Originally posted 2017-10-16 14:53:40.
Sometimes I hop on the r/MentalHealth subreddit to see what kind of questions people are asking. It’s a good source of inspiration for article ideas.
For the most part, it’s a helpful thread where the depressed and lonely ask for help and validation from perfect strangers and those strangers, in turn, say encouraging things.
But it’s also a place where the untrained go to diagnose one other. I guess because it’s so easy a caveman could do it.
After all, aren’t mental health diagnoses just a checklist of symptoms?
If they’re not doing this on Reddit, they’re most certainly using Google. If you search for “what is my mental health diagnosis,” Google will return over one BILLION results.
And while I’m sure every one of those entries is super accurate, maybe it’s a good idea to stop using the internet for self-diagnosis.
If you struggle with a mental illness, you need to see a professional. Learn all you want about various conditions and treatments, but have a licensed clinician do a complete bio-psycho-social on you so they can make an accurate assessment.
You’d do the same for your car if it was acting up. Surely you have a similar amount of respect for your brain.
Here’s the problem:
Google didn’t go to graduate school. Google doesn’t have a professional license. Google doesn’t answer to clinical supervisors or ethics boards, nor does it take a nuanced and contextual approach to case conceptualization and diagnosis.
It just kinda spits out data based on algorithms and ad revenue. And while its algorithms are actually pretty spectacular, you can’t really overstate the degree to which advertising revenue influences things.
So Google, in this regard, cannot be trusted. And frankly, neither can your judgment. And that’s because you’re not looking at yourself objectively.
Misdiagnosis And Self-Diagnosis
It’s not just self-diagnosis that’s the problem. Often, the problem starts with misdiagnosis by medical professionals who should know better.
ER doctors are some of the worst offenders. Having an M.D. behind your name does not make you an expert in psychiatry.
If you’re a psychiatrist, that’s another story. But an internist or a trauma surgeon or a resident — sorry, no. Not without requisite training.
I talk to patients all the time who were labeled by doctors as having one thing when clearly they did not.
It’s no wonder people look to Google for answers.
I used to work at an opiate treatment facility. As part of my job, I performed comprehensive clinical assessments on new clients. That’s where you gather a bunch of information so you can make an objective diagnosis of their presenting conditions.
One day I met a woman in her early 20’s who told me an interesting story. At the conclusion of a 5-day meth-binge, she had been admitted to the local ER, because she was, to use her words, “acting like a god damned psycho.” After all, five days with no sleep would do that to any of us. Also, the crank didn’t help matters, either.
So this young ER doc diagnoses this girl with Bipolar Disorder Type I and writes her scripts for olanzapine, aripiprazole, and ziprasidone (these are antipsychotics) and sends her on her way.
It’s standard practice for the ER to run a tox screen in a situation like that. I have no idea if they did. All I do know is that she left the ER with three powerful medications to treat a mental disorder she didn’t even have. Just because you get high doesn’t mean you are mentally ill.
A month later, she shows up in my office with track marks on her arms and a Ziploc back of unused medication in her hands, claiming that she has bipolar disorder.
Our conversation then went something like this:
Young Lady: I have bipolar disorder.
Me: I see. Do you take medication for bipolar disorder?
Young Lady: Nope, never have. The ER gave me meds but I don’t take them.
Me: Ok. Tell me about your symptoms.
Young Lady: Like what?
Me: Oh, the usual. Severe bouts of mania followed by horrific bouts of despair. Delusional thinking. Psychosis.
Young lady: Oh no, nothing like that. I get crazy when I’m high but that’s it.
Me: Congratulations, it’s unlikely you have bipolar disorder.
So I sent her to see our staff psychiatrist, who said the same thing I did. And when this young girl joined my substance abuse group, the bipolar diagnosis never came up again. She was totally fine once she got the meth out of her system.
You see, the first thing you’re supposed to do before making a mental health diagnosis is to eliminate and physical or medical conditions that might be the real culprit. By any measure, five days with no sleep, plus IV methamphetamine use, constitutes a significant medical condition.
The bottom line? That ER doc should never have slapped her with that label.
And that wasn’t an isolated event. Over the years, I’d say north of 60% of my clients who reported a diagnosis of bipolar had received said diagnosis when they were high.
The other 40%?
Some were told they were bipolar by family members and friends. a few had a legitimate diagnosis. But most had diagnosed themselves with the help of Google. And they were almost never correct.
Here’s a video PsychCentral published about self-diagnosis of mental illness:
Regarding mental health diagnoses — here’s a good rule of thumb. If you have more than three diagnoses, whoever diagnosed you has no idea what they are doing. Especially if that person is you.
It’s considered a best practice for clinicians to find the one (maybe two) diagnosis that best explains the majority of presenting symptoms. Sometimes you can’t do that, but it’s a target to shoot for. Here’s a common scenario:
A patient is sexually abused as a child. As an adult, they struggle with depression, social anxiety and difficulty concentrating. They hop on Google, read some articles, and determine they have Major Depressive Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, and ADHD.
There are two problems here.
First, one diagnosis easily accounts for all those symptoms— PTSD. The presence of trauma. Depressed mood. Anxious thoughts. Can’t sit still. Can’t concentrate. These are things you see when you work with patients who struggle with PTSD.
Second, the treatments for those four disorders vary wildly. You don’t give a patient with GAD a stimulant like Adderall. You don’t do trauma work with a patient who has ADHD. You don’t just treat the depression if you’re dealing with PTSD. And so on and so forth.
This, of course, is just one example of a specific situation with a specific set of criteria. In general, though, self-diagnosis is always going to cause problems. Here are three reasons why:
First, diagnosis is more than just a collection of symptoms.
It’s fine if diligent research prompts you to seek out professional help, but giving yourself a label is counter-productive. Labels weigh us down. Labels add pressure.
But the bigger issue here is that people can’t decide with any level of objectivity what criteria do and do not apply to them. And even if they could, a diagnosis is more than just a checklist of symptoms.
Take something like Post-Traumatic Stress Disorder. Look at the graphic below and you’ll see some of the diagnostic criteria.
Auditory hallucinations or paranoid ideation are two symptoms commonly seen in people suffering from PTSD, but you won’t find them on any list of criteria. They are associated features, but that’s not at all obvious if all you do is read the criteria.
Diagnosis is more than just a checklist of symptoms. If that’s all it was, people like me wouldn’t have to go to school for three hundred years to learn how to do it.
Second, professional objectivity is critical for proper diagnosis.
This is the definition of “objectivity,” according to Merriam-Webster:
Expressing or dealing with facts or conditions as perceived without distortion by personal feelings, prejudices, or interpretations.
The very definition of objectivity precludes self-diagnosis. After all, you’re talking about yourself when you self-diagnose. That sort of thing is, by definition, distorted by personal feelings and prejudices.
You are not a dispassionate third-party observer. You are not far enough removed to avoid subjective interpretation. You’ve got skin in the game. Your judgment is impaired.
Third, correctly diagnosing people is hard.
As I’ve mentioned before, doctors and other healthcare professionals screw it up all the time. So do I. So does everyone from time to time.
If you don’t have the proper training and experience, avoid self-diagnosis. And even if you do have the training, you still shouldn’t do it.
The Concept Of “Spectrum Disorders”
One of the big reasons why diagnosis is hard is that all mental disorders exist on a spectrum. Think of a rainbow and all the colors and shades you might see. That’s a spectrum. So, too, are the myriad ways mental disorders can present.
Depression, for example, is not a finite construct. An obvious symptom is a depressed mood, but for many, the chief feature is anger, difficulty concentrating, or irritability. Some people lose weight when they’re depressed. Others gain weight. Some struggle with suicidal ideation and feelings of hopelessness. Others deal with insomnia. Frequency, duration, and intensity are factors to consider as well.
Context is important, too. If your dog just died and you find yourself crying, that is NOT clinical depression. If a bear busts through your tent and starts mauling you, the fear that grabs your heart is NOT a panic disorder.
Nervousness before an important job interview does not constitute generalized anxiety disorder. One instance of fasting does not constitute anorexia.
And the difference between post-traumatic stress and post-traumatic stress disorder is the difference between a pothole and the Grand Canyon.
Disorders, by definition, impair your ability to function, whether it be cognitive, social, psychological, physical, or occupational in nature. If you’re in a car accident and you fear driving for a few days, that’s post-traumatic stress. It’s fairly normal. It’s just a defense mechanism designed to keep you safe.
On the other hand, if you find yourself having flashbacks, avoiding cars and struggling with intrusive thoughts about car crashes to the point where it’s impaired your ability to function, that’s a lot closer to actual PTSD.
While the DSM5 does provide a checklist of criteria for every known mental illness and personality disorder, it’s important to note that people are more than the sum of their symptoms. And while a correct diagnosis can guide treatment, an incorrect label carries with it the unnecessary burden of stigma, shame, and fear.
So much more can and should be part of a mental health diagnosis, which is why I urge my clients to stay away from diagnosing themselves. If it were easy, anyone could do it.
But it’s not about professional pride. It’s about your well-being. It’s about your safety. It’s about your life.
Mental illness is a complicated and serious matter. If you really want answers, get evaluated by a professional.
Don’t mess with self-diagnosis. Use Google for celebrity gossip and movie spoilers. Your life will never, ever be best explained by the results of a search engine.