Does Mental Health Diagnosis Free You or Stigmatize You?
I’m in a video therapy session with a new client, Emma. She’s crying. I’ve just shared the mental health diagnosis and treatment plan I wrote for her. It is hitting her hard. Did labeling her mental health contribute to stigma? Or does diagnosis help reduce suffering? To answer these questions, context is important. I don’t give my clients a mental health diagnosis until the fourth session.
How I Get to a Mental Health Diagnosis
In the first session with Emma, I heard the problems that brought her into therapy. Then, I offered supportive tools to begin making things better. In the second and third sessions, we split our time. Half of each session was devoted to learning more about the problems and offering more help. The other half of those sessions was devoted to interviewing Emma. This interview covers symptoms and many other aspects of physical, mental, and social health and history.
In the fourth session, I present the diagnosis to the client. I explain which parts of the interview helped me come to the conclusions that I did. I give my clients time to ask questions about their diagnosis and sometimes walk them through the entry in the diagnostic manual so they can see which criteria I thought they qualified for and which ones they didn’t. Sometimes, in this process, I draw incorrect conclusions and have to change my diagnosis. Finally, after reviewing the diagnosis, I identify how I intend to reduce their pain through the course of treatment. Sometimes, we change that because treatment planning is a collaborative process.
Diagnosis in Context and Diversity
We met Emma at this point, crying after seeing the treatment plan and walking through it together. She states that no other therapist or psychiatrist has done such a thorough interview or explained her symptoms. She is relieved there’s a name for what’s hurting her. The diagnosis reduces the self-shaming she’s been doing for years.
In the next session, Emma asks to begin the session with some questions about the diagnosis, “Isn’t this just pathologizing the natural diversity in how my brain works?” I smile. This kind of strength bodes well. She has already embraced her diagnosis, not as a flaw but as a source of pride and identity.
“Yes, to a degree. If we lived in a human community that cared for each other more, we wouldn’t need diagnoses the same way. Your differences, including the strengths of your diagnosis, would be accepted. Other members of your community would compensate for your weaknesses. You probably wouldn’t be considered different.”
She’s nodding now with me. Then her head tilts, and her brow furrows. She asks, “So, why do I need a diagnosis?”
“Well, we don’t live in that society. We live in this one. You’ve been suffering for a long time because you’ve been expecting your mind to work in a way it doesn’t. You don’t have the people around you to celebrate your strengths or compensate for your weaknesses the way you need. So, you’re suffering. The diagnosis describes how you’re suffering and suggests some treatment options to reducing that suffering.”
Now, she’s energized. She’s starting to find the diagnostic process (and how I talk about it) empowering. She continues, “So, with my diagnosis, I have language for why I can’t do certain things I’m expected to do, but also tools for getting around those challenges?”
There’s nothing more to say except, “Exactly.”
The Relationship, Not the Diagnosis, Is Freeing or Stigmatizing
Most of my clients find the mental health diagnosis process liberating because I create a safe relationship and provide care over several sessions while gathering the information needed for a responsible diagnosis. Then, I talk through the diagnosis in an informative and collaborative way. This is a humanizing process because we make it one together.
To learn more about the services I provide click here.
Another article on fighting stigma here.
[All client examples I use in public writings are composite sketches of clients and do not represent any one client]
