Diagnosis - Helpful or Stigmatizing?
“I have ADD,” “ I was told I’m borderline,” “My diagnosis is depression.” People may come to therapy with a diagnosis from a physician, psychiatrist, a previous therapist or self-diagnosis through their own research. When it comes to your state of mind, it may be more helpful to understand what factors are contributing to how you feel, the decisions you make, the ways in which you live your life.
We all move in and out of states of mind and emotion. Our experiences and how they are responded to influence what we feel and think. Insecure, anxious, depressed and avoidant are some examples of distressing states any of us can experience. Mental health diagnosis can leave us feeling scared, pathologized and hopeless. Deep understanding and exploration of experiences are essential steps in gaining relief from troubling states.
Jane feels anxiety about losing relationships. She has a job she likes and friends but she constantly worries that she will be judged as “not good enough.” Her concentration is disrupted with worries of rejection. How do anxieties and fears come to take up so much space in ones life? There is always a context for feelings and behavior.
Let’s consider the context for the feelings of the woman in our example.
Jane’s parents were unhappily married. It was unbearable to witness her mother’s rage toward her father. Equally distressing was her father’s depressed response to his wife’s hostile attacks. Jane was exposed to intense conflicts between her parents. She found herself as children sometimes do, trying to change her parents mood and behavior – she tried to convince her mother to tone down her attacks and tried to support her father and alleviate his pain. Parenting her parents, she tried to help them to break the cycle. Though suffering in the marriage, Jane’s parents weren’t able to resolve their conflict. Jane became convinced that if she was “good enough” they would get it together. She felt like a failure experiencing her father’s depression and her mother’s rage growing in intensity, sometimes aimed at her.
Within the family system, Jane played the role of the parent who could not affect change. Her parents preoccupation with their misery deprived her of the validation for the impossible burden she had taken on. As an adult, she finds herself frequently struggling with anxiety, worrying that life will not work out because she’s not “good enough.” In therapy, Jane's therapist listens deeply and warmly, to the stories of her present and past. Jane feels validated and begins to face the lack of validation in her childhood. Making these connections, she recognizes that her anxiety has a context – this state of mind originated in childhood when she tried to make things better but could not influence her parents to change.
With this awareness and no longer feeling so alone, Jane can begin to understand that her anxiety is a state of mind which gets triggered when she seeks connection in relationships. The rejection she anticipates is fueled by actual experiences which were repeated many times throughout childhood. Jane identifies that her anxiety is linked to past unresolved distress with no one on board who might be able to see how painful it was. With a context for understanding her anxious and insecure states of mind she is free from the rigid diagnosis of “anxiety disorder” – context opens the door to empathic understanding, a balm for psychic pain.