Diagnosis, labels and Step 1

20140627_185025 Something we’ve talked about in my Abnormal Psychology class is the hazard of diagnoses being taken as labels, which which may be problematic as self-fulfilling prophecies.  With the release of the DSM-V in 2013, some labels stopped existing (e.g. Asperger’s Syndrome) and others became official (e.g. Hoarding Disorder).  My professor will sometimes expose a very philosophical view of diagnosis, referencing Thomas Szasz’s The Myth of Mental Illness (which is over 50 years old now) that labels make people victims who are consequently blamed for their status.

As someone with a few diagnoses in recovery/remission, I feel like it comes down to whether we take a diagnosis as an excuse or as an indication of something to be worked on.  This is something I’ve gone over with my kids as they’ve dealt with diagnoses.  Another thing I’ve emphasized with them is that very few diagnoses are purely weaknesses (though I’m not sure this has stuck with my ADHD kid; I should probably revisit that.)  Am I depressed or sensitive, anxious or conscientious, autistic or autonomous?  (short answer, depends on if it’s interfering with my ability to function.)

Of course there is also the splitting of words, which goes back to whether it’s helpful for Alcoholics to label themselves as diseased.  I’ll also hear it argued that “One day at a time” is the opposite of what they should be striving for, since it sounds to the common ear like a motto for hedonism.  Shall I compare thee to the DSM-V?  One of the controversial changes to major depressive disorder was the removal of an exclusion for bereavement, because some argued that the old language implied that bereavement is protective against depression (as opposed to expected).  This kind of sojourn into opposite land is fun for semanticists, but kind of terrifying to see in psychology.

Maybe I’m ready to go back to considering myself a recovering overeater.  For a long time I followed a philosophy that all addictions come back to codependency in the addict, an inappropriate surrendering of will to the drug of choice.  The DSM-V has a designation of Binge eating disorder, but I’m not certain that even in my heyday I met the criteria for that.  Huh, I guess it’s only once a week for at least three months and had to involve excess quantities, lack of hunger, and distress (guilt, disgust).  I experienced one of those things on a daily basis pre-recovery.  But I haven’t been diagnosed with it professionally.  It was actually in connection to what might qualify as avoidant/restrictive eating disorder that I was diagnosed with Anxiety Disorder and OCD.

Ah, the hazards of self-diagnosis.  I take a dim view of others doing it, especially when it’s some self help book fad, like with Adult ADHD.  Though I think a lot of these books sold on my earlier points, that healing begins with understanding and some weaknesses can be strengths.  I also ran into a lot of pitfalls in my early efforts at recovery.  I guess that’s why sponsors are important.  I always had trouble in the sponsor role.  I was frustrated that my first sponsor didn’t tell me more about what to do, which was actually good.  Well, I eventually muddled through, but it took a long time.  It’s a bit like the blind leading the blind, but at least the other blind understand what it means to be blind, rather than a “normal” person telling you to “just buckle down.”

I guess, in the end, my recovery efforts with “spiritual disease” and my cognitive changes with diagnoses should probably be kept separate.  I once heard an analogy that Molokai and Maui, if you get underneath the surface of the ocean, are intimately connected.  But on the surface, one is the most beautiful and the other the least beautiful of the Hawaiian islands (according to people who have been there).  It was a shorthand for being more open to the possibilities of what lies beneath the surface, of what we see in people.  I’m using it here to say I think 12 step recovery and cognitive modification are not that different, but I guess it’s important to keep them that way.

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