Be Careful with that Mental Health Diagnosis
Don’t Lose Your Agency or Pathologize Your Humanity
It’s Understandable that We Want Answers and Solutions
When we are in psychic distress it is understandable that we want answers and alleviation of our symptoms. Seeking a medical/psychological diagnostic label is often a first step taken in the hope of reaching a cessation of our distress within our Western Medical Model of healthcare. However, some limitations and problems may become apparent when we ask truthfully and thoroughly if getting a diagnostic label always leads to complete answers and the best solutions when dealing with mental health issues.
Being Human Isn’t a Symptom
Often, there can be a temporary sense of relief in having a label for what is happening to you, but as you can see if you look deeper, a mere label may not really be accomplishing as much as you think. First, there is always the danger of taking experiences that are often transient and well within the normal range of human experience (even within the normal span of the neurodiversity we now recognize), and then unnecessarily pathologizing them. Trapped somewhat within our own subjective minds, and living in a rather judgmental world that values conformity, we all can often feel as if we are the “impostor”, and that something is inherently, unusually ‘wrong’ with us — when so often this is not the case.
Having a Rich Inner Emotional World Isn’t a Symptom
Additionally, we live in an age where we have been culturally conditioned to fear the feeling of our emotions, and would much rather intellectualize about them than experience them, such that so many phenomenological experiences of being alive and human (like having an inner emotional world) are now perceived as ‘problems’, and so should therefore be ‘solved’ as the ‘pathologies’ they are perceived to be.
Your Experiences Aren’t Just a Biological Symptom
Further, the given diagnostic label may tend you towards believing that there is a solely biological cause for your predicament (if it even is a predicament), and this usually is not the whole truth (or the truth at all), and you are therefore led to an incomplete or erroneous solution. This all is the result of a cultural bias toward biology alone as the cause of all our psychological situations, with little regard for the power of our personal consciousness and its latent power over our thoughts, our emotional world, and our behaviors. The bias toward only biological causes also affords little understanding of the influence of our cultural environment on our consciousness with its inherent and considerable power.
I urge you to take a moment to consider the following before you accept a diagnosis without understanding what it means in the scientific/psychological/social/cultural context of how it was created. Diagnoses can be useful, but they also can rob us of agency if we don’t hold them lightly and understand that they are merely a utilitarian short-hand (a useful fiction of sorts) that guide us in understanding ourselves.
What is a Diagnosis Really? And What is it Not?
A mental health diagnosis is: a short-hand label of convenience and utility for a constellation of psychic symptoms and experiences you may be having that we have seen similarly grouped together in others in the past. A diagnosis suggests that we believe that the symptoms or mental artifacts you are experiencing arise together with a common cause or causes, and as such will respond to treatments aimed at the believed common cause(s). Notice the word ‘believe’. The mental health field is young, relatively speaking, and knowing what causes all of our mental health challenges or irregularities is an ongoing, evolving endeavor.
What a diagnosis is not: It is not an indication that we know with certainty that what you are experiencing has an absolutely known etiology (cause) rooted solely in biology and neurology. This is an important point, as we live in a world where we are often conditioned to approach our mental health issues with the same frame of mind as we do our biological diseases. We live within the philosophical “Medical Model” in the West, where we often believe biology is everything, and where we often approach our consciousness as if it is merely inhabiting the body and brain as a ‘ghost in the machine’, and consequently should be ignored medically and experientially. This bias causes us to approach mental health issues too often assuming biological causes only, while neglecting our inner influence within consciousness over our thinking, our moods and our mental health overall. As such, we often imagine that the depression we are experiencing has been ‘contracted’ in the same manner we might a medical disorder such as the flu, diabetes or cancer. These adopted, unexamined belief systems rob us of our agency over our own mental health states.
Am I Just a Ghost in the Machine?
In the mental health field, we live in the shadow of a medical world created with a view of the human body as a mere biological mechanism. Freud himself was an unsuccessful neurosurgeon (unsteady hands) who himself saw the human psyche in material, physical, ‘hydraulic’ terms (Hydraulics was the fashionable, popular, new mechanical science of his time). From a materialist point of view, consciousness itself is not seen as a source of agency and power, but as simply ‘epiphenomenal’ (meaning a sort of accidental, unintentional, hallucination of the physical brain). Take this to its logical conclusion, as many have, and you end up with stated absurdities like: “You only believe that you are conscious, but it’s all an illusion caused by the brain. It isn’t real.” What can that even mean? It suggests that “I”, an illusion, is having an illusion…. Really?
I don’t intend to waste space arguing the absurdity of such a proposition, as the fact that you subjectively know that you are aware and conscious is in truth the only first-hand, first order, direct truth in the world that you will ever know. But with good reason I raise all of this to point out that our conditioned popular understanding of ourselves is one where we are taught to largely ignore the power of our consciousness, and think of ourselves as living powerlessly inside of a machine that runs and controls us and our emotions, feelings, thoughts, and subsequent actions. This is a taught position of little agency and power. We end up believing and acting ‘as if’ our emotions and thoughts happen ‘at us’, and not from the truth that we generate all of these ourselves.
The result of this unconsciously held world view is that when we have a chronic emotional and psychic distress taking place, we assume that ‘the machine’ is failing, and our first attempt at a solution is often to tinker with the machinery through psychotropics. We assume an innate ‘chemical imbalance’ is taking place in the nervous system that must be altered and rectified through an external medical intervention. We may consider therapy as an adjunct treatment, but often view that as secondary to the belief that our emotional experiences originated mostly with a biological/chemical problem. This suggests a loss of agency, as we believe some biological process is ‘happening at us’ to cause our state of consciousness and distress, and only marginally consider that we are playing any active part in our changed emotional/psychic state through our thoughts, and/or our acceptance or rejection of our natural emotions. In truth, we have an innate power to keep altering the state of our consciousness from within, and more direct internal power over whether we have more serenity and peace, or more agitation and suffering (more on ‘how’ below).
So Much Can Be Solved by Not Rejecting the Experiences of Being Alive as a Human
From a Somatic Psychology perspective, the rejection or reluctance to feel our emotions physically and experientially, as they arise in the body, is a primary reason for the difficult appearance of large versions of emotions like high anxiety, deep sadness or depression, etc. This topic of somatic awareness deserves its own deep dive exploration for anyone experiencing psychic distress (it is on the cutting edge of Psychology today), but suffice it to say for now that so many of our solutions to our perceived distress lie along the line of shifting from a rejection to an acceptance of our inner states, rather than a knee-jerk pathologizing of what we experience. (At the bottom of this piece I’ll suggest some exercises that engender somatic acceptance of emotions, and so can bring more emotional stability and peace).Let it be noted that ‘acceptance’ of emotions does not mean inaction or resignation in regard to them; it means learning to actually experientially feel them as they appear in the body (rather than just think about them), which results in them eventually resolving and moving through us.
Etiology of So Much Psychic Distress is Yet to be Proven to be Solely Biological
It is a bias from the “Medical Model” that bleeds into Psychology and Psychiatry that causes us to look for biological or “chemical imbalance” causes for psychic phenomenon and mental health disorders first, and then often neglect to look for — or sometimes completely ignore — other causes that relate to consciousness (i.e. thoughts, emotions). This is a bias that has no scientific justification, and is merely the trend of our culture’s bias at this time for a materialist, mechanical view of the human condition and everything in life.
What is neglected is that within the realm of consciousness we have agency to work with our thoughts around our world view and view of self, both of which have impacts on our emotional states. We also have agency over whether we feel our emotions and allow them to resolve themselves, or end up repressing them and storing them in our bodies (as we were taught), thus resulting in long-term psychic distress and unease.
Like most things in the human condition, we will probably always find a biological substrate running in parallel to any phenomenological psychic experience. But this does not prove any primacy of biological processes over consciousness processes, or any causality of the biological strictly causing the psychic (more on this below).
Loss of Agency
When one believes that all the psychic and emotional movements you are going through are biologically determined, you are left in a position of believing that nothing about your thinking or actions (short of medication compliance) in the moment have any effect on these situations. You end up believing that altering your chemistry through pharmaceuticals is your only recourse for change. You are left trying to operate from a belief system that says you are just a ghost inside a biological mechanism that is out of your control, short of what you do to the mechanism medically — either chemically or surgically.
Now of course, this belief system of you as a biological machine only is what your conditioned intellectual mind is trying to convince you of, and to the extent that you believe it you do lose a great deal of your agency. But consider, if you completely believed this story, heart and soul, then you would no longer talk about your issues with anyone — either informally or in therapy — expecting that to provide any alleviation of symptoms. For after all, that would be you tapping into consciousness — something outside of the biological machine. But the truth is, you do talk about your problems, fully expecting relief from doing so. So please notice, some part of you doesn’t believe that you are just a ghost in the machine. Consider the old saying: “A problem shared, is a problem halved”. We all know intimately that just sharing our trials and tribulations with a friend can make us feel calmer and more relaxed and “better”. This shouldn’t be true if my mental health issues are only biological imbalances or neurology. While we will go into this further below, the truth is that when we talk about our problems with others we ‘accidentally’ allow ourselves to feel some of the previously repressed and stored emotions that were attempting to arise in us, and that were just waiting to be felt and resolved. Again, this points to solutions that are outside of biological interventions. Please note that something in you already deeply, intuitively knows that you have power within consciousness, and that you are not just a biological mechanism.
Example of Loss of Agency through a Diagnosis Held Poorly: “I Have Depression. I Have a Chemical Imbalance”
Consider the following. Someone is told that they ‘have’ depression, and it is because of a chemical imbalance in their brain. I have often heard new clients talk about themselves and their depression experience this way. First off, to believe that you ‘have’ something like this, is to already suggest a belief that ‘it’ has come from the outside like an intruder, and suggests that what you are experiencing is not an event that perhaps you are playing any part in through your thoughts or your relationship with your emotions. This is already suggesting a loss of agency and lack of ability to address it, because it doesn’t seem that it is an emotional experience that is yours to work with directly, experientially. In reality, part of the alleviation of depression through somatic means would be to feel the sadness in your body that has accumulated to make up this large depression. The depression is often a symptom of learning to habitually not feel sadness as it accumulates in the body. But to reframe it as a ‘condition’ caused by biology alone suddenly removes one from this solution, and takes one into the realm of believing only in chemical tinkering. (To be clear, this isn’t an argument against medication as part of a larger treatment protocol for depression, just an argument for care in not framing mood/psychological issues in terms of biology and psychopharmacology alone).
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To frame depression mostly or solely as a chemical imbalance is not warranted scientifically and is a bias in the mental health community. It assumes a linear causality to moods and consciousness that is not proven at all. We do seem to see in fact, changes in neurotransmitters as moods change, but we cannot say that these precede the mood change or follow them. The best we can say is that they arise simultaneously. Knowing this does not preclude us from adjusting brain chemistry as best we can as an aide in helping people with severe mood disorders. Surely in severe mood disorders, few would argue that medications are not a godsend and life-saving. But if we can be clear that there is no simple directional causality, then we can stop propagating the damaging and agency robbing belief that mood issues are solely biological in nature.
With Psychic Phenomenon, Biological and Psychic Experiential Movements Co-Arise without Linear Causality
You like puppy dogs. You are currently a bit sad at this moment. A little puppy wanders into your room, all wagging tales and eager to be petted and play with you. You smile and feel a bit elated in mood. If we had you attached to an appropriate monitoring apparatus, we’d see your serotonin (and other neurotransmitter) levels rise. If we believe, as the Medical Model suggests, that our emotions are the result of processes that start first in the brain/nervous system as chemistry in a linear causality fashion, then we have a logic problem. If that model is true, then the endless questions arise:
Did your brain just tell your brain to first release serotonin so you would secondly feel elation — as if mood is controlled causally, solely by mechanical cognitions and chemistry? Do we really believe that some mechanism in the brain said: “You like puppies, and so should feel happy at seeing one, so we should release serotonin so you feel happy that a puppy just entered the room”? If so, what step proceeded this set of mechanical cognition steps by the brain calculating: “We should feel happy at seeing puppies and always release serotonin when we see one.” And what step proceeded that step to say it is time to have a calculation about what makes us happy and to scan for things and see if anything is present to think about thoughts that say we might release chemicals to make us happy”? Trying to understand consciousness with linear causality results in what is called an ‘infinite regression’ problem. No matter how far back we go, we can’t find the first originating cognition or calculation or biological process that is supposed to have started the whole hypothesized logical linear sequence that leads ultimately to the emotion.
A better understanding leads us to discarding the idea of linear causality (which works well enough in the natural sciences, and was borrowed from there) when we look at human consciousness. It makes more sense to see that emotions arise simultaneously with our biological, neurological activity, and one cannot say that one precedes or follows the other. And when we disentangle emotions and psychic movements from biology in this way, we are making it easier to understand that biology cannot be the whole story and origin of psychic phenomenon like thoughts, moods and emotions. Biology plays a part, no doubt, but it clearly isn’t the whole story, and so it cannot most powerfully and efficiently be the sole solution.
The point of this short detour to discuss how consciousness and its power arises simultaneously with biology is to give us our agency back and realize that with all mental health issues we have power to address them through our consciousness — thoughts, emotions, and awareness of both. We are not merely at the mercy of biological processes making us mentally ill or at unease.
Shame and Guilt Temporarily but Unskillfully Averted with a Diagnosis
We live in a culture that teaches us all to live in so much guilt and shame. This is especially noticeable when we believe that our inner worlds of thoughts, emotions, and experience is out of line with what can be a culturally conceived narrow band of what is acceptable and ‘normal’ for people. We guilt and shame ourselves for our perceived mental state ‘condition’, but then find temporary relief when we are told that it is ‘not our fault’, because it is our biology, or our brain wiring, or a ‘chemical imbalance’. Because we negatively judge our thoughts and emotions and inner experience of life, we can end up seeking a medical justification to put the (unnecessary) blame on our biology. The story is: You are not responsible for this; it is a medical condition that is happening at you. To be clear, the wisest position would be to drop the judgment and the idea of responsibility altogether, and replace those first with a compassionate acceptance of whatever experience is taking place. In other words, if we weren’t negatively judging our inner experience and feeling such shame and guilt, we wouldn’t so often gravitate towards a medical diagnosis for the purpose of alleviating shame and guilt (although there still are other utilities to a diagnosis).
Although it may not be the whole drive behind reaching for a formal diagnosis, many find a sort of relief in having conventional medicine inform them that they have a ‘disorder’ and ‘diagnosis’ with mental health issues; it can provide a narrative in the mind that provides temporary relief from the shaming they have been enacting upon themselves.
Pitfalls to Watch — Embracing a Victimhood Role
An early mentor of mine once said: “Victimhood is the most powerful role any of us can embrace. And we all will embrace this role at various times in our lives. Watch out for it.” I myself have embraced it accidentally at times. You will too. See it and step out of it when you can. Getting a diagnosis is an opportunity to accidentally step out of your own power and agency and view yourself as a victim with less power than you really have. Try to remember that you haven’t really changed since someone offered this diagnosis to you, but that you have just been offered an abstract, conceptual label to grossly describe what you might be experiencing. This label is only meant to serve you and your practitioners in guiding treatments. Nothing really has changed except perhaps your conceptual perception of yourself.
Don’t ‘Reify’ the Diagnosis
When we ‘reify’ an idea, we take an abstract concept and start to hold it as if it is a real solid object in its own right. Again, the diagnosis is a label designed as a short-hand to communicate that there is a loose constellation of symptoms or experiences that a person is having that seem to be similar to those observed in others in the past. There can be a utility to this if it leads to understanding that leads to treatment. But it does not mean that you ‘have’ something physically concrete that is definitely known, as if we are discussing a cold or flu virus. We should not hold psychological conditions or experiences as if they are strictly physical/physiological happenings in our bodies like cancer or diabetes.
Current Possible Over-diagnosing
Currently there are a particular number of mental health diagnoses appearing more commonly that raise a number of alarms due to there frequency of appearance. Questions legitimately arise as to whether certain diagnoses have unfortunately come into vogue and popularity with the general public (and some therapists) and are being overused. There are also reasons to become concerned with the rise of internet use and people self-diagnosing, as well as untrained non-professionals applying certain diagnostic labels indiscriminately and inappropriately. Among these diagnoses are Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, Adult Attention Deficit Disorder, Adult Attention Deficit Hyperactivity Disorder, Adult Autism, and Adult Autism with Attention Deficit Disorder. While these diagnoses have their appropriate places, at the moment these labels are particularly susceptible to being inappropriately adopted by people self-diagnosing, and I suggest, potentially harming themselves in the ways laid out in this paper. Additionally, in all fairness, the professional psychotherapy community should also take a moment to check itself as to the legitimacy of its current rate of such diagnosing (as it always should with all upwards trends in diagnoses).
Litmus Test — Does Your Diagnosis Provide any Treatment (Actionable) Solutions?
We have acknowledged that there is some utility to diagnoses with mental health issues. But clearly some discernment is needed in knowing how to best hold, understand, and use diagnostic labels for our best mental health outcomes.
You’ve just been given a diagnosis and label. Perhaps you feel some relief at having an ‘answer’. Perhaps you find it easier to step out of your own mind created shame and guilt now that you have a diagnosis. Now ask if the diagnosis does anything more. In some cases, it can lead to some more targeted treatment in therapy. In a few cases it may result in some psychopharmacological aids. Perhaps it helps with payment through insurance for treatment. All of these are useful outcomes of having a diagnostic label. The trouble comes if one does not see the limitations of a diagnosis, and one allows it to define one’s self in the limiting, agency-robbing ways described in this discussion.
My experience as a therapist for three decades now is that a diagnosis can facilitate communication between therapists and treatment team care-givers. Diagnoses can facilitate some financial possibilities where insurance companies, public and private, are involved. Diagnoses are also useful when courts or government entities are somehow involved in the client’s life. And as explored above, diagnoses offer some modicum of shame and guilt relief to some. However, when it comes to actual psychotherapy treatment, there are many times where achieving or changing a formal diagnosis may not change as much in the treatment protocol as one might believe. Let me elaborate…
In good targeted therapy, where the therapist and client have successfully identified the symptoms they wish to address, the approaches wouldn’t change because of an external label attached to the identified symptoms. As a good example, let us look at what are called ‘mood disorders’. And let us look at someone who has moods that swing from elation or mania, to a minor or major depressive state over time — often diagnosed as bipolar disorder. Using somatic psychology principles, we would investigate the understanding that this individual has difficulty being in their body with their emotions (i.e. happiness and sadness), and runs to their mind to intellectualize about imagined external causes of their emotions (e.g. my boss, my job, my partner, etc.) instead of remaining bodily with the appearance of the emotions in their torso, which would allow them to be felt and resolved. Over time this habit of avoidance can develop into a cycle of ups and downs in mood. The effective solution is to learn to be embodied and feel the physical appearance of these emotions as they arise, and in doing so, allow them to resolve. The cycle is thus interrupted.
From a formal diagnosing stance, this person could be given a diagnosis of bipolar I or bipolar II, depending on the severity of the cycles encountered. But notice that outside of pharmacological interventions, the psychotherapy recommendation remains the same whether a diagnosis is given or not. One can treat mood disorders without emphasizing labels and diagnoses because they unfortunately often tend to engender whole narratives about origins in biology or fundamental neurological brain structures, all of which can often hamper a client’s beliefs about their ability to alter themselves positively. As a matter of fact, over many decades I have treated many individuals who have been given a previous diagnosis of bipolar disorder, who successfully moved themselves to a place where this diagnosis is no longer appropriate. Again, all of this is not to deny the utility at times of diagnostic labels, or suggest they never be used, but to bring awareness to their limited utility and potential harm when not understood for what they really are. (To be clear, one can put the diagnostic label in the chart for practical insurance reasons, but then never mention or emphasize it again within therapy — the work to change how one is interacting with their emotions is what one emphasizes).
If My Psychological Issues Aren’t Only Biological, What Are They?
To be clear, we are biological and psychic/psychological beings. So, there will be a biological substrate to your psychological issues that can help or challenge your progress towards your best and most serene and peaceful life. And there can be biological supports to ease your journey. This piece is intended to just make it clear that beyond biology you have far more power to alter how skillfully and with what peace you move yourself through the world than you were taught to believe. So, what can you do with yourself beyond pharmaceutical intervention to progress yourself toward health?
Somatic Psychology and Self-Awareness
As noted above, our solutions for mental health should not be focused solely on the human body as a mechanism that we merely inhabit as a ghost, simply at the whims of this machine that ‘happens at us’. We can move beyond just tweaking the chemistry of the central nervous system. What is needed to bring health is an increase of awareness of ourselves as conscious, thinking, emotional, intuitive beings that naturally have a flow of intelligences taking place throughout our bodies, minute by minute; intelligences in our bodies that we can speak of as emotion and intuition. These are natural ongoing processes that are often repressed or ignored, and are an addition to our traditionally accepted intellectual intelligence that we allow in our heads/minds.
Embodying Practices Over Labeling
Somatic Psychology is less about learning something new, and more about unlearning the conditioning that causes us to fear the natural ongoing unfolding of emotions in our bodies. Somatic practices typically involve learning some embodying practices, such that one learns to move more of their conscious awareness out of their thinking mind/head where they have been taught to concentrate it, and down into their body. It is about having your consciousness evenly distributed throughout your body, as it was naturally when you came into this world. When more of your consciousness is in your torso where emotions arise, you naturally experientially feel emotions at their inception, and this is the natural acceptance and true feeling and resolution of them. This is contrary to our taught conditioned stance that has us inhabiting our heads/minds talking about our emotions, in order to avoid the felt experience of the emotions that we have come to fear in our bodies.
A typical formal embodying practice would be a belly-breathing meditation. Many other embodying meditation practices exist. Other practices like Yoga and Thai Chi or Qigong all are embodying in nature and so tend to teach one to learn tolerance and acceptance of the appearance of emotions and intuition in the body. There are many practices that are very embodying but less formally recognized as embodying as such: All exercise including walking, running, and working out at the gym. While engaging in these practices, make a concerted effort to not be thinking about other things in your head, but rather notice what it feels like in your body and muscles and viscera as you practice them. Allow your awareness to inhabit your body naturally as you engage your body.
You are not the Tool, and the Tool is not You.
Whether you have mental health issues, believe you deserve a mental health diagnostic label, or even if you believe you are in fairly good mental health, we all in this culture have been taught to fear and run from our emotions to some extent. We all can benefit from practicing to be more freely at ease inhabiting our bodies and experiencing our emotions and intuitive intelligences more easily in the moment without friction or resistance. From a Somatic Psychology perspective, the solution does not require an intellectual labeling or conceptualizing at all; on the contrary — the phenomenological experience of the body now needs prioritizing. A diagnostic label is a tool, and a limited one at that. You are not the tool, and it is not you.
