I’ve written about this several times, but never said it quite this directly: No one is a diagnosis. No one fits the criteria for “bipolar” or “depression” exactly. No one is a “Patient Like You.” It’s why someone only has to have five out of eight characteristics to be diagnosed with depression. Because there is recognition within the medical community that “depression” isn’t a single thing, much as “bipolar” isn’t a single thing. Those words represent diagnoses that exist along a spectrum.
In writings elsewhere I have suggested what I call a “dimensional” diagnosis. (And this is probably because I’m a computer science-y kind of gal.) Basically you have symptoms and diagnoses that exist along multiple axes. Then, depending on where the dots cluster, you essentially have a Venn diagram of diagnoses.
It’s OK if you didn’t quite follow that. I know. It’s complicated.
But humans are complicated creatures. I like chocolate ice cream, you like vanilla. Humans are a heterogeneous bunch.
Why then, if we understand this, do we have names in the first place? Is the term “bipolar” really even useful?
In short, yes, it is. And yes, we need those labels, even if they are ill-fitting.
One Size Doesn’t Fit All
When a woman goes and tries on a dress she picks a size. Let’s say size 10. But size 10 is different to every designer. Some lines have a tiny size 10 while others have a large size 10. But every label says size 10. And women generally know to bring two or three dress sizes into the change room.
But the label “size 10” still exists even though no one can agree on what it actually means. Women will say they are a size 10 even though sizes 8 – 12 exist in their closet.
So should the size label be removed just because you never know if it’s going to fit?
I would suggest no. Removing the label would simply remove our ability to talk to each other.
“Yes, I would like to order 25 dresses in size, um, you know, the ones that will fit most people.”
Ah, yes, that would improve the situation dramatically. Who knows how many dresses you’d have to take into the change room then?
People with “Depression” or “Bipolar” Aren’t All the Same
And naturally, a dress size is infinitely easier to quantify than the human psyche. There is no 38 – 29 – 40 in your brain.
So the fact that “depression” means many things isn’t surprising in the least. So does “cancer.” So does “epilepsy.” But we still have those words.
People need a way of talking to each other. “Oh, you have a mental illness? I have a mental illness.” Of course, if neither of them has names it’s tough to say anything else.
Clusters of symptoms represent diseases. Always have and always will.
Our understanding of the human brain will get better and maybe one day we’ll be able to say, “I suffer from an X deficiency,” or, “I have a Y malformation.” That would be more accurate and helpful, but not possible right now.
You Don’t Have to Agree with a Diagnosis for it to Matter
And it really doesn’t matter what people call you as in it doesn’t affect your illness. What diagnosis they officially put on your paperwork doesn’t change your symptoms. The treatment is still going to be trial and error anyway. But with that “name,” however murky, doctors have a place to start with your treatment.
It’s important to know whether to start treatment with an antidepressant or a mood stabilizer or an antipsychotic. Actually, it’s critical, because making the wrong choice can produce all sorts of nasty effects. And if we can’t talk to each other about a disease, and if we can’t share knowledge about a disease, then we will never be able to make that determination.
True, it may turn out to be wrong. You may have a case of depression that responds better to an antipsychotic than to an antidepressant, but at least knowing you are “depressed” gives us a place to start.
You, personally, may not identify with one diagnosis or another. And they may put multiple diagnoses on your paperwork in an effort to clarify to other practitioners what they’re seeing. None of that changes who you are, but it still matters. Because research on “Natasha’s disorder” is pretty tough to find but research on bipolar disorder is much easier.
We Are Not Our Diagnosis, But We Still Need One
We can all recognize beyond a shadow of a doubt that we are all individuals, but that still doesn’t negate the need for categorization. We need to be able to talk to each other and we need to be able to do research and evaluate treatments. Without labels, we can’t do any of that.