Why We Need Self-Diagnosis

WHY WE NEEDSelf-diagnosis is portrayed as the psychological equivalent of looking up exotic diseases on WebMD, but really, it’s a healthy process that leaves people with mental health problems more empowered.

So why are people so against it? I think anti-self-diagnosis rhetoric is based on a series of misunderstandings.

  • Self-diagnosis is not the same as an off-handed comment. For example, someone saying “Yeah, my books are in alphabetical order– I’m kind of OCD about it” is not the same as someone revealing that, after lots of careful thought, they think they have OCD. It can be kind of tough to tell the difference sometimes, but it definitely exists.
  • There are no laboratory tests for mental illnesses. Say you think your finger is broken and you go to the doctor. You report your pain, but your doctor also has an x-ray done and reveals that your finger is, in fact, broken. Everyone agrees it should be put in a cast. However, there’s no laboratory test for even the most common mental illnesses. So how does psychological diagnosis work?
  • Diagnosis relies on the self-reporting of symptoms, which people really can understand and report accurately. When you have a broken leg, you might report the pain, which is an important part of the diagnosis. With mental illnesses, you’re self-reporting every aspect of the disorder. This involves a couple of steps: realizing you have a problem, researching that problem, checking your experience against the symptom, and finally making a decision. For example, you might begin by realizing that not everyone has constant, life-altering fatigue. So you research it and find out that it’s commonly an aspect of depression. Depression? You agree that you feel sad a lot of the time, and often have thoughts of suicide, so you go to the doctor and report all this, and probably get a diagnosis of depression in return. This means that even when you have a doctor’s help, a large part of the diagnosis process rests on you.
  • Not everyone can access healthcare to get an official diagnosis. Assuming you have insurance (which is not a given) wait times for doctors can be essentially infinite, leaving you to fend for yourself in the meantime.
  • However, self-diagnosis doesn’t mean that there are no professionals involved. Professionals may unofficially diagnose, or agree with a self-diagnosis. For example, my therapist doesn’t believe strongly in diagnoses, so she gave me a very vague one to appease the insurance company while still exploring my symptoms. Now, she would diagnose me with something very different. Other professionals won’t officially diagnose more “severe” mental health problems due to the accompanying stigma that the patient may face.
  • Professionals almost always under-diagnose. When you see a general practitioner, you will almost always come away with a diagnosis of depression and/or anxiety. Many people with less common disorders, like Dissociative Identity Disorder, go through a variety of professionals before someone diagnoses them accurately.
  • The right diagnoses don’t always exist, even when they should. I am an enthusiastic advocate for the inclusion of Complex PTSD in the DSM, but as yet it hasn’t happened. That means that the diagnosis that accurately suits me, and has helped me grow immeasurably, doesn’t officially exist. (The reasons are mainly inter-scientist politics.) Therefore, a professional diagnosis is always going to be slightly inaccurate.
  • The point of a diagnosis is to get better and/or learn to manage your illness, and a self-diagnosis can do just that. People can use a self-diagnosis to find a community and coping skills that they may not have had access to otherwise. For example, someone’s self-diagnosis of Borderline Personality Disorder might lead them to find Dialectical Behavior Therapy techniques that they can practice on their own or with guidance.
  • Someone else’s psychiatric diagnoses aren’t your business. Interestingly, mental illnesses are really the only self-diagnosis that gets called into question. People won’t even ask, “Are you sure it’s the flu and not just a cold?” I wonder why that is…

Please feel free to comment with your thoughts!

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Ancient Anorexia

Knowledge about anorexia nervosa (often known just as anorexia) didn’t hit the mainstream until 1978, through Dr. Hilde Bruch’s book The Golden Cage, which chronicled case studies of the problem. Frustrated therapists around America were calling her for help with patients who didn’t eat– tough cases that the psychiatrists didn’t know how to handle. Is this just a modern problem, a result of cultural pressure to be thin, or is it a basic human experience? How far back can we trace it?

I realize that this could be a controversial and/or sensitive topic, so I would like to go no further without a disclaimer. Though I have never personally experienced anorexia or any sort of eating disorder, I have been diagnosed with a couple other mental health problems, so I have nothing but sympathy for those suffering from something that may be invisible to others. So please, if this problem affects you and I have dealt with it poorly, let me know in the comments and I promise to be receptive.

A primary feature of anorexia is controlling one’s eating for a higher purpose. Today this is usually beauty. control, or perfectionism, but in the past the severe restriction often served the sufferer’s sense of religion. Of course, this perception may be skewed by the era’s tendency to record religious matters over the secular details of people’s daily lives.

Saint Catherine of Siena, the patron saint of fire prevention, is an early example of anorexic behavior in the Western world. Over the course of her life, which ended in 1380, she reported being in constant physical pain, and ate almost nothing for long periods of time. After being disappointed that an assassination attempt had failed to result in her martyrdom, she starved herself to death while working ‘strenuously’ on behalf of the church. A century earlier, Saint Hedwig of Silesia engaged in similar fasting behavior.

Jane Balan supposedly did not eat or drink from February 15th, 1613 until her death three years later at age 13. After a sickness with fever and vomiting, she totally refused to eat. The author who described the incident blamed a cursed apple for imbalancing her humors.

Sir Richard Morton, in 1689, produced the first medical description of what we now think of as anorexia. Its medical name was coined by Sir William Gull in 1874, who was the first to recognize it as a psychological condition. It became officially recognized as a mental disorder in 1980.

 

Further Reading:

Contemporary article about Hilde Bruch’s book

Saint Catherine of Siena

History of anorexia, from Encylopedia Brittanica

 

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How do cough suppressants work?

The active ingredient in cough medicine, DMX or Dextromethorphan, is actually a psychoactive drug that, at high doses, causes dissociation, visual distortions, and loss of motor coordination. Though I don’t personally recommend it, some people chug cough syrup recreationally and call it “robo-tripping.”

This doesn’t seem to make sense: how can one chemical affect your sore throat and your brain? As it turns out, the purpose of the DMX in cough suppressants is to turn off the part of the brain that causes the coughing reaction to avoid irritating the throat more, but at higher doses ends up turning off other parts of the brain, too. Your “reptile brain” gets confused, causing disconnects in your experience of the mind/body relationship.

Sources:

The DEA on Dextromethorphan

Deconex