The one you feed: the impact of having a mental health diagnosis
In February 2022, I was diagnosed with anorexia nervosa. I've lived with an eating disorder for 10 years; every moment with an insidious presence, I have neither the words nor space to describe. I know I'm unwell because mental pain and physical side effects make that clear, from the never-ending, non-forgiving noise in my head to the fact I stopped menstruating. But neither symptom is what led to the diagnosis. A doctor referred me to a psychiatrist, and I agreed to the appointment for my husband. We both expected the psychiatrist to diagnose disordered eating, but only one of us was prepared for anorexia. And hearing words I wasn't equipped for has been a particularly challenging time. I wish it were a stronger person writing this article, one seeking support and ready for recovery, but it isn't. And following diagnosis, I've done everything I can to reject the name given to my experience.
Which begs the question, what now?
What is a mental health diagnosis?
Mental and physical diagnoses work in much the same way. They're a label given to a group of symptoms that describe what a person is going through. A general practitioner can diagnose some conditions like anxiety or depression. A person might be referred to a psychiatrist for less common disorders, such as bipolar.
"There are many standards for diagnosis," says Hu Bojun, a counselor at United Family Counseling Center in Shanghai. "The ICD (International Classification of Diseases) and the DSM-5 (5th Edition of the Diagnostic and Statistical Manual of Mental Disorders) are widely used. However, the PDM (Psychodynamic Diagnostic Manual) is also popular and provides a different working hypothesis of what something is."
According to the National Alliance on Mental Illness, a diagnosis helps someone understand their symptoms and what caused them.
"Most importantly, diagnosis is a roadmap. Based on evidence from other people who've been in similar situations, it signals treatments that are helpful to overcoming distress," Bojun adds.
Hu Bojun is a counselor at United Family Counseling Center in Shanghai.
But the question of psychiatric diagnosis has long been debated. A diagnosis determines proper medication and the most helpful therapeutic approach in some cases. For others, the concern is that having a diagnosis makes emotional or psychological difficulty sound like a disease and can interfere with a person's ability to make the most of their strengths or manage their problems. A study led by Dr Kate Allsopp in 2019 encouraged mental health professionals to think differently.
Allsopp said: "Although diagnostic labels create the illusion of an explanation, they are scientifically meaningless and can create stigma and prejudice."
So, what do you do when you've been given a diagnosis? How can it help, and how might it harm? And what hope is there if, like me, you can't accept a diagnosis at all?
The help
People can find comfort in a diagnosis because it allows them to make sense of some quite scary or confusing symptoms. Harry Harding, known to many as Hazza, is a presenter at Guangdong Radio and Television. He experienced six months of poor mental health at 19 years old.
"I found myself increasingly fatigued and stressed, I struggled to focus or maintain a positive attitude," he remembers. "I tried to make lifestyle changes to solve the issue, but it didn't work, and I felt helpless."
Hazza sought the help of medical professionals and was diagnosed with anxiety and depression. "Learning it was a mental health condition, a legitimate reason for how I was feeling, lifted a huge weight off my shoulders."
The validation of suffering is a welcome experience for many and one Bojun sees in her clients. "If a person feels someone is on their side, that they're getting a diagnosis not as a way to control or stigmatize them, but as an effort to ease their distress, it can be very reassuring," she says.
Hazza is a presenter at Guangdong Radio and Television.
Putting a name to what's happening also gives access to medication, support groups and treatment programs.
For Hazza, that was a mixture of medication and coping strategies that helped him navigate unhelpful thoughts and emotions. "I slowly became more engaged and optimistic about life. I had more energy and reconnected with the people and things I'd avoided. I'm grateful for the help I received and proud to have done something that made me happier and healthier."
But as night follows day, being diagnosed isn't a positive experience for everyone. On a closed Facebook group, one physician wrote: "I would never want to have a mental health diagnosis on my record."
The harm
Most state medical boards require disclosure of mental health problems on physician licensing applications. A survey conducted by information and analytics institution Elsevier found female physicians report substantial and persistent fear regarding the stigma of diagnoses. Of them, 50 percent believed they met the criteria for mental illness but had not sought treatment, and only 6 percent with a formal diagnosis had disclosed it. Key reasons for avoiding care included the idea a diagnosis was embarrassing or shameful.
Stigma is lessening around widespread mental health issues, but discrimination can impact everything from employment to relationships. A severe diagnosis such as schizophrenia may also damage the credibility of the sufferer, silencing their voice or reducing them to a walking diagnostic label. Another problem is that some people embody their diagnosis and become a collection of symptoms. But as Bojun clarifies, "symptoms only describe a set of experiences, not the wholeness of an individual experiencing them."
For better or worse, labels evoke an image. Any thought or emotion that opposes that can trigger an avalanche of unhelpful narratives and actions, including rejecting a diagnosis altogether. For me, it's the belief that I don't fit the mould of anorexia. Not everyone with the illness is a walking skeleton, but those that are have come to represent it. A person must meet all the current DSM-5 criteria to be diagnosed with anorexia, including having a distorted view of themselves and their condition. Knowing this isn't enough to accept that the line between my self-image and reality has blurred. And when anorexia has the highest mortality rate of any mental health condition, it's a refusal that could quite literally kill me.
The hope
A Cherokee is teaching his son about life.
"A fight is going on inside me," he said. "It's a savage fight between two wolves. The first is darkness and despair, while the second is lightness and hope. The same deadly battle rages inside us all."
The son thought for a moment, then asked: "Which wolf will win?"
"The one you feed," replied the Cherokee.
The Cherokee's story speaks to my inner conflict. I want to live, but so does my eating disorder. Choosing which wolf to feed might seem obvious to the ill-informed, but mental health conditions are complex.
"Meaningful diagnosis must be given in a context where someone is seeking help," recognizes Bojun. "In that scenario, it can be a significant step toward recovery."
Having had an eating disorder for so long, I'm told I might never be without mine. But there is hope. Because if I can one day acknowledge anorexia as part of my experience, I can also refuse to feed it. And until then, I am more than my diagnosis. I am a partner, a daughter, a friend and a columnist. I laugh, I love, I cry, and I dream. I am a person, living with anorexia.
For Hazza, a healthier future means making space for anyone living with a mental health condition.
"I hope more resources become available," he says. "Especially for those in financial hardship because seeking support can be expensive. And while mental health is becoming less taboo, more needs to be done to encourage acceptance and allow people to reach out."
Perhaps part of the problem lies with putting others and ourselves into one-size-fits-all boxes. Rather than shoehorning symptoms into diagnostic labels, we need to base our understanding on individuals and what they go through.
"I think most clinicians have this ideal in mind," assures Bojun. "In that future, diagnoses become part of a wider effort toward a deeper understanding of what it means to be human."
