Schizophrenia/The Problem With Self-Diagnosis Part 2

The other day, I published a post about a recent brush I had with inaccurate self-diagnosis. After reading a book about schizophrenia and personally identifying with most of the symptoms it described, I worried intensely that the disease had gone undiagnosed in me for years. However, once I got ahold of my psychiatrist, he reassured me that my standing diagnosis, borderline personality disorder (BPD), is correct. He was thoughtfully convinced that while I do have an abnormal number of similarities with the average person with schizophrenia, I’m missing key behavioral issues and psychotic experiences that would lead him to diagnose me that way.

I’m very, very glad I called him as soon as I had my doubts about his original assessment of BPD. I might have lived in an intense state of anxiety for a long time if I had convinced myself I had the wrong diagnosis. That’s why, in Part 2 of this post, I want to discuss the critical importance of letting qualified doctors have the final say about your potential psychiatric diagnoses.

As I’ve come to realize after years of living with BPD, diagnosing a mental health disorder is a very different process from diagnosing a non-psychiatric problem. For one, bodily symptoms are usually objective and quantifiable. If you have the flu, for example, its effects on you are easily observable. You cough, you have a headache, you feel sick to your stomach. When you contrast that with a healthy person, the difference is apparent. It can be measured.

Psychiatric problems are not so easily measured.

A psychiatrist has to very carefully compare your feelings and decisions to those of a healthy person, but this presents problems: How do we define what “healthy” means in a psychological context? There is not, and cannot be, a standard, because everyone reacts to life uniquely. One person’s normal habit may be another person’s inconceivable decision, but both behaviors may be considered healthy.

So, without a concrete metric by which to compare the normal and the abnormal, psychiatrists often make judgement calls as to whether a person is sick, or just idiosyncratic. That takes an extremely well-trained eye.

In and of itself, that’s enough reason to always let mental health professionals diagnose you instead of doing it on your own. They’re more qualified to stay objective and contrast your experiences with what’s considered “healthy”.

Doctors also possess the clinical experience to spot subtle symptoms. Any (extremely determined) person could read the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, and feel qualified to diagnose mental illnesses. But I’d strongly argue that they wouldn’t be qualified. There is a holistic element of the diagnostic process that the DSM can’t define, because it’s fairly intangible. People with mental health issues often have a certain demeanor that can’t easily be defined, but a good doctor knows how to spot it.

But it’s different for every disease and every individual. That’s why a qualified person, not a book, is required to make diagnostic decisions. It’s also why no psychiatrist worth their salt will do intake appointments over the phone if they can possibly avoid it. A patient’s entire presentation may be just as important to determining their condition as their descriptions of their symptoms.

For example, when I had that panicked phone call with my doctor about schizophrenia, he told me that I “just don’t come off that way”, and I immediately knew what he meant. People suffering from schizophrenia tend to display a certain element of distractibility and difficulty organizing their thoughts and speech that’s really difficult to define. It just has to be sensed, and my doctor didn’t sense it in me.

There’s a multitude of reasons why it’s better to let a doctor make your diagnosis than doing it yourself, but the reasons I’ve explained here are some of the most frequently forgotten. They slipped my mind when I read a book about schizophrenia and panicked, even though I’ve been going through the diagnostic process for a decade. But I ultimately did the right thing by calling my psychiatrist right away.

That being said, it’s fine to do research on your own. In fact, I would even recommend it. A psychiatrist can’t diagnose you until you make an appointment with them, which you would likely only do if you (or someone who cares about you) suspect mental health issues are at play in your life. Usually, the only way to get a professional diagnosis is to start that process at home by educating yourself about the symptoms you think you might be experiencing. However, when it comes down to the final word about your psychiatric health, let someone with a medical degree make the call.

And if you’re symptomatic and you have a medical degree, go to a different doctor and get a second opinion. While I don’t doubt your ability to help other people, your point of view on your own thoughts, emotions, and behaviors may be skewed by whatever is affecting your mental health. It’s much harder for us to be objective about our own realities.

Of course, if you really feel that your doctor’s assessment of you is inaccurate, it’s never wrong to get a second or even third opinion. Doctors should be trusted skeptically, because while they’re the experts, they can make mistakes. I was misdiagnosed bipolar for ten years before I sought a new psychiatrist who was able to tell me I have BPD. That only happened because I sensed my old doctor was missing something. If I hadn’t done research into bipolar disorder on my own time, I never would have realized it’s not the right label for me. Your opinion does matter. So, listen to the experts, but stay reasonably critical if something feels off.

The bottom line? While it’s important to educate yourself about what you might be going through medically, you shouldn’t convince yourself you know what’s going on until you see a doctor.