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  • Patrick Bryant, LCSW, NBCCH

Armchair Diagnosing: Exercise caution, and don't believe everything you read


If you've scrolled through social media, listened to a podcast, read a magazine article, or watched one of the countless videos streaming out there, you've likely encountered titles like, "10 reasons your partner may be a narcissist." or "5 reasons trauma is responsible for all of your problems," or any number of other labels; some actual diagnoses and many simply classifications given popularity by professionals with resources to publish books. Maybe you've identified with some of this content, maybe you've felt validated by some of it, maybe you've even saved yourself some severe emotional pain by heeding advice from them. I'm not here to judge any of that. My intention is to encourage you all to filter this content through a lens of critical thinking and as much objectivity as you can muster.


In graduate level training, budding therapists are taught to scrutinize literature for validity and reliability, rather than accepting these findings as noteable at face value. This basically means the standards of testing are appropriate, findings are based on studies that test what was intended to be tested, and the results remain consistent when the study is replicated (APA, 2014). Articles that have been peer-reviewed have been read and analyzed by numerous professional peers within the field, weighing the content against facts, scientific evidence, and practice-based evidence. They are concerned with the validity and reliability of how these findings were developed and delivered, as well as the relevance to populations noted in the study and publication.


In contrast to published content based in science, there is literature based on anecdotal experiences, opinions, and subjective insights from the author or person being interviewed. Even some articles you find in magazines with the word "Psychology" in the title may fall into this latter category, rather than the former. Remember, though the author of what you're reading in this magazine, and other like it, have the fancy letters after their name, this is still a magazine, not a research journal. Allow me to restate that many of these subjective pieces still have relevance for some of the readers. I've written some of these "practice-based evidence" anecdotal pieces, myself, for other similar publications. There is value in professionals sharing their experience with the general population. The real problem is when authors start creating labels for people they've never met, or suggesting that anyone can simply diagnose someone as having a personality disorder based on a 10-item checklist.


Personality Disorders are serious, and sometimes severe, labels. Criteria for accurately diagnosing these disorders has been researched, argued, validated, scrutinized, revamped, and sometimes completely changed. Persons charged with diagnosing these disorders have received a great deal of initial training, and hopefully maintain quality and relevant continuing education in these areas. "Empowering" everyone to make these judgments needs to come with caution. And, here is where I offer some anecdotal content. So, keep in mind this is my personal experience with clients, colleagues, and general populations. I've met with hundreds of people in a clinical setting over the course of my career - some significantly impaired by the symptoms and conditions they experience, others needing some fine-tuning on more healthfully navigating life events, and plenty inbetween. One thing that stands consistent among the entire spectrum is the potentially harmful impact of labeling or being labeled with a disorder one doesn't actually have. These labels can be equally harmful for folks who do meet criteria for these diagnoses, but aren't provided with all of the necessary information, just a label from pop-culture content. The anxiety, shame, fear, and sometimes ridicule these folks have experienced from a serious label, without truly understanding what it means for them, only adds to their discomfort, negative self-perception, and worldview.


If you're concerned that you, or someone with whom you are closely acquainted, is experiencing some signs of mental/emotional struggles, I invite you to be curious before sliding into a role of judge, jury, and executioner. Seek professional guidance from a qualified and LICENSED mental health expert. Just because one graduated from graduate school and passed the licensing exam does not necessarily mean they are qualified to accurately diagnose. In fact, most ethical mental health professionals will likely refrain from diagnosing your partner, parent, child, family member, or co-worker based on your personal experience. Our job is to help you navigate the life you're in, not assign labels to other folks along for the ride. There may be clear signs that your mother exhibits signs of Borderline Personality Disorder, or that your partner is emotionally blunted and lacks empathy in similar ways a Narcissistic Personality Disordered person would. Though your experience is valid, subjective experiences are not enough to diagnose. What's most important is to understand your experience of this person, and help you navigate it. Unfortunately, that level of understanding and guidance won't likely come from an internet search or an eloquently worded article found online or in a magazine.


Before you start giving into the urge to accept a label someone you've never met assigns to you or someone you know, I invite you to pause. Consider what you're actually looking for. Validation? Support or guidance? A way out or safety? Resilience? How are you feeling toward this person, this situation, this relationship? What would you like to do to improve YOUR experience (maybe collectively in a relationship or maybe just for you)?


Now, based on what's actually happening in your lived experience, how might you get those needs met? Do you have access to adequate resources? What are ways you can confidently and effectively navigate your life with the people in it? You may even consider if you want to, or have any obligation to, navigate your life with a specific person associated with your distress. You get to make these choices regarding who you invite into your inner circles, and who you don't. Therapists can help you formulate healthy and effective boundaries to support your interpersonal needs. They can offer guidance on ways to shift focus from unrealistic expectations to attainably moving toward intentions. They can provide support and treatment for the distress, psychological symptoms, or social/emotional/mental challenges you're facing. Some modern approaches to treatment don't rely so heavily on labels or diagnoses. Instead, it's more important to understand your experience, barriers you encounter, and healthy sustainable ways to navigate toward your needs. In my experience, and suggestions from modalities like mindfulness-based psychotherapies, humanistic or person-centered therapies, and Internal Family Systems, labels aren't always necessary in order to effectively address the sources of your distress.


Sometimes, being able to name what is happening is helpful. We are humans; part of our instinct is to identify and label an experience, in order to better recognize it or address it, compared to other experiences. This labeling can be linked to survival. Understanding that a riddish vine with three 3-tipped leaves per stem is called Poison Ivy helps many folks avoid a lot of pain. Knowing that a busy intersection requires attention, and may possibly present hazards, is often helpful. However, if we start identifying all three-leafed vegetation as harmful or all intersections as a hazard, we may find ourselves stuck in perpetual cycle of discomfort or hypervigilance, or give too much power and authority to parts of us interested in protecting us from harm, thereby, automatically avoiding, exiling, destroying something completely benign. The above hypothetical story is why accurate information is so important.


So much of the work our therapists do at The Peaceful Place is based on curiosity and compassion rather than automatic judgments and reactions. Remember, mindfulness is simply paying attention to here and now with curiosity and compassion, rather than judgment. This present-focused mindset is why we ask ourselves "What's actually happening right now? Are my feelings, sensations, thoughts attached to what's actually happening, or a story? What do I need based on what's actually happening? How do I get those needs met?"


In summary, you don't have to discount everything you read about mental and emotional health that doesn't come from a scientific journal. In fact, some of those articles are difficult to attain information, even to a trained eye. The citations and kadence of the writing can be hard to follow. I encourage you to explore content and to be curious about your experiences. Just proceed with caution when someone lures you in with a psychological label or a "10 reasons why..." explanation of your partner or parent whom the author has likely never met. Instead, consider what you need to healthfully, effectively, and realistically navigate your situation. Prioritize how you will meet these needs. And, simply start. Funnel these steps toward meeting your needs into attainable, "bite-sized" pieces, to make starting more approachable. Momentum will take its course, and you'll be on your way. If and when you need assistance or guidance, consider talking with a licensed professional, perhaps, even one who specializes in an area you're struggling to navigate.


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