Our collective attitude towards mental health conditions has shifted dramatically in the past few decades. With increased understanding and acceptance of the complexities surrounding mental health, we are more likely to recognise symptoms in ourselves and others, and more open about our experiences.
Celebrities such as Chrissy Teigen and Lady Gaga have shared their complex mental health diagnoses, contributing to a cultural shift from shame and secrecy to bravery and transparency.
Yet, it’s hard to know whether the rise in mental health diagnoses is because more people are willing to seek help, or because mental health issues themselves are increasing.
There’s no doubt, though, that more people than ever are receiving diagnoses, particularly among younger generations. In 2022, one in four people aged 17-19 had a mental disorder, compared to one in 10 in 2018. Meanwhile, one in six adults experienced some form of depression in summer 2021 – above the pre-pandemic level of one in 10.
Diagnosis of mental health conditions remains a complex issue. "Giving something a name has power, but that power can be helpful or damaging," explains psychotherapist Charlotte Fox Weber, author of What We Want. "When it comes to naming a mental health problem, names and terms can be tools or weapons."
Does a diagnosis help or hinder?
In simple terms, diagnosis is the act of being told you have a condition; it’s the label given to you by a medical professional. In many cases, the diagnosis can open the door to specific support and treatment, such as medication or therapy, but this isn’t always the case.
According to Jane Caro, associate director of programmes at the Mental Health Foundation, many people find diagnosis helpful, as it validates and de-stigmatises the struggles they’ve been experiencing. "To them, a diagnosis means it wasn’t them just making it up."
This was the case for Vairi Alison, 37, who was diagnosed with bipolar disorder eight years ago. "When I received my diagnosis, my first reaction was relief," she says. "It helped me to understand there was a reason as to why I had struggled for so long. I now accept that my diagnosis is a part of my story and I’ve been able to use this to manage my mood changes. I can now identify that how I feel is symptomatic and not fact, which allows me to tell myself it will pass."
Diagnosis in the long term has been invaluable for Alison, but she has also experienced its downsides. "I became angry and overwhelmed for a while," she says. "It terrified me that this would be something I’d have to face for the rest of my life. It also made me question a lot of my past decisions and actions. I convinced myself I wouldn’t have made certain mistakes if I wasn’t living with the condition."
Then there’s the danger that can arise from trying to shoehorn people into neat boxes. "It’s almost like having a neat system of distinct categories that you can put people into but, actually, there are many people who are dealing with complex difficulties and don’t fit into any one category," explains Caro. "For those people, the process of being diagnosed can feel like a dehumanising experience because they’re not able to connect with that diagnosis."
Plus, says Fox Weber, labels can become self-fulfilling prophecies. "Once identified, it can become the lens through which everything is seen," she says, which could make the condition feel even more all-encompassing than it was before.
Although these downsides are important to consider, the ultimate benefit of a diagnosis is that it should lead to more specific treatment, and allow an individual access to find a community and peer support. "A specialist can give you advice and a treatment plan following diagnosis," explains Dr Trudi Seneviratne OBE, consultant adult and perinatal psychiatrist and registrar of the Royal College of Psychiatrists.
Is self-diagnosis the same thing?
In addition to the usual "Dr Google", experts are noticing a trend in people self-diagnosing mental health conditions using online personality quizzes, and apps like TikTok.
Charlie Rosse diagnosed herself with mild depression, anorexia and anxiety. "I noticed that what I was feeling was more debilitating than just sadness or shyness, so I did some research on the NHS website and found a questionnaire thatI think they use at the beginning of therapy to decide what kind of help the patient needs," she says.
"I didn’t want to get a formal diagnosis because I didn’t feel it would help." Most worryingly, she cites NHS waiting lists as a key reason. "The process is so slow and you see people waiting months for appointments. As my problems are mild, I thought it would be better not to take a spot from someone who really needs it and I would be better off doing my own research to help myself."
While the NHS website is trustworthy, many sources aren’t– so Caro advises caution: "Self-diagnosis encourages us to catastrophise. Most of us could look through diagnostic manuals and diagnose ourselves with umpteen things."
She continues, "If you find it comforting to feel part of a community, or it enables you to access self-help resources, then do it – but always make sure the source of information is legitimate."
One of the problems with self-diagnosis is that you could assign yourself the wrong diagnosis (which could mean coping strategies and treatments aren’t right for you), but this risk isn’t eliminated even if you go down the professional route. Misdiagnosis is a common occurrence – after all, it’s not as simple as having a scan to determine a specific physical illness. Many mental health diagnoses are qualitative, and ultimately subjective.
"I see incorrect diagnoses of depression, anxiety, panic disorders and PTSD a lot," says Dr Seneviratne. "Psychosis is also often missed or misdiagnosed as anxiety."
The impact of being too hastily diagnosed, misdiagnosed or given multiple labels from different professionals can be huge. "The sense of shame is a big factor," says Caro. "When someone receives multiple diagnoses, they may start to think things like 'What’s wrong
with me? I must be a useless person,' and that is quite damaging."
Allegra Chapman, co-founder of diversity and inclusion consultancy Watch This Space, believes she was misdiagnosed with depression and anxiety in her teens and 20s. "It’s likely that the depression and anxiety were symptoms of, or were caused by, neurodivergence – I have ADHD and I believe myself to be on the autistic spectrum," she says. "If healthcare professionals had uncovered this sooner, it could have
saved me a lot of pain and confusion. I’ve come to learn that many healthcare professionals lack significant understanding of neurodiversity, particularly in women and girls."
In fact, this speaks to a wider problem across healthcare – both physical and mental – in which women’s health issues are frequently misunderstood or misdiagnosed.
Seeking a diagnosis is an individual choice, but one thing all the experts agree on is the importance of not suffering in silence. "Write down how you’re feeling or speak to people close to you to see if they have noticed a change in you," suggests Dr Hana Patel, GP specialist in mental health (topdoctors.co.uk). Remember – you are not alone.
The diagnosis roadmap
If you think you or a loved one would benefit from receiving a mental health diagnosis, here’s the usual path to take...
See your GP
"GPs are able to diagnose and initiate treatment for common mental health presentations such as stress, anxiety, depression and postnatal depression," says Dr Patel. "With more complex mental health conditions, we have a role in managing patients once they are diagnosed by a psychiatrist and have started on treatment."
Get referred to a specialist
"When you get into more complex conditions such as psychotic illnesses, schizophrenia, bipolar affective disorder, eating disorders and neuropsychiatric issues, this is normally where psychiatrists come in," says Dr Seneviratne. "Your GP can refer you to a psychiatrist in the same way they’d refer you to an obstetrician." In some areas, you may be able to self-refer, and you could choose to skip the GP and see a psychiatrist privately.
A psychiatrist will provide a full examination, exploring whether the root of someone’s symptoms could be a physical issue. "We do biological investigations such as blood tests or checking someone’s thyroid, as well as looking at family history. We also look at psychological factors, and explore any social or cultural issues," says Dr Seneviratne. "We will then ask: is there a place for medication in this? Is a biological treatment needed, or psychological treatments such as talking therapies? Psychiatrists will also look at whether someone needs support with the social side of things, for example benefits, housing, or getting a job. We are qualified doctors who have then gone down the route of specialising in all things mental health, so it’s a very holistic approach.’
The process could end with receiving a mental health diagnosis, and your psychiatrist will talk you through relevant treatment options, from medication to therapy, as well as peer support groups. It’s likely you’d then be handed back to GPs and local mental health support services for follow-up care.
For more information, visit the Mental Health Foundation website.
This feature originally appeared in the May 2023 issue of Red Magazine.
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