🎧You Separate from the Pack | Chapter 13

Sarah Fay

Dec 02, 2023

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Onscreen is the Drop the Diagnosis! conference via Zoom. It’s run by a British organization I’ve never heard of that vows to challenge the culture of psychiatric diagnosis. Two men and two women sit on a stage. I take notes but can barely keep up.

One of the men says, “Treating in terms of diagnoses isn’t working. Rates of mental illness are increasing, as are suicide rates in some cases. We need an alternate system.”

They talk about transdiagnostic approaches to mental health problems. The transdiagnostic approach conceptualizes mental dysfunction along a continuum and targets the processes common to the diagnoses we now use: perception, thought, language, attention, learning, memory, emotion, and sensation. Instead of labeling a patient with major depressive disorder or generalized anxiety disorder or PTSD or anorexia, the focus is on the underlying process present in all these disorders. It acknowledges and embraces the myriad causes that contribute to mental and emotional distress and stresses their complexity and the unique ways they manifest in each person.

Onscreen, the moderator asks a question I miss because I’m too busy taking notes. One of the panelists answers, “Iatrogenic harm.”

I google it, butchering the spelling (itragenic?), but Google Scholar suggests the right word. Iatrogenic harm refers to the damage caused inadvertently in the process of treatment, whether by the careless use of diagnostic labels, misdiagnosis, overdiagnosis, over-medication, withdrawal from medications, abuse, etc. Iatrogenic illness typically refers to the adverse effects caused by physical medical treatments, but it can be applied to the side effects of psychiatric treatment, too.

It will be years before I read the academic psychologist Lucy Foulkes’ excellent book Losing Our Minds: The Challenge of Defining Mental Illness, in which she encapsulates what we actually know about mental illness and distress. She writes that the causes include “a bundle of hundreds of layers of explanation—some biological and some environmental—and those layers all interact with each other.” The biological layers include our brains and DNA, but that’s a tiny part of it. Primarily, mental illness is the result of myriad factors: our personalities and psychologies, our past experiences, the societies we grew up in, our friends and family. She goes on: “[Y]ou may be better off just accepting that it all played a role: the factors that led to your disorder are as many and varied as we are.” But if a simplistic medical model dictates treatment, we’re lost.

Most importantly, Foulkes writes how mental illness builds based on compound interest—but not the good kind. The longer one suffers from it, the worse it gets. It’s “a suite of interrelated, mutually enhancing symptoms and difficulties that, once established, might even be said to cause itself.”

A woman on the panel recommends that all patients work with their clinicians to establish an exit strategy—a term I’ve never heard—once they’ve received a diagnosis and been prescribed medication. An exit strategy is a plan for when the patient is better, including how to titrate off medication.

When the patient is better? How they’ll titrate off medication?

Ultimately, my recovery will occur in large part because I give myself an exit strategy, which includes “dropping” my psychiatric diagnosis. Learning the flaws in our diagnostic system is forcing me to heal. The truth about psychiatric diagnoses is unsettling. It means there’s no easy answer, but it also means there’s hope.

Years from now, I’ll discover that in the recovery community (yes, there’s a whole community of people who’ve healed from schizophrenia and bipolar disorder and every other psychiatric condition), diagnoses aren’t even discussed. They’re in the past; recovery is the future.

The definition of recovery that will most resonate with me comes from the Depression and Bipolar Support Alliance (DBSA): “Recovery is the process of gaining control over one’s life—and the direction one wants that life to go—on the other side of a psychiatric diagnosis and all the losses usually associated with that diagnosis.” Because losses come with a diagnosis and being denied the right to heal. No matter how a person receives a diagnosis—whether it’s a misdiagnosis or an overdiagnosis or it comes as a shock a limitation or even a relief—to heal, one has to get to “the other side of psychiatric diagnosis.”

After the conference ends, I walk through the park. Along the path, ten teenagers—most lanky and lean—run past me in a line. Three wear sweatshirts with the name of the high school I attended emblazoned on them. The park sits between my apartment building and my old high school—the school where my mental illness began.

The students run the path ahead of me and loop around. The one in the lead wears a long-sleeved, bright yellow t-shirt without my high school’s logo and name. He runs loose and relaxed, his legs kicking up behind him.

The runners loop around and pass me again. The one in yellow is way ahead of the pack.