Pick & Mix Diagnosis

Since my the start of my mental health career I’ve been given a stunning array of different diagnoses. These include (but are not limited to) depression and anxiety, depressive personality disorder, psychotic Illness, schizophrenia, schizophrenia and borderline personality disorder, schizoaffective disorder and have had psychotic depression mentioned recently. This might not be so bad if I had spent 30 years or so in the system, but my first contact was in 1997 (ish) and I entered psychiatry-proper in the winter of 1998. That makes about a diagnosis or two a year, which means that if I remain under their care I might get through the DSM-IV before I’m done.

Taking my experiences on their own merit it’s easy to dismiss it as an anomaly, to say that I am a particularly ‘difficult’ case or that it was just plain bad luck. If it wasn’t that I know of so many other people that echo my diagnostic history I would probably assume that I had somehow mislead the doctors and that it was me that was at fault. As it is the majority of people in a service user/survivor group I go to have been though it too – as have many of my friends in other parts of the country.

Labels range from bipolar disorder, chaotic personality disorder, schizophrenia, schizoid personality disorder, borderline personality disorder, emotionally unstable personality disorder, schizoaffective disorder, depressive psychosis, mania, hypomania, cyclothymia, dual diagnosis, post traumatic stress disorder, depression, severe anxiety and dysthymia. They seem to be almost interchangeable depending on the attending physician, and which part of a person’s mental health and personal history they focus on.

For some people a change in diagnosis leads to a change in medical treatment – including medication and the availability of therapy. Anti-depressants can be swapped for anti-psychotics, mood stabilisers can be added or taken away and medication can be withheld all together. For people like me (the lucky ones, or maybe the ones with vocal family support) medical treatment is more or less constant throughout. For most people, through, it comes complete with an attitude shift in the caring profession (positive or negative).

I have been transformed from ‘poor sick girl’ with psychosis to ‘manipulative attention seeker’ with BPD in one wave of the doctor’s magic wand. The behaviour of the nurses towards me whilst admitted have often depended on whether they leaned towards the ‘mad’ or ‘bad’ interpretation of my symptoms. The weird thing is in my own opinion (and of those that knew me well) I didn’t change a bit – I was still me, and I was still in distress. The only change was the amount that me, and my family, felt we were being blamed for all of this.

In an age when we rely so heavily on the idea that the medical profession know what they’re doing, and reassure ourselves that we live in enlightened times, this causes me more than a little concern. As long as a person’s mental health is seen in simplistic ‘fit in a box’ terms this pick and mix diagnostic problem will continue. It’s important to realise that we are all complicated individuals and that the source of our distress cannot be so easily pinpointed (whether it’s in a 5 minute appointment, 30 minutes or a matter of years).

Each doctor, nurse or support worker only sees a specific part of us this part will depend on circumstances. They each see us through eyes that are biased by previous experience and areas of interest, and fit the symptoms they see into a ready-made schema which may not resemble us at all. In the field of mental health where there are no x-rays, blood tests, and easily discernable signs and symptoms, it seems silly to pretend there are.

Diagnoses can be useful, they can be a shorthand to explain what a person’s difficulties are and can help a person identify with others in a similar position. The problem comes, however, when the emphasis and faith placed in the label outstrips that given to the person themselves. Oh, and they lose an awful lot in translation.

Rachel Waddingham © 2003