Sorry for the long text, I’m still dealing with some side effects…
So first, a little background. About a decade ago mental health wasn’t anything I worried about too much. I had a couple of things I did to keep my mental health running well, but there wasn’t all too much I had to do. Of course nothing is always 100% great, but for the most part, things were going well. I had good, even great friends. I had a job I loved, pretty much my dream job with a great boss. I could almost say I loved life. Eventually the one missing puzzle piece came, or so I thought - I got into a relationship. Well, her “mother”/egg donor was a narcissistic, (mostly psychologically, but not only) abusive piece of shit. I’m not going to go into details since they’re not relevant for what I’m trying to get off my mind right now (and it will let me avoid potentially triggering topics for whoever might be reading this). Well, within a little under two years my mental health went from what I described before to just about as bad as you can imagine, again without going into detail for the same reason as before. Since a little over 5 years ago I’ve had pretty much no contact with my ex and her “mother”, and in that time I’ve been battling my mental health problems. Things have gotten much better, but in the meantime I’ve gotten into a weird state…
The last two months I was in a day clinic, today being my last day. Honestly, save for a couple of more minor issues, the staff was great - including the head doctor, something I’m not used to. They were there to help people, and you noticed it. They didn’t get stuck in arbitrary treatment rules, but focused on what the patients need. In my case, they did a paradigm shift in my treatment, and while it’s something where the effects are still unfolding (and in the short term had some pretty negative effects - something I was clearly warned about and consented to), I’m hoping that it will have a good effect that will help with my symptoms.
My path there wasn’t simple, though. When I arrived, I did the standard depression test they do around here which uses a score to assign the severity of the depression - and I landed smack dab in the middle of a mild depression. My first thought - whelp, I’m in a mild depression and need to take a couple of months off of work to go to a day clinic? Something doesn’t add up there, a thought which, looking back, the staff there apparently had as well. I eventually had an hour long conversation with the head doctor which essentially amounted to “what exactly do you need from us?” I went through my background, a fairly long list of symptoms, and the broad strokes of what happened to me. “Do you know what it is?” “No, not directly. My psychologist said something along the lines of ‘I don’t believe in treating diagnoses, I believe in treating people’, which is a thought I can kind of get behind. When getting things lined up to start my treatment here a number of people had mentioned PTSD, but I prefer not to interfere with which diagnoses I get so I don’t usually go into much detail there.” It apparently gave her some food for thought, a couple of days later she asked if I would be OK with a therapist change, since a different therapist can do a method she thought would be good for my situation. I deferred to her judgement, and so we changed therapists, and the therapy continued from there.
Then, today, I had my final (short) talk with my individual therapist. We eventually went onto the topic of diagnoses. She asked me if I remembered what I got on the depression test from where I started, since she hadn’t gotten it during the therapist change (in retrospect, I wonder if that was a tactful “mistake”). I remembered what I had scored, and she said that the diagnosis they were working with for the treatment was a medium depression, later mentioning “if you had a mild depression, we wouldn’t have been allowed to treat you here”. I asked if there was anything else, and she said no. There was no singular event like a car crash or a violent event that she could use to diagnose PTSD, and she couldn’t diagnose “parts of PTSD”. There was nothing else that really fit the bill, either, of which she mentioned a couple of examples. I had to fill out the depression test again, and I didn’t get to see the results myself because of time constraints, but I’m pretty sure I didn’t even score a mild depression, and even if I did score it, it was just, just barely.
Which brings me to the diagnostical situation I’m in now. I’m still pretty far from mentally healthy. There are a number of things I either can’t do or have to be extremely careful with since they can trigger some pretty bad things, including bodily symptoms, incapacitating me in severe cases. It holds me back from a number of important things. But my diagnosis? Technically, it’s a clean bill of health, at least if my impression from the last depression test is correct. Which does not reflect the reality at all. Heh, maybe if I think about it enough I’ll land in depression territory again.
My therapist from the clinic said I can always come back if I need it - which would have the advantage of not going into all the details of what happened in the relationship back then, and also of them knowing exactly where they have to start the treatment. But what if I end up having to go somewhere else for whatever reason? I wouldn’t have a diagnosis that warrants treatment in a day clinic, unless things had seriously gone downhill since then. If I technically don’t have a depression anymore and there’s no other diagnosis left, that would mean I might not even qualify for individual therapy, which I definitely still need. I’m probably worrying too much (probably also a side effect from my last intense therapy session which was only yesterday), but it is kind of a weird feeling to know that you’re still fucked up mentally but can’t even get a goddamn diagnosis.
Anyone else ever have or heard of anything like this?
I have some questions, no pressure to answer if they’re too heavy. Do You feel like your depression isn’t that bad, or isnt bad enough? Or are you feeling like depression is the wrong diagnosis? Or do you feel like you might feel relief and be able to tackle the trouble if you had a diagnosis you felt fit better?
No problem.
Do You feel like your depression isn’t that bad, or isnt bad enough?
I don’t feel all that depressed in the first place. Meanwhile, whatever it is I’m dealing with mentally is bad enough. Maybe I don’t feel like mild depression sounds bad enough to describe what I’m going through.
Or are you feeling like depression is the wrong diagnosis?
Yes, kind of. Or at least only a partial diagnosis, that misses a pretty important aspect. And now that my depression symptoms have gone down far enough that I probably don’t even score mildly depressed, it does feel like the wrong diagnosis.
Or do you feel like you might feel relief and be able to tackle the trouble if you had a diagnosis you felt fit better?
I don’t know, but I do feel like it would be easier to explain what I have. Let’s say it was diagnosed as PTSD. Then, I could just say “I have PTSD”. For people who know what it is, it clicks - “ah, OK, got it”. In my case I have to explain “well, this and this happened to me X years ago, and ever since then I have problems with X, Y and Z, which results in that and that. It’s diagnosed as depression (or, technically, I might not even have that anymore), but depression doesn’t adequately describe what I’m living through.” And even before the depression diagnosis was slipping away, I always felt like depression was a very symptomatic diagnosis, which says nothing about what’s happening nor what the cause is. I like to compare it to a diagnosis of “leg pain” - well, what is it? Did you work out yesterday and have sore muscles? Do you have cancer in your leg? Did you get shot in your leg? Those are all things that need to be treated very differently, but will all cause leg pain. Which, now that I think about it, is a good comparison considering the treatment I had. What I got there was a form of trauma therapy. You couldn’t properly use that form of therapy on someone with depression who hasn’t had any trauma even if you tried. But both I and that theoretical person without any (significant) trauma are both diagnosed with depression.
It really sounds like you’re going through a lot, currently. That’s really heavy, my friend, I absolutely feel for you. I get the feeling you feel like calling it depression is just too simplifying and you feel like the definition doesn’t fit well enough.
I have to say I’ve never heard of people categorising depression in any gradient before, is that new? It sounds like you wish you had some concrete way to explain the severity to people, of what you’re going through, without having to go into details, which can absolutely be triggering, I’ve been through some super heavy stuff and I absolutely get it. It sounds like it’s really bothering you that it’s being simplified, you feel? Maybe they don’t have a better name for what’s going on for you?
I don’t know if this is helpful, When they do diagnostics, it’s usually something like “if you fit 5 or more of these 20 traits” which feels like a stab in the dark, a lot. People are misdiagnosed and then some wholee swathes of people are missed from a vital life changing diagnosis, too. Like for instance, right now they’re only just realising autism and adhd present entirely differently in girls and women, because of how they’re socialised to behave and girls and women have been rarely if ever, diagnosed historically.
That’s changing now, now psychiatry is catching up to a huge thing it’s missed. They might catch up and diagnose a better fit for what’s going on for you. Maybe they don’t have the right words yet. Ultimately you want to be able to focus on healing and learning to live alongside what’s happening for you, as much as possible and I could see how this could be a huge barrier. And especially exhausting not being able to categorise it for people close to you.
It does sound like you know what’s going on, x then causing xyz symptoms, means you have an eye on it, and that’s actually awesome, and harder to do than people realise. And I suppose for now you can break it up and battle those demons, individually? Have you found they’re effective in giving you helpful tools to handle x y and z?
Yeah, unfortunately I’m going through some other difficulties, as well. I was able to somewhat successfully push them to the side to focus on the therapy, but there still there. And yeah, Depression doesn’t seem to fit very well as a definition.
As to the different severities of depression - I’ve “only” been dealing with this for about 5 years, but every time I had a depression test it was the same one. IIRC, it’s 15 questions, every answer gives you a different number of points. For instance:
Enjoying things
- I can enjoy things as much as previously.
- I cannot enjoy things the way I did previously.
- I can barely enjoy things I used to enjoy.
- I can’t enjoy anything at all anymore.
The points get added up. Between 10 and 20 points it’s a mild depression, between 20 and 30 a medium depression, and above 30 it’s a major depression.
Maybe they don’t have a better name for what’s going on for you?
Essentially, that’s it. Essentially, I’m in a diagnostic gab. And my worry is, if the depression isn’t present as such, they might not have any name at all to describe what’s going on with me. My therapist did mention, though, that when they can start working with the DSM-11 (whenever that will be), that it might have a better diagnosis for what I have.
It definitely does feel like a stab in the dark. Even starting with the depression questionnaire, it’s always bugged me, because you’ll have to chose between “I’m not sad” and “I’m often sad”. Well, what if I’m only sad occasionally? And a couple of interpretation differences can quickly change your diagnosis.
I do have tools to battle different things, but I’m still not ready to be without therapy. It might work for a year or two, but eventually I would be worn down to the point of needing more serious therapy again, which is a point I don’t want to get to again.
Yes, trauma is so poorly understood that what you are describing is what mostly everyone with trauma-induced pathologies is experiencing right now. If it doesn’t fit a DSM diagnosis perfectly, or the literature doesn’t have a clear prescription for addressing it, you’re bounced out of systems so that they can save money.
I’ve had the impression that trauma is poorly understood as well, especially considering the number of people I’ve met in therapy who come in with different diagnoses but end up having major trauma in their past as well. It’s made me seriously change the way I think about mental illness, to that point that I generally assume that when I learn someone has a mental illness, I assume that there’s trauma somewhere there until I know otherwise.
As to being bounced out of the system - that, thank God, isn’t quite the case for me. The clinic was very people oriented, even at times skirting the system in order to ensure the best results for the patients. My health insurance has also been very cooperative, to the point that my therapist was suspicious of the whole thing until she actually got to talk with my insurance provider. In that regard, I’ve been very lucky.
What about stress respectively trauma? Dealing with narcissist terror can induce that easily. Did they or did you mention that at all? Your symptoms sound like stress to me.
Second thing I want to point out: You probably didn’t get into that relationship “by chance”. My take is that certain patterns click when you meet the “right” person, and then those patterns, acquired in the childhood (where else, where else), take the wheel. Wanna say: You probably bind to narcissistic structures quite well because you endured similar structures in your childhood. Any talks or diagnostics about that?
Lastly: Clinical psychiatry is a business, and they tend to work their most profitable sheet. If your patterns didn’t fit their specialisation maybe they handled you within their targets but not within your targets? Maybe ask where they see you when they had to relay you to another facility or treatment.
Important: These are my takes after skimming your post, not your diagnoses. I wish you all the best. Get well and enjoy life 🫶
Thank you ♥️
The symptoms do seem like stress to me - which is why PTSD (a stress disorder after all) sounded about right to me. In fact, some of the people I know who are diagnosed with PTSD have said that a number of my symptoms are similar to theirs. And it seemed like from what my therapist was saying, the symptoms kind of do match - it’s just missing a kind of big bang that can be pointed to, since in my case it’s a long-winded rumble instead of a bang.
The question of if I bond to narcissistic structures is one I’ve looked and ruled out. My ex isn’t narcissistic herself (at least wasn’t back then), her mother was. If it hadn’t been for her and her mother essentially using her as a hostage, I would have stayed as far away as possible from her mother, which is what usually happens when I get to know those kinds of people. What I do seem to bond to since then is people who have endured trauma themselves, which is a problem in and of itself.
And I understand the part of psychiatry being a business, which is something I always have in the back of my mind (although they seemed a lot better in that regard in comparison to the psychiatric institutions I’ve been to in the past) - but I’m not quite sure I understand what exactly you’re figuring might have happened due to financial motivations.
Everyone could use a therapist. Even therapists see a therapist.
Regarding your diagnosis, mild depression is still depression and can get situationally or clinically worse over time if not treated.
You need a diagnosis not for a therapist but for the insurance company to bill and categorize your care. That’s it. Anyone can go to a therapist if they think they need it. Psychiatrists are only if you or the therapist thinks you need medicine. There are also holistic psychiatrists but they are rare.
My diagnosis changed many times and to be frank, I don’t even know if it is accurate. But diagnoses don’t matter, symptoms do. They don’t treat the diagnosis; they treat the symptoms.
Fun fact: one of the nurses in the clinic switched sides and was at that very clinic as a patient for a while.
Regarding the diagnosis - that’s sort of the way my regular psychologist sees it as well, and you’re probably right on that. I guess it’s just frustrating that I don’t have a term or something that I can point to and say “that’s what I have”.
Yeah, well that is why psychiatrists have to go through so much more years of school versus regular doctors. It is a complicated matter, mental health and being an invisible illness means it is abstract in a way.
