Anxiety and depression: how to understand and cope with a diagnosis

Who would want a mental health diagnosis? We don’t want that label stuck on our foreheads!

I recently published an article where I argued that your mental health challenges, such as anxiety and depression, aren’t necessarily an illness.

That’s true. It’s also true that they sometimes grow out of control for some of us and seriously impact our quality of life and how we function at work, at home, and in our social relationships. That’s when we should start seeing them as an illness.

Formally, however, it’s an illness if a healthcare professional decides we qualify for a diagnosis. And a mental health diagnosis isn’t something we usually want, right? It almost feels like a criminal conviction, like being judged and labelled as “a wrong ‘un”.

Let’s explore

• why it feels that way, 
• why it shouldn’t feel that way, 
• why a diagnosis sometimes feels like a relief anyway, 
• why a diagnosis sometimes is necessary, and
• how to cope if you don’t get a diagnosis.

(Featured image: We might need help from the health services. It’s okay.  – AI-generated illustration.)

A 20^th anniversary

As I’m writing this, it’s been 20 years since I got my depression diagnosis. I hadn’t yet understood that depression was more of a symptom than the real problem.

Now I know my depression came every time I was exhausted from managing my anxiety. When I was worn out from being constantly in ‘fight or flight mode’, my mind and body sometimes gave up and withdrew into a ’freeze mode’.

Anyway, I still remember clearly how I simultaneously felt devastated and relieved by getting the diagnosis that day twenty years ago. Let’s look at the devastation first.

Why it sucks so much to get a mental health diagnosis

Well, for me, it was mainly about the blatantly unfair shame of mental health challenges. Shame was the principal reason why I waited 40 years before I did anything about my situation.

But the fact that this shame is unfair and should be unnecessary doesn’t mean that it’s totally irrational. Here are a few things that can realistically happen if people knew about your diagnosis:

• People may ‘put you in a box’. They have opinions about how depressed/anxious people are, and presume that’s how you are. They see your illness, not you.
• You might be discriminated against. Some of them will treat you better, some worse because of your diagnosis. It’s not always easy to say what feels worse of those two.
• It is possible you can lose opportunities, such as job offers.
• Insurance companies can reject you. If you, in the worst case, live in a country where you need health insurance to get essential health services, a rejection or an unaffordable insurance offer can have grave consequences.

However, while the potential insurance problem might be real, the other risks might not be as high as you think. The first fact you should consider is:

The diagnosis isn’t tattooed on your forehead

Remember, the healthcare professionals you talk to will be legally required to maintain confidentiality, and your GP health record is under strict privacy regulations (at least in most countries).

In most cases, unless you need to take time off work or to be hospitalised, you don’t necessarily need to tell anyone else about your diagnosis. Except people close to you, and you choose to tell them.

You might need to tell a few white lies, but you have the right to protect yourself from harm, for instance, the risks mentioned above.

I know it’s hard, at least at the start, to talk to healthcare professionals. And if we think about it, talking to others shouldn’t be too hard either. Because:

How out-of-the-ordinary do you think you are?

According to mind.org.uk, 8 per cent of the English population have what they call ‘mixed anxiety and depression’ in any given week. This means that this week, as you are reading this, 4.5 million Englishmen and -women have mixed anxiety and depression. And we haven’t even counted the other relatively normal problems mind.org.uk mentions, such as Generalised anxiety disorder (GAD), Post-traumatic stress disorder (PTSD), depression, and phobias.

The Norwegian health authorities say that a quarter of the population will have an anxiety disorder at some point in their life, and 15 % of the population every year. There’s no reason to believe the situation is substantially different in other comparable countries.

So, if you talk to a healthcare professional about your anxiety or depression, how likely is it that they are thinking, “Wow, we have a nutcase here!” Let me promise you, if they react negatively at all, it’s because they are bored! How many sufferers of anxiety and depression do you think the average GP meets every year?

Then, pick someone else you dread should get to know about your problem. Your boss at work, for instance. How likely is it that you are the first person they know who has an anxiety or depression diagnosis? For all you know, they might have one themselves.

That said:

For some, getting a diagnosis is a relief

As mentioned above, I felt partly like that myself.

Because, after decades of thinking, “What’s wrong with me,” it was, in a way, clarifying to know what was wrong with me. In my case, to know at least parts of what was wrong with me. To put a label on it inside my mind, something to focus on.

It’s hard to solve a problem without knowing what the problem is.

Furthermore:

Sometimes, a diagnosis is necessary to get the help you need

Unless you are so rich, you can buy any health services you fancy, of course.

You will usually have to go through two tiers in a public health system:

• Primary healthcare, where your GP is the gatekeeper and decides whether to refer you to:
• Specialised healthcare, where you will find counsellors, psychologists, psychiatrists, etc.

The GPs are the gatekeepers, and the key they need to open the door to specialised healthcare is a diagnosis found in their diagnostic manuals. They can’t open the door if they don’t find a suitable key for you.

Sometimes, we need specialised healthcare. Even though a mental health diagnosis feels stigmatising, it might be just the thing you need to proceed on your healing journey.

But what if your GP can’t find the right key for you?

The current diagnostic manual used in most European countries is ICD-11. If you wonder what GPs will look for if you are suffering from depression, you can start here: ICD-11 Depressive disorders.

If you, for instance, drill down to ICD-11 6A71 — Recurrent depressive disorder, you will see that this diagnosis requires:

A history or at least two depressive episodes separated by at least several months without significant mood disturbance. A depressive episode is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a Bipolar disorder.

If your GP can’t do all the necessary box-ticking, you won’t get the diagnosis, and the door to specialised healthcare won’t open.

What happens now depends on which type of healthcare professional you’re facing.

Some don’t care, are paid by the number of patients they see, whatever the outcome, and will try to fob you off as quickly as possible.

Some of them know that the human mind is too complex for simple box-ticking and will try to help you as much as possible. This might involve exploring other possible diagnoses.

So, what if you’re fobbed off?

Please don’t give up.

There are two things you can do:

• Learn as much as you can about your problem. Researching your symptoms and possible causes doesn’t automatically mean you’re a hypochondriac. On the contrary, if you educate yourself, you can better assist the healthcare professional in the diagnostic process.
• Don’t be afraid of asking for a second opinion. So much depends on the knowledge and attitudes of the healthcare professional you meet. They must know what they are talking about and be willing to listen to you.

Remember, always: You are the only person with first-hand knowledge about your health.