Winnie-the-Pooh is being diagnosed: about usefulness or uselessness of psychiatric diagnosis

Winnie-the-Pooh, by A.A. Milne, was one of my favourite books in the childhood. My heart would fill with warmth when I entered the magical world of the Hundred Acre Wood, where lived Pooh, a good-natured, honey-loving bear; Owl, omniscient bird; the meddlesome Rabbit; Eeyore, the gloomy donkey; Tigger, a frisky tiger; Piglet, a timid and worried pig; Kanga, an energetic kangaroo and her son Roo.
These nice and kind Milne’s characters also intrigued a group of Canadian neurodevelopmental paediatricians who published an article with the title Pathology in the Hundred Acre Wood: neurodevelopmental perspective on A.A. Milne. (See link below). So, Winnie-the-Pooh is diagnosed with obsessive compulsive disorder regarding his obsession with honey and repeated counting of honey pots, attention deficiency disorder and even Tourette syndrome. Piglet suffers from generalised anxiety disorder. Eeyore, the grey donkey, suffers from depression, of course. Owl has dyslexia, and Rabbit is full of self-importance. Roo is growing in an environment, which is detrimental to him since his closest beings are his possessive mother Kanga and hyperactive and impulsive Tigger. The paediatricians are also concerned about Cristopher Robin, a parentless child who spends all his free time together with animals.
This article is not meant to mock at people with a diagnosis, but it is a kind of parody of the authors’ scientific perspective of the world and their need to analyse, diagnose and to define every being although it is a fairy-tale character.
In their article something unpleasant can also be observed, something regarding mental disorder diagnosis. What once used to be a person with all their attributes, behaviour, way of thinking and acting, has now become a mere bunch of symptoms.
Pooh, who used to be the good old bear with a big heart, after the analysis, becomes a multitude of pathologies. The diagnosis for the Hundred Acre Wood residents is futile since they will never learn about their diseases and disorders, and therefore they will live “happily ever after”. But what is the purpose of diagnosis for us, real people?
HOW CAN A PSYCHIATRIC DIAGNOSIS BE USEFUL?
A diagnosis of mental disorder can be at least as frightening (if not even more) as a diagnosis of a severe physical disease. However, some people find it helpful, since their mental pains, thoughts, emotions and behaviours, which have caused chaos and terror, now get only one name, one label. If you know what’s happening to you, you can do something about it. Awareness of it can bring a feeling of self-control and some safety, if nothing else.
If you know what’s troubling you, you can get informed about the illness and learn about its treatment. A psychiatrist usually suggests drug treatment, yet most people try to find other sources of help and support as well (psychotherapy, hypnosis, autogenic training, supportive groups…). Nowadays people know a lot about their diseases, they would know that their causes lie partly in genetics and partly in the environment, and that they are not the ones to be blamed for their hardships. A diagnosis can help the individual to become more self-emphatic, and his relatives to be more understanding and tolerant of the individual’s altered state. If we are cognisant of the diagnosis, we know that our relative is not a lazy, incompetent fellow, but a person feeling depressed; we know that his excessive concern, which can be quite tiresome for others, is part of general anxiety disorder, or that his emotional coldness, remoteness and apathy are caused by schizoid personality disorder.
HOW CAN A PSYCHIATRIC DIAGNOSIS BE A LIMITING FACTOR?
On the one hand, getting a diagnosis is quite useful to many, but on the other hand it can be an arduous burden and limitation. Besides unpleasant side effects of psychiatric medication that an individual has to endure (fuzzy mind, apathy, increased appetite, attention problems or even epilepsy), it is stigmatisation that hurts the most.
“Unwelcome, weird and undesirable” is how people with severe mental diagnosis feel. Because of their decreased professional competence, they are left out and pushed to the edge of society.
Obstinate social ignorance of mental disorders is hindering efforts to reduce stigma towards persons with mental illness. I can often hear people say, “Have you heard that Mr X’ nerves are shot. Awful! Yeah! He allegedly committed … but fortunately, he was put to an asylum.”
Obviously, it is much easier to grow prejudice and fright and make every effort to label and frown, than to get informed.
The problem of labelling does not originate solely from society but also from an individual himself. A diagnosis is above all a label, a tag that one can live up to and identify with. Once the diagnosis has been established, for example general anxiety disorder, one starst paying more attention to symptoms indicating this disorder.
On the one hand the awareness of data that supports a certain belief is being raised, but on the other hand all the data contrary to this belief are discarded by our brain as irrelevant. So, one more often than not perceives concern, anxiety and thought disorder, but one does not pay enough attention to moments of ease and contentment. If a person keeps doing things in this manner, one can stop being a person with a unique interlacement of features, wishes, volition and plans, who at the same time has anxiety disorder. Instead of that, one identifies with the disorder itself which becomes the final denominator, and oneself becomes a person with anxious personality (This can easily be perceived with expressions used for identifying with some other diseases – “depressives”, “schizophrenics”, “anorexics”, “bipolars”,…)
A diagnosis can become one’s own predominant story, while other stories fade away in the background. It is difficult to escape this trap because of the thoughts, which attach every mood, every emotion and every event to one’s disorder. The alteration of the perspective can be made even more difficult by the psychiatrist who focuses solely to symptoms, or sometimes because of one’s family members and friends, who, concerned about person’s safety and welfare, pay too much attention to the disease, and not to the person as unique human being.
With diagnosis one has to take into the account the effect of placebo and its negative “twin brother” nocebo respectively. The power of thoughts and their effect on one’s body and psyche is tremendous, so a strong belief that one will never get better, is anything but helpful. With a diagnosis such as depression, with its recurrent nature or schizophrenia, which is supposed to be incurable (which, of course, is not true, since there are many cases of complete recovery), this data can bereave the patient of his hope and courage, and through nocebo it has a negative effect on the course of the disease.
A DIFFERENT VIEW AND REDEFINING A DIAGNOSIS
When a person gets a diagnosis, he cannot possibly forget about it or brush it aside and live happily ever after like Winnie-the-Pooh. What one can do is to not take his diagnosis word for word (in Diagnostic and Statistical Manual of Mental Disorders), but to regard it as one of the bits of information about his present state. We can get more information about what a diagnosis really is if we look up for its etymological meaning. The word diagnosis originates from a Greek word diagignoskein, which literally means to examine thoroughly, find out, learn. That is to say that we try to get to know, understand and explore what is going on inside us and discover the causes.
Each and every one of us is different, therefore our experience of ourselves and the world around us differs too. Likewise, mental state differs from person to person, although a diagnosis labels it with the same name. For every person who is treated for depression, this state has a different meaning and different contents. Therefore, it can be of great help if a diagnosis is given a new name – a name that will have a special to a person who is struggling with it. As such it will promote the improvement of the mental condition and help to understand and break taboos against mental diseases, i.e. help the client to prevent diagnosis and its labelling force from taking hold of his inner power for change.
One of my clients was diagnosed as having GAD (General Anxiety Disorder). During the therapeutic research he quickly found out that diagnosis represents an omnipresent and permeating anxiety for his well-being – a paralysing threat of danger that is awaiting for him everywhere. This fear was fuelled by his thoughts, which continuously got trapped in a loop that we called “What if…” In the therapeutic process we then followed these thoughts and discovered that they do not originate from “Here and now” but from circumstances of his childhood.
Omnipresent anxiety and fear for his safety gradually (and not by themselves but because of great efforts, will-power and work) turned into a bundle of thoughts, feelings and behaviours, which he called a State of High Mental Alertness. Such state of mind is much easier to control, since the client can check whether it is appropriate (whether there is a real reason for alertness), the state appears only in certain situations (therefore it is not omnipresent anymore), and the client can help himself how to step out from such a state using simple solutions he has learnt during the therapeutic process.
In the example above, we can see how the contents defined by a diagnosis can be altered in one person alone. Just imagine what a variety of contents there are from one person to another! Diagnostic system does not pay any attention to these differences which are often of crucial importance for the improvement of one’s mental condition, but it keeps classifying, labelling, sorting out, and sweeping them into the dustbin without distinction. But the truth is that each of us has “his own dustbin”, and that’s why it is so important to define our own inner world with a name that will stand for what is meaningful to Us and what is essential for Us.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80580/