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When my pdoc, who I've been seeing for five or six years, writes out my diagnosis, he writes, "depression, anxiety, ADD, psychosis, chronic fatigue." To me, that sounds more like a cluster of symptoms than a diagnosis.

In other healthcare fields, having a diagnosis is what gets you proper treatment; in psychiatry, you treat the symptoms. So, having a diagnosis for physical ailments actually helps in the treatment process, but not so much in mental health. 

I don't, usually, like labels, so it's strange for me to want a clear-cut diagnosis, but I kind of wish I had one. I am wanting to ask my shrink, but I'm also a bit scared of being boxed in.

What, in your views, are the pros and cons of having a clear-cut diagnosis vs a cluster of individual symptoms? 

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Well, I have a clear-cut diagnosis, and I've had it since I was 12 or 13 years old. I don't view it as helpful. It has not helped me get better treatment. Antidepressant after antidepressant was thrown at me to no avail. I lucked out in grad school because one doctor (not even a pdoc) gave me Tegretol to try (he said it helped his sister). It worked quite well. Then after my hospitalization, pdocs were a little more open to trying different things such as mood stabilizers and AAPs. As a result, I'm on a cocktail that helps me more than anything in the past did. Basically, my cocktail is a cocktail that someone with bipolar might be on. So my diagnisis of unipolar depression hindered me getting effective treatment.

There is also the problem of identifying too closely with the diagnosis and becoming the diagnosis. The diagnosis is not you. It's just one aspect that you have to deal with.

I also suffer from either Asperger's or Schizoid Personality DIsorder. I do not have a diagnosis because pdocs aren't too keen on diagnosing things that they can't treat with a medication. But therapists have suggested it, and all I know is that I've always been "odd." Sometimes I wonder what it is and would like to have a label to stick on it, but then again I think maybe it's neither and it's just part of my uniqueness or "jt's syndrome."

For me it's far more important to treat the symptoms effectively than to have this label to stick on things that may or may not be accurate.

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We don't know what causes mental illness, all we can do is observe behavior. There are no lab tests but there are "pen and pencil" tests. We are limited to being able to only treat symptoms. Without labs, scans, and cultures there isn't a clear diagnosis. That's what having no confirming tests and not knowing fully how the illness works gives you.

Then there is the problem to tolerating meds. People end up on what they can tolerate, which gives them limited treatment choices.  All this leads to throwing meds at you and see what happens.

 

 

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That's when I was first treated, @jt07, age 12. I was given the diagnoses of depression, anxiety and ADD. The psychosis showed up about two years ago (gee, thanks for that), and the chronic fatigue showed up maybe 4 years ago. Since the psychosis, I've wondered about SZ/SZA. My pdoc has said, very simply, that I "don't seem schizophrenic."

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hey there,

i'm going to disagree with you on this part of what you wrote: 

Quote

In other healthcare fields, having a diagnosis is what gets you proper treatment; in psychiatry, you treat the symptoms.

if i'm understanding what you mean here, this is different from my experience.

i technically have three diagnoses. one is adhd from when i was eight. as a result, because i was unmedicated as a child, i got extra time on exams. i also got extra recess. that was ONLY because a ...i forget the exact term...neuropsychologist or something like that... signed off on my forms to do so. and THAT was on the basis of the diagnosis alone.

my primary diagnosis, however, is (paranoid schizophrenia). i'm also diagnosed with OCD, which manifests as the mostly obsessions with mental compulsions/violent intrusive thoughts, fear of harming vulnerable people/things. in both cases, sure, the symptoms are addressed by medication, but INSURANCE is looking to justify whatever medication i'm prescribed and does so on the basis of diagnoses. i also have gone through a disability process and being declared permanently and completely disabled is a direct result of the SZ diagnosis.

so those are ...semi-pros, i guess. the other "pro" is that certain things make sense that are otherwise nonsensical. like, why in the fuck do i have violent intrusive images that i cannot rid myself of? it helps to know i have OCD and not that i secretly wish to dismember a vulnerable child or pet. you know?

cons... well, i have fought several times, in court as well as more informal hearings on whether to commit me, my SZ diagnosis. i think it brands me as something the media portrays very negatively or weirdly. i think knowing that and my inability to believe that i am schizophrenic or believe that's a legitimate diagnosis and not a tool by which they're discrediting everything i say and do... those are cons. like, this dentist situation, for example. he straight up told me that someone in my situation he is not comfortable doing extensive dental work unless i am orally sedated. and, frankly, i'm lucky he's willing to work with me at all. schizophrenics are often denied care based on diagnosis. 

i don't know...i think the answer is likely different for every person with mental illness. those are my pros and cons, but i can totally imagine having other ones suited to a person's diagnoses, lack thereof, or just different circumstances.

if YOU would be more at ease, if YOU feel like having an identifiable "cause for concern/cause for symptoms/cause for the distressing parts of your experience", then i think you should push. to give yourself peace of mind, in that sense. i can also see someone who wants clearly defined things being in favour of diagnosis and someone who wants to remain flexible and not labeled, rejecting pushing for diagnosis. 

i guess i'm saying that a lot goes into whether you should or shouldn't push for one. for some, it would depend on what said diagnosis might be. for others, it might be necessary for insurance purposes or to get admission to programs. if you feel like you need to know, then you definitely should advocate for yourself getting the information you need to move forward. xx

 

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I have mixed feelings on how I feel about diagnoses. While I could say that getting my diagnosis "officially" changed from MDD to bipolar when I started with my current pdoc was less important than getting on a mood stabilizer, for me, it also felt like validation and that she was listening to all my concerns rather than my old pdoc who essentially blew me off because I was externally pretty functional. I also know that doctor/therapists will sometimes bill under a diagnosis that for whatever reason is more advantageous - either because it makes getting appropriate treatment easier or because it has fewer potentially negative ramifications for insurance or whatever. 

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2 hours ago, mellifluous said:

hey there,

i'm going to disagree with you on this part of what you wrote: 

if i'm understanding what you mean here, this is different from my experience.

i technically have three diagnoses. one is adhd from when i was eight. as a result, because i was unmedicated as a child, i got extra time on exams. i also got extra recess. that was ONLY because a ...i forget the exact term...neuropsychologist or something like that... signed off on my forms to do so. and THAT was on the basis of the diagnosis alone.

my primary diagnosis, however, is (paranoid schizophrenia). i'm also diagnosed with OCD, which manifests as the mostly obsessions with mental compulsions/violent intrusive thoughts, fear of harming vulnerable people/things. in both cases, sure, the symptoms are addressed by medication, but INSURANCE is looking to justify whatever medication i'm prescribed and does so on the basis of diagnoses. i also have gone through a disability process and being declared permanently and completely disabled is a direct result of the SZ diagnosis.

so those are ...semi-pros, i guess. the other "pro" is that certain things make sense that are otherwise nonsensical. like, why in the fuck do i have violent intrusive images that i cannot rid myself of? it helps to know i have OCD and not that i secretly wish to dismember a vulnerable child or pet. you know?

cons... well, i have fought several times, in court as well as more informal hearings on whether to commit me, my SZ diagnosis. i think it brands me as something the media portrays very negatively or weirdly. i think knowing that and my inability to believe that i am schizophrenic or believe that's a legitimate diagnosis and not a tool by which they're discrediting everything i say and do... those are cons. like, this dentist situation, for example. he straight up told me that someone in my situation he is not comfortable doing extensive dental work unless i am orally sedated. and, frankly, i'm lucky he's willing to work with me at all. schizophrenics are often denied care based on diagnosis. 

i don't know...i think the answer is likely different for every person with mental illness. those are my pros and cons, but i can totally imagine having other ones suited to a person's diagnoses, lack thereof, or just different circumstances.

if YOU would be more at ease, if YOU feel like having an identifiable "cause for concern/cause for symptoms/cause for the distressing parts of your experience", then i think you should push. to give yourself peace of mind, in that sense. i can also see someone who wants clearly defined things being in favour of diagnosis and someone who wants to remain flexible and not labeled, rejecting pushing for diagnosis. 

i guess i'm saying that a lot goes into whether you should or shouldn't push for one. for some, it would depend on what said diagnosis might be. for others, it might be necessary for insurance purposes or to get admission to programs. if you feel like you need to know, then you definitely should advocate for yourself getting the information you need to move forward. xx

Thanks so much for your thoughtful reply, Melli. I suppose it is different for everyone. Food for thought. 

1 hour ago, thunder said:

I have mixed feelings on how I feel about diagnoses. While I could say that getting my diagnosis "officially" changed from MDD to bipolar when I started with my current pdoc was less important than getting on a mood stabilizer, for me, it also felt like validation and that she was listening to all my concerns rather than my old pdoc who essentially blew me off because I was externally pretty functional. I also know that doctor/therapists will sometimes bill under a diagnosis that for whatever reason is more advantageous - either because it makes getting appropriate treatment easier or because it has fewer potentially negative ramifications for insurance or whatever. 

Huh. I hadn't thought about it from an insurance perspective. I feel like I get blown off for being "high-functioning" a lot, too.

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From a health insurance point of view, it's less of a concern currently with the ACA (in the US) protecting people with pre-existing conditions; however, I do know people who've had issues getting life insurance or had to pay more for life insurance based because of various diagnosis. I haven't personally dealt with this, so I don't know details. I do know that when I first started getting treatment in college, which was pre-ACA, my therapist tried to use diagnosis that would cause the least issues with identifying me as having a pre-existing condition, which basically meant he billed as "adjustment disorder" until my insurance no longer accepted that, even though we both knew there was more going on than that, we just wanted to try to get me through until I had health insurance through an employer or such before tagging me with something that would make getting insurance harder. Fortunately, the ACA passed while I was in graduate school, so this concern became irrelevant. Also, certain diagnosis can make it harder to get security clearances or to enlist in the military, and I'm sure there are other things that they can impact, so a lot of times, doctors/therapists like to use the "least severe" diagnosis that will still get things covered reliably, just in case somewhere down the line you're trying to do something where say, a bipolar diagnosis could be problematic but maybe "mood disorder NOS" isn't. I don't know really know details, I just know this is a thing that some docs/therapists will consider.

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Personally I would prefer to avoid official labels. I've mainly gotten negative responses from my bipolar 1 diagnosis and certain other past diagnoses that I didn't agree with anyway. I don't mind getting medicated for a correct diagnosis but I don't want the discrimination. If you want a more specific diagnosis that's up to you but consider possible repercussions also. You can't really take the diagnosis back. 

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