labels

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.