We've come so far. We really have. October is mental health month, and lots of helpful information is swirling about, helping us to remember to ask "RUOK", and to consider the value of confronting and tending to our emotional health needs, rather than stuffing them or staying hidden in the shadows.
This is important progress. According to a recent Mental Health in America 2015 survey, it's also timely: over this past year alone, Americans reporting mental health issues has increased by 1.2 million. That many of us say we are saturated in stress, anxiety and have bottomed out. And, unfortunately our friends across the world aren't faring well, either. A World Health Organization 2012 report calls depression a "global crisis," estimating its affect on 350 million people worldwide. We desperately need to keep getting traction in raising awareness, generating resources and taking collective action.
We also need to be careful as we sort through the sea of information available, given how our mental health is often being described. Many of us in the mental health and social sciences community (and beyond) are worried that the pendulum has swung too far and that as a society, are taking labeling, diagnosing and prescribing to a whole new-and potentially harmful level. We are treating mental health as an individual or family problem, rather than looking at our context that often takes the starch out of us and sucks our lifeblood out.
"Disorder" lexicon floods our vocabulary, and while the frameworks of diagnosis can be freeing and very helpful, they also have limits, especially when they are deficit driven and don't factor in the impact of our environments, along with individual, family and community strengths.
Allen Frances, MD, Psychiatrist and professor emeritus at Duke University School of Medicine says we are falling fast and furiously into the trap of "the medicalization of normal," explaining that great care has to be given instead of locking down on labels without looking at the big picture.
We gravitate towards diagnosis, because it can provide an important organizing framework that explains behavior and phenomena that can otherwise be incredibly perplexing and hard to make sense of. For anyone who has struggled or watched someone you love endure mental health challenges, you know that finally "getting an answer" can be monumental-and often, critical. Pinpointing what is "actually going on" can bring about a great deal of understanding, and invaluable information on how to best proceed. There is tremendous relief when we can get to the bottom of things and sort things out with trained and caring professionals. The benefits of intervention cannot be overstated.
But, over the years, I've witnessed aspects of this conversation that leave me concerned. The eagerness to understand and explain can lead to people take on their diagnosis as a label, and even internalize it as a full-out identity. I've heard and seen this repeatedly and it makes me cringe, quite truthfully. Here are some examples that may seem strikingly familiar to you too:
John: I'm Bipolar.
Me: Actually, that is not your real name. You are John, a beautiful soul with an artistic temperament who has endured a lot of trauma. Yes, you have scars, and you may find yourself consistently inconsistent, but there is so much more to you. While the bipolar spectrum might help explain the up and down moods, rocky job and relationship history, you are a dynamic human being with a lot of charisma, and if you stay the course in your treatment, will make great strides. John is your name, not bipolar. And by the way, I bet you bring a lot of joy to people, and will keep being able to do so as you leverage the resources at hand to keep your moods at a more steady level.
Sabrina: I'm ADHD.
Me: Yes, you are indeed spunky, Sabrina... and quite the ball of fire, for sure. But last time I checked, you are not "ADHD". You are a spirited person who needs some attention to get your focus and attention where it needs to be. Your executive functioning skills need some development. It sounds like your Aunt, sister and Dad are all in the same boat too. Oh, and it wouldn't hurt if you started walking or running vigorously to help with your tendency to get over-stimulated. And yes, creative projects and activities are a must--when you aren't structured and engaged, that is when you tend to struggle the most. You are Sabrina. Brilliant and wonderful, but I refuse to call you ADHD. You may have ADHD, but that is not your defining feature, and certainly not your name.
In today's less than perfect world, with tremendous pressures, many of us are falling prey to symptoms of anxiety and depression, and could on a given day find ourselves "qualifying" for a diagnosis. When we look at the DSM-V, the "bible" of assessing and diagnosing mental health symptoms, we may well find our experiences represented on lots of the pages-anxious thoughts, racing hearts, and exhausted bodies. And none of this should be taken lightly. Getting help and deciphering what is happened should be a top priority.
Still, we want to carefully discern how we then go on to make meaning of our "issues," so that we can not only properly address symptoms and disruptions, but also be able to understand ourselves as whole people operating in a land of chaos. We are not simply "ill," "bipolar," or "ADHD," but human beings with names, talents and so much to offer, who are experiencing challenges in the throes of an incredibly complex landscape.
Our minds and bodies are not machines. They are wondrous, but also fraught with limitations-and will break and get sick when we push too hard. We are both incredibly strong and fragile too. And yes, we may technically have depression, ADHD or other mental health spectrum issues, but there is much, much more to us.
We need ongoing education to help us understand the wonder and complexity of human behavior, health and functioning, and to prevent and protect ourselves from the ravages of burnout and mental health issues. Our approaches need to be comprehensive -- grounded both scientifically and medically, and in a way that accounts for our emotional and spiritual essence, and doesn't limit us to linear checklists and labels as the end-all-be-all.
Assessment and diagnosis have a vital place in providing understanding and setting the course for often life-saving and life-altering treatment, and should not be dismissed or devalued. But, we also need to remember we are human beings, with names and stories, and should never be defined by a diagnosis. That you are Jamal, Aiyana, Kate, Yin, Marianna, Bill, Sanjay and Alberto. That you may be hitting bumps in the road, but you've got a lot of gumption, and with the right help, and some time, will make amazing strides. That I am Kris, and while I may battle anxiety, my name is just Kris, and I'm a work in progress, just as we all are.