I think John’s latest post is his best yet – and i’m chuffed that he might think i’ve got some of that punk attitude. Coming from John, whose sense of inclusivity i’ve always admired, I take it as a big complement.
So i’ve been thinking hard about inclusivity. I’m going to get a bit philosophical here but all these ideas are pouring out my head……!
I’ve talked before about getting the label – and said that it was a wholly positive thing for me. But I don’t think that’s the whole story. Modern psychiatry is becoming ever more detailed in its categorisations of mental illness, and some are concerned that aspects of ‘normal’ human life and behaviour are getting gathered up in all this and labelled and ‘medicalised’. But the real trouble as I see it is, that once we apply an illness label, once we define an illness, we also define something that we have to call ‘normal’. We then set up a situation where my mental illness sets me apart from the rest of the ‘normal’ population. It sets up a black and white divide. I have bipolar disorder. Anyone who doesn’t have a diagnosis of bipolar disorder is ‘normal’ and therefore doesn’t face the challenges I face. But bipolar disorder is the perfect example of what i’m trying to demonstrate – there’s not an on-off switch that takes you from ‘normal’ to bipolar. Many people everywhere in our societies cope with varying degrees of mood instability or difficulty. Those of us who ‘do’ psychiatry are here because the severity of that condition affects the running of our lives, and ultimately our very safety. Symptoms of bipolar are common across the population – what’s required to make the diagnosis is that those symptoms are ‘severe enough’ to seriously affect the living of life. As the DSM-5 states – one of the possible criteria requirements for the diagnosis of bipolar disorder is:
‘The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalisation to prevent harm to self or other, or there are psychotic features‘
I think this criteria should be given more prominence than it has – it’s possible to diagnose bipolar disorder without invoking it, if other symptoms are sufficiently severe. But it’s an important thing to bear in mind. But getting back to what you do with a diagnosis – take care that it doesn’t make you feel that you’re separate from the rest of the population. There is no separation – be kind to everyone because everyone’s on a hard road. That’s the punk attitude.
The other thing I was thinking about diagnostic labels is a wholly positive (for me) thing – that once you have a diagnosis, you also have access to a language that you can use to your own benefit. Rather than having to reinvent the wheel every time I speak with my CPN (community psychiatric nurse), we have a common language with us in the room when we talk. It took me a while to learn this language, to be honest. (First time I was in hospital, high, psychotic and very suicidal, a fellow patient told me one morning that I looked ‘agitated’…… ‘I don’t get fucking agitated!’ I yelled – ‘agitated is a word that consultant psychiatrists use – not me!… ). But once you establish the groundwork you can then use language to best express how you’re doing – and expression is everything. Shared language leads to shared thought, shared experience, a breaking down of barriers. I’ve always felt that my job as a psychiatric ‘patient’ is to communicate as best I can from my side of the fence over to others who are trying to help me.
So which should it be? Should we take care of using labels because they define a ‘normal’ that doesn’t exist and make us feel separate from our fellow suffering human beings, or should we embrace the fact that it can allow us better use of language to bring ourselves together and cross divides? I think it’s both. But only if we address ourselves to what we’re doing when we apply a label, and why we’re doing it. Labels should be applied as a way of defining what we need – not what we are, and definitely not as a way of defining some ‘normal‘ that we should all be aiming for (there’s a great amount of despair to be had in aiming for ‘normal’ – for anyone with or without a psychiatric diagnosis….). A label should be part of a conversation that’s entirely individual about where the difficulties are, and what can best be done to try and alleviate them.
When I started in psychiatry the aim of the team was very clearly to get me back to my ‘pre-morbid functioning’ – back to work as a doctor – back to ‘normal’. This proved impossible, and I’m grateful to say now, that I do have this conversation with the team – the diagnoses are now in fact far less important than the discussion about need, and how best to address it.
And inclusivity? That’s just about humanity. We all have that – regardless of what other labels we pick up along the way.