If you feel you’re being dismissed or disregarded, the question isn’t what disorder you actually have. It’s actually whether or not your relationship with your clinician is a workable one.
Welcome to Crazy Talk: a mental health advice column written by yours truly, a mentally ill and queer writer reclaiming his “crazy” to educate and empower. In a world that tries to push us to the margins, I’m all about getting loud and kicking the stigma where it hurts. In this column, we explore what it’s like to live with mental illness without shame or apologies. Expect frank advice, a little self-deprecation, and a good dose of humor.
Someone posed a question to me recently that really struck me: What happens if we identify with a particular mental illness, but our therapist or psychiatrist shuts us down? Who do we believe if we know our lived experience, but our clinician insists that they know better?
This happened to me years ago when I tried to tell my first psychiatrist that I might have some kind of complex trauma. I said that I might have PTSD; she said I was exaggerating and labelled me “histrionic.” Talk about shitty.
Joke’s on her, I guess, because my clinicians now strongly agree that I’m dealing with C-PTSD. Seven years later, my medical record reads “history of psychological trauma,” and all forms of therapy I receive are now trauma-informed. I’m finally getting the right treatment — I only wish I’d advocated for myself sooner.
On the flip side, for years I insisted I had bipolar disorder after being diagnosed with it many times before. But it turned out to be a misdiagnosis — I had borderline personality disorder, in actuality — and, thanks to the patience and compassion of a really solid clinician, I was able to better understand over time what these labels meant.
These examples point to a complicated reality: There isn’t a straightforward answer to this question. We can be totally right and our clinicians completely wrong, but sometimes we might not have all the information we need to make the right call.
Sometimes when we disagree with our clinician, it’s because our clinician isn’t listening to us and is unwilling to work with us. Other times when we disagree, it’s because we might not have the expertise (yet) to make the subtle distinctions between otherwise similar diagnoses — like when I thought I had bipolar disorder but actually had BPD, which can behave in remarkably similar ways.
So here’s a better question: Is this the right clinician for me? I wrote a pretty in-depth article about finding the right psychiatrist, and another advice piece about being diagnosed for the first time, which can be useful points of reference when grappling with psychiatric labels.
Some questions to start with: Is my clinician open to getting feedback? Do I trust them? Do they trust me? Are they explaining everything to me in a way that makes sense? Do I agree with my treatment plan? How does this label ultimately serve me? Is this diagnosis useful or helpful to me?
Disagreement alone isn’t a deal-breaker. And with time, you might change your mind or you might change your clinician’s — both have been known to happen and can actually happen quite often! But if you feel you’re being dismissed or disregarded, the question isn’t what disorder you actually have. It’s actually whether or not your relationship with your clinician is a workable one.
Share your thoughts with your clinician. Don’t be afraid to push them and ask how they arrived at a particular conclusion, and disclose why you do or don’t agree with their assessment. You bring in your expertise on your emotional reality and they bring in their expertise from the field. In an ideal scenario, both perspectives are valued and a necessary part of the collaboration.
If you’re both willing to keep an open mind — sharing trust and respect between you — it might not be a total loss, even if you don’t agree in the beginning. If your clinician can support you in your search for clarity and empowerment, even if your conclusions don’t initially align, you might make a better team than you thought.
But if the relationship feels one-sided and you don’t feel respected, it’s time to cut them loose.
At the end of the day, a diagnosis is a tool that’s intended to help you, based in one person’s medical opinion. It’s meant to serve you. If it’s not helping, you have every right to push back until you find something that does. That’s a part of the process — and any clinician worth their salt is going to understand that.