You Are Not Your Mental Health

For many people, receiving a diagnosis of a mental health issue is a revelation, a kind of validation that explains the confusing symptoms they’ve endured, sometimes for years. Suddenly, the world feels a bit more manageable because now, there’s a label for their experience. For the first time in a long time, they feel understood.

Take my friend, Thomas (not his real name). In his mid-thirties and already a few years into this demanding, high-stakes job , at a tech company, he needed some time off to, in his words, “get his head right.” Luckily, his employer was supportive; they even covered sessions with a specialist, and, before long, he received a list of diagnoses, including generalized anxiety disorder.

When we met for coffee after his first meeting with a psychiatrist, he looked more relaxed than he had in ages, almost surprisingly happy with the results.

He seemed relieved.

Thomas’s reaction is not uncommon. When someone gets a diagnosis, many of their past struggles—anxiety and behavioral issues—finally make sense. A diagnosis provides structure to what once felt like chaos and new potential strategies for coping. At last, they have the piece of the puzzle they lacked to better understand themselves: –an adversary.

But over time, I started to notice changes in Thomas. His identity increasingly became interwoven with his conditions. Conversations that used to range widely across everything from our favorite movies to new tech gadgets were now about his symptoms, his medications, and his therapy sessions. Thomas’s focus had moved almost entirely inward, leaving little room for his usual curiosity or connection with others–our conversations turned into monologues.

He seemed less interested in spending time with our mutual friends, and when he did, he acted differently. When he didn’t join us for a get-together, he’d let us know over WhatsApp that he felt too tired, chalking up his fatigue to his anxiety or the medications he was taking.

What was meant to be a temporary break from work stretched into something much longer. A few years passed, yet he never returned to working at the tech company. Rather than seeing himself as resilient despite his diagnosis, Thomas began to over-identify with his anxiety, which only made him feel worse.

This reaction, again, is common. Systemic issues within mental health care can hold patients back from healing. For example, psychiatric experts are studying iatrogenesis, or how “health care causes harm to patients.” In mental health, an iatrogenic illness is “a disorder precipitated, aggravated, or induced by the physician’s attitude, examination, comments, or treatment,” according to the American Psychiatric Association.

Being diagnosed with a mental illness or disorder subjects a person to society’s stigma associated with it: The person may feel they are treated like a mentally ill person, which makes it harder for that person to disentangle the illness from their identity down the line.

None of this is to say anyone struggling shouldn’t get help. However, as with any treatment protocol, we should never accept someone’s advice blindly without asking important questions, even if they are wearing an official-looking lab coat and have a PhD after their name. The healthcare system isn’t flawless and shouldn’t be given carte blanche to label people for a lifetime.

A diagnosis should help people not only manage their disorder effectively but also uncover the root cause of their troubles and what healing looks like for them. It should lead to eventual recovery whenever possible, just like any other medical diagnosis. We must not allow a diagnosis to become an identity.

Psychiatric Diagnoses Are Far From Perfect

Over the past 40 years, mental health diagnoses have increased dramatically, not just in the United States, but worldwide. Contributing to that is insurance companies’ requirement that medical professionals diagnose patients to receive reimbursement for services.

The increase is also partially attributed to widespread mental health awareness—which has led to both improved recognition of mental illness and, unfortunately, overinterpretation, or people’s misinterpretation of common psychological distress as mental illness. Overinterpretation is exacerbated by the “wellness” industry, which has taken to using terms like ADHD and trauma as if they are everyday occurrences.

That has encouraged a culture in which more and more people seek a diagnosis rather than a deeper understanding of the source of their symptoms.

The spike in mental illness worldwide is also spurred by the globalization of Western psychiatry, according to Ethan Watters, author of Crazy Like Us. Watters believes we have made mental health diagnosis and treatment a one-size-fits-all model that does not fit all cultural contexts.

In his book, Watters describes how pharmaceutical giant GlaxoSmithKline launched a mega-marketing campaign for an antidepressant pill in Japan that was intended to fundamentally change the country’s cultural definition of depression.

Previously, Japan approached depression very differently than the West. Called utsubyô, it was considered as chronic as schizophrenia, and only a tiny portion of the population was diagnosed with it. But that meant GlaxoSmithKline’s pill would have a small market. The company set out to redefine depression in Japan to expand its customer base.

Watters interviewed Dr. Laurence Kirmayer of McGill University in Montreal, who said that a Japanese man will express mental health symptoms differently than a Nigerian man, who will express them differently than an Iranian man, and that ignoring those different expressions “obscures the social meaning and response the experience might be indicating.”

Through his research, Kirmayer also found that the symptoms an American doctor might diagnose as depression would be viewed as “social, spiritual, or moral discord” in other cultures rather than an illness. We’re giving diagnoses to people who, according to their cultural norms and beliefs, are not ill.

That’s not the only bias that lives within the healthcare system and skews psychiatric diagnoses.

Let’s start with diagnostic overshadowing, “the misattribution of symptoms of one illness to an already diagnosed comorbidity.” This means that a physician may assume a person’s symptoms relate to their existing known condition rather than investigate whether they indicate a new condition. According to a 2022 concept analysis of the term, diagnostic overshadowing is related to other common cognitive biases in health care, such as:

• Anchoring: “the focus on a single-often initial piece of information when making clinical decisions without sufficiently adjusting to later information.”
• Premature closure: “acceptance of a diagnosis before it has been objectively established and alternative diagnoses have been fully investigated.” It’s one of the most common cognitive biases in health care.
• Implicit bias: “attitudes and beliefs about race, ethnicity, age, ability, gender, or other characteristics that operate outside our conscious awareness” and how they affect patient care.

All of these cognitive biases lead to diagnostic errors in mental health. Mental illness and disorders are notoriously difficult to diagnose because, unlike physical conditions, they don’t usually have an objective, definitive test. A 2021 study found that just over 39 percent of patients with severe psychiatric disorders, such as schizophrenia, were misdiagnosed.

Meanwhile, ADHD diagnoses—and treatment—are soaring. Today, about 7 million U.S. children aged 3–17 years, or 11.4 percent, have been diagnosed with ADHD. From 2016 to 2022 alone, 1 million U.S. children aged 3–17 years received an ADHD diagnosis.

The reason for the drastic increase in kids with ADHD, according to some experts, is that ADHD is overdiagnosed and misdiagnosed. The disorder has many symptoms in common with other conditions, even medical and environmental (not just mental) ones. Stress from childhood trauma may be misdiagnosed as ADHD because they share symptoms, including difficulty concentrating in school, disorganization, and high distraction. One study found that kids who are born closest to the cut-off for the school-start age tend to be diagnosed and treated with ADHD at a higher rate than their older peers, suggesting that relative maturity is overlooked in diagnosis.

ADHD overdiagnosis in kids may be facilitated by the “easy patient” mentality, stemming from yet another bias: completion bias, which occurs because “human brains are wired to seek completion and the pleasure it brings.” For the average person, being able to complete a small task, like sending an email, offers an immediate, satisfying reward. For doctors, it means prioritizing more straightforward cases (e.g., medicating children with ADHD) over complex problems.

Unfortunately, pills don’t teach skills. But doctors, stretched thin and subject to completion bias, often don’t have the time or desire to help patients learn to manage distraction without pharmaceuticals.

My point in calling out these systemic issues is not to disparage the healthcare system but to demonstrate why it’s not foolproof. It’s to show anyone suffering from a mental disorder or illness why they shouldn’t make their diagnosis their entire identity. It’s important to seek help if you’re suffering. But make sure your diagnosis doesn’t overshadow your whole self. Even a correct diagnosis is still only a piece of who you are. We have to be careful how we label ourselves.

Be Careful How You Label Yourself

We all label ourselves, and often these labels hold us back. “I’m a procrastinator,” many people tell me. But all that does is make them think procrastination is inevitable when it isn’t. Innumerable others say, “That won’t work for me” upon hearing about a productivity technique, for example—but that self-sabotaging excuse prevents them from trying anything new.

How we label ourselves sets expectations for ourselves, and expectations shape our reality. So we shouldn’t use fixed nouns—including diagnoses—to describe ourselves.

Addiction researchers know the negative consequences of identifying as nouns, which is why they avoid calling people “addicts.” Instead, they call them “people who are struggling with impulse control.” That language tweak reduces stigma, separates people from their diagnosis, and reframes the addiction in their minds as something they can overcome rather than who they are.

Some behavior researchers are even reconsidering addiction’s classification as a chronic brain disease because they’ve found the label is counterproductive to recovery. The classification makes people believe addiction is an “internal uncontrollable urge.” But many emotions- and trauma-focused therapists have come to understand that addiction is “a defense mechanism against painful emotions (shame, anxiety, sadness, anger) that have never been named, validated, and expressed in the presence of a supportive other,” says psychologist Juli Fraga.

“I don’t think it helps to tell people they are chronically diseased and therefore incapable of change,” Kirsten E. Smith, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine, told The New York Times.

That’s why people suffering from addiction—or any mental illness or disorder—shouldn’t let their diagnosis become their identity. They don’t need a label; they need better ways of managing those painful emotions. By focusing on our behaviors, not fixed characteristics, we can release harmful perceptions of ourselves that hold us back from healing.

Doctors, too, need to check themselves in treating diagnosis as identity. “Research consistently demonstrates that health-care providers tend to hold pessimistic views about the reality and likelihood of recovery, which is experienced as a source of stigma and a barrier to recovery for people seeking help for mental illnesses,” according to a Healthcare Management Forum article. This bias keeps people centered on their psychiatric diagnoses. It reinforces a “victim” mindset , making patients believe bad things just happen to them rather than recognize they can take steps toward meaningful change.

Researchers have found that illness identity—“the set of roles and attitudes that a person has developed in relation to his or her understanding of having a mental illness”—plays a critical role in a person’s recovery. They suggest that buying into the definition of oneself as mentally ill adversely affects a person’s hope and self-esteem and inhibits recovery: People offered “services such as supported employment or illness management may not take advantage of or benefit from them because they lack hope that any progress in treatment is possible.” Another study found that reclaiming any lost sense of identity is an important part of recovery.

People who are struggling with mental health should not hesitate to seek professional help. But those who receive a diagnosis may find value in viewing it as a recovery tool rather than as their identity.

Author Matt Haig, who speaks freely online about his experience with depression, ADHD, and autism, put it well when he wrote:

On an individual level it can be dangerous to set ourselves in stone. To say ‘I am like this because I have x or y or z’ so I will keep acting like this because that is who I am. … There was always a temptation to use mental illness not as an excuse but as a kind of fatalism. You know. I will always secretly drink/be grumpy because I am depressed. And sometimes you need to say no. … I can be better. And by embracing that possibility we can change.

Don’t let your diagnosis define you.

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