Finding Choice: The Politics of Mental Illness and Diagnosis
Comfort or Curse?
For some people, getting a diagnosis is comforting, a relief. Having a diagnosis or a label can help us understand our struggles. Diagnosis can be a ticket to getting support. These labels can also help us find community, connecting us with people who have similar experiences so that we feel less alone or weird or damaged. Diagnosis can also provide guidance for how we might change the things we don’t like about what’s happening for us. These labels can give us language that helps us describe our experiences to other people and a way to explain why we do the things we do (or don’t do). Having a diagnosis can be very useful.
For others, diagnosis is a trap, a box, an identity that invites judgement and stigma. This is especially true for what the media often call “severe mental illnesses:” borderline personality disorder, bipolar disorder and schizophrenia. A diagnosis can be an excuse for behaviours that legitimately harm others, used like a trump card. A diagnosis can steal our power, especially if our “illness” is controlling us rather than us being the agents of our own actions. Diagnosis can also lock us into treatment plans, further stealing our own control of what happens to our bodies and minds. Lack of control potentially abolishes our access to our unique ways of knowing and to listen to the signals we are getting from our nervous systems and intuition. Part of healing is getting our power back — not being subjected to systems that repeat lack of control. Diagnosis doesn’t work for everyone.
Yes, We Can Blame the System
We must pay attention to the fact that people of colour, women and people living in poverty are most often subjected to the medicalized mental health system. Many people with “severe mental illness” are survivors of trauma, both individual and generational. Also, our society is traumatizing overall. Trauma is embedded into how western society (what cultural scholar bell hooks termed the “imperialist white supremacist capitalist patriarchy”) functions; our society was built through colonization and the genocide of Indigenous peoples and cultures and through slavery and racism. Our society was also built through sexism, specifically the extraction and control of resources from land and from the female body as well as the devaluation of anything deemed feminine, including emotions and emotional and domestic labour.
Importantly, diagnosis was not always the way we did things, and therefore it is not the only option to understand our difficult experiences (psychiatry researcher Bonnie Burstow would call these “problems in living.”). In some other times and some other cultures, people with certain abilities and sensitivities would have had a place in their community as seers, witches, wise people, prophets and healers, and they would have had communal knowledge and support to manage their unique experiences (medical doctor Gabor Mate talks a bit about this in this video clip).
So, yes, we can blame the system — and then we can use our analysis and knowledge to fulfill our collective responsibility to make the system better.
You Matter: Your Story, Your Feelings, Your Choices
The way that we come to these labels is important. Did the diagnosis come after a quick appointment with a psychiatrist you had never met before? Did it come from a doctor who has known you for a long time? Did it come through your own research and questions? How we come to these labels can determine whether they are a sword we wield to carve our path through this messy jungle of a world or a sword that drives our injuries deeper. If we got to tell our story in our own way, what might be different when we ask for professional support?
When we came to the diagnostic label is also important. Human life is filled with both joy and suffering. In our moments of intense suffering, when we are completely overwhelmed, desperate and vulnerable, of course we would all fit the criteria for “mental illness.”
The world as it is right now is a stressful place for a lot of people. With all that is going on, we should probably all feel sad and worried. (Folks who feel less sad and worried probably have more privilege and therefore access to more resources, like benefits, money and stable housing.) When we internalize that we are the problem and blame ourselves for feeling terrible — or even worse being terrible — instead of identifying that there are terrible things in the world, that’s part of how the system keeps itself going. As uncomfortable as some of our feelings may be, they are so important — they might be signals to help guide us to creating a better world for ourselves and each other. When more people feel more ease and less suffering, that will likely be a signal that the world is more just.
The overall point is that you have choices.
What You Can Do If You Like/Don’t Like Your Diagnosis
If you have gotten a diagnosis that you disagree with, you have options. You can ask for your disagreement to be noted in your medical file and you can put your file (or that specific note) into a “lock box.” You are worthy of support and care because we all need support and care — not because someone else decided something was wrong with you in certain way and gave it a name.
If you have gotten a diagnosis that you do agree with, you also don’t have to 1) tell people (this includes the person who is your therapist), 2) let people assume what it means about you or your life — you get to explain, 3) identify with it forever and always; it might change. Sometimes you might want to tucked inside the box, all cozy. Sometimes you might want to be outside the box, for a break or a different view. Sometimes you might want to set the damn box on fire. You get to choose and you deserve the resources and support you need to make those choices.
