I decided to write a few different profiles of hypothetical people to try to explain why self-diagnosis is important. I also wanted to illustrate how your gender, race and class, can impact access to mental healthcare. I used stock images just to give a face to these hypothetical people. Understand that people like them exist in the real world and many of the stories here have some details from real stories. What I want to show is how self diagnosis can help people or in some cases be the only resource they have. My other point is that self diagnosis doesn’t usually do harm, even when it’s wrong, but shaming self diagnosis or taking away a disabled person’s agency DOES.
If I got anything wrong when writing about groups I don’t belong to, please let me know.
TW for discussion of self harm, suicide, ableism, racism, transmisogyny, misgendering, alcohol and mental illness
Jacob is a white man in his early twenties from a middle class background who feels really down since he lost his first job. He figures that it’s just disappointment from unemployment, but he stops looking for work. He starts sleeping in more and more. He starts eating hardly anything. He also stops showering and lets his hair grow out and it becomes matted. Eventually a friend intervenes, helps him clean his house, gets him to get a hair cut and gets him a job at another place, but Jacob just doesn’t have the energy to go most days and figures he’ll just be fired again because he feels worthless. He loses the job and blames himself. He starts drinking a lot because it’s the only thing that helps. One day he starts to wonder if maybe not everything is his fault. He starts researching depression. Several months later, even though he’s afraid to say it, he mentions to a friend that he might have depression, but his friend says that Jacob just needs to get back on his feet and stop blaming other things for his problems. Jacob wishes he never brought it up. He believes his friend is right and stops looking into it. He could have gotten healthcare, but because he thinks he doesn’t need it, and begins drinking more. Things worsen for him.
Thanh is a Vietnamese-American teenager from a middle class background who has, for as long as he can remember, not really understood what people mean when they say they experience joy. He has always had a hard time ever feeling confidence in himself. Sometimes, he just cries for no reason and doesn’t know why. Other times he thinks about dying. He is the oldest sibling in a big family and has had a lot of responsibilities caring for his younger siblings. Sometimes he doesn’t have the energy, but his family doesn’t understand. One day when he tells a friend about this and she tells him it sounds like depression to her. He looks into it and it sounds a lot like him. After researching for about a year, he self-diagnoses as having depression. He decides to see the school councilor and gets a referral to get therapy. His family has insurance, so he is able to see a psychologist in the long term. After time, Thanh starts doing a lot better. Even though his family still doesn’t understand, he knows his own limits better and the talk therapy and medication help.
Renisha is a working class Black woman. She is a young adult juggling night classes to become a nurse while working as a store clerk to help support her parents and siblings. Lately, she has started having weird thoughts about sexual and violent things that frighten her. She would never do these things, but the images and thoughts incessantly repeat in her mind. She has to wash her hands many times to make them go away. She also checks the stove and locks ten to twenty times before leaving the house, which has made her late to work before. She is also very anxious about germs in the house and will sometimes become convinced a table needs cleaning multiple times. Her parents and siblings thing she’s “weird” and a “gemaphobe” and sometimes make fun of her for it. One day, Renisha sees a post by someone on tumblr who describes having symptoms like these and says they have OCD. Renisha talks to them about it and starts researching. She realizes she has OCD too, but she can’t get help because her family doesn’t have insurance and they can’t afford it. She joins OCD forums and learns about cognitive therapy and tries some of the thought techniques. They help her cope with her symptoms. She wishes she could see a professional, but now she is glad to know she is not a freak or bad person and has coping mechanisms.
Ankur is a nonbinary Indian-American from a working class background who qualifies for medicare and has been seeing a psychologist for a while now because they have been really depressed. What they haven’t told their psychaitrist is that they also get so angry sometimes that they have gotten in physical fights with people for no reason. They also haven’t mentioned that they experience bouts of dissociation where they feel detached from themselves. Also, none of their friendships seem to last and their emotions change at the drop of a hat. One day, Ankur has the bravery to bring this up in therapy. The psychiatrist tells Ankur that depression can manifest in lack of self control and anger. Ankur starts to do some research and begins to look into Borderline Personality Disorder. Ankur brings this up to the psychologist, but the psychologist dismisses this out of hand because he believes that people with BPD are manipulative, deceitful, and risk taking which doesn’t describe Ankur—there is a lot of stigma that comes with BPD and the psychologist has bought into it. Ankur continues taking the medication the psychologist gives them even though it doesn’t work. Ankur figures that an expert would know better than they would.
Marisol is a Mexican American trans woman from a middle class background who works from home and has been feeling so anxious she doesn’t leave her house much. She is read as a woman nearly 100% of the time and lives in a very LGBT friendly place, but she still feels an incredible amount of anxiety, even at trans gatherings. Being in crowds makes her feel like she is having a heart attack. She doesn’t know what’s wrong. Her friends think she’s shy or insecure and pressure her to get out more, but if they push her to go out when she doesn’t want to, she just starts having trouble breathing and freaks out. Finally, Marisol starts to do some research, and starts looking into agoraphobia, social anxiety and panic attacks. She does a lot of research for many months, looking at the different details. She realizes that she has agoraphobia. The one time she talked to a therapist when her father died years ago, she was misgendered and the therapist acted like her gender was a pathological symptom. Marisol has a panic attack just thinking about seeing another mental healthcare professional and realizes she can’t see anyone at this point in her life. Knowing she has agoraphobia doesn’t make Marisol’s symptoms improve, but she now knows what’s going on and can tell her friends so they understand. She determines ways to work with her condition. If she hadn’t known, she would have continued blaming herself for being inactive and pushed herself when she wasn’t able to.
Bridget is a white upper class woman with a lot of issues around anxiety. She can’t figure out why she never feels at peace. She is always anxious, now matter how good her life his going. Right now, she is engaged to be married and has a stable job as a chemist at a prestigious university. But no matter how good things are, she can’t sleep, and when it’s really bad, she doesn’t eat. Sometimes she feels so anxious she can barely breathe. One day she tells her sister about this, and her sister brings up anxiety disorders. She starts doing research and begins to think she has Pure OCD because she has repetitive thoughts and worries about things, like questioning whether she loves her fiance or obsessing over the idea she chose the wrong career, and OCD involves repetitive, irrational negative thoughts. Bridget reads into cognitive therapy around dealing with looping thoughts and it helps somewhat, but her anxiety is overwhelming. Finally, she sees a mental healthcare professional because she has good insurance and the psychologist diagnoses her with Generalized Anxiety Disorder. Bridget was wrong about her condition, but the self-diagnosis got her to take some steps to cope and to finally seek professional help. Before looking into it, she just thought she was a “high strung person” and needed to stop sweating the small stuff. Now she is doing better.
Hanako is a Japanese American from a working class background who has always had a hard time making friends. Sometimes she finds that she can’t put words to her thoughts or feelings. When people are sarcastic, she usually doesn’t get it. When people around her are laughing at a joke a teacher made at school, she often gets confused. A lot of the time she can’t read people’s emotions. Most of her peers, who are white, think it’s because she’s Asian and doesn’t speak English well or there’s a cultural barrier. But Hanako was born in the United States. Also, Hanako is really good at memorizing facts in history class and often aces the tests, but people call her the r-word because sometimes she makes strange noises or starts rocking back and forth in class. Her parents take her to a doctor, who dismisses Hanako’s issues as being shy and unsociable. The doctor is white and unconsciously draws from stereotypes she has of Asians. The parents aren’t convinced, but they don’t have the time and money to keep seeing doctors. Hanako works very hard through school. She gets into college on a scholarship, but feels unprepared: no one else in her family has gone. In college, her issues make things harder: she makes no friends and sometimes she’s mute in class when called on or can’t articulate herself well, so she stops participating and her grades suffer. When she sees a few different psychologists on her college campus, they say the same things her doctor said. Because Hanako can’t get an official diagnosis for anything, she blames herself, struggling in school and with relationships and not knowing why. She drops out of school and never seeks mental healthcare again.