Does a diagnosis make a difference?

Photo by Juan Pablo Serrano Arenas on

My last post – The Retreat led to an interesting discussion about depression and anti-depressants in the comments section amongst fellow bloggers. I had been to my GP as I’m off work so needed a sick note. I asked my doctor to write depression on the note which was in itself a significant step for me. I got a prescription but I hadn’t started taking them as I was going on The Retreat, and when I got back I felt so good I didn’t think I needed them. I planned to go back to work next week and ‘get on with it’. It hasn’t quite worked out that way. I continued to feel good until Wed and was functioning better – eating better and fitting in the yoga. Wed I had a riding lesson back where it all started 12 years ago; the 2nd time around horse part of my life. I was flooded with memories and I missed my old horse. I enjoyed it but I came home feeling really sad. I didn’t want to do yoga but I managed a little. By yesterday morning my thinking was dark again, I was crying and couldn’t be bothered doing anything. When I tried my brain was sluggish and I got easily frustrated. I decided to take the tablets.

What has been different is I’ve been more aware of this shift and I’ve not transformed it into something else; an irritation with C, a complaint or just a hissy fit about not much at all. I’ve also stopped myself going too far down the self critical ‘it’s all your fault you always mess up’ path too. That I credit to the retreat and yoga. It helps me keep a little bit of me in an observing role to myself so I can check what I’m doing more easily. I was resistant to it yesterday but managed a 5 minute meditation. However I’m not functioning well and I have now decided to label that ‘depression’. I am depressed or I have depression? Does it make a difference which way I say it? Does it make a difference to label it?

I don’t like diagnoses which is odd considering it’s my job to hand them out. When I first started psychiatry 30 years ago we were taught that basically people were either mad, sad or bad (I kid you not!). Psychosis, mood disorders and personality disorders. I quickly noticed that the people I met had stories to tell and usually their stories told of loss and bad things happening to them. Some people couldn’t tell you their story but their body told it for them – the young girl in a wheelchair with fixed contractures of her legs meaning it unlikely she would walk again though there was no physical reason. She had been sexually abused but she smiled and told you all was fine. She didn’t know what she was doing in a psychiatric unit. I found that the so called bad people were the most likely to go mad or be sad but because someone had labelled them ‘Personality Disorder’ no one was very sympathetic when they did. I still find this 30 years later; even though all the evidence backs up what I noticed back then. In Child Mental Health there has been a shift towards more diagnoses so that a huge proportion of referrals now are for assessments for diagnoses such as ADHD and Autism. I found that giving the child’s symptoms a label and then trying to medicate them away didn’t really work that well; especially if nothing else changed around the child; and especially if other things were not as they should be. I remember as a very green consultant seeing a child who I thought had severe ADHD. I gave the meds and at follow up asked his mum how it was going. ‘Oh I didn’t give him those she said – I stopped giving him Powerade’. A powerful lesson for me that symptoms can reflect many possible causes. I didn’t stop diagnosing completely but I tried to use it as a systemic intervention; a way of shifting parents thinking and their interactions with the child, as well as a way to get support in school. I also couldn’t help noticing that sometimes when you treated one set of symptoms a different sort popped up like an unsolvable puzzle that keeps changing shape. Quite a lot of my patients could have any number of diagnoses and none of them really helped with changing anything. I found that when people were able to put words to their secrets, their unspeakable experiences, their shame often their symptoms diminished somewhat. I was learning that symptoms have a function as well as a cause.

In 2006 I came across Pat Crittenden and the Dynamic Maturational Model (DMM) of attachment theory. ( This made more sense to me than any other way of conceptualising mental health across the whole spectrum from well to really unwell had ever done so far. How you function is rooted in your early experiences and is your best adaptation to that unique context is the premise of it in a nutshell. Of course it’s a lot more complicated and I will write more about it in other posts as it has literally changed my life professionally and personally. The more I studied and trained in this the less I diagnosed, and the more I focused on trauma and adaptation.

The DMM conceptualises depression as when your strategies no longer work for you to get your needs for comfort and safety met, and you know it’s not working. Psychodynamic thinking about depression speaks of anger turned on the self; cognitive behavioural of negative thought patterns that bring you down. Women are so much more vulnerable at times of hormonal shifts – puberty, childbirth, menopause which supports a more biological understanding. I’ve used different thinking in different combinations to help patients understand what might be going on for them; a one size fits all approach isn’t that helpful. I still prescribed for patients, recognising that depression stops them from helping themselves, alienates one from loved ones and support. A barbed wire fence that keeps the pain out but the support as well. I know that meds alone can’t fix things but they can get you to a place where you can more easily help yourself. Ive not applied this to myself though. Is it arrogance that makes me think I’m different? Shame? Stigma?

Overcoming addiction is multi-faceted. We have to change our habits, find new coping strategies, new ways to manage our emotions, to have fun, to relax etc etc. We also have to deal with all the unprocessed losses and traumas that alcohol blocked out. I’ve been conceptualising my lack of energy and motivation as this – I’m processing lots of unresolved stuff as well as grieving the person I was and taking responsibility for the mistakes I’ve made. I’ve had therapy in the past so I’ve been surprised there’s still a lot of pain buried in my psyche. Also I’ve thought of it as a reorganisation process (that’s the attachment model term for significant change in how we adapt). I’m slowed up because doing things differently takes time; it’s learning a new way that isn’t yet second nature to me. I’ve also attributed it to cannabis. I’m lazy and demotivated because I’m still smoking dope. I’ve smoked dope a long time though and it’s not stopped me wanting to get out of bed in the morning before or had me crying at the thought of going to work. I’ve been reluctant to think of it as depression, an illness – until now. I’ve had enough symptoms for more than enough time to meet criteria for a diagnosis but I’ve resisted. So what difference does it make?

Firstly I think it’s given me permission to take time off work and look after myself. It is socially acceptable to stop functioning when you are unwell. Whilst I am trying to maintain as much functioning as I can, I’m not being so hard on myself for not managing all I set out to in a day. If I manage anything at all that’s ok. This is helping me keep some self compassion and stopping me from beating myself up mentally. It allows me to focus on what I can manage; walking the dogs, doing some yoga, trying to cook and eat well instead of going to work, not performing well and coming home too tired to do those things. Not doing them drags me down further. I can start from where I am at and build it back more slowly. It also allows me to separate it out from myself – one of the most helpful things a diagnosis can do. I’m struggling at work because I am depressed; rather than I’m struggling at work because I’m no good at my job. My GP said I’m self medicating with the cannabis. That’s a part of it for sure and I’m hoping that as I am able to do more I will want to smoke less. That the anti-depressants will take over some of the functions of the cannabis.

I still think the depression is related to the massive change of removing alcohol, processing unresolved issues and learning new ways of being. However I have to function as well as do this. I feel as if I’ve spent several months navel gazing and whilst necessary on one level too much of it takes you away from others and doing things that are good for you. It’s all about balance. Self awareness versus self absorption. I’m hoping the meds will help me reset that balance – reach out instead of hide away as I continue to find out who I really am without the shadow of alcohol. Help me embed the new habits that will help me stay well and connected to others and give me the energy and motivation to make the other changes I need to make; on the outside as well as on the inside.

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  1. Oh wow wow wow! This is an amazing post with some great information and insight. It’s EXACTLY what I needed to read and I need to read it again and process it all. Too much navel gazing is totally my issue. “Self awareness versus self absorption”. When does focusing on yourself become unhelpful? I suspect I have stepped over the line!
    I think a diagnosis can be useful in this circumstance, if only, as you say, to give you distance from the illness or emotions. That space and ability to refer to depression as a separate entity can be a life saver. I know it enables me to distinguish between a ‘normal’ low mood and tipping into something more serious and debilitating. I hated having the diagnosis, in fact I didn’t accept it for a long time. I’m glad I have moved past that now though.
    Honestly, thank you for taking time to post this. I know it can’t have been easy with how you’ve been feeling yourself, but it’s immensely helpful for those of us who are also struggling to hear about both your professional knowledge and experiences and also your own personal take on it. I, for one, needed to hear it right at this moment so thank you.
    Claire xxx

    Liked by 3 people

  2. Really interesting post, I shall definitely read up on the link you gave. I’ve never experienced real depression myself but have seen how devastating it can be to others. It is usually a whole mix of elements but without doubt every client I’ve seen who presents with depression has also experienced some major trauma. The interesting thing is the source of the trauma when it emerges hits me like a thunderbolt but is often seen as having little consequence to the client which is clearly a defence mechanism. The trauma becomes normalised for some ,translated as something else but so often comes back to bite them.
    Your posts are always illuminating and real. Thanks
    Jim x

    Liked by 2 people

  3. “A one size fits all approach isn’t that helpful” – that’s such a powerful statement. We’re all complex and unique, and no diagnostic label could ever capture that; they can only point in a potentially useful direction.

    Liked by 2 people

  4. Wow, so much of this posts resonated with me, I identified with so much of it! Knowing about mental health + how to help others doesn’t guarantee that we do it for ourselves. It’s so much easier when it’s for others. When it comes to helping ourselves… yikes… it involves this strange process of getting to a place where we 1. Aren’t in denial about our state anymore (in this sense a diagnosis can be useful too – for sure, it separates the pathology from our sense of self/identity, but it also breaks through walls of pushing our suffering away and “wakes us up” to reality and the fact that we need to do something differently. I know that for me, receiving a diagnosis of depression after more than 15 years of self-medication was the ultimate game changer and although it was a brutal shock, it was also the beginning of the healing process, even if it was very painful at first), 2. Are able to treat ourselves as well as we treat others : with the same degree of kindness, patience, gentleness and awareness, etc. 3. Are able to do the work and are fortunate enough to be able to create the environment in which we can start to heal – which requires time, space, support. The question of “am I depressed/undergoing a depressive episode” haunted me for years, but has disappeared this year with sobriety. It used to be very helpful to think of it as an episode ( vs. “who I am”) but now, retrospectively, having come out of a quasi 20 year long on and off depressive episode and yet having believed that that was who I was doomed to be , I think that ultimately what matters is less how we relate to depression but the awareness that it is there (acceptance of reality) and the willingness/confidence that IT IS POSSIBLE to heal from it (acceptance of the non-fixed, modifiable quality of reality). And yes: though meds are obviously not the cure as they don’t address the root cause(s), I 100% agree with you that they will get you to the place where you can finally start addressing the real stuff. Without meds for the initial year, I would not be in this place (sober, happy, med-free) five years down the road. Long story short, yes, ditching the booze brings up a ton of shit that we’ve more or less kept in check with substances for all this time, and I sincerely believe that patience, acceptance and loving kindness towards the self are the antidote to the harshness/guilt/self flagellation that so easily come with depression. ❤ sending big big hugs and apologies for this interminable comment 🙂 xxxxxxx Anne

    Liked by 1 person

    1. No apologies needed Anne sharing your experience really helpful – I know I’ll come through this and it’s all about building a life and habits that mean you don’t need to self medicate – you sound like you’re doing really well with that further on the path and that’s inspiring! 💞💞

      Liked by 2 people

  5. Thank you for this honest and informative post. You are right, there is a shit ton to process when we ditched alcohol and it is overwhelming at times! I think you hit on something toward the end when you mentioned the connection piece, and the importance of reaching out and connecting with people even when we may not want to. Xx

    Liked by 2 people

  6. Medication always creates a lot of debate.
    When I was off work last summer I thought it would be a week, maybe 2. In the end I was off for 9 weeks.
    By the time I decided I needed that break I could see the deep hole of depression all around me. All my years of self care just couldn’t overcome the trauma of my divorce.

    Give yourself time for the meds to work, for your body to relax. You have lots of suppprt here.
    Stillness and peace


    Liked by 2 people

    1. Thanks Anne – I thought I’d be off a couple of days and I’m in the 3rd week now and realising that I may need longer – now I’ve acknowledged the depression I can’t just box it off and I’m realising how depleted I am- I had a lovely weekend of music with great friends and now I’m exhausted! Definitely stillness today! 💞💞

      Liked by 2 people

  7. Thank you so much for posting this for all the reasons mentioned in the above comments. I really appreciate all your knowledge, insight and willingness to share with us. There’s tons of such helpful information for me as I have a loved one that I am trying my best to be there for. ( and I always will do and be there ) Really needed to read this and again, THANK YOU! Thinking of you and as Jim said, you are always illuminating and real! ❤

    Liked by 2 people

  8. Speaking as someone with an unofficial diagnosis of a personality disorder (unofficial because thankfully my clinical psychologist understands just why), I’m glad you don’t think we’re Bad. That Bad Things happened to us, not because we are Bad.

    I hope your meds start working soon. I was put on antidepressants with an antipsychotic as an adjunct. Meds have enabled me to function and stay functioning.

    Liked by 1 person

    1. Thank you! I think they are starting to – I certainly don’t think anyone is actually bad – all humans struggling in an imperfect world – glad your meds are helping you – they def have a place but too often that’s all people get offered x

      Liked by 1 person

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