Dear Therapist:

As there has been an increase in mental health awareness in the community I am noticing that people can be somewhat quick to point out what they believe are mental health issues in others. I see this particularly when it comes to personality disorders, more specifically Borderline Personality and Narcissistic Personality. I see these terms get thrown about and I am hoping you can clarify for the readership. Are personality disorders really that common? How easy would it be for a layman to be able to notice these issues? How would someone know the difference between someone that is just a difficult person and someone who has a real problem? What role do you think that a non-professional can have in identifying these issues and getting people the help that they need? I also wonder, and this may go to the premise of this column, if you think it is beneficial for people to be educated about these things when it can lead to accusations and misuse of these diagnoses?

Response:

As with anything, there are advantages and disadvantages to the increased awareness of mental health issues in our community and in the general population. Certainly, awareness has led to an increase in treatment for those who need help. It has also led to better treatment options. In a community where there are open forums and discussions about mental health issues, people feel less stigmatized, judged, and isolated. Awareness of mental health issues has helped family and friends become involved in helping those of us who suffer.

As you point out, however, people are sometimes quick to diagnose others (and themselves) based on little knowledge or understanding. I think it obvious that only trained and experienced mental health professionals should be diagnosing mental health disorders. Professionals are not infallible, and sometimes diagnoses are not very clear-cut. However, professionals are trained to identify problematic issues, and to diagnose based on specific criteria. These criteria are evaluated based on knowledge and experience. Additionally, professionals are trained to be objective in evaluation and treatment. When someone is emotionally involved or connected, this creates for subjective evaluations based on emotions that are often not consciously acknowledged.

Every mental health issue—and indeed every human issue—exists on a spectrum. Most people have anxious feelings, borderline tendencies, or narcissistic thoughts. To some extent, diagnoses are arbitrary. Of course, we can identify qualities, thoughts, feelings, and actions and assign a diagnosis based on the official criteria. But who decided on the criteria? Do they take into account the person’s other qualities, personality, defense mechanisms, and coping skills? Does a diagnosis truly help us to treat people?

Diagnoses are simply labels. whose purpose is to help create a universal language that can help mental health professionals create comprehensive treatment plans. Diagnoses do not define people. Nor are diagnoses treated. We treat problems. Two people can see me with the same “diagnosis,” but who require completely different interventions. In fact, one of them may not require treatment at all for that diagnosis.

Before public dialogue about mental health became the norm, people were more focused on problems (their own or others’). Until someone had a clear issue, it was often not discussed or even identified. Although this may have had its benefits, many were left untreated and unheard. At this point, the pendulum may have swung too far in the other direction. As with any issue, I think that the goal is for us to find the happy medium between “blissful” ignorance and constant layperson diagnosis.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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