i practically begged my therapist to diagnose me

does that make me a bad person?

and

Sep 28, 2022

mixed feelings is a bi-weekly advice column. Every other week, a different mental health expert, author, or journalist will respond to your problems and existential questions. If you like this sort of thing, why not subscribe?

dear mixed feelings,

I feel guilty to admit that sometimes I wish I could just get a diagnosis for some kind of mental illness. I practically begged my therapist to diagnose me with something the other day.

I know it’s stupid and self-diagnosis is awful but I feel so overwhelmed all the time that sometimes I feel like having something to identify with and claim would make me feel better? I know it sounds crazy and selfish but I have a lot of anxiety around social expectations, family expectations, work expectations…it feels like my head is going to explode and I just want everything to stop.

In my heart I know that a diagnosis won’t do it and to be honest, some of my best friends have severe mental illnesses and I would never wish that upon anyone, but I guess when I hear someone has depression or is dealing with a mental health issue, I feel like I understand them better and I’m more likely to allow them to put themselves first…I guess I am wondering if wishing [a psychiatrist] would diagnose me with something makes me a bad person…—problematic, she/her

dear problematic,

On top of a variety of mental health issues that have been misdiagnosed more times than I can count, I’ve struggled with physical and mental fatigue for years. I often find it hard to spend a day on my feet—and it’s been a subject of insecurity for as long as I can remember. I’ve spent hours searching for potential illnesses that could make the problem make sense—not even so I could fix it (few of the disorders I researched had cures), but more so that I could have something to blame other than myself. Something about saying “I can’t make it out tonight, I have chronic fatigue syndrome” felt a lot easier than saying “I can’t make it out tonight, I’m tired.” I felt ashamed of the way my brain worked, and a title felt like the only thing that could prove I wasn’t just lazy or selfish.

But the hunt for a diagnosis didn’t take away my guilt or shame. Fixating on pathologization ended up validating the idea that no one would accept or understand me unless I could get a doctor to tell them to. Diagnosis can feel like the easiest explanation for things we wish we could change, but it isn’t imperative (or even always useful) to a journey towards healing and fulfillment.

the funny thing about guilt

The good news is that the answer to your question is simple: No, you’re not a bad person for wanting a diagnosis. With all the flotsam on the internet about mental illness (and diagnosis in particular), I get why you might feel that way. But let’s step back for a second. What are you really looking for when you seek a label like “depression” or “anxiety disorder”? From where I’m standing, it seems like you crave a sense of identity and community; a reason to validate and prioritize your needs; a way to understand yourself and to feel understood by others. These desires don’t make you “awful” or “selfish”. They make you human.

Diagnostic labels allow you to find out a lot about a person in a quick, easily digestible way. This makes them especially useful on the internet, since the algorithms that propel internet culture and help form online communities operate best when people can be put into easily definable categories. Being part of a group feels undeniably good, especially when they’re being sold as the only way to absolve yourself of the guilt and shame that can come with less normalized needs. It’s very common to see posts that tell you not to feel bad about being disorganized, for instance, because it's a trait of ADHD or depression—but doesn’t it make more sense to say that you shouldn’t feel bad about being disorganized in the first place?

If you need accommodation at work, an individualized education plan, or if you’re considering taking medication, an official diagnosis is not only necessary, but crucial to your wellbeing. It might be wise to speak with a psychiatrist and learn about your options if you’ve been considering something more than talk therapy for some time. But as it pertains to the guilt you’re feeling, it sounds like a big part of your desire for a diagnosis is that you have difficulty taking your struggles seriously without one.

stop moralizing your emotions

Your reaction is reasonable, especially given that most people won’t accommodate a need, or even try to understand it, if there isn’t an identity label attached to it. But we shouldn’t feel guilty for feeling anxious or tired, no matter whether we have generalized anxiety disorder or depression.

“The individual behaviors that fall into being disordered in the DSM are all normal behaviors.” says registered clinical counselor Sam Van Ginkel. (Edit note: the Diagnostic and Statistical Manual of Mental Disorders is widely considered to be the authoritative guide to the diagnosis of mental disorders.) We all feel sad, we all feel anxiety, we all feel anger. We all struggle in our relationships and we all engage, unfortunately, in self-defeating behaviors. “All of us experience things that sometimes get in the way of the quality of our lives,” Van Ginkel adds. “It’s actually a really subjective degree to which these end up seeming disordered. I think that diagnosis can often be very helpful, [but sometimes] we're very quick to think that something is a disorder, when in actuality, it's just part of what it's like to be a human.”

I can tell from your question that you’re feeling a lot of guilt about your mental health. But here’s the great thing about addressing those feelings of shame at the root: not only will it put you in a better state of mind about seeking a diagnosis, but it just might end up making the desire for one feel a little less urgent. Try communicating your feelings to your friends and family in a way that avoids judgment. Focus on describing your emotions without moralizing them as “good” or “bad,” or drawing conclusions about who you are because you feel it. Another reason why diagnoses can be so attractive is because it often feels like they can do the talking for us, but there’s no replacement for open communication and self-reflection.

We shouldn't need medical jargon to know that our struggles are real. That said, this is not to say that diagnosis isn't a key component for many in seeking appropriate treatment. At the end of day, my point is that we should aim to build a world in which the spectrum of human need can be accepted as is. We all deserve to be able to communicate our needs to ourselves and to those around us without needing a label to justify them. Feelings of anxiety, loneliness, fear, and sadness aren’t always necessarily pathological, they’re human—just like the desire for community, understanding, and validation that a diagnosis can provide. These emotions are neither fixed by a diagnosis nor caused by the absence of one, because there’s no silver bullet to inner peace or mental health; there’s just a long but fulfilling journey towards understanding ourselves and others.