-- What is a psychiatric or mental health disorder? --

There are times when we all feel sad, worry, or have difficulty concentrating, and it can be challenging at times to know if you or a loved one is experiencing a normal reaction to life’s ups and downs, or has developed a problem that would rise to the level of a diagnosis.

Mental health diagnoses such as depression, ADHD, or obsessive-compulsive disorder, are made when a person has a certain number of specific behavioral symptoms that are causing a problem in some aspect of their life. The criteria for these diagnoses are set by the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM), which is currently on the fifth edition. Simply put, we use diagnostic labels to describe sets of symptoms that frequently present together.
 
Clusters of symptoms that we label with a specific diagnosis are thought to reflect problems in a specific brain region or network, have a similar cause, or benefit from similar treatments. Using labels is essential for advancing research. Defining a problem is the first step in figuring out the cause and solution. Labels can also be helpful for decisions about whether a person qualifies for certain legal entitlements such as disability benefits or school accommodations.  For many people, having a name to their problem can be very validating and can help them feel less isolated in their challenges.
 
However, our labels are not perfect. This imperfection reflects the incredible complexity of the human brain and behavior. Labels suggest a binary state where someone has a disorder or doesn’t, which rarely exists.  Labels can become self-reinforcing such that the person now defines their identity with the label. For example, a learning disability may be viewed, erroneously, to justify not pursuing a certain educational or occupational goal (“I have dyslexia so I’ll never be a doctor”).  Labels can be used to de-humanize people such that one’s entire lived experience is now explained away with the label. Consider these parallel descriptions for the same sets of behaviors:
 
“She was an eccentric, creative thinker with seemingly boundless energy who experienced life to its fullest with deep sorrows and great joys.”
 
“She was diagnosed with bipolar disorder at age 18 and continued to experience symptoms across her life.”
 
These labels have societal implications. Having a certain diagnostic label can be a gatekeeper for treatments, legal protections, and financial benefits and bias can creep into how such labels are applied. Diagnoses can be used to justify discrimination and pathologize normal variability, particularly when providers do not acknowledge the impact of dominant cultural narratives and expectations. Inadequate training and experience can intensify this effect.   
 
Ultimately, a diagnosis is only one (often imperfect) way to describe a specific set of behaviors. As a neuropsychologist, I prefer to think in terms of strengths and weaknesses. Often times, the solution is not in getting rid of a “symptom.” Rather, by accepting one’s unique brain “fingerprint,” one can turn a perceived weakness into a source of resilience.