trying to categorise the Mind Mess™️

psychiatry, diagnosis and the complexity of labels

Oct 18, 2023

This week I saw my psychiatrist again. In preparation for this, she had me fill out literally 10 pages of questions covering almost every category of psychiatric symptoms (relating to things like anxiety, phobias, mood levels, socialising, executive functioning, food, suicidality, psychosis, personality functioning and more).

the backdrop 🎭

I haven’t seen a private psychiatrist before. I have seen several public ones, but in my experience they were limited in their time and resources and weren’t always able to provide what I needed. And also, most of them kind of sucked. So I went without a psychiatrist for quite a few years and my GP took over my psychiatric medication management. But that hasn’t been sustainable. My health (both physical and mental) and my long list of current medications require a higher level of care – my GP didn’t feel comfortable managing it after a while.

So I have found a private psychiatrist. I’m incredibly privileged to be seeing her at all. I waited months for my first appointment and it is very expensive, which is impactful and stressful on its own, but I am so grateful regardless.

At the end of that first appointment, when she presented me with a small mountain of forms to fill out, she had a few ideas of new diagnoses and medications she wanted to explore. This is not in place of other diagnoses but on top off, or underneath. She said, I want to know what we are treating or, at the very least, what symptoms we are treating. She said it would be a long road – I have lots of complicating factors to consider: I take prescription medication five times a day; and I have been diagnosed with six mental illnesses and six physical chronic illnesses. It’s hard to tease apart what is symptom, what is side effect and where any of it is coming from.

the main act 🤹🏻‍♀️

Going in to this second appointment, I didn’t have any expectations. I thought we would go over my forms and she’d ask me more questions and I didn’t think much beyond that. I was prepared for the long road. And I was right; that is what happened. Until the last 20 minutes.

She surprised me by saying she was a bit stuck. It shouldn’t be surprising: I have been told my health is complicated many times. What surprised me is the speed at which she was stuck. It was my second appointment and I’d expected the long road to be longer.

She told me I essentially met the criteria for two different disorders, both with specific and different medications as treatment. She was confused and unsure and needed time. And that is where I am now. Confused and unsure and loaded with diagnosis and medication information to read. Appointments to check my pre-existing conditions that could be affected by new meds. She will talk to my psychologist and see if they can figure out my mind mess together.

I wasn’t prepared for how triggered I would be by the simple statement of I am a bit stuck. It was harmless and honest but when I heard it I was immediately stressed. All the times I was told I was chronic and complicated, which in the public system equals unfixable and dischargeable. Told that I didn’t fit nicely into any box. That they couldn’t figure me out. Too much, too messy. Easier to remain unknowable.

And now this doctor, who had just told me we would take the time to excavate everything, was defeated.

To be clear, she didn’t actually say she was giving up. She didn’t even imply it. But the story I tell myself when someone pauses and feels unsure, in my health and its treatment scares me. I have been there before, more often than not, and I am scared to be there again.

siri, call my oldest wisest self pls ☎️

I have needed my oldest wisest self this week, more than usual, so here is what I am trying to tell myself.

validate me 👉👈

It makes sense that I am feeling scared and stressed, given the context of my treatment history and the things other professionals have said to me that were disrespectful and damaging.
It’s understandable that, after ten years of active treatment and a lifetime of mental illness, I was holding on to the idea of firm answers and finding a diagnosis and medication that could impact me positively. And it makes sense that I was worried when that idea was doubted.
It’s not unusual to not perfectly fit into criteria for any given illness. Many people have experienced this.

gimme context 🧭

As a society, we place high value on diagnoses. They allow us to access specific medications and treatment plans, and as humans we instinctively like things to make sense and be easily categorised. So, it makes sense that I would like a label and to easily categorise my symptoms into disorders neatly.
Our medical systems are racist and sexist and unjust in many ways and psychiatric diagnoses have often been shaped by white men focusing on white patients and western cultures. Psychiatric disorders are just a collection of (often vague) symptoms that have been recognised to occur in many people.
Many psychiatric disorders are relatively newly defined (in the history of psychiatric care) and their definitions and criteria shift often as there are so many things we don’t know about the brain and how it works.
It is easy to pathologize everything when you are looking for problems and analysing everything critically but many psychiatric symptoms exist on a spectrum and are, at some degree, part of the normal human experience.

be kind 💓

If I am struggling, I deserve treatment and help, regardless of diagnostic status.
I have labels that have empowered me before because they have helped me understand myself and also they are just a tool that has aided me in this understanding. I can still learn more about myself without a new label. If I look at myself and my emotions, thoughts and behaviours curiously, non-judgementally and regularly, I will learn about myself.

check myself 👀

The system we live in is complexed and messy and full of contradictions and so it’s fine (and natural!!!) that my thoughts and feelings are complicated and messy and full of contradiction.
My feelings don’t need to fit tidily into a perfect box. I am disappointed or I am scared or I am hurt or I am anxious or I am still hoping. I am all of those things at once. When I try and prove otherwise, I do myself a disservice. That’s what it is to be human.

Thanks for being here. See you next week.

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