What a Mental Health Diagnosis Means (And Doesn’t Mean) About You

Photography: Alekon pictures and Stefan Spassov on Unsplash

“Freddy Jones is a 58-year-old, African-American male carrying a diagnosis of bipolar disorder.”

This is how most mental health professionals talk about you.

“Freddy Jones is a 58-year-old male immigrant from Congo who has been diagnosed with bipolar disorder. He has discussed an inability to sleep due to constantly working on his album. He speaks rapidly, switching often between subjects of creating the music, advertising the record, and how to turn a profit.”

This is how I’ve been trained to talk about you.

What’s the difference? The first sentence dehumanizes Freddy and sounds as if he himself is an illness. The second sentence describes Freddy as a human being with a story and a point of view on a diagnosis that he received.

I am a therapist in Massachusetts with experience serving individuals who struggle with mental health issues. When I began graduate studies at Boston University Medical School, I was originally taught to speak to doctors. I felt well-equipped to head into hospitals and show everyone how well I could assess and treat patients with my fancy new medical jargon.

But then I began working at a human services agency that didn’t love my approach. “Stop using the medical terms,” they said. “Tell us what’s really going on with the person,” they said. At first, I didn’t understand. I was telling them what was going on. Didn’t they hear me? This patient has bipolar disorder. What else did they need to know?

But as it turns out, they needed to know a lot more, and so did I.

Let’s break this down. Traditionally, mental health professionals turn to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) when diagnosing an individual. To meet criteria for Bipolar Disorder I, for instance, a person has experienced at least one manic episode.

But what is a manic episode?

Manic episode can mean: impulsive decision-making; distracted, racing thoughts; overly talkative; loss of need for sleep; euphoria; increased energy; abnormally upbeat. That is already a lot of descriptors for one type of episode. To pare it down, Freddy most likely struggles with decreased need for sleep, talkativeness, and racing thoughts.

But what are racing thoughts?

Racing thoughts are unwanted, rapid-fire thoughts that cause a person distress. In some cases, it makes it very difficult for a person to sleep. In Freddy’s case, he has stopped sleeping, and his thoughts turn rapidly from making music, to advertising his album, to making money.

Why didn’t you just say that in the first place?

That’s the question, isn’t it? Why are mental health professionals not very specific when discussing the people they serve? Seems like it would make life much simpler. Well, for the most part, we are not trained to do this. As the mental health field progresses, it has become common practice to work under a “medical model” in which we use evidence-based practice to appraise, diagnose, and treat patients. This shift may have taken place as a way to break stigmas around mental health as a pseudo-science. If the evidence-based practice is good enough for medical doctors, it should be good enough for everyone, right? That would make sense if not for this little snag…

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