People who live with a mental health diagnosis and utilize the
services of psychiatrists, therapists, psychologists and the like are being
done a disservice. And this disservice is dangerous. It has its roots in
arrogance and cultural bias. I have experienced this disservice firsthand.
There is a myth of high and low functioning individuals with
mental illness. These terms are problematic for many reasons, but mostly
because they assume that everyone with a diagnosis should be the same. They
assume that everyone with a diagnosis have the same challenges, coping skills,
supports, etc. Basically, these terms assume that there is only one way to be
mentally ill. So, individuals with bipolar disorder behave this way, people
with schizophrenia behave that way and so on. This myth does not take into
account the individual as a unique person with a unique set of circumstances.
Soapbox alert! People with a mental health diagnosis are as
varied as people without. Our experiences are not the same. Our symptoms and
our responses to our symptoms are diverse. What is debilitating and limiting
for one individual is not even a consideration for another. This is why this
trend of cookie cutter psychiatry fails many of us.
Over the past three years I have been able to work full time
and manage things moderately well with a diagnosis of schizophrenia. There have
been bumps in the road, but for the most part things have gone well. For several
years following a breakdown in 2007 things didn’t go so well and prior to that
I was “successful” in a great career, but always on the brink of falling apart.
What I’m getting at is cookie cutter psychiatry misdiagnosed
me for almost twenty years because it labeled me high functioning. I was
misdiagnosed and received inappropriate medical treatment due to the arrogance
and cultural bias of my health care providers. I didn’t present as a
stereotypical individual with schizophrenia. I had an advanced degree, was able
to hold down a job, was articulate, well groomed, etc. The health care
providers who were treating me had low expectations of individuals with mental
illness and even lower expectations of people of color. I didn’t fit the
stereotype of what an African American woman with schizophrenia was, so I must
have been alright, right? Wrong.
This kind of psychiatry is dangerous. From this perspective,
doctors and other health care providers miss symptoms, assume wellness,
over/under medicate people and misdiagnose. Okay, so what are some possible
remedies? Well, for one, psychiatrists in particular need to spend more time
with their clients. Fifteen minutes is not enough to me to get a full picture
of a person. They also need to be keenly aware of their own cultural biases. We
all have them. Let’s just get real about them and check them at the door. How
about also assuming that the people they are serving are experts on themselves?
Another big one is taking advantage of collateral contacts. No one lives in a
vacuum. Doctors need to consult family and friends when clients agree to get a
well-rounded view of who they are dealing with.
High functioning, low functioning are labels that act as
shortcuts for doctors who don’t want to do the footwork. We are “individuals” managing
a diverse jumble of symptoms and trying to make sense of them. We deserve to be
treated like the multifaceted people we are. We deserve to be in partnership
with our healthcare providers without limiting labels.
