How I Depathologize My Madness

I was in my local Democratic Socialists of America for only a month or two before my agoraphobia and the Discord server full of anxiety-inducing doomers forced me to part ways with them, for the time being anyway. Along with channels for specific focus groups, there were affinity channels for people with shared identities to discuss whatever, usually organization related to that shared identity. When I talked about psychiatry abolition in the one for disabled people, I was generally met with two responses: sympathy and agreement that psych wards were carceral, but also reluctance to agree that the whole system has to go because, quoting one person, “I'm quite fond of my labels.”

One of the things even disabled leftists that agree with the abolition of psych wards really struggle with is the idea that the primary tool of oppression for psychiatry, the diagnosis, is really that oppressive at all. Many people who are diagnosed with one or two mental disorders appreciate having specific words to describe this important part of themselves. Disabled people often have a history of being misunderstood and not believed, and for them, a diagnosis is the one thing that gives reality to who they say they are. This is especially true if the diagnosis grants them more effective treatment that genuinely helps and/or they sought the diagnosis themselves.

I've gone back and forth on whether and how I'd discuss my history with diagnosis on this website. I'm not a fan of diagnostic labels, for probably obvious reasons. I considered putting a paragraph about my madness in my longer about, but it always just felt like a less direct way of saying what I'm diagnosed with, and I just didn't like writing it. The longer I question this whole system, the less willing I am to define myself by any part of it. At the same time, I feel like talking about diagnosis as an abolitionist matters when I know so much about it. So, this is the blog where I talk about that, not because I want everyone to know what I'm diagnosed with, but because I want to show people what some of the alternatives are when the only way you know how to understand and discuss your mental health is through your diagnoses.

I've always had a complicated relationship with diagnosis. Sometimes, it was validating, so much so that I'd seek out the diagnosis myself. Other times, especially in childhood, I really didn't want to be diagnosed with anything at all. I ended up diagnosed with at least five distinct mental disorders, two of which are considered severe mental illnesses, and at least two more that were more informally acknowledged so they wouldn't end up on my record and potentially put me at risk of incarceration and/or less effective medical care. I say “at least” here because I don't really keep track of this shit anymore and have to write it all down to remember again.

All of these labels quickly become meaningless when you have so many of them. Because there is no broad diagnosis to capture the effects of significant developmental trauma, the people that go through it get slapped with a large number of diagnoses that overlap and still leave stuff out of the picture. Even with one or two diagnoses, the names still don't actually convey as much as you'd think. My autism is extremely different than my girlfriend's autism. The accommodations we need not only come from completely different angles, but sometimes even conflict with each other.

When talking about my neurodivergence, madness, or whatever you'd like to call it, I am very focused on having others understand me, much like the disabled people that are fond of their labels. However, I know from experience that simply naming a diagnosis doesn't make anyone get me better, even if I only mention the one that I think matters in a given situation. A good example here is dissociative identity disorder. Back when I identified with the diagnosis, nobody knew what it was. What use is a label to summarize a complex experience if I then have to explain it for several minutes anyway?

I am not completely averse to all things psychiatry and sometimes reclaim outdated terms in place of whatever the most “accurate” jargon is at the time. I generally call myself plural, but when I'm in the safe community that is my church, I often say I have multiple personalities instead. A lot of systems would shudder at this choice in language, but it gets the job done. I'm punk, so I like using abrasive words, especially when it's the kind that psychiatry left behind because it validated the personhood of multiples too much.

Outside of church, uh, I don't really say anything at all. There aren't a whole lot of situations where I'd have to talk about my system with someone who doesn't already know what plurality is but also is trustworthy enough for me to say I have multiple personalities without worrying that they'll take it the worst way possible.

Psychiatry views “symptoms” as flaws that need to be corrected and paints them all with the same brush. I agree that mental illness is a thing, but I don't think simply being diagnosed with a mental disorder is what makes someone mentally ill. Words like delusion, paranoia, and hallucination all pathologize what should be a range of experiences. I'm often cautious when I'm out in public because I'm afraid of getting grievously injured in some spectacular way, and you could call that paranoia, but if I didn't have this exaggerated fear of tangible harm, I would ignore any subtle instinct telling me something's off and just keep going about my business. That's in contrast to the time I watched a scary movie while I was already not doing super great and got too scared to leave the house out of a fear that a serial killer would cut off my limbs with dry ice. One of those is an adaption to having easily-ignored instincts and the other was a manifestation of fear that prevented me from living my life. I only see one of the two as a problem, but psychiatry sees them as the same.

If I were to simply say, “I have schizophrenia,” you might be able to guess that I get paranoid, but you'd also probably make a lot of other assumptions about how well my beliefs line up with what psychiatry has decided is reality. If I say, “I get paranoid,” you'd assume that I'm talking about unreasonable fears that should be gently reassured out of or otherwise dismissed. I don't want people to guess what I'm going through and I certainly don't want them to believe their daily worries are inherently closer to reality than mine. If I say, “Sometimes, my brain exaggerates potentially dangerous things so I don't ignore my instincts,” it avoids framing a beneficial adaption as something that needs correcting. If I say, “I once watched a horror movie about a serial killer and got so paranoid of one being after me that I couldn't leave my house for a couple days,” it acknowledges the role of unreality without implying the fear is worth dismissing. I don't mind telling people that I get paranoid when I can do it in a way that they're able to empathize with.

The language psychiatry came up with to describe “symptoms” actively prevents connection. They're variations in behavior we see in all people, shaped by a difference in development, trauma, neurotype, or a combination of the three, but psychiatry frames them as wholly different from normal behavior. Saying I have somatic symptoms in response to stress is detached, dehumanizing. Everyone has somatic symptoms in response to stress. Do you get a stomach ache when you're really anxious? How about a headache when you're overwhelmed? That's all somatic, and I think people see me as less of an other if I relate to their experience with headaches and stomach aches as I say I get muscle knots in my arms when I'm stressed out.

In medical contexts, I choose language based on its usefulness and my comfort level. The amount of information I'm willing to give depends on what I think the professional actually needs to know. When I apply for a new therapist through a group, I write that I'm neurodivergent and have developmental trauma in the space for diagnoses on the form; anything more specific than that gets me a therapist that thinks I can't possibly know myself and tells me what I should think. When speaking to a non-psychiatric medical professional, I casually mention that I have autism for the sake of explaining demeanor and “mental health stuff” for the sake of not completely hiding it if they ask if there's anything else. Avoiding diagnostic labels in a medical setting gives me the power to decide what people know about me instead of allowing them to decide for themselves based on their preconceived notions. It also means I can determine my own accommodations by only mentioning the necessary information it'd take to get them. Outside of a psychiatrist's office, my quality of care has never been reduced because I chose not to mention every single one of my mental health diagnoses. There are very few medical contexts where telling a professional that I have a pre-existing mental health condition that might impact whatever physical symptom I'm asking for help with does anything except get me discriminated against.

Diagnostic labels still have some place in my life, not because I think they should exist, but because it's really the only language that makes sense sometimes. The same can be said about “symptoms” that I don't think should be seen as disordered. I believe that the way I think and speak make perfect sense to me, but when I'm self-conscious or not being understood, the only way I can quickly explain why I'm like this is by saying I have disorganized speech. I can't talk about the underlying neurotype for ADHD specifically without mentioning, well, ADHD. Activist groups sometimes try to coin new terms for this reason, but they usually sound stupid and always run into the problem where I'd have to explain something rather than just use the fucking word and have people get it. I live with my discomfort around psych language by making the speech my own, usually by spitting in the face of all the people trying to reform psychiatry rather than abolish it. I'll use schizophrenic as a noun and call myself an autist or a retard when I'm poking fun at myself. NAMI and all those autism advocacy groups that think autism should be depathologized while their schizo cousins rot can get fucked.

The use of diagnostic language isn't always about getting other people to understand you, though, and I don't think as many people would be attached to their labels if it was. There are still times where I need to make use of a diagnosis to figure out what I'm supposed to do next. It was difficult for me to start addressing what felt like a pattern of very impulsive, repetitive behaviors in response to feeling dirty or wrong until I started viewing them through the framework of OCD. It helps me understand what's going on and how to manage it if I call what I'm doing compulsive, regardless of whether I actually meet the criteria for OCD or not.

Of course, psychiatry doesn't want me to approach diagnosis in this way. Psychiatry wants a diagnosis to be an exact, all-encompassing sentence that is done by a medical professional... and yet, it has no place for someone with one condition to improve to the point of it looking like another. I was first diagnosed with schizoaffective (depressive type), and then I was told it was schizotypal by a handful of doctors that didn't know depressive type even existed, corrected back to schizoaffective with a new psych shortly after, and then it was PTSD with psychosis in remission after more than a decade of taking antipsychotics and decrypting my own psyche. If I tell a doctor I have OCD and they believe me, it will be assumed that I will always have OCD—and, if I actually improve to the point of no longer having noteworthy “symptoms,” I'll just be told I never had OCD in the first place the second I get a new provider.

Good God, man. I see psych dweebs compare mental health conditions to physical ones, arguing that they're just as real and clearly defined as diabetes or cancer, it's just a load of horseshit. You can't find out that someone has OCD through a blood draw. Imagine if you beat cancer and your doctor told you that you aren't ever really cured because it can always come back, and then you move to a new city and your new doctor says you actually never had cancer on the basis that you were able to beat it. Fucking asinine.

In a world where psychiatry has not yet been abolished, I use diagnoses as tools without respecting their intended purpose. OCD as a concept is useful to me in this moment, but not as a label I would apply to myself. I'm certainly not going to follow treatment guidelines that seek to rid me of the symptoms rather than teaching me how to use them for growth. Whether my interpretation of OCD is “accurate” or not is irrelevant; it gets the job done and that's all that matters to me. I also don't care what someone actually diagnosed with OCD thinks about me doing this because a psychiatric diagnosis is not a culture that can be appropriated. When it stops being useful, I'll discard it and move onto another framework for whatever comes next, hopefully something more holistic.

I have a lot of sympathy for people who are fond of their specific diagnoses and don't want to let them go. I used to feel the same way, even when one of those labels was one of the most damaging diagnoses in the DSM. In college, antisocial personality disorder made sense of some worsening behaviors that I thought needed an explanation other than the toxic guy I was dating. When my life fell apart, viewing myself as a good person that just made some really horrible decisions would've kept me bitter. I changed because I looked myself in the face, saw my flaws as fundamental, and understood that I had completely rebuild myself from the ground up if I wanted to ever have friends that I could keep again.

Being told I met the criteria for ASPD was monumental to me becoming the person I am today, and it's also one of the main reasons why I think psychiatry needs to be abolished. For years, I needed my therapist and friends to validate my diagnosis, because if they didn't, they wouldn't respect how much I'd grown. I couldn't feel comfortable unless everyone knew, according to psychiatry, that my entire personality was disordered in a way that makes me inclined to hurt other people—and that is fucked up. Whether you like your labels or not, no one should have to view the parts of themselves they dislike through the lens of a disorder in order to be seen.