Why do I care so much about labels?

My therapist and I spent a significant portion of our last session dissecting my desperation to be diagnosed ADHD and why I have always clung onto diagnostic labels.

Some people have a sense that they may fall into a particular medical category but because they are experiencing no ill-effects, never seek confirmation from a doctor. I’m not one of those people, although I was once. I’m out here collecting diagnoses like Pokémon now. Except I don’t care for Pokémon, so it’s a poor analogy.

As I said, there was a time when I was intent on having nothing diagnostic to my name. At least nothing psychiatric. My attitude towards mental illness as a child and teenager was the result of having grown up when there wasn’t as much openness to discussing its existence. I don’t think I knew that ‘normal-seeming’ people could be functional yet struggling against their brains. I honestly questioned what there was about me that was so abnormal as to have ‘contracted’ a psychiatric illness in childhood. It was the preserve of troubled adults, not precocious 12-year-olds. I’m not on TikTok now, but maybe if I were 10 years younger, I might be. And then I may have been subjected to all manner of mental health content in the way that young girls seem to be these days.

When I hated diagnostic labels
I eschewed the labels bestowed upon me 15 years ago and kidded myself that if I denied their legitimacy, no one could act as if they were real. Obviously, the label maketh not the illness - you can be very unwell and it not be on your medical record for many reasons - but having one doctor’s pronouncement become immortalised on the computer screen of every doctor who treats you subsequently represents an acknowledgement of the seriousness of the situation. And serious situations can be hard to comprehend, whether you’re mentally ill or not. But when you are mentally ill, denial is all the likelier. My response to having my GP confirm my parents’ supposition that I had an eating disorder was to pretend it hadn’t happened, then eventually accept the need to change my behaviour to avoid the worst-case scenario. In my eyes, this was being sent inpatient and I could not let that happen, ironically, for my sanity. So I superficially complied with the outpatient psychologist and the psychiatric trainee to the point at which they agreed to discharge me. I failed to buy into the cognitive work that would have stood me in better stead had I been able to engage. My ‘recovery’ was brittle, surface-level and, ultimately, incomplete. This is common among people with eating disorders: bridging the gap between ‘quasi-recovery’ and the real deal can, in the case of some, become the effort of a lifetime, never to materialise. It feels like the effort of my lifetime so far, that much is true.

Why I then could not live without those labels
Despite hating the diagnosis that put more worried people on my case beyond just my parents, I came to need it. It was embedded into my self-concept so deeply that I could not imagine myself emerging the other side of the illness and consequently, plucking the label from the inside of my skull and throwing it to the ground. My eating disorder became the vehicle for the care I received and there was a part of me that liked the singling-out it did. Everything I achieved, I achieved in spite of my messed-up head. And having an overtly restrictive eating disorder meant the mess manifested itself tangibly, on and through my body. There could be no denying the needs I had, even if my compliance in other areas of life may have suggested I was thriving.

It embarrasses me to admit that I came to like the label of anorexia. I wasn’t quite sure of the extent of my attachment to it until I neared ‘recovered’ and shrunk back into the familiar shadows of active illness. The anxiety I feel now that my mind isn’t generating eating-disordered thoughts ad infinitum has made nausea a daily fixture for me. I thought I might even be pregnant recently, but sickness is simply the effect of not knowing what the hell to think about now that food occupies a more proportional portion of my cognitions. I don’t feel like myself and it’s horrible because this self right here is the one I’ve been aiming to return to all these years.

I need a reason for people to go easier on me
Aside from warranting you care and attention, a diagnosis can provide the impetus for others cutting you slack. If you’d asked teenage me whether I needed anyone to cut me slack I would have said no. I was fine. Well, I wasn’t, but more slack wouldn’t have made things any better for me. I was clinging onto the delusion that I could keep going at 100% effort without consequence. It took me to make proper headway in recovery, at university, to realise that my eating disorder was the scaffolding holding my perfectionist success together. With some of it dismantled, everything fell apart. And then, I needed some slack cutting. Friends, family, tutors, I was dependent on them all tailoring their treatment to my unstable, extenuating circumstances.

Fast forward to early 2024 and I’m several more counsellors down, I’ve broken up with my dietitian again and I’ve recently quit NHS therapy part-way through my allocated 10 sessions. I’ve lived in five flats in three years, and I’m on my third job in as much time, and my second boyfriend, and I’m significantly less okay than I was as a teenager. I’m getting some slack in the form of time off work, advised by my GP, and my colleagues are gracious in their support. I’m not sure I’m cutting myself slack though. I hate how I’m not coping, in spite of the labels I’ve amassed. So I do what feels familiar and get back in touch with my dietitian. I’m ready this time. For real. I’ll commit and not self-sabotage. I promise myself. Again.

I’m still seeing the dietitian now - the longest stint I’ve done since we first met in 2021 - and this, to me, represents my ongoing commitment to myself. Because I haven’t got sick of working on my problems and thrown it all away for the umpteenth time. Another factor in this longevity is that my dietitian is the one to whom I owe the discovery that I’m neurodivergent (I’ve gone into this in more detail in a previous post, for sure). And because we’ve been exploring this together for the last year, continually finding new aspects of my life to pick apart from a neurodivergence-eating disorder standpoint, I see no reason to stop now. Plus, I need the constant reminders from her to cut myself slack.

Give me more labels
It didn’t take me long following my non-diagnosis of ADHD in the summer to decide I was going to try Right to Choose on for size and seek a second, non-private opinion. I’d rushed to a readily available service initially, with little patience for waiting to find out the verdict - in true ADHDer style. I then hurried to test that psychiatrist’s hypothesis that I was autistic instead of ADHD, unable to contemplate joining a months-long waiting list. My need to receive a neurodivergent label from a qualified professional came from the instinct I had that I there was no way I could be neurotypical. But my gut feeling stemmed from actual knowledge that I wasn’t operating how I was expected to, nor how I expected myself to. Which meant finding life really hard, mental health issues aside. So yes, I wanted that slack, those reasonable adjustments at work and those around me to know that my ‘atypical’ responses in certain situations were, perhaps, typical, given my neurological makeup.

I can self-identify as ADHD and no one questions it, but having been told I am not inattentive or hyperactive enough to be diagnosed, I feel that I have to prove that non-diagnosis wrong; overturn that decision at the metaphorical psychiatric court of appeal. I’m stubborn. Autism, an eating disorder, depression and anxiety don’t explain the extent of my daily difficulties. And I want to try a medication that might make my already-medicated life even easier, most of all. Maybe it isn’t about others cutting me slack at all, but more about me feeling validated in spite of my differences. Which weren’t differences I bargained for when I was growing up, a high-achieving, compliant child, with little awareness of neurodivergence beyond the male stereotypes.

It’s all very complicated, the self-discovery that stems from late identification of one’s neurodivergence and the decisions about which avenues of help and formal assessment to pursue. My therapist reminded me last week that life is hard, regardless of your health status or diagnoses, and that maybe there are some deficits of mine that cannot be explained by neurodivergence. I’ve no doubt I am ‘just crap’ at many things in addition to mini golf, and that the alternate-universe neurotypical version of me would be as bad at those too. On the flip side, I want to give myself the chance of getting better at executive functioning, which may come from ADHD diagnosis and consequent appropriate coaching and/or medication. I would like to smash fewer objects (literally) in the frenzy that is me going about my every day.