Things You Learn in Therapy
Things You Learn in Therapy
Ep 140: The Double-Edged Sword of Mental Health Labels in the Age of Social Media with Dr. Tim Hess
Have you ever watched a TikTok about ADHD symptoms and thought, "That's totally me!" or found yourself wondering if your social discomfort might actually be diagnosable anxiety? You're not alone.
In this thought-provoking conversation with returning guest Dr. Tim Hess, we dive into the increasingly common phenomenon of mental health self-diagnosis. We explore how our success in destigmatizing mental health conversations has led to an unexpected consequence: the transformation of clinical diagnoses into personal identities and social labels.
The easy access of mental health information through social media has created a world where anyone can share "facts" about psychological conditions, leading many to adopt diagnostic labels without professional assessment. We discuss the powerful appeal of having a name for your experiences—how a diagnosis can bring validation, community, and in some contexts, accommodations or relief from expectations. But we also wrestle with the critical question of "clinically significant impairment" and what happens when normative human experiences become pathologized.
Dr. Hess shares insightful observations from his work in college mental health, where he frequently encounters students who arrive with firmly-held self-diagnoses. We examine the paradoxical position mental health professionals now face: historically emphasizing respect for clients' self-knowledge while also maintaining diagnostic expertise. This tension raises profound questions about gatekeeping, accessibility, and how we respond to human distress in institutional settings.
Whether you've found yourself researching symptoms online or you're a professional navigating these waters with clients, this conversation offers nuanced perspectives on finding balance between validation and accuracy, between personal experience and professional assessment. Listen in as we explore one of the most complex challenges facing mental health work today.
This podcast is meant to be a resource for the general public, as well as fellow therapists/psychologists. It is NOT meant to replace the meaningful work of individual or family therapy. Please seek professional help in your area if you are struggling. #breakthestigma #makewordsmatter #thingsyoulearnintherapy #thingsyoulearnintherapypodcast
If you or someone you know is struggling with mental health concerns, please contact 988 or seek a treatment provider in your area.
If you are a therapist or psychologist and want to be a guest on the show, please complete this form to apply: https://forms.gle/ooy8QirpgL2JSLhP6
Feel free to share your thoughts at www.makewordsmatterforgood.com or email me at Beth@makewordsmatterforgood.com
www.bethtrammell.com
Hey listener, welcome back. I am so happy that Dr Tim Hess said he was going to come for a second episode, if you didn't tune in last week. Tim came on last week to talk about all sorts of fun things particularly related to men's mental health what we're kind of seeing, what we're learning, what we might want to know about that. And today we're actually going to talk about something totally unrelated to that, because this topic applies to everyone.
Speaker 1:Yes, everyone, and I am here for today's discussion because I have both engaged in this myself and also gotten to where I want to poke some people in their forehead about doing it also. So, because people already know you, because they listened to last week's episode, we don't need you to introduce yourself, but you can if you feel like it. But we're talking about self-diagnosis today because it's an important topic as mental health is becoming more mainstream, and also this podcast is really meant to provide high quality, accurate information to the general public, and there is a lot floating around. That sure is heck, ain't the truth. So, tim, come on, let's go.
Speaker 2:Yeah. So if you didn't listen to last week we made kind of some jokes about, sometimes I feel like there are tsunamis I'm yelling at right, like these waves that are coming upon the profession and I feel like I'm screaming at them but I'm going to get drowned. I work in college mental health and so self-diagnosis is a thing and it feels like we have more and more students who are coming to therapy with a self-identified diagnosis and most of the students who have them feel very certain that this is the thing. And we see the full spectrum right.
Speaker 2:Like I have panic disorder, I have social phobia, I have test anxiety, I have OCD, depression, bipolar trauma, I have emotional abuse, ptsd, complex PTSD. I've got ASD, I'm on the spectrum. I have autism, I've got borderline, I've got antisocial. My parents were narcissistic. I have an eating disorder, like I dissociate, I've got altered, all of it. And so I appreciate your start, beth, where you said I have done this and I want to poke some people Because I do think as a provider, for me too, my initial reaction is often frustration, but the empathy piece I think is key. So I appreciate that and for me, I don't feel like there's a lot of really good research on it yet or not.
Speaker 2:I should say not that I'm aware of right Like I have not I do not know all things, so, to your point, around like truth and accuracy, like I do not know all things, but does feel like a trend, and for me, I think part of it's happening for a couple reasons. One so there were the Garrett Lee Smith Memorial Grants I think is what they're called and they came out, I think like 80s, 90s, 2000s-ish, but they were grants designed to decrease stigma around mental health. Like, essentially, the grants told children you should talk about your mental health, that would be a really good idea. And like the kids believed us, right, and then they grew up and now they're here talking about their mental health. And we had all of these stigma reduction interventions right to make mental health more available, more colloquial, more a thing. And I think part of this is the ripple of our own success. We did it, y'all. We convinced everybody it was okay to talk about mental health by talking about mental health and here's what depression is and here's what ADHD is and here's what this is, and so people just started believing us and doing it for themselves.
Speaker 2:And then I think there's this companion piece with technology, right With social media, with apps, websites, web communities, forums, right, where there are a mixed bag, sharing information as well, and so there are some really good ones out there, but it's that democratization of information. Anybody can share anything they want of information. Anybody can share anything they want, and anyone can share quote, unquote, facts. And so I think what I often hear about in social media spaces they're using our language, but not in the same way, but we've known this in therapy for years.
Speaker 2:Right, the number of students who come to my office and tell me I have panic attacks. And I say, oh my gosh, please tell me what your panic attacks are like. And they say, well, you know, my heart starts racing and my hands get sweaty. Okay, like, that's not great. So, like, how often is that happening for you? Well, like, it's happened twice since, you know, in the last month. Okay, all right, how long does this last? It lasts for three minutes, and Tim's outside voice says, oh my gosh, that must be a really rough three minutes. And Tim's in voice says that's not a panic attack, because and we all know this, right, like, that doesn't meet the criteria. So I'll pause there, because I feel like I'm just going to like ramble and rant, and I like it better when you and I have a conversation, so I'm going to pause there.
Speaker 1:I mean, I like it better when you just keep going. But I also appreciate that I can ask questions too. But I hadn't actually pondered this idea that there's sort of this direct correlation between decreasing stigma and increasing self-diagnosis. It's like, yeah, when we get, we get to talking about it more, and then we're inevitably going to, you know, have more, we, we want to have an answer and I I think about this. Self-diagnosis is a a direct result of kind of this decreasing stigma. It's also because people on social media are like, yeah, well, I have autism and you might too, and here's, you know, here are the symptoms. But really to what you just described as like a, like a true clinical panic attack, that kind of lives and breathes in our DSM, our sort of like book of all the disorders that the American Psychological no, american Psychiatric now I'm losing my mind that they have said these are mental health disorders.
Speaker 1:There's a difference between you know, kind of describing the symptom and then describing a symptom that clusters around a clinical diagnosis.
Speaker 2:Yes, yes. And so I think the other piece too and then I'll come back to the DSM is I think the profit models are a part of this. Profit models in social media right Clicks for views, so we prioritize profitability and interest over accuracy and expertise. And profit models in mental health provision right Like it's not just the youths, it's the way the world has moved and in some ways, is the unintended consequences of the structure we've built around it. And the DSM, I think, is part of that too. Right Like we know the DSM is socially constructed. We know it is not true for all people in all cultures.
Speaker 1:Is socially constructed.
Speaker 2:We know it is not true for all people in all cultures. But diagnosis I think about diagnosis right as kind of this medical shorthand. It was a way at a time for us to understand people's experiences in a less pathological way and drive treatment and communicate right. And I think sometimes what I forget myself I'll own this for myself is I forget there's a full psychiatric range. Like sometimes I'll have a student in my office and they're talking quickly and I'm like wow, they've got pressured speech. And I'm like no wait, tim, they're just talking fast for the subset of the range that you see, like there's a full psychiatric range here of speech speed. This ain't pressured, maybe it's faster than they usually speak, but like let's be thoughtful about that.
Speaker 2:And so I do think there's all of these factors, right, that have kind of built this universe where self-diagnosis has emerged, and so in some ways, to your point, we probably shouldn't be surprised. But I don't think that's what we were building it for, right. But I think that's what's happened as we have given some things away with good intention that people have said yes, I will take that, thank you, and I will share that with everyone around me. And so then people take the gift and I watched this TikTok video on DID and I think I have multiple personality disorder now and it's like let's talk more about that, but probably not Statistically, probably not Statistically, probably not, and you've told me you have no trauma history, so probably not so so it's interesting okay.
Speaker 1:So the other thing that we haven't necessarily said explicitly yet is that having a diagnosis can sometimes feel better yes, yes, yeah, yeah, talk about that. You know like it feels better to have a name for why I get angry after two hours at, you know, a child's birthday party.
Speaker 2:Absolutely and.
Speaker 1:I want a name for that. I don't want to be just like well, beth Tramiel, just like. Runs out of tolerance for birthday parties at the two hour mark. You know a to to agree with me, then even the better.
Speaker 2:But I can run with a self-diagnosis, you know, feels pretty good, yes and this is what's interesting, I think a lot of clients absolutely I'm smiling too bad um is. I think it feels like for a lot of people they have transformed diagnosis into an identity or a social label. That's actually what they're doing. Yeah, okay, wait we're going to say that again.
Speaker 1:We transformed a diagnosis into an identity or social label.
Speaker 2:Yeah, yeah, because this is the thing like what you're talking about, right, like a label can bring validation. Right, like I'm not quote-unquote I don't like to use the word crazy, right, but like that, a sense of like I don't feel out of control or I don't feel like I'm losing it. I have a label for this. Yeah, I think any more in society, labels can bring a connection, they can bring community, they can bring some realness to something, right, like look mom, look dad, it's real, I'm not just making it up, I'm not just being sensitive, this is a real thing. I also think the thing that I will say out loud, that I don't always know if we want to say out loud, is sometimes it can be used to alleviate responsibility, because it's a thing I have social anxiety, so you can't make me give this speech in front of this whole class because I have social anxiety. You need to change the academic expectation for me in this class and I want to be really thoughtful, because I think this is the tension right is the pendulum has swung the other way, I think, around some accommodation in many good ways, because the world is not always the affirming inclusive, accepting, inclusive space. It should be and it's an and right, this is the paradox piece. I love paradox. This is the paradox piece is for some folks, I think a label brings relief and in that relief, then it can change how I experience myself in the world around me.
Speaker 2:We had a former psychiatrist here who used to tell students it's not your fault, but it's your responsibility, which I actually think is an interesting consideration, right, like the sense of like. Maybe it's a little genetic or environmental like. That's where this be coming from and you now get to decide what you want to do about that and nothing can be the answer if you choose. But typically in our world, I think we're often working to help people navigate spaces more effectively and navigate those gaps. Help people navigate spaces more effectively and navigate those gaps Because these labels have power. They impact our thoughts, our feelings, our behaviors, our beliefs about ourself and the world, our clients.
Speaker 2:We all have mental models around mental health and responsibility and change, and we've seen this in our work for decades, right? Clients who come in and say this thing will never, ever change. Well, now we need to talk about that because you're here and, like I do this work, because I believe in change. So we need to have a conversation, and so I think it gets tricky and I worry about where is the clinically significant impairment right? So criteria C, d, e right For a lot of college students.
Speaker 2:They might have mental health symptoms, they might have symptoms of depression, they might have symptoms of autism spectrum disorder, they might have symptoms of social anxiety, but is there clinically significant impairment and functioning? I don't know what. If this is pathologizing, a normative experience, you're a first-year student here at our campus. You literally know no one here. Of course you feel anxious in spaces. Of course you're afraid everyone is looking at you and judging you right? Of course this is what we would expect. And yet the need or wish for a label to make this a pathology. And so I think it's interesting to me all of the dynamics that I think sometimes get wrapped in in the seeking of a label for my experience and which label I pick, and then what that does inside of me as I move through space.
Speaker 1:There are so many things that I love and appreciate about what you kind of just said, because I think this conversation is, you know, two psychologists who are talking about this phenomenon that happens on the daily right. Like we're seeking information, we're beings that are, like, created to seek information, to understand ways of being or ways of knowing within the world. I think that that's a natural way that we, you know, engage with the world. And also we're two psychologists who are saying, yes, sometimes a diagnosis can be helpful, it can help you feel a sense of relief over this set of symptoms, and it also from the beginning. From the beginning, its purpose has been to drive treatment.
Speaker 2:Yes.
Speaker 1:So, you know, from our standpoint it's sort of like less important what it is. From our standpoint it's less important what we're sort of calling it one way or the other, because we're still focusing on not just oh well, everybody who comes into Dr Hess's office that has the diagnosis of depression gets the same rubber stamped treatment plan. Right, it's like not everyone with the same diagnosis feels the same way, and so our treatment is really focused on, yes, this diagnosis, but really more those symptoms that go beneath the label, beneath the diagnosis in our DSM. So I think that message and I'm going to say one more thing, and then I'm going to let you respond, because I know I've been talking a while that clinically significant impairment.
Speaker 1:So when I'm training, you know supervisees, or I'm training students to become therapists, and even when I teach abnormal psych at the undergrad level, everyone has depression. Sure, everyone has anxiety, everyone has some version of ADHD. I mean, I believe we all sort of have. We could all check off a symptom underneath those labels. But just because we experience some of the symptoms of depression and some of the symptoms of anxiety and some of the symptoms of ADHD, it doesn't mean it causes that specific thing, causes clinically significant impairment. And that's really at the crux of all diagnoses and why self-diagnosis isn't always the accurate clinical picture.
Speaker 2:Correct and I think it's that professional gatekeeping around diagnosis that I think the next 10 to 15 years, one of the tsunamis is this what do we do? Historically as a profession, we have told clients you tell me who you are, what your identity is. I'm not here to challenge that. I will affirm that in you and I think that's a good thing. And what do we do when it happens now? What do I do when the student comes into my office and says this is the diagnosis I have given myself and I'm like but it's not, and our history has been. You tell me.
Speaker 2:And so I think for me, what I'm trying to do more in my work is like tell me what that means to you, tell me what me, what you mean by that and why. What does this label get you? And why is this important? Because we've had clients who have come to us and said you know, I've really been struggling in my relationships with therapists because this is my diagnosis and none of my therapists see it the same way. So none of them are listening to me, none of them are hearing me, None of them are believing me, and in the room I can tip my head to the side and I can smile and nod and I can respond with. I'm sure that's been really frustrating and hard for you to feel like none of your therapists have really heard and understand you. We need to attend to that and talk about that in our relationship and inside I can be like I'm one of them. So what are we?
Speaker 1:going to do. You're like. I might repeat the pattern like.
Speaker 2:I'm one of them, Like, so I might repeat the pattern yes, and and as a profession, what are we going to do with this? Yes, Like what? What are we going to retain in our expertise and our power, that is, diagnostic control and diagnostic gatekeeping, and I have some mixed feelings about that. And what are we going to let go of and let be? Because access to a label sometimes there are lots of barriers to getting a real label, and we've also had the experience of somebody whose self-diagnosis is pretty accurate, right, Like.
Speaker 2:We've had some folks who it's like I think you're right, but spectrum disorders are an interesting case example the number of people who think they're on the autism spectrum is interesting. There are some folks where it's like you know what, you're probably not wrong. And what do we do when testing for an adult to get this diagnosis is so labor intensive, time consuming and expensive labor-intensive, time-consuming and expensive. So it is complicated. For sure it is a hot button, I know, for lots of us, and so part of me wonders what do we need to do differently to shift some of it? And so I wonder sometimes what is the function of the self-diagnosis and what would it be like as part of it that we've built a culture where the way you get help, the way you get support, is by having a label.
Speaker 2:And, to your point, we aren't as good at responding at the symptom level, so we aren't as good. If a student comes to class like a student, feels like they have to say I have social phobia, I can't do the speech Versus, I get really nervous giving speeches and it feels like I need to figure out, like I really don't want to give this speech. I get you know, because I really I hyperventilate or my mind goes blank and responding to the distress and the symptoms in a better way Do we interrupt the pull for I have to have a label for this, because we do a better job of being present and sometimes holding the line on maybe expectation around some of these pieces. So, yeah, I feel like I'm a little scattered around it today, Beth, with you, no here's my sort of last question as we sort of wrap up this brief episode.
Speaker 1:We know that we could talk about this for a long time too. But so one thing that I hear a lot from supervisors, people who I mean professors, teachers, people in some sort of authority role. They say they ask me well, beth, what am I supposed to say when my student says I can't show up for the exam today, I'm having a mental health crisis. I can't show up to work today, I have bipolar and I'm in a depressed episode? I think there's a in the safety of the therapy relationship we can, you know, confront or challenge clients in the safety of that relationship to say I believe you can do hard things, let's try, let's try it Right, let's try it. Relationship. How do we help people who are in positions of, you know, authority or power to find that balance of holding people accountable to you know, doing the job they have to do, while also having empathy toward you know the real struggle that people have with mental health? Do you have thoughts on that?
Speaker 2:sure I mean. I mean I think I work in higher ed so we get faculty consultation calls all the time, right With this issue. I got this email from a student or they came to office hours and they told me this thing and they were really upset and like what do I do? And so I think the balance of being human, the balance of recognizing like I can go to my boss, my supervisor, and say you know what it's not going to get done on time, can we talk about an extension? And that's probably going to happen, like that's how most things work in the world. There might be a time where the response from him is nope, I need you to prioritize it and you got to push through and get it done.
Speaker 2:But many things in the world there might be some flexibility or give that we can do.
Speaker 2:And sometimes there is a line you know it is a fundamental change If you want to become a teacher, you have to student teach, and so it is not a reasonable academic accommodation that if you have social phobia, we're not going to make you student teach. Now, if you have social phobia, we might think about where you're going to student teach. Who might be a good teacher to pair you with. We might think about what we have some flexibility in, but this is the thing, and I think some of it's the pendulum has swung. I think it will come back a little bit, but it swung because we didn't always do a good job of this and maybe that's a piece we haven't said enough here that I think you and I both know and believe, but it feels maybe important to say is we know the world has not always been an affirming, accepting, accommodating place for people who have a diagnosis have clinically significant impairment, and so this is both probably some of this is both an appropriate correction and some ripples on things we're going to have to sort.
Speaker 2:Because, you know, in higher ed there are students who need reasonable academic accommodations to address clinically significant impairment related to a psychiatric disability that is preventing them from being successful in the university context, and we can build equity and building that for them so they can demonstrate what they know and be successful. And if we don't gatekeep some of that a little bit, is it equity if? If everybody gets extended test time and maybe it is maybe maybe there are some folks who would or were screaming into the the ether right now being like yes, like yes, and that those are the things I think we've got to wrestle with and I and I don't have good answers on, but I think feel like the things we're going to have to wrestle with are and there's not going to be a clear answer but getting clarity on how we think about that and how we tackle those things, wrapping this part up with this sort of sentiment that equitable doesn't certainly doesn't mean the same and sometimes doesn't even always mean precisely fair in the way that you see things right.
Speaker 1:So I think this idea of equity is actually one that I think to. What you're saying is something that is what we need to wrestle with. It's not just oh well, equity is just well, if they need it, then we give it to them.
Speaker 1:Or if the you know it's like equity is okay, what? Let me look at this whole picture. Let me understand what is sort of happening at a broader level, not just this sort of tiny specific situation, because if you're only looking at it that way, you're often missing the bigger context that really matters to equity. For sure, man, we could just keep going. I know you're doing a good job of holding your mouth closed. Well, what y'all didn't see was that Dr Hess was like I have thoughts and I am going to wait because we're at the end of the episode and I want to say more, but I can't right now.
Speaker 2:Anytime, though, we can talk right.
Speaker 1:I am so grateful for the time that we got to spend together because, yeah, I mean, I just think there's so many things to say out loud and this is really the reason for the podcast, right, is I get to have conversations like this? You know, you and I see one another and we don't have a mic in front of us and we have conversations like this. And I learned so many things from talking to other therapists and other psychologists and I thought we really have to get this kind of conversation out so that people can start thinking about these things too, that it's not just therapists and helpers who need to be thinking about the world kind of through this lens. It's we need more people on the boat with us.
Speaker 2:Absolutely.
Speaker 1:Thank you for saying yes to being here. I appreciate you so much and I can't wait for our next adventure together in front of a microphone. For both of us you are amazing. Thank you for the work you do. I truly appreciate the work you do, I appreciate you too. Oh, I love it. I love it so much. Okay, so, listener, thank you for being here and until next time. Stay safe, stay well, ciao.
