A review by dessuarez
Pathological: The True Story of Six Misdiagnoses by Sarah Fay

informative reflective

5.0

I sought therapy in 2019 because I thought that I was evil. Not because of my anger issues, nor my suicidal ideations, nor my growing dependence on certain substances, nor the fact that I worked myself to the emergency room every few weeks, nor the unbridled resentment that I had for my mother. None of that really bothered me; Why would they? I had been living with them side-by-side with my self-hatred for, at this point, almost two decades. No, the only thing that bothered me was that the part of me that was evil — the part that said awful things about myself and other people — was no longer something I could control. 

 

I was made to fill out a short form. A single page with about ten questions about whether or not I felt this and that within the last two weeks — this seemed to be the minimum amount of time that one could develop a pathology. “What’s wrong with me?” I asked as my therapist perused my answers. And then, I asked my real question, “Am I a narcissist?” 

 

I obviously learned about narcissism from the internet. I was chronically online with little to do with other children ever since I started elementary school, and I was desperate for a reason why my interests didn’t align with their interests, and why we couldn’t get on like other children just seemingly did. I suspected that I could be a narcissist because I saw myself in fictional characters — mostly villains — whom the internet agreed were narcissists: Ozymandias, Magento, Sherlock, Hamlet, Jay Gatsby… 

 

In high school, when everyone (especially on Tumblr where I hung out) was picking and choosing mental illnesses to turn into their personality, I couldn’t justify calling myself depressed (even though I was), or anxious (even though I had my moments), or hyperactive, or obsessive… As I felt more alienated from my peers and as my screentime grew, my empathy for people obviously lessened, and that’s when I decided: I was a narcissist, which meant (as I understood it at that time) that in the very depths of who I am, my most essential self was evil. Reinforced by my parents’ expectations and their disappointments, and proven by countless failures that every teenager had to endure to grow up, I had carried this idea with me for years and I had put it into paper at my therapist’s office, fully expecting a single outcome. 

 

“You have symptoms that are consistent across multiple personality disorders.” Well that was new. 

 

Apparently, according to the DSM, I could have any of the “dramatic, emotional, and erratic” personality disorders in the Cluster B i.e. Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder. The keywords here being Personality Disorder. When I wrote about this in 2019, I wrote about it this way: “It’s not, like, a headache. It’s not going away with a couple of aspirins. The way I think, the way I act, the way I feel is broken. There is no me outside of my personality disorder. The personality disorder is myself.” 

 

I was also 20 years old. Granted, it is acceptable under the DSM-5 to diagnose people over 18 with a personality disorder, but I don’t suppose my personality had already been set by the time I was 20, and anyway, even my chronic biological illnesses like scoliosis and GERD have treatment options at early stages that could fully correct them, but this cognitive condition was forever? 

 

I did not actually start to question this diagnosis until not one, but two friends with ADHD (one of them self-diagnosed, and the other medically diagnosed by a psychiatrist) came back from that same therapist with the opinion that this therapist didn’t exactly believe that ADHD was something that could be diagnosed in adults. And, like, what the fuck, right? 

 

At this point, I had believed for at least a year now that my personality disorder was, if not cured, at least under control. Socializing with others like I had never done in my developmental years allowed me to practice and cultivate empathy (duh, right?), and tens of sessions of cognitive behavioral therapy helped me develop self-compassion, which allowed me to work with criticism better and have resilience during times of failure. Most importantly, I no longer had to overcompensate with grandiosity to cover up for how much I hated myself, because most of the time, I didn’t anymore. But I was still keeping that label, however vague — Cluster B Personality Disorder — front and center in my chest in case, God forbid, I ever forget that I was “broken”. 

 

And then I come across this book. I had never met anyone who was alive and in treatment for so long that the revisions to the DSM would have affected them in such a personal way, so meeting Sarah Fay and hearing her story was certainly thought-provoking in the highest possible level, like this might actually change the way I live level. 

 

I had grown up in a time when the DSM was so crucial in legitimizing mental illnesses that would otherwise be extremely stigmatized in society, and so I had never imagined that the revolutionary DSM would have such a… not low, but also not very high… level of reliability, that some of its diagnoses are based on research funded by the manufacturers of highly addictive medication that these diagnoses would generate lots of revenue for, that once upon a time homosexuality was pathologized in the DSM, that just like any other science there’s still a lot that we don’t know about how mental illness works exactly in the chemical and biological sense, and that, in the end, DSM diagnoses are really just opinions, rather than cold hard truths. A DSM diagnosis is certainly better than an unfounded self-diagnosis, but the dangers of making your DSM diagnosis your personality is pretty much the same as the dangers of making your self-diagnosis your personality. 

 

Fay does a great job of critiquing the mental illness industrial complex while still encouraging people to seek professional help for their mental illness. It really helps a lot — like it’s goddamned life-saving, as especially shown in Fay’s case — to have just the slightest bit of skepticism when accepting a diagnosis. Knowing that a DSM diagnosis is not and shouldn’t have to be your whole entire life allows you to think more clearly about your treatment options, to have the confidence to probe your doctor about the medications that they want to put you on, and to do your own research — to seek out people who are going through the same things you’re going through, rather than take a cocktail of medications blind because you just trust the DSM so much. Realizing that it’s got its flaws reminds you to proceed with caution. 

 

I am in treatment again, this time chemically, and so I definitely needed to read this. I am in treatment because of the emotional and mental fallout from discontinuing a hormonal medication I had been taking for over ten years, so I’ve been clear with my psychiatrist about this; I do want some medication, but I want us to have a plan to discontinue it. We never talked about my personality disorder, not because I maliciously tried to hide it from her, but because it just never came up. I talked to her only about the symptoms that I had been experiencing (which may or may not be related to my personality disorder) — the symptoms I am actually seeking treatment for. At the same time, at the advice of my psychiatrist, I still see that therapist every once in a while. I haven’t asked for a re-diagnosis or anything and I don’t think I will. I don’t think I need it — controversial opinion? I don’t know. I’m trying out this new approach to treatment where I’m not really asking for a diagnosis more than just treatment for my symptoms, and help for the traits I want to change about myself. I am, after all, in treatment so I could get better, not just so that I would have a mental illness to make as my identity.