🗝️ Sanity Classics: Diagnosis - angel or demon?

🗝️ Sanity Classics: Diagnosis - angel or demon?

Mental health diagnoses are often attacked for being unscientific, oppressive, and prone to abuse. But for many, they remain the only route to dignity and sanity.

Tanmoy Goswami
Here's one of the most complicated and polarising questions in mental health care: Does getting a mental health diagnosis help or harm?

Teenagers are increasingly turning to TikTok and Instagram to wrongly diagnose themselves with ADHD, autism spectrum disorder, or dissociative identity disorder – a trend that has alarmed parents and therapists because of the harm it can cause, according to a new report by CNN. But for some people, getting a diagnosis can be a life-saver. It can help them connect with a community, feel less alone, and find the support they need.

Has getting a diagnosis helped you, or has it made things more difficult? Read today's Sanity classic on the double-edged sword of diagnosis, including my own story. Then write to me with your take on this debate. I'll share your thoughts in a coming edition.

PS: Well-researched and deeply reported pieces like this cost me a lot of time and effort. If you value my work, support me now by choosing one of the options below.

Content warning and disclaimer

Contains potentially distressing material, including reference to suicidality. Sanity is not a therapy platform. Please do not self-diagnose if you experience a mental health concern. Consult a professional.

I usually dread the question with which Anamika, my therapist of three 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.

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