"
On most days, I have no clue what's on my mind. The mind isn't a table. You can't just scan it and say: There's my child's toy aeroplane, and yesterday's leftover sandwich, and aha, there's that broken fridge magnet I've been meaning to fix. The mind is occupied by absurd, shadowy things. It's a pain having to catalogue them in intelligible words at 10 AM on a Tuesday.
But this Tuesday, I was ready. I wanted a specific outcome from the next 60 minutes. So when Anamika asked me, I told her exactly what was on my mind.
“Do you think I have borderline personality disorder?”
You see, I've had this nagging suspicion for a while that the shittiness I feel these days is different from the familiar racket of depression and anxiety with which I have lived my entire (adult) life. Let me try to describe it: a ghastly mix of fear of abandonment; short periods of feeling okay, even good, about myself, followed by abject self-loathing and self-directed anger; extreme highs and lows in how I see other people; spells of intense panic when I stop breathing; unbearable sensitivity to the tiniest of real or imagined slight from people near me, like a toothache that grips my whole being; and a strong urge to dabble in what Anamika calls 'self-annihilation'.
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I'd perhaps have ignored all this as a mutation of my mood issues, except one night a month ago I experienced something utterly confounding. I found myself jumping from one end of the bed to the other, thrashing my arms and legs and shaking my head, as if to get rid of cockroaches from my body. I felt like sand slipping away from my own hands. My brain was coated with a viscous, gaseous substance, muffling the flow of signals in and out. All the words had been suctioned off from my system, so I could only groan and grunt.
Emptiness isn't the absence of things, I remember thinking later. It is the presence of nothing.
The whole episode lasted maybe 10 minutes, but it felt like forever. A couple of days later, it happened again, this time in the middle of the afternoon.
I told Anamika I was spooked. "Sounds like you felt undocked for a bit," she said calmly. Some fresh crisis came up in the next session, so I didn't probe this further. But the suspicion grew.
In between launching a new website, completing freelance work, meeting my voluntary commitments, and trying to be a partner and parent, I felt a rising desperation to understand what was happening to me. So I started digging around. And the words 'borderline personality disorder' kept leaping out at me. I know I know, self-diagnosis is terrible. Internet-based diagnosis is an abomination. Which is why I decided to check in with the expert.
"So, do you think I have it?" I asked Anamika, all businesslike. I was trying to pretend that her answer, one way or the other, wouldn't affect me. I was asking as a matter of intellectual curiosity. No big deal.
I immediately knew my charade had failed, because Anamika smiled.
