Author’s Note: This article is not intended to shame those who have self-diagnosed themselves, but rather to examine the usefulness and appropriateness of self-diagnosis in treating mental illness.
Have you heard someone get frustrated at someone else’s rude behaviour, only to explain it by saying that they’re a narcissist? Or have you ever been frustrated by someone’s inattention only for them to claim they have ADD and laugh it off? I believe that terms for mental disorders have become confusing because they are not always used in reference to the disorder, but as a way to describe normal personality traits. This, in turn, has led to a slippery slope where the meaning has become clouded, and with the availability of information on the internet, people are more willing than ever to diagnose themselves. In this article, I aim to examine the implications of self-diagnosis and the effect it could have on medical treatment, and question the causes and effects of self-diagnosis in a social commentary.
First, I must admit that self-diagnosis is a personal topic for me as I have slipped into the trap of self-diagnosing at times in the past and have not seen any positive results–only an increase in anxiety. That isn’t to say someone else wouldn’t be able to use their diagnosis as a way to seek treatment, but I self-diagnosed in an unhealthy manner.
A Personal Account
Going back two summers ago, to 2013, I had been experiencing strong feelings of anxiety for several months. Prior to this, I could confidently say that anxiety had never been an issue for me, so the onset of anxiety was not only uncomfortable, but cause for worry in and of itself. It is hard for me to truly recall all of the thoughts in my head, as the worries would come and go, to be replaced by other worries, until the original worries came back, repeating the cycle again. I was working in a job that I hated, barely scraping by financially, and often going days only eating off-tasting peanut butter from the dollar store. The job, working as a line cook in an established gourmet burger restaurant, caused the most stress as I adapted to a new work environment and learned how to work as a cook, a role in which I had no prior experience and was hired as a favour of a friend who managed the place. I was teased at times and belittled as I struggled to work on my performance, comparing myself to several others who had worked there for years. My anxiety grew as the harsh words of others weighed on my mind, making me question my functionality as a person. I began taking antidepressants, but they had no real effect on me–I felt the side effects but none of the benefits. I shambled by day to day as a stressed bundle of nerves. I knew of anxiety, but the failure of my purely pharmaceutical treatment made me re-evaluate myself and determine with absolute certainty that something was wrong with me as a person.
The months went on; I kept working and returned to my final year of school to finish a small number of credits that would get me my honours degree. The demands of work and my increasing anxiety made it difficult to muster the energy and motivation to go to class, and I gradually went less and less until I didn’t go at all. I knew something was wrong with me. I questioned what it was about me that left me unable to meet the demands of life, and I felt a great amount of stress as I saw friends and classmates accomplish what I just wasn’t able to do at the time. This is where I fell into the trap of self-diagnosis. I knew something must be wrong with me, so rather than stress about how I couldn’t measure up to others, I began seeking a diagnosis, something that would explain why I was unable to cope. Now, all of the times I got bored in class and became inattentive served as evidence that I might have ADD. If someone moved something at work and or made a mess and I felt bothered, it made me think I had begun showing signs of OCD. My natural shyness and gullibility, compounded with higher than average intelligence, nerdiness, and underdeveloped social skills, convinced me that I had found the final diagnosis: Asperger’s–or maybe social anxiety, but probably Asperger’s. The latter culminated in a heated family discussion at Christmas dinner where I resentfully told everyone of my ‘condition’ and then proceeded to diagnosis other family members with Asperger’s and other psychiatric conditions. Looking back, I am definitely embarrassed that I could be so arrogant to start handing out diagnoses like I was a trained psychologist, but the embarrassment is checked by the fact I understand what led me to that point, and I can forgive myself for the human error with a more realistic understanding of the situation.
The following summer, of 2014, I experienced less severe anxiety and had mostly solved problems my problems at work. I had worked on my cooking skills with a fervor, to the point that I was untouchable because I was able to perform better than the people that had teased me in the first place. I had always thought that I would be happy when I hit that point, that perfection would afford me the peace I had wanted from the start. I was wrong. For a period of a couple weeks, I began to get drunk every night as a way of relieving my stress, leading to my self-diagnosis as an alcoholic. I quit drinking, and quit the job, which did a lot to make me feel better, but I still faced feelings of anxiety. It was at this time that I finally saw the doctor again. I didn’t know what to do; for all of my different diagnoses, I didn’t feel any better and certainly didn’t use the knowledge to make myself feel better. Instead, I just focused on what was wrong with me, feeling a bit of relief that I could put a label on it, though it was still a preoccupation of my thoughts. I finally gave in and saw a doctor, who, after a lengthy chat, told me that I had generalized anxiety disorder. I doubted the validity of his diagnosis–it was more mild than what I felt I was experiencing and didn’t correspond with the more serious disorders I had diagnosed myself with. I began antidepressants again, and to my surprise, they worked, and I felt like an entirely new person. I accepted the doctor’s opinion that I suffered from GAD and kept taking my medication. I took them for a while, but with a fresher and more realistic approach, I was able to come off the medication and treat any anxiety that would occasionally come rearing its head by adjusting my coping methods.
What led me down such a wayward path in the first place? Looking back, it is easy to see that I felt stress from everything in life–from schooling, from family, from work and from personal relationships. It was my first time living away from home, and I was not adjusted, having being babied as the youngest son. When faced with demands greater than what I was used to, I recoiled, and reflected upon the situation, always determining something must be wrong with me. Instead of changing things up, like working less to make more time for school and relaxation, I looked for an answer, a diagnosis that could excuse my behaviour and make me feel like less of a failure. I compared myself to others and climbed deeper and deeper into a hole of anxiety. I would play video games instead of facing the things that stressed me, to the extent that I would feel more anxiety because I let more and more responsibilities pile up and didn’t know how to face them. My coping methods were bad, and my life suffered. It was only when I was able to open up and ask for help that things got better–when I let my emotions out, rather than hold them inside to fester and multiply. I got googled.
Self-Diagnosis VS Traditional Diagnosis
Why wasn’t I in a good position to be diagnosing myself?
An important factor to consider in self-diagnosis is psychological distance, which can be understood as thinking in terms of the self versus the other. When people are presented with a set of symptoms, they would be more likely to diagnose themselves with something more serious than if they were trying to diagnose a stranger. This is because of the level of worry; people tend to worry more about themselves and assume the worst, placing more emphasis on negatives rather than on other factors which could ‘soften’ the diagnosis. When a diagnosis is made on psychological health matters, someone is often experiencing a degree of anxiety/worry, which inevitably makes them more prone to assume the worst if they’re the one making the diagnosis. For a more accurate diagnosis, you need to see yourself through a mirror, to be further removed. This is an advantage, as you can realistically look at symptoms and what they might mean; hence, a doctor is able to examine one more impartially than they could themselves.
The available resources on the internet can be questionable, too. Upon typing “Am I Bipolar?” into Google, one will find some articles about the disorder, as well as a list of symptoms and several quizzes that are meant to help screen for Bipolarism. I took the liberty of examining a test called the “Goldberg Bipolar Screening Questionnaire” from counsellingresource.com, a website titling itself as a mental health library. A few questions are:
“At times I am much more talkative or speak much faster than normal”
“At times I have been more active or did more things than usual”
“My confidence ranges from great self-doubt to equally great over confidence”
I could answer yes to all of those questions, but I do not have Bipolar Disorder. To be more active or less active could merely be fluxuating moods or a change in lifestyle. One suspecting they may have Bipolar Disorder may be inclined to take a test and determine they do have the disorder when the results come back positive, though many of the questions are vague and could be explained logically in a way that does not account for the disorder. A doctor may use a test like this, but rather than use it to make a diagnosis, it would be used as a screening tool, to help the doctor figure out what questions to ask when trying to arrive at a diagnosis.
There is the obvious issue of training, knowledge and experience when it comes to diagnosis. While someone experiencing symptoms will have a good understanding of the symptoms and perhaps has read about an illness they can connect with, a doctor will have a greater understanding of how the symptoms fit into different illnesses, as well as experience treating the condition in question, although this can vary depending on rarity. Diseases often have many subtleties that can’t be fully comprehended by a list of symptoms, but involve more nuanced behavioural tendencies. For instance, mood swings are a symptom of many diseases; they are part of Bipolar Disorder, Borderline Personality Disorder, and major depression. A doctor specializing in mood disorders would have the knowledge (from reputable sources) to know which questions to ask in order to differentiate between disorders and determine treatment, while the patient may be armed with only a symptom checklist from Google in hand.
Diagnosis of the self has potentially dangerous consequences if the diagnosis is wrong. Psychiatric disorders share symptoms with each other (irritability, insomnia and lethargy to name a few), but they can also share symptoms with medical diseases. For example, hyperthyroidism and pneumonia both share anxiety and depression as a symptom, and while one could probably distinguish pneumonia because of the other physical symptoms, treating hyperthyroidism as if it were depression would lead to ignoring other physical symptoms.
Furthermore, what is the usefulness of a mental health self-diagnosis? Being diagnosed by a doctor would give one the means to get a prescription, or to be referred to a therapist, but someone diagnosing themselves at home either has to decide if they want to see a doctor, who would perform their own diagnosis and decide on treatment, or try and work it out themselves. For example, someone who thinks they may have depression may choose to treat themselves through natural remedies such as exercise, eating healthier and getting enough sleep, which are all good habits regardless of depression or not, and would consequently feel better. At the same time, if the person in question actually had Bipolar Disorder, they would still experience feelings of hypermania, even if the depression wasn’t bothering them anymore. Seeing a doctor is a necessity when dealing with mental health issues in order to try and treat them as effectively and thoroughly as possible.
In a reversal of the aforementioned situation, someone could potentially diagnose themselves with Bipolar Disorder when they realistically are only suffering from depression. In a situation like that, without treatment, the self-diagnosis would only serve to increase anxiety, as one ruminates on their affliction without doing anything about it. Seeing a doctor would help this person to frame their problems in more realistic terms and help them treat their issues, but if they made the decision to handle their disorder on their own then they may spend a lot of time overthinking the problem and therefore take a lot longer to recover. That is speaking from personal experience, however, and I can’t claim that every single person would follow in my footsteps.
Why is it that people self-diagnose when mental health resources are more abundant than ever?
A Social Commentary
I believe society plays a large part in that. In school or the workplace and certainly in the media, we are bombarded with stories of actualized self-starters who are able to accomplish anything they try. Whether or not they are portrayed as perfect, the average person is bound to accept that certain people are superior in ability and capability, while on the other hand, we are raised with the idea that everyone is equal and that we can be anything we want to be–an idealization of human perfection becomes entwined in the fabric of our existence. In North America, conformity/similarity has become a virtue, and so when people deviate from the norm in substantial ways, whether that is not feeling as socially adept as other people or preferring a quiet evening reading over a ‘fun’, boisterous party, we perceive our difference as making us less, because it’s easy to look around campus or the workplace and see that fitting in is good and being different is bad. When a person, especially yourself, acts in surprising ways, adopting behaviours we would deem negative, it is easy to fall back on popularized terms to describe them.
A thoughtful article on the rising prevalence of Autism Spectrum diagnoses illustrates the colloquialism psychological terms have undergone:
Not that Nugent himself is always rigorous in applying the label to others. “When I get mad at someone I have a retail interaction with, like if I’m attempting to buy a shirt from someone who doesn’t understand what I’m saying, later I’ll say, ‘That guy was kind of Asperger’s-y. It means: not sensitive to my needs. I’m guilty of using the term in a sloppy vernacular way like everyone else.” (Wallace, 2014)
How many times have you observed someone with a high preference for order and neatness and thought to yourself, “that guy is so OCD”? Psychological terms and disorders have become commonplace in describing people that act in ways that deviate from societal norms or in ways that one may find personally unappealing. The common usage of these terms undermines the seriousness of the mental disorders in question and simultaneously shrouds the severity of a diagnosis in mystery. If we apply the label of OCD to someone that feels a need to have their DVDs arranged in alphabetical order, then the person, whom always checks their car wheels for blood to assure they haven’t hurt anybody, is inevitably short changed. This is not problematic in a sort of competitive way, where whoever has the worst symptoms is ‘the most authentic’, but rather that someone who likes orderliness may go on to assume they have OCD, when it is really just a regularly occurring personality trait.
The previously mentioned article on Autism goes on to describe the increased demand for psychological evaluations for Asperger’s when the diagnosis became popular, as well as examining the claims of those who have self-diagnosed themselves with the disorder. The author describes many claims from wives, convinced that their husband must have Asperger’s because of their inattentive or emotionally lacking behaviour, as well as husbands whom the author felt only wanted a diagnosis as a convenient excuse. The most convincing piece of speculation that self-diagnosis has become a cultural Phenomenon, however, is the author’s visit to a group meeting of people with Asperger’s:
It’s a largely male, mostly white group, ranging from a teenager to people in their sixties. They seem afflicted, or visibly off, to different degrees. Some appear to be straight-up [Neuro-Typicals]. Some, shorts hiked high, look like central-casting nerds. A handful have strange affects: A young Orthodox Jewish man in his late twenties smiles to himself, and another young man holds his hands near his chest, silent and fidgeting. Many, though, are smiling and socializing. “I like your forest shirt,” one man says to a taciturn man named Gabe, who wears a green polo shirt patterned with trees. (2014)
The author describes a variety of the people in this group, some that are easily distinguished as being on the spectrum, and others that appear completely normal. The validity of their diagnoses is not the point of this quote, but rather the image that it paints of a group of people who generally feel like outsiders among the rest of society, meeting and appreciating the differences they all share. With the author’s assertion that some people seem completely normal, one can be led to question why they might be there. I believe that in a society that encourages similarity, people outside the norm are pushed to find a label, even a disorder, that might explain why they are not the cardboard cut-out that they feel like they are expected to be. The diagnosis is their shield–if I have Asperger’s, then my social deficits aren’t my fault; I was just born that way. Such a diagnosis may bring one comfort because of the feelings of acceptance it invokes, but at the same time, it turns the disorder from a medical issue to a banner of identity. The usage of terms in such a way blurs the line between Psychology as a science and Psychology as a means for knowing oneself.
Looking back at my thoughts on Psychological disorders as an identity and the increasing trend of self-diagnosis, I would conclude that Psychology is crossing more into the mainstream, credited by the modern information age that makes it easier than ever to look up symptoms and apply them to yourself. If people want to use a disorder like Asperger’s as a way to identify themselves and feel a sense of community, I’m not going to condemn them for it. Browsing forums at Wrongplanet.net, it is apparent that the label of Asperger’s has brought many people peace and a more somber perspective of their lives, even if they never talk to a doctor about it. Psychology may be experiencing an overlap right now as it serves a social function in addition to its medical function, and this can be confusing to decipher, but one thing isn’t–if you are suffering you should see a doctor. Accessible information may make it easier to do any number of things (read: build your own robot), but the training and experience of a doctor can never be replaced by reading a few articles.
I’ll leave you with a question: with the prevalence of disorders being placed onto spectrums of severity, do you think that some disorders may be the case of normal personality traits being possessed in unhealthy levels that lead to anxiety and the development of problems surrounding said traits? With proper parenting and social acceptance is it possible that people could simply possess high levels of a certain personality trait without it progressing into a disorder?
Edited by: Kim Rooney
Goldberg I. Goldberg Bipolar Screening Questionnaire, A Screen Test For Bipolar Spectrum Disorders. http://counsellingresource.com/lib/quizzes/bipolar-testing/goldberg-bipolar/
Pillay S. (2012). The Dangers of Self Diagnosis. Debunking Myths of the Mind. https://www.psychologytoday.com/blog/debunking-myths-the-mind/201005/the-dangers-self-diagnosis
Wallace B. (2014). Autism Spectrum: Are You On It? http://nymag.com/news/features/autism-spectrum-2012-11/
Wells-Moran J., Dombeck M. (2014). Risks of Self Diagnosis. Seven Counties Services, Inc. http://www.pvmhmr.org/353-self-help-book/article/9661-diagnosis-vs-self-diagnosis