Saturday, December 19, 2015

Why I'm Against Self DX

Recently I have seen a trend among young people where they are self-diagnosing themselves with Borderline Personality Disorder. Anyone who does not believe is self-diagnosis is labeled at, "ableist." Ableism is discrimination in favor of able bodied people (including the brain). I disagree with both self-diagnosing and that I am ableist because of this belief.

One thing these young people do not seem to understand is the difference between self-advocating and self-diagnosing. They believe that a person who does not believe in self-diagnosing is trying to invalidate them and say that they are lying or faking about something being wrong. This is not the case at all. I fully support young people researching and learning about various mental disorders and using that information to advocate for themselves when they are able to see a professional; or using it as a means of self-care. A lot of self-care for  BPD can be used by people with other disorders  or even by neurotypicals. No one, at least not me, is telling these young people that they are making things up or faking. Before I was officially diagnosed with BPD I did a lot of research, but I never diagnosed myself with it.

That is because I view a diagnosis as something that is official. It is something you can put on a medical record, it is something you can use if you took short term sick leave, and it is something that a Doctor would be able to see on your health records. A person cannot walk into a hospital and say, "I have diagnosed myself with BPD, please put it on my records." The line between educating and speculating and diagnosing seems to be blurred for many young people.

Before I was diagnosed with BPD I was first diagnosed with ADHD and then Bipolar. BPD shares similarities with these disorders as well as Schizophrenia, D.I.D., and other personality disorders. Because of the complexity of BPD it is often difficult to diagnose even for professionals. Though it doesn't seem to be the case for those advocating for self-diagnosis it seems that it could be really easy for someone to read the criteria for BPD and diagnose themselves based on that. Self-diagnosing any mental illness is dangerous least of all because so many symptoms in the DSM overlap. An article about BPD said the following regarding self-diagnosing the disorder;

Although it may seem easy to “self-diagnose,” it is important to know that a valid diagnosis of BPD involves a fairly extensive assessment. This should be done by a professional trained to make valid psychiatric diagnoses, such as a psychologist or a psychiatrist. All too often, I have seen people receive a diagnosis of BPD (sometimes in error) based on a clinician’s impressions after a very brief meeting.

Diagnosing BPD takes time and effort and must be done using methods with scientific support, such as structured diagnostic interviews, during which the clinician asks the patient a set of standardized questions about symptoms and experiences in order to arrive at an accurate diagnosis. Examples of these include the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), or the Diagnostic Interview for Personality Disorders (DIPD). It is important for patients to know that the gold standard way to diagnose BPD includes these structured interviews and that they are much more reliable than the clinician simply asking questions that occur to him/her or using informal impressions to make a diagnosis.
I wish these young people would understand that getting angry at people with a difference of opinion and accusing them of being ableist is hurting the fight to end mental illness stigma. There are certainly times where a difference of opinion is cause for anger ("I believe women deserve to be raped," "abortions should be illegal," "let's kill all the muslims"), but this is not one of them. Getting angry and hurling insults at people who do not believe in self-diagnoses is like calling me an animal hater because I eat meat or saying I hate my best friend because I dislike dark chocolate and she likes it. Ableism, as mentioned before is discriminating against people who are not able bodied. I am not doing this. I am not denying they have some sort of mental illness, I am not stopping them from doing research, and I am not saying that illness could very well be BPD. I am just saying they cannot diagnose themselves.
I've heard the argument from young people that some do not have the means to see a professional and seek an official diagnosis. I understand this, and I pity those people because it's horrible to have to live with an illness and not get proper treatment. I fully encourage them to educate and research in order to provide self-care until they are able to get proper professional treatment. Being ableist, to me, would be telling them that there is nothing wrong with them and discouraging them from caring for themselves. What these young people do not understand is that there are serious instances of ableism out there, and they are getting angry at the wrong people.  Obviously I can only speak for myself, but it seems a lot of them almost want to have an official diagnosis. Which is fine, but they need to understand it has to be done by professional. Unfortunately the problem I seem to keep running into is that young people are picking and focusing on certain phrases and then using that to twist words. If I were to say, "I believe you can think you have a disorder, research it, provide self-care based on that research and self-advocate. However as far as an official diagnosis goes, that is something I believe is able to be put on a medical record," many would react harshly and accuse me of ableism simply because of the second part of the sentence. They would ignore that I am agreeing that they may have BPD, they would ignore my support. This makes me incredibly sad for these young people because they could do so much to help end stigma, but they are attacking the wrong people.
Another issue I have seen is accusations of me being "classist" because I have mentioned my degree. Tell me, who would know more about space? An astronaut who has been through school and training or an 18 year old who reads a lot of books about space? Obviously the astronaut. I have more experience with this disorder because I have lived with it longer. That is not ableist or classist, it's a fact. I had mentioned that I have a Master's degree in Psychology and that is part of the reason I am looking at "diagnosing" from a more professional point of view. This is not classism, and this is not me saying I am better than them. I do not have a degree because I am well off. It took me 10 years and during that time I was almost homeless, struggled to keep jobs, and dealt with many hardships. I do not understand why it is so difficult for these young people to accept a person is more knowledgeable than them. Being so does not equate to me thinking I am better than them. However, if you take someone who has no degree and has only been learning about the disorder for a year or two vs someone with an advanced degree who's officially diagnosed and has been studying the disorder for 8 years; who do you think would be more versed in it? I am more than happy to use my knowledge to help these young people, but it seems as though they are more interested in being part of some BPD clique or hurling accusations. Teaching is important, but it's impossible to teach those who do not want it. 
Young people need to learn who is advocating for them and who is truly against them. I am the former. They must understand that as someone who has studied psychology I personally view diagnosing as an official thing done by professionals. This is not be saying I don't support their self-advocacy or their belief they have BPD. It saddens me that this is all they hear when I explain myself. Think about it this way; Let's say you came up to me limping and said, "I think my ankle is broken." I responded with, "Okay, let's get you to the hospital so we can be sure. If you can put weight on it, it may be just sprain." I am acknowledging the ankle may be broken, taking steps to help the person, but also saying they should find out for sure. I feel many of these young people would get angry if I didn't say, "yes! It's totally broken! Don't go to the Doctor's because you know for sure!" rather than seeing I was supporting them. For those who cannot get professional help for whatever reason, it would would be the difference between me saying, "Um, no you don't have BPD. You're so stupid and don't know anything!" and "I definitely see why you think you have BPD. Just be careful cause it's a difficulty disorder to diagnose. I wouldn't say it officially, but totally self-care based on your findings." Unfortunately all they hear if there's even a slight difference of opinion is, "I don't believe you." This is simply not true.
Lastly, there seems to be many young people who do not want to acknowledge that there are people out there who view BPD as a clique or trendy badge. They do not believe that people want to invade BPD spaces because they think the disorder sounds romantic. Not believing this is ignorant and these kids need to take their blinders off. Because it does happen.
Learn to read intent, learn to look past the surface. Learn who is on your side and don't push them away.

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