Looking Beyond Labels: Why Diagnoses Don’t Always Help

a woman sitting on a bench in front of a cloudy sky.

Looking Beyond Labels: Why Diagnoses Don’t Always Help

 

If you’ve ever gone to see a therapist or psychiatrist, especially if it’s been covered by your insurance, you’ve likely received a mental health diagnosis. This type of diagnosis is derived from The Diagnostic and Statistical Manual of Mental Disorders, or DSM. The manual, currently in its 5th edition, is intended to be a means by which mental health professionals can assess an individual’s functioning based on predetermined criteria that are decided upon by a council of medical and mental health professionals. At its best, the DSM offers professionals a way to understand their patients’ needs more clearly, in order to provide targeted and effective clinical care. But the truth is, this diagnostic system often doesn’t function at its best. 

 

Realistically speaking, every diagnosis in the DSM is a snapshot of normal human behavior at a certain degree of intensity and duration. Take Major Depressive Disorder, for example. To meet criteria, a person needs to exhibit at least 5 of 7 specific symptoms over the course of at least 2 weeks. These symptoms include insomnia, depressed mood, loss of interest or pleasure in most activities, poor concentration, and changes in appetite. The truth is, most of us have, at some point or another in our lives, exhibited these “symptoms.” Sure, we may not all go through several of those things at once, or for as long a period of time; but what’s described by that diagnosis is well within the spectrum of the typical human experience. 

 

What tends to happen far too often is that diagnoses become labels that serve as markers of identity. Professionals, if they aren’t mindful, think of their patients as disorders rather than people. They focus so much on symptoms and criteria that they fail to see the unique, dynamic, multidimensional human being in front of them. They fail to consider important and highly relevant factors such as context, culture, and environment; and, most unfortunately, they assume their patients’ experience and needs, rather than being curious about them. For people on the receiving end of these diagnoses, getting labeled as “depressed,” “anxious,” “bipolar,” “ADHD” or “borderline” can feel stigmatizing and damning. It’s not to say that people aren’t helped by getting a clear diagnosis; it can certainly be relieving to put a label on what you’ve been experiencing. But when that label starts to dictate how you see yourself and what you believe to be possible for your life, it’s a problem. 

 

At Evergreen, we take a non-pathologizing approach to therapy. This means that, though we’re knowledgeable about the DSM and have a firm understanding of diagnostic criteria, this isn’t what we lead with in our work with clients. We believe that each person who comes to therapy is a unique individual having a distinctive experience in a specific context. We don’t listen to find out what’s wrong with our clients; we join with them in a state of sincere curiosity about what’s been happening in their lives and what they desire for the future. We listen to identify their strengths and resources, and we collaborate to discover solutions. The way we see it, every diagnosis—just like every part of the human experience—can be broken down into separate pieces. So, instead of working on your depression, we’ll focus on your guilt and explore it in ways that offer clarity and relief. Instead of working on your anxiety disorder, we’ll look at the mental, emotional, and physical dimensions of the anxiety you’ve been experiencing. With that understanding, we’ll collaborate with you to design solutions that will help you feel more grounded and less overwhelmed. Our aim, with each client we meet, is to honor their unique experience and look beyond labels to create new possibilities.

It’s a Long and Winding Road

a train track with trees in the background.

I had a startling encounter with myself recently that came at an unexpected time, with unanticipated intensity. During a heated argument with someone I love, I found myself in dark yet familiar territory: The Shadow Land, as I’ve come to call it. This is a place I’ve known all my life—one that I decided years ago to travel far, far away from but that somehow has a way of calling me back from time to time. In the midst of this particularly painful exchange, I found myself there again and felt all those old emotions that I swore to myself (much more than once) I’d never feel again. I was out of my depth; I felt out of control. As the awful words tumbled out of my mouth and the dark emotions surged through me, I disconnected from the purest parts of myself and went completely into shadow mode. I didn’t like who I was being or where I was going in that moment, but I was compelled to keep spiraling deeper into it. What a painful experience. What an awful, well-worn path to tread. It’s tough to admit this—especially given the pressure placed on people in my position to act as if we’ve got it all together all the time— but if owning up to it makes any sort of contribution to anyone else’s process, it’s well worth it.

As someone doing the kind of work I do, I have the benefit of getting an insider’s view of the painful insecurities and disowned shadowy bits that plague most people. If we’re willing to look closely, all of us can find parts of ourselves we’re unwilling to own; parts of our stories we’re unwilling to forgive; parts of our lives we’re unwilling to accept. Some of us are at war with ourselves, unable to live comfortably in our own skin. Others—perhaps those who have ventured into the territory of healing and made the brave and radical decision to shine love and acceptance where there has been darkness—know the pain and disappointment of realizing that the work isn’t done. This was my experience as I found myself losing touch with my light. This is the experience of owning the unfortunate yet inevitable truth—that self-acceptance and self-love are a lifelong project.

We’re living in interesting times, where self-improvement is in style, and everywhere we look, someone’s offering a quick and easy solution to peace everlasting. But let’s be honest: human nature is more complex than we’ll ever understand, and the road to total self-acceptance is a long and winding one. Books, seminars, coaching, and therapy can give us direction and equip us with the tools we need to find our way; but Life, as always, remains in charge, finding myriad ways to put us in touch with the unacknowledged, unforgiven, disowned parts of ourselves. The dark matter, as it turns out, runs deep—and so does the work of shining our light there.

After spending some time battling my demons and forgetting everything I’ve ever known—or taught—about self-acceptance and self-love, I found my breath and allowed myself to re-align. I called upon my courage and committed to doing some exploring of everything that was unearthed when this person so close to me triggered something I had no idea was lurking beneath the surface. But first, I did some serious ugly crying, jotted some notes in my journal, gave myself a big hug, and got back to the business of living. Because this is what we self-helpers tend to gloss over: sometimes, we can’t just Namaste the pain away and bathe ourselves in blissful self-love. Sometimes, pulling ourselves together and wearily declaring a truce is all we can manage. The process, as I said, is a deep one, and the journey toward boundless self-love might be never-ending. So sometimes, the best we can do is stay with the process and sit with the pain of what hasn’t yet healed, trusting that shining the light of our awareness into the darkness is its own powerful form of progress.

It’s easy to fall into the trap of thinking that if only we read enough, meditate enough, go to enough yoga classes, or repeat enough mantras, we’ll be healed forever. I mean, how appealing is it to believe that we can free ourselves, once and for all, from the shackles of insecurity, self-doubt, and self-loathing? But the truth is, when we buy into the notion that the self-love project is one we can conquer swiftly and completely, we only add to our own suffering. Maybe instead, we can let ourselves settle into the lifelong journey and appreciate the process of learning as we go. Maybe we can brace ourselves for those dark nights of the soul, trusting that they’ll usually wind up being the greatest contributions to our growth.

Listen, I’ll be the first to tell you: personal development work is not for the faint of heart. It’s gruesome to face down the self-limiting beliefs and unresolved emotional drama living inside us. But despite what any late-night infomercial or well-funded Facebook ad might try to sell you on, it’s the only way transformation can happen. We’ve got to face it and feel it to heal it; and we’ve got to be ready for the lifelong project of self-growth, self-love, self-acceptance, and self-improvement. But though the journey is long and the work deep, I, for one, take great comfort in knowing that we’re in this together. All of us breathing and learning and healing and growing, side by side—all of us contributing to and gaining from one another’s beautiful journeys.

The Practice is the Purpose

a woman doing yoga on the beach in front of the ocean.

In an effort to invite more consistency and discipline into my routine, I’ve recently developed a morning ritual to propel me into the day. Now I’ll be the first to admit, I’ve never been one to consistently follow rituals or routines. I tend to start out strong—swearing to myself that I’ll stick to it no matter what—only to flake off when things start to feel redundant. But this time, I’m approaching things a little differently, guided by the wisdom of something I learned from one of my meditation teachers several years ago.

When I first attempted meditation, I was a self-proclaimed “stress ball.” It was hard for me to sit still for even a few minutes, and my mind felt like it was always racing a mile a minute. No matter how much I tried to slow down or calm down, it never seemed possible. Yoga, which I had been practicing for many years by the time I found my way to sitting meditation, was the closest I could get to stillness—and even that felt like a fairly excruciating challenge. During my initial conversations with the meditation teacher I mentioned, we’d talk about the fundamentals of meditation and address my curiosities and reservations. I explained to him that as much as I wanted to develop a practice of meditation, I just wasn’t the Zen type. “My mind is too busy,” I told him. “Plus, I’m prone to anxiety, so it’s really hard for me to slow down my thoughts and just breathe in the moment.” Part of me wanted him to teach me how to overcome these apparent obstacles; but if I’m being honest, the bigger part of me hoped he’d buy my excuses and exempt me from the difficult practice altogether. He did neither of these. All he did was flash his playful, patient smile and insist, in one way or another, that I keep coming back to my cushion each day. “Just keep sitting,” he’d say. “And remember, the practice is the purpose.”

These words confounded me every time I heard them. They struck me like some sort of complex riddle that I couldn’t quite solve. At once simple and profound, the phrase was clearly supposed to be encouraging; but at that time in my life, all it did was make my head spin. Nonetheless, I heeded his advice and kept returning to my cushion every day, eager to get to the other side of my struggle and reach some sort of clearing, where my mind would become silent, and enlightenment would be mine.

When I look back at these times and remember the thinking that guided me through them, I can’t help but smile. I had no idea what my teacher was talking about, but boy, is it clear to me now. You see, it’s been years since I started meditating, and I can tell you without the slightest bit of hesitation that I’m nowhere near enlightenment. And there hasn’t been a single meditation session that’s led me to a completely silent mind. But I can also tell you that meditation has profoundly and radically transformed my life. No matter what I feel, how resistant I might be, or how much my sessions challenge me, I return to my cushion—over, and over, and over again. And each time I do, I learn and I grow. Each time I do, I realize how right my teacher was: the purpose has always been the practice.

Neuroscience research supports that we can change our brains—and, thus, change our lives—through committed and consistent practice. But we don’t need science to tell us that; it’s evident everywhere we look. How do professional athletes get so good at their game? Practice. How do long-term, successful couples quickly resolve issues in their relationship and reestablish harmony? Practice. How does anyone who’s exceptional at anything get to that point? Yep, you guessed it: they practice, with purpose, repeatedly and consistently. They keep coming back, no matter how difficult or mundane the task may be. And it’s important for us to remember that we all have that capacity. Over time, our brains and bodies reward our practice, yielding positive results that, if we let them, can reinforce our efforts.

Now that I understand what it means for the practice to be the purpose, I challenge people not to count themselves out of meditation because their minds are too busy. And I talk back to my own narratives about not being consistent enough to stick to a morning ritual. There’s beauty in devotion and discipline. Even when it seems like nothing is happening, practice works some pretty brilliant magic—the kind that can change our lives and evolve us into the best versions of ourselves.

So, what practice can you commit to? And who might you become through your purposeful dedication to it?