As many of you may know, a couple of years ago I was enrolled in a master's program for expressive arts therapy. It seemed like a really perfect fit, but many of the topics we covered hit too close to home and triggered me into distress. By the middle of the second semester, I was also doubtful that I would be able to continue this work professionally. It was heavy and emotionally taxing work, and as a neurodivergent woman, I already carried enough on a daily basis.
Still, I am very proud of some of the essays I wrote and I wanted to share them. This paper was for my psychopathology and psychological assessment course, and reflects on the role of diagnosis from a personal and professional lens. I hope you enjoy, and maybe can relate with some of my experiences and findings. And, for the record, I got a perfect score :)
Reflection Paper 1
Rivi Dollinger
January 28, 2024
MCP 5108: Psychopathology & Psychological Assessment
Introduction and Personal History
If you knew me a decade ago, you would never recognize me today. Due to various mental health issues and serious challenges surrounding my own misdiagnosis, I was a shell of the person I am today. My misdiagnosis destroyed me. An accurate diagnosis, however, led to remarkable levels of growth, meaningful work, and self actualization.
Needless to say, I have very mixed feelings on the role of diagnosis, and deeply personal experiences with the benefits and pitfalls of the diagnostic process. Because of my own experience with misdiagnosis and overmedication, I am quite hesitant around the blind support of our current biomedical model. As an adolescent, I was misdiagnosed with Bipolar disorder. I am sure there are many reasons why this happened– a lack of understanding around the presentation of autism in women, mistaking emotional dysregulation for psychotic mood swings, and numerous other causes. But in the end, whatever the reasons, it was because of this diagnostic process, specifically, that I suffered for years. I was given antipsychotics with numerous side effects, and seen more as a collection of symptoms rather than as a full person.
The Power of Naming
It was not until I learned the term “neurodivergence” that I was able to name my obstacles and challenges in an honest way, free from shame. Because many individuals in the mental health system have been disparaged and dismissed for their symptoms, having an authentic name for these experiences can guide the journey forward.
Having a name for symptoms does not necessarily make them any easier to live with. Take for example, “emotional dysregulation”. In my case, the initial naming of the symptoms (such as mood swings, rather than emotional dysregulation) was incorrect– misinformed by cultural and societal misinformation. I am unaware if my adolescent doctors used this language, but paired with the Bipolar misdiagnosis, this symptom was treated with the same intensity as psychosis and mood swings. The distress I felt was real, but treating it as something that could be simply tweaked with medication minimized my experience and autonomy.
It was not until I learned the term “neurodivergence” that I was able to name my obstacles and challenges in an honest way, free from shame. Because many individuals in the mental health system have been disparaged and dismissed for their symptoms, having an authentic name for these experiences can guide the journey forward.
Having a name for symptoms does not necessarily make them any easier to live with. Take for example, “emotional dysregulation”. In my case, the initial naming of the symptoms (such as mood swings, rather than emotional dysregulation) was incorrect– misinformed by cultural and societal misinformation. I am unaware if my adolescent doctors used this language, but paired with the Bipolar misdiagnosis, this symptom was treated with the same intensity as psychosis and mood swings. The distress I felt was real, but treating it as something that could be simply tweaked with medication minimized my experience and autonomy.
Still, I can acknowledge the power of naming. The power of having an authentic name for my neurodivergent experiences offers me comfort and solace– a way to understand and define my own narrative. Instead of seeing my symptoms as clinical problems to be solved, I now view them as part of my life and my identity.
Negatives and Concerns
The systematic and standardized practice around diagnosis compares individuals to an extremely oversimplified standard of normality. This standard is defined by doctors and medical professionals– many of whom are white men, lacking in cultural competence and diverse research.
With this, I see diagnosis as a limiting tool. The diagnostic process utilizes a simplistic and potentially prejudiced understanding of the human brain. With the age of information and the internet, diagnostic manuals fall farther behind with an increasingly insensitive and outdated view of mental health. Because of the complexity and reliability requirements around academic work, this problem will only expand as technology and artificial intelligence grow faster and more widespread.
Diagnosis can impede an individual’s self work, minimizing the complexity of their life experience into a list of symptoms and a predetermined plan for action. There is no cure for depression, but diagnostic models can treat it that way. As though with a diagnosis, subsequent proper treatment leads to a straight line of recovery. Nothing is ever that simple.
Positives and Treatment
Diagnosing a patient with a disorder, even if that diagnosis is paired with a treatment plan, still relies on the patient to follow through in order to heal. We have to hope that our patients are willing to accept help, and have the proper support to begin the healing journey in a meaningful way. If mental health professionals diagnose their patients in a formal or informal way, the truth remains that this is a very small part of the healing journey.
The Westernized, individualistic approach to self care and health hurts vulnerable and marginalized communities. Self advocacy remains of utmost importance, but that kind of confidence and resilience is built over time. A patient coming out of years of depression and pain cannot be treated with medication or therapy alone. Without support systems, a diagnosis and treatment plan cannot be effectively put into practice. Healing is a journey, and even with that first step of diagnosis, there is a long road ahead.
Conclusion and Moving Forward
I believe the diagnostic system must be accompanied by a support structure to be successful in the long term. There needs to be a cushion, be that familial, social, and/or financial, for individuals caught up in the mental health diagnostic system. Treatment (with diagnosis being the first step of this process) can be expensive, challenging and time consuming. It should not be journeyed alone.
The role of diagnosis should always be viewed in relation to healing and recovery. Diagnosis should not be the first step, and it should not be the last one. It should be a part of the healing journey, offering guidance and support towards a meaningful, comfortable, and successful life.
References
DSM-5-TR: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
Hays, P. A. (2016). Addressing Cultural Complexities in Practice (3rd ed.). American Psychological Association (APA).
Kawa, S., & Giordano, J. (2012). A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice. Philosophy, Ethics, and Humanities in Medicine, 7(1). https://doi.org/10.1186/1747-5341-7-2
Lewis-Fernández, R. (2014, June 12). Culture, DSM5, and How It Will Impact Your Work. Www.youtube.com. https://youtu.be/e9C_K37i2R4?si=s_qLaPIWR1qWExov
Mcgoldrick, M., & Hardy, K. V. (2019). Re-visioning family therapy: Addressing diversity in clinical practice (3rd ed., pp. 3–12, “The Power of Naming”). Guilford Press.
Morrison, J. (2016). The First Interview. Guilford Press.
The systematic and standardized practice around diagnosis compares individuals to an extremely oversimplified standard of normality. This standard is defined by doctors and medical professionals– many of whom are white men, lacking in cultural competence and diverse research.
With this, I see diagnosis as a limiting tool. The diagnostic process utilizes a simplistic and potentially prejudiced understanding of the human brain. With the age of information and the internet, diagnostic manuals fall farther behind with an increasingly insensitive and outdated view of mental health. Because of the complexity and reliability requirements around academic work, this problem will only expand as technology and artificial intelligence grow faster and more widespread.
Diagnosis can impede an individual’s self work, minimizing the complexity of their life experience into a list of symptoms and a predetermined plan for action. There is no cure for depression, but diagnostic models can treat it that way. As though with a diagnosis, subsequent proper treatment leads to a straight line of recovery. Nothing is ever that simple.
Positives and Treatment
Diagnosing a patient with a disorder, even if that diagnosis is paired with a treatment plan, still relies on the patient to follow through in order to heal. We have to hope that our patients are willing to accept help, and have the proper support to begin the healing journey in a meaningful way. If mental health professionals diagnose their patients in a formal or informal way, the truth remains that this is a very small part of the healing journey.
The Westernized, individualistic approach to self care and health hurts vulnerable and marginalized communities. Self advocacy remains of utmost importance, but that kind of confidence and resilience is built over time. A patient coming out of years of depression and pain cannot be treated with medication or therapy alone. Without support systems, a diagnosis and treatment plan cannot be effectively put into practice. Healing is a journey, and even with that first step of diagnosis, there is a long road ahead.
Conclusion and Moving Forward
I believe the diagnostic system must be accompanied by a support structure to be successful in the long term. There needs to be a cushion, be that familial, social, and/or financial, for individuals caught up in the mental health diagnostic system. Treatment (with diagnosis being the first step of this process) can be expensive, challenging and time consuming. It should not be journeyed alone.
The role of diagnosis should always be viewed in relation to healing and recovery. Diagnosis should not be the first step, and it should not be the last one. It should be a part of the healing journey, offering guidance and support towards a meaningful, comfortable, and successful life.
References
DSM-5-TR: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
Hays, P. A. (2016). Addressing Cultural Complexities in Practice (3rd ed.). American Psychological Association (APA).
Kawa, S., & Giordano, J. (2012). A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice. Philosophy, Ethics, and Humanities in Medicine, 7(1). https://doi.org/10.1186/1747-5341-7-2
Lewis-Fernández, R. (2014, June 12). Culture, DSM5, and How It Will Impact Your Work. Www.youtube.com. https://youtu.be/e9C_K37i2R4?si=s_qLaPIWR1qWExov
Mcgoldrick, M., & Hardy, K. V. (2019). Re-visioning family therapy: Addressing diversity in clinical practice (3rd ed., pp. 3–12, “The Power of Naming”). Guilford Press.
Morrison, J. (2016). The First Interview. Guilford Press.
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