I once assisted a learner with her eating disorder. She believed she had inherited this condition from her mother, who inherited it from her mother and passed it down to her and her sister. “All the women in my family have eating disorders,” she said. “We are all wired that way.”
“Do the men in your family have this condition?”
“No, silly. Just the women.”
“How do you suppose that happened?”
“Eating disorders are a girl thing, I guess. You know how we all like to be pretty and skinny and stuff?”
“Is that your idea of an eating disorder?”
“Well, it’s what I was diagnosed with by my other therapist.”
Having been diagnosed with body dysmorphia and anorexia myself, several years before, and overcoming these conditions, I was quite perplexed.
Professionally, I am a hard sell on nearly any psychological diagnosis. Diagnosis, I believe, often serves to replace our less interesting character with some glamorous, more interesting clinical identity.
“I am a borderline. You know how we borderlines are.”
The impact of replacing ones personal identity with a clinical diagnosis, however, is quite detrimental.
“I am A MANIC-DEPRESSIVE;”
“He IS A schizophrenic;”
“She IS A borderline personality;”
“He IS ADHD;”
“She IS Down syndrome.”
As if these poor incapacitated and forever-ill people are the perfect illustrations, TEXTBOOK EXAMPLES, of the conditions they are supposed to BE (rather than conditions they are believed to HAVE).
No one is the epitome – the walking example of a diagnosed mental health condition (unless they design their identity and behavior around a particular diagnosis). In reality, diagnoses, although established for treatment and billing purposes, oftentimes serve an alternative function. Mental health diagnoses may give intrinsic meaning to people who, otherwise, view themselves as less unique and less interesting without the label to define them. Providing someone with a psychological or physical diagnosis (the more unique the better), can be the frame of reference from which they begin to understand themselves and their potential for growth and change.
Generally, a diagnosis is used to construct a treatment protocol around a specifically identified condition. Mental health diagnoses are no different. Like a toothache, a malfunctioning gall bladder, tonsillitis or cancer, A MENTAL HEALTH DIAGNOSIS is NOT intended to be static and unchanging. It is intended to be treated and influenced. (Unless, of course, the diagnosis is accompanied by the word terminal, we often hold out hope for physical recovery. Mental health diagnoses, however, all seem to be terminal conditions.)
The mental health diagnosis is crafted to identify the condition (not the person) and is made to ensure proper treatment and resolution of disease. Mental health diagnoses are not meant to be set in stone, like a hand print in a wet cement. Mental health diagnoses are, instead, intended to be ever-evolving and, hopefully, incrementally lead to a lesser degree of the diagnosis and a treatment plan that is reflective the individual’s progress toward recovery.
If a patient’s mental health diagnosis is not evolving, the treatment s/he is receiving is unquestionably deficient.
My learner with the eating disorder wasn’t such a hard sell on diagnoses. She seemed, actually, quite satisfied to have them. Along with her eating disorder she also had obsessive compulsive disorder, borderline personality disorder, something called relational-dysfunction disorder (a disease I had never heard of before) and a germ phobia. The day I met with her, she was more focused on her eating disorder, so we proceeded to work toward understanding that condition. (I find that people are often more interested in understanding their diagnosed condition, rather than actively doing something about it.) The following is an example of how we accomplished that goal:
EI Guide: How can I help you with your eating disorder?
Learner: After I eat, I put my fist in my mouth and make myself throw up.
EI Guide: How is that a problem for you?
Learner: I don’t know; you tell me.
EI Guide: I will take a wild guess and say that you value yourself primarily on how thin you are?
Learner: Hmmmmmmmmm . . . (She thought for a moment.) You’re right; but that doesn’t help me understand why I make myself throw up.
EI Guide: What would it mean to you if you were heavier? More weighty?
Learner: It would mean that I was ugly and I wouldn’t have any friends. It would mean my husband would divorce me. It would mean other women would criticize me. My children wouldn’t be proud of me. It would mean a zillion things.”
EI Guide: It isn’t likely that you wouldn’t have any friends if you were weightier, unless you chose that outcome. Lots of weighty people have friends. I’ll play along, though. What would it mean if all these fears turned out to be true?
Learner: It would mean that people didn’t like me.
EI Guide: For those reasons, alone?
Learner: Yeah, I’m a good person, otherwise.
EI Guide: Why don’t we spend some time talking about the system you use to evaluate your worth, rather than why you stick your fist in your mouth? I can’t really stop you from doing that. That is something you will have to resolve to do on your own. I can help you manage this idea that your bathroom scale and other people’s opinions of you have become the source of your self-acceptance. Maybe once you take control of how you place value on yourself, you might find that you don’t want to stick your fist in your mouth anymore.
- Diabulimia: A Powerful Memoir (diabetesmine.com)
- Difference Between Bipolar and Borderline Personality Disorder (everydayhealth.com)
- New Trends in Eating Disorders (everydayhealth.com)
- Are eating disorders diseases or are they mental problems? (zocdoc.com)
- Borderline Personality Disorder (cozyblanketsnowflakerepetitioncompulsion.wordpress.com)
- Life After an Eating Disorder (everydayhealth.com)
- Articulated Thought and EI Theory (eitheory.com)
- Experts Urge BMI Method For Calculating Weight In Kids With Eating Disorders (medicalnewstoday.com)
- Getting Your Eating Back on Track With a Food Plan (psychologytoday.com)
- Some Facts About Women’s Mental Health (P 2) (justsimplyinlove.wordpress.com)
- Therapy woes and Personality Disorders (alexishereidrawlikenick.wordpress.com)
- The Distortion of Body Dysmorphic Disorder (everydayhealth.com)
- Linehan and Jung as Wounded Healers: Two Dialectically Different Approaches to Dealing With Inner Demons (psychologytoday.com)
- DSM-IV: Depression Defined (everydayhealth.com)
- Some Facts About Women’s Mental Health (P 3) (justsimplyinlove.wordpress.com)
- Pica: The Eating Disorder That’s Not About Food (everydayhealth.com)
- Quick note on mental health diagnoses (thoughtsunthinkable.wordpress.com)
- The 2011 TWIM Awards – The Results! (twim-blog.org)
- My Glamorous, More Interesting Clinical Identity (eitheory.com)