The Freedom of Diagnosis
Diagnosis is a scary word. It immediately triggers visions of hospital beds, syringes, and machines with green lines pulsating. You’re in a room, a clinic, grey and sterile, abstract art on the walls, a window overlooks a generic cityscape, the doctor has a somber look on their face. They point to X-Rays and make statements with big words that they act like you should know. Their voice fades out and the buzz of panic sets in. “This is it, this is the end”, you think to yourself. And sometimes it is.
But what if I told you that it could be a beginning?
You’re in a room, grey and sterile, charts, graphs, and infographics line the walls on your sides, the wall behind the doctor is a carefully curated collage of certificates, photos, and newspaper clippings saying “I know what I’m doing”. The doctor has a somber look on their face and they give you your diagnosis. But instead of their voice fading out and the buzz of panic setting in, the buzz fades out, and the voice comes into sharp focus.
“Yes, your depression is quite severe, but treatable. You won’t need medication in the long run. And you have anxiety, but it can be resolved. You also have traits of Borderline Personality Disorder. Not really the disorder per se, but traits. It’s treatable.”
You nod and say, “So, I’m not imagining it, right?”. “No, no you’re not. All of it is treatable” the doctor says. They give you three sheets of paper, each with a list of things you’ve been experiencing since as long as you can remember. Things you assumed were “just your personality”. You stare at the paper wondering how it possibly had you so figured out. How did this piece of paper know so much about you? Did this mean that there were other people like you? People who had been studied, treated, and had recovered? Could it be that you weren’t just “a mess of a person”? Could it be that you were just a collection of neatly categorised symptoms? Was this sheet of paper telling you that you can be “fixed”?
You are stunned. Only one thought keeps repeating itself in your head for the days afterwards. “It’s not me. It’s an illness. It’s not me. It’s an illness.”
Being able to separate these illnesses, these diagnoses, from you as a person becomes one of the most freeing experiences you’ve had in your life. You can finally hold these pieces of paper and say “This is the problem. It’s not me.” You laugh. You are so relieved.
The nature of mental illness is such that it feels inseparable from the concept of YOU. It sits in your brain like a parasite and tells you it’s YOU. It’s YOUR fault. YOU are the problem. When actually it is just that. A parasite. A totally separate entity that feeds off you, that drains you.
Historically, people with mental illness were deemed to be beyond help. They were “crazy”, “insane”, “mental”, “coo coo” when they were really just unwell. In contrast, historically, human anatomy had always been separate from YOU. A broken bone was nothing more than a broken bone. But a crazy person could never be anything other than a crazy person.
But is there really such a straight line that separates our body and its parts from our consciousness? Where does that line exist? If we tell ourselves that a sprained ankle is nothing more than a body part that is in distress, why can’t we do that with the way our brains process information? Why can’t we describe anxiety as a body part that is in distress? Isn’t the brain just another organ that makes up our body?
I think it’s because we romanticise our personalities. We create neat little boxes for them. We have Myers Briggs. We have sun signs and moon signs. We have troubled artists and aggressive businessmen. We have kind mothers, and obedient daughters. We have angry young men, and grumpy old men.
People take pride in their personalities. After all we’ve pieced it together over so many years. Painstakingly deciding what kinds of music is cool, what kind of fashion describes us best, what kind of books we like to read, or if we like to read at all. We take the worst parts of ourselves and laugh it off, telling others that that’s just the way we are. Myers Briggs says so. Jupiter’s current position in relation to Saturn says so. Or we bury those shameful parts of ourselves so deep that they come out of the woodwork to those who love us the most and deserve it the least. Or we lean into the worst parts of ourselves and stand firm in our decision to always be troubled/angry/sad because it’s fuels our art, or drives us to be better, or pushes us to seek justice.
We cling so tightly to this flawed decision making that we bully and humiliate those who don’t conform to what we decide to be correct. Anyone that doesn’t follow the oppressive, repressive rules we set for ourselves is an idiot. It’s a great way to reinforce our image of ourselves. All other music is not real music. All other gods are not real gods. All other fashion is not real fashion. All other histories are not real histories. All other cultures are not real cultures.
This careful curation and rigid reinforcement, and this this insatiable need to be in control of the way we are viewed is what destroys us in the end. It’s what prevents people from seeing that there are different, better ways to live. It stops people from seeking help. It’s what prevents people from getting better. It destroys individuals, families, friendships, communities, and nations.
But what if, and just hear me out, our personalities are not fixed? What if we put it all together based on what we had access to at the time, and nothing more? What if it were okay to say, “I am me, and these traits that make up who I am are changeable”. What if you’re not actually a “control freak”? What if you seek control because you feel unsafe? What if it’s not your depression that fuels your art but actually prevents you from being able to create more consistently? What if you’re not “crazy”, you’re just unwell? What if all the things that define you could be observed from a distance, reorganised, cleaned up, sharpened, put away, or coloured differently? What if this notion of “who you are” is not at all you are but just are just parts of you, pieces of you, that make up who you are right now?
The Ship of Theseus Paradox comes to mind. In simplified terms — if every piece of wood in a ship is changed, one by one, over time, until all the pieces are different than the original ship, is it still the same ship? If every cell in our body dies and is replaced, are we the same person? If every trait that made up our personality changed, would we be the same person? I don’t have an answer, no one does.
But my question is — Is changing such a bad thing? Would it be so bad to see a doctor who could tell you that it’s not you, it’s an illness? Would it be so bad to recover and rediscover yourself? Would it be such a horrible thing to find your own peace after a lifetime of chaos or find your own adventure after a lifetime of fear? Would it be so bad to find a balance and take safe explorations? Maybe the angry young man could become the kind, patient teacher? Maybe the obedient daughter could turn into the outspoken activist?
I think Millennials especially fear therapy, they fear diagnosis, they would rather power through with blinders on than stop and say “I need help”. I think we’ve learned as a generation how to ask for consent and how to say no, but we haven’t learned yet how to ask for help. We’re at the age where we’re expected to have already figured it out and are embarrassed that we don’t. The generation before us thought therapy was unnecessary, and the generation after us has turned it into a lifeline, neither of which is a balanced approach. But being stuck in the middle, maybe we’re the perfect generation to find that sweet spot.
We’re old enough now to brave the idea of “what will people think” and do something different? We now have kids and nieces and nephews who learn from us, so maybe we should figure ourselves out a little bit? We have the money for maybe a session or two at least, or some self help books and video courses? We’re old enough to know that something might not be right but young enough to have the time and energy to get better?*
* Yes I know not everyone falls into these categories, but I’m speaking to those who do.
If I may — Allow yourself to be diagnosed. You may find that you’re in better shape than you give yourself credit for. You may find that you don’t need to be strong, your brain just needs a little help.
If I may — Let diagnosis be your ticket to freedom rather than a death knell. Use diagnosis and therapy as a way to free yourself of a personality that you’ve outgrown, a personality that has not served you well, a personality that has alienated people or allowed you to be taken advantage of.
If I may — Free yourself of the expectation that change is not allowed and that consistency is everything. Free yourself and then you can really live.
If you have been feeling unusually sad/numb/suicidal/stressed for more than two weeks continuously, please seek help as soon as possible. It doesn’t have to be this way. Help is available and things can get better.
If you are in Bangalore, my doctor is Dr. Ravi Prakash — https://www.lybrate.com/bangalore/doctor/dr-ravi-prakash-psychiatrist
If you are in India please use Practo or Lybrate to find a doctor/therapist/counsellor near you.
