I'm not mad, I'm just drawn that way.
Diagnosis should be harder and also not matter as much.
This January, I’m posting a few “get to know me better” pieces.
I am well-studied in mood and personality disorders. I’ve consumed research, articles, textbooks, memoirs, podcasts, documentaries, conference presentations, courses, and various alternative medicine seminars. My interests are both personal and professional. I study the portrayal of trauma and mental health in mainstream media and the complexities of narrative therapy in practice. Multiple members of my family and I have been diagnosed and treated for these disorders, but my research began before any official diagnosis. I felt different so I went looking.
I was a bright child, an early and advanced reader, and I was slotted into the “gifted and talented” side of school by third grade. I was compulsively curious, which made me a good student but also a rebel. I didn't accept facts without proof or rules without reasons. ‘Why’ was my favorite word. ‘What if’ was my favorite story.
Kids can be gifted or different without being mentally disordered. But on the one hand, I knew I could check off a lot of risk factors: adverse childhood experiences, family history and genetics, stressful life events. And on the other hand, I liked labels. Labels and categories and diagnoses are answers. They’re information. They’re ‘why’.
And in the 90s, mental illness was having a moment. Prozac Nation, An Unquiet Mind, and Girl, Interrupted were bestsellers. I’d always loved biographies and memoirs so I devoured these. I saw myself in their pages— and yes, a big part of that was that we were “gifted”, “neurodivergent”, “mentally ill”, “different”, “damaged”, “difficult”, choose-your-own-euphemism. But a bigger part of that was that we were unapologetic about it. We weren’t going to hide it, we were going to wear it. We were going to scream it. We were going to make you buy our book about it.
It was a moment but it wasn’t new. See also Sylvia Plath, Virginia Woolf, Emily Dickinson, and Emily Brontë. See also Ibsen’s Nora and Hawthorne’s Hester and Shakespeare’s Ophelia. It’s not surprising that mental illness was used to explain away and hide away women who didn’t conform to society’s view of womanhood. It’s not surprising that misogyny has been a part of, really the foundation of, psychiatry’s treatment of women from the beginning.
“I thought especially of her uneasy feeling… that if she had continued her labors long enough, all stories would have turned out to be versions of Cinderella—and of my own increasing suspicion…that Cinderella would turn out to be basically all stories.”
—“Narrative Versions, Narrative Theories” by Barbara Herrnstein Smith, Critical Inquiry, Vol. 7, No. 1, On Narrative (Autumn, 1980), pp. 213-236
Susanna: [reading from a book] ‘Borderline Personality Disorder. An instability of self-image, relationships, and mood… uncertain about goals, impulsive in activities that are self-damaging, such as casual sex. Social contrariness and a generally pessimistic attitude are often observed.’ [pauses] Well, that’s me.
Lisa: That’s everybody.
—Girl, Interrupted (1999). Script by James Mangold, Lisa Loomer, and Anna Hamilton Phelan, based on the memoir Girl, Interrupted by Susanna Kaysen, 1993
When I first encountered Histrionic Personality Disorder, I thought it was a new term for Hysteria. ‘Histrionic’ and ‘Hysterical’ are near synonyms. They both indicate an overreaction, a melodramatic response. The difference comes from intent: histrionics present as overemotional, and hysterics are overtly overemotional. This suggests that histrionics control their overly emotional presentation but hysterics cannot hold it back. However, if one has a personality disorder that causes them to present as overemotional— isn’t that the same thing anyway? Aren’t they both the function of a disordered mind?
My confusion grew when I got to Borderline Personality Disorder. ‘Border line’ between what? Well, I looked it up. Back in 1938, psychiatrist Adolph Stern—which sounds like a fake name but okay—first used the term ‘borderline personality’ to describe patients on the border of neurosis and psychosis. So, patients who exhibit symptoms that can’t be easily classified because they could be classified as either, or both, or neither—which also sounds fake. But okay.
I have been diagnosed with both of these conditions. As well as post-traumatic stress disorder, generalized anxiety disorder, and major depressive disorder. That’s a lot of disorder. Either there’s something really wrong with me, or there’s something wrong with the way we diagnose people. (Spoiler alert: it’s the latter.)
Read more about my diagnosis and treatment in this essay:
But as I said, I like labels. I took to ‘histrionic’ the way I did to ‘Capricorn’, ‘bohemian’, and ‘feminist’. It’s descriptive. The problem is when the powers that be try to make it prescriptive. Giving me the diagnosis of Histrionic Personality Disorder is fine, great even, so long as it doesn’t affect my ability to live the life I want to live. The problem is those powers that be don’t want me to be different. If I am different they might have to accommodate my difference in order for me to be a functioning member of society. That sounds like a lot of work. That sounds expensive. That sounds hard. If I am different but functioning anyway they might have to acknowledge that ‘not different’ aka ‘normal’ is more than one thing. That it is in fact many things. That ‘upper-class, straight, white, cis, neurotypical, able-bodied, middle-aged man’ is not the default. To me, that sounds obvious. To them, that sounds fake.
So, instead, they pathologize my difference. They pathologize my personality. They pathologize me. They make me feel like not fitting in is my fault. Feeling sad or anxious about it is my fault. They tell me to see a doctor about it. But not to help me. They sell me a label so they can sell me a medication. So they can bill my insurance.
And that leads to a handful of disparate but connected issues.
The for-profit mental healthcare industry caters to people who are different but functioning so they don’t have to actually do any of that expensive hard work accommodating disability or disorder.
Advocacy focuses on de-stigmatization. It is meant to be a first step—educate the general populace that mental disorders are based in neuroscience and could afflict anyone for any number of reasons none of which are a moral failing. But education is hard, neuroscience is harder, and choose-your-own morality based on predisposed bias or whatever your favorite “news” or “science” outlet is telling you is easy. The general populace splits into two loud wings shouting either “everyone is mentally ill and it’s good actually” or “everyone crazy is a criminal” and a third much bigger group of people who shrug-emoji. So we never get to any other steps, still, no work is done, and de-stigmatization becomes a political cudgel instead of a tool for change.
The mental health space is flooded with people who need a little help, get it, and get better, with people who needed a little help, got it, but have decided to stay in treatment, and with people who are okay as is but like the idea of treatment/validation (which is fine on its face but more of a problem in combination)—all of whom are relatively easier to treat. Meanwhile, the people who need treatment the most and who need consistent treatment, and thus are harder to treat so fewer people are willing to treat them, have the least access to care. Or accommodations. Or advocacy.
All of those are generalizations, of course. But so is most of mental health discourse and a lot of, if not most of, if not all of mental health diagnosis is also based in generalization. Which is okay if they’re used as guidelines to help create a treatment plan specific to the individual. But that only works if we’re dealing with a small percentage of the population. Scaled up to “more than one in five U.S. adults live with a mental illness” (NIH), it’s impossible.
As Barbara says, every story can be read as Cinderella—but not every story is Cinderella. As Lisa says, everyone can be read as Borderline—but not everyone is Borderline.
If there’s nothing wrong with me, maybe there’s something wrong with the universe.
—“Remember Me”, Star Trek: The Next Generation (1990), script by Lee Sheldon
I don’t think it’s me. I think it’s them.
References
Prozac Nation by Elizabeth Wurtzel
An Unquiet Mind by Kay Redfield Jameson
Girl, Interrupted by Susannah Kayson
Narrative Versions, Narrative Theories by Barbara Herrnstein Smith
Girl, Interrupted (1999)