Diagnostic Labels: Why Won’t They Tell Me What They’re Thinking?

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Reader’s Question

Ever since I was 13 I have been in the mental health system. It’s hard to explain, but I met this girl at school when I was 14 and she had Borderline Personality Disorder. She was not yet diagnosed but was at 18, so I didn’t know that at the time. We went through a rough friendship: she would love me one minute and hate me the next and all that. Then one day out of the blue she stopped talking to me.

About six months later she would come to my window and shine a torch through the window and then she started calling my name and started threatening that she was going to kill me. Over the next six months it got worse. I tried telling people, but they didn’t get it as they said she doesn’t even live in the same town anymore and they thought I was talking about some strange dream or something. But I wasn’t. She would keep awake, and I started sleeping during the day and stopped eating and withdrew from life. I stopped going to school and was having panic attacks. When I finally told people at the mental health centre and I mentioned her name, they suddenly treated me differently and labeled me with borderline tendencies too.

I have major depression and anxiety and my mum thinks that this girl who talks to me, hits me and bullies me is psychosis — but the mental health people say it’s not. I have had really bad depression and had suicide attempts but only because this girl told me I had to do it. (Other people, when they are around, say they can’t see or hear her.) I have also been in very hyper moods: one lasted over three months, and I would give lots of money to people on the street who looked sad, I would clean and hardly sleep; people around said when I talked I didn’t make sense, and I wouldn’t stop moving, singing and dancing.

I am depressed at the moment and I have this knowledge that really pisses people off: I know that everything can feel pain and emotions, so that includes tables, floors, doors, pens, paper EVERYTHING! It saddens me that people don’t treat things with respect, and no matter how hard I try I hurt things too. I hear some things talk to me, like a frying pan and the shower curtain, and people think that’s weird but I think they just don’t listen.

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We had a massive earthquake in September and I think the earth is trying to tell us something, that it’s mad and not happy. I have worked really hard to try and make it happy again so the earth will stop moving.

I’m sick of being told that I am weird and that the mental health professionals don’t know what’s wrong. Does this sound like Borderline Personality Disorder? Psychosis? Or something else? Oh and I’m now 19 years old. I feel the doctor I am seeing at the moment won’t tell me what she is thinking and doesn’t want to label me, because she says she doesn’t know what is wrong; she is a GP doctor.

Please be honest and tell me what you think might be going on either in or outside of my head/body.

Psychologist’s Reply

People say you don’t make sense when you’re hyper, but now that you are depressed you make perfect sense. Others might not agree with you or see things as you do, but it makes cohesive sense to you that things are just the way they appear to you to be. How can you trust others when you think they just don’t pay attention? How could you know if something is wrong with you if they won’t tell you? How can you tell if there is something wrong with you or with everyone else? These are valid questions that deserve answers.

At 19 years old, here in the United States, you are considered an adult. As an adult, if you talk to a mental health professional they will tell you what they’re thinking unless 1) they think it might harm you to hear it directly or 2) it is outside of their role to explain things diagnostically. For example, a therapist may not tell you flat out that you have XYZ disorder. She may just want to work with you as you are and try to treat what she sees as troubling to you. Does that make sense? My point is, don’t blame them too harshly if you’re not getting a straight answer. If a straight answer is what you want, you can get it. You just need to ask the right person.

At this point, I would normally recommend that you get a psychological evaluation to answer your questions. However, if you have been in treatment for as long as you say, no doubt you have already had one or more. I recommend that you go back the the mental health centre you were at as a boy and ask to see your records. They will probably say they will release them only to another professional, because the records need to be explained to you in plain language. That is appropriate. If you trust your GP, then ask her if she will interpret the records for you. If not, find a psychologist who will. Then you will see what they thought, why they thought it, what diagnosis they offered at the time and what they recommended for treatment.

Let me say something about mental health ‘labels’. It is not true that diagnoses never change. They change all the time. When a patient goes for treatment, we expect that the diagnosis leaving treatment will not be the same as when you enter treatment. If that were not true, then treatment would be totally useless! If you went to a doctor with a broken arm, your first diagnosis would be: broken arm. When the cast was cut off and your arm was fixed, the diagnosis would be — nothing! There would be nothing wrong with you! Well, mental health diagnoses can change like that. They may not change so drastically for severe, persistent diagnoses like psychoses, but they do change. Getting a proper diagnoses and then coming to understand it and agree with it can be very liberating. It can validate for you what you are experiencing, and it can detail for you exactly what kind of treatment could be helpful and why.

If you do decide to get a new psych eval, then find a clinical psychologist to do a formal procedure. It’s painless and shouldn’t take much more than a day to do it. There is an expense involved, but it sounds like your peace of mind requires it. You have valid questions. You deserve valid answers.

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