Diagnosing
Let’s talk a bit about diagnosing. I continually work with clients who have the fear/worry of walking into my office with a concern and walking out with a slew of diagnoses. This fear keeps a lot of people from seeking counseling. They don’t want to be labeled. So in this blog we’ll discuss the stigma of a mental health diagnosis, the process of diagnosing, when it’s necessary to diagnose, and ways to advocate for yourself.
“Can I still live a fulfilling life?”
The Label: The Stigma
The reason people don’t want the label is for a few reasons.
- It’s scary to be diagnosed with something (physical or mental)
- The stigma of mental health is alive and well in our society today
- And here is a fear of what the aftermath will be after receiving a diagnosis (“How will I have to change?” “Do I have to tell people?” “Can I still live a fulfilling life?”)
I would say with confidence that the stigma of acquiring a mental health diagnosis feels like it has major societal implications and assumptions, that deteriorate one’s confidence and reputation. It feels like a dirty secret that we don’t want to get out. This only makes one feel more isolated and insecure. Therefore, the stigma of mental health prevents people from getting help, only exacerbating their symptoms and suffering. The historic mental health stigma (hysteria, Oedipus complex, OCD, narcissistic, psychopath…) has persevered through centuries of human evolution and will take a lot of effort to unlearn. But it is possible. In this blog, we’ll talk about ways we can break down stigma and advocate for ourselves. The one “soap-box moment” I will have is this: WE MUST STOP MAKING EVERY NATIONAL CATASTROPHE INTO A MENTAL HEALTH PROBLEM AND THEN DENY FUNDING—OR SUPPORTING—MENTAL HEALTH SERVICES.
The Process:
If you go to therapy, and decide to use your insurance, you must understand that the therapist working with you MUST diagnose you in order to be paid by your insurance company. We classify a diagnosis based on an ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) code. ICD is the diagnosis, and the CPT code is meant to tell the insurance company what we did about it. It’s has a very medical undertone, and therefore it can be very frustrating for the client and therapist. Mental health is not as “cause” and “effect” as the rest of the medical field. But this is the reality of working with insurance companies. Additionally, these diagnoses DO NOT GO AWAY unless you protest them (feel free to ask questions about this in the comments section, as we don’t discuss it in depth in this blog).
Why should I care? Well if you’re starting a new job, and you consent to a background check, they will see these diagnoses. If you go to a doctor and need a prescription for something, they will see these diagnoses. If you have a baby, your midwife/nurses will see these diagnoses. Additionally, we can start to wrap our identity in the diagnosis (es) we have acquired. So, although it’s a means to get insurance to pay for your services, we also want a diagnosis to be helpful and ACCURATE.
Please be aware of these things before you choose a therapist. Sometimes it is cheaper and less risky to just pay out of pocket, because the diagnosing part is not needed unless it is requested or supportive to healing.
“These diagnoses DO NOT GO AWAY unless you protest them. ”
The manual used for mental health diagnoses is called the DSM-V. It was just updated a few years ago, and is still controversial. But clinicians and medical professionals still argue about the jargon to use when detecting and naming mental illness. And some clinicians, psychiatrists, hospitals, and insurances are still using the DSM- IV-TR (previous update) as a diagnostic reference….ask what manual your clinician is using.
When it is necessary to diagnose:
It’s also important to note that diagnosing is not bad. It can be very helpful. Let’s name a few positive outcomes to establishing a diagnosis:
- It names the pain- when individuals are living with mental illness they feel like an alien or that they are “just a certain way.” Giving their experience a diagnosis, can offer relief in that it gives a name to the suffering. It offers validation to the way they feel and the way they have interacted with others. It offers relief in understanding: It’s not you. It’s your disease.
- It can offer helpful information to one’s support system- when someone is living with mental illness they NEED SUPPORT. Family and friends are everything for a healthy recovery. And living with someone who has a mental illness can be rather difficult. But if family/friends can understand that the destructive/toxic behaviors they see are the manifestation of an illness, it builds compassion. Your friends/families will take things less personally and offer better support.
- It helps in destigmatizing mental illness- if we can start viewing mental illness as equal to physical illness, we can increase support and diminish the “suffering in silence” that so many people with mental health issues face. A diagnosis is an explanation for a series of symptoms. And we know that someone with a chronic medical condition has certain limitations in their day to day life. The same can be said for a mental health conditions. There are good days and bad days. Similarly, we can call in sick when we have a medical condition, but we feel guilty when calling in for a mental health day. The more we get comfortable with mental health diagnoses, the better the opportunity to educate employers, teachers, and parents in validating mental illness.
Advocating for ourselves:
BE IN THE KNOW! Again, if you are going through your insurance company, please understand that you will be receiving a mental health diagnosis for the sessions you see a therapist. So, make sure you are part of the conversation about your diagnosis. As mentioned above, our identity can start to shift when we receive a diagnosis of any kind. This is even more the case with adolescent clients. So ensuring that the diagnosis matches your (or your child’s) experience is paramount.
To offer a bit of supportive info…it usually takes about 2-3 sessions to really be able to diagnose someone. So how are they diagnosing you before your third session? Ask!
As a clinician, if I’m billing through insurance (and my client isn’t already approaching me with an established diagnosis) I’m usually giving my clients an “adjustment disorder” diagnosis or offering a preliminary diagnosis with NOS attached. NOS stands for “Not otherwise specified.” These diagnoses are vague and helpful when we are working on—and honing in on—an appropriate, valid, and supportive diagnosis. They can be amended as further work is done. Or, if you’re not comfortable with diagnoses, “adjustment disorder” may be all you need to get the support you deserve without the added stress of a complicated mental health diagnosis.
The most important piece is to make sure that this is a CONVERSATION. Mental health practitioners are very comfortable with throwing around mental health diagnoses—which is great but can also be damaging. We, as clinicians, have ease in working with diagnoses, but we equally can get indifferent about how we identify these lived experiences .
Talk from your intuition. We play around with words in therapy: “I feel bipolar when I talk to him;” “That makes me depressed;” “I’m so OCD about that;” “That makes me anxious;” “I think I have PTSD surrounding that.” These are accessible phrases but are not necessarily accurate of our experience. Dive deeper. What does “OCD” mean to you? What is your experience of depression? How does anxiety feel in your body? These are less stigmatizing—yet still validating—ways to view our life experiences!
What questions/comments do you have???