Can Diagnosis become Identity?

A Reflection on how Diagnoses are similar to Maps, and Why it is useful to remember that Map is not the Territory

A few years ago, I was seeing a patient in the Emergency Department who had come in with abdominal pain. As part of her evaluation, I needed to take some blood tests.

The moment she sat down in the chair, she became visibly distressed. Her hands started shaking, and tears began to form in her eyes.

She told me that she was frightened of needles.

I reassured her gently that many people with fear of needles go through it uneventfully.

I explained that it would only feel like a small scratch and that it would be over in a matter of seconds. I asked her to take a few deep breaths and try to relax.

Before she could respond, her partner immediately said, “She can’t relax. She has anxiety.”

For a moment, I was wondering as to how to respond. This was the first time I came across a similar statement.

She was eventually able to calm down, we completed the blood test, and moved on. The procedure itself was straightforward.

Yet, that sentence stayed with me.

At the time, I had only recently started working in the Western World. I had grown up and completed my medical training in the South of India, between rural and semi-urban settings. I was now adjusting to a new healthcare system, a new culture, and a new way of practising medicine.

What stood out to me was not the anxiety itself. Anxiety is a universal human experience. Every human being knows what it feels like to be worried, fearful, uncertain, or overwhelmed.

What stood out to me was the Language.

He said “She has anxiety.” Not “She is anxious”.

I found myself wondering whether there was a difference between saying “I am anxious” and saying “I have anxiety.” At first glance, they appear to mean the same thing.

The more I thought about it, however, the more I wondered whether they might lead us to think about ourselves differently.

Now, as a Psychiatry Resident, that question has eventually led me to reflect on the fundamentals of psychiatric diagnosis.

The sea can look different from every shore, yet it is the same sea. The Human Mind is no different.

What Exactly Is a Psychiatric Diagnosis?

One of the common misconceptions about psychiatry is that psychiatric diagnoses function in exactly the same way as diagnoses elsewhere in medicine.

Sometimes they do. Often they do not.

If someone has pneumonia, there is some infection in the lungs. If someone has diabetes, we can identify problems with blood sugars and insulin regulation. If someone has cancer, we can identify abnormal cell growth.

In these situations, the diagnosis is attempting not only to describe what is happening but also to explain how it is happening. (and sometimes why it is happening)

Psychiatric diagnoses are quite different.

The classic textbook Fish’s Clinical Psychopathology notes that the definitive classification of disease ideally rests upon understanding its cause. However, until causes are fully known, medicine often relies on syndromes, i.e, recognisable clusters of symptoms that tend to occur together.

Psychiatry frequently operates within this reality. Many psychiatric diagnoses are not direct explanations of why a person is suffering. Rather, they are carefully observed descriptions of particular patterns of human experience.

For example, if a person experiences excessive worry, physical tension, poor sleep, restlessness, difficulty concentrating, and impairment in daily life over a period of time, we may give that pattern a name: Generalised Anxiety Disorder.

It should also be noted that just because a person is anxious, that does not mean that he has Generalised Anxiety Disorder. There are more criteria to come to a diagnosis.

The diagnosis describes the pattern of experience.

This does not mean the condition is not real. The suffering and the impact on people’s lives is real. Genetics, neurobiology, and environment - all of them matter.

Yet I think there is something important to recognise — many psychiatric diagnoses begin as descriptions of experience, rather than complete explanations of experience.

From Experience to Identity

The relationship between language and identity is an interesting one to experiment with.

Consider three statements.

“I am feeling anxious.”

“I have anxiety.”

“I am an anxious person.”

Most people would regard these as variations of the same idea. However, they are not.

The first describes a state. It tells me something about what is happening right now. And it attributes the feeling to oneself.

The second describes a condition. It suggests a recognised pattern that may persist over time.

The third describes an identity. It tells me something about who I believe myself to be.

Human beings have always lived through stories. The words we use to describe ourselves are rarely neutral. They shape how we understand our experiences and, over time, how we understand ourselves.

A diagnosis can begin as a description of suffering. Sometimes, without anyone intending it, it gradually becomes part of a person’s identity.

The same process can happen with mental health diagnoses. A person may begin by saying, “I have been struggling with anxiety recently.” Over time, this can become, “I have anxiety.” Later still, it can become, “I am an anxious person.”

Whether that progression is helpful or harmful probably depends on the individual.

For some people, receiving a diagnosis is enormously validating. It provides relief, understanding, and access to support. For others, the diagnosis can slowly become a lens through which every experience is interpreted.

This is where the role of culture and social conditioning comes in.

Looking at the Mind Through Different Lenses

Part of what made me reflect on this was the experience of moving between cultures.

Growing up in the South of India, I was accustomed to hearing emotional suffering described in particular ways. People would speak about family difficulties, responsibilities, financial pressures, relationships, religious concerns, and stressful life circumstances. The suffering, although was real, it was often understood through the context of a person’s life and his/her relationship to the world.

In the western world, I found myself hearing diagnostic language more frequently in everyday conversations. People seemed more comfortable describing their experiences through psychological terms.

These observations are based entirely on my own experience. They are not universal truths about India or Britain. Both societies are enormously diverse, and both are changing rapidly.

Yet, the contrast made me curious about something larger.

The more I work in psychiatry, the more I wonder whether our understanding of the mind is shaped not only by science but also by culture, language, philosophy, and history.

Every culture inherits certain assumptions about what it means to be a person. Every culture develops its own ideas about suffering, resilience, responsibility, healing, and recovery.

Even the idea of a “self” is not understood identically everywhere.

If our understanding of the self varies, might our understanding of mental suffering vary too?

The question is not whether one culture is right and another is wrong. The question is whether any single framework can fully capture something as complex as the human mind.

A Diagnosis Is a Map

As a Psychiatry Resident, I use diagnoses every day. They help clinicians communicate. They help researchers study patterns. They help patients access treatment and support. They are enormously useful.

But I sometimes wonder whether we forget what a diagnosis is.

A diagnosis is a map.

Maps are incredibly valuable. They help us navigate unfamiliar territory.

Yet a map is not the territory itself.

No map can capture every tree, every path, every hill, every stream, and every change in the landscape.

Similarly, no diagnosis can fully capture a human being.

A diagnosis may describe a pattern of suffering. It may even help explain part of that suffering. But it can never tell us everything about the person experiencing it.

Beyond the Label

Diagnosis matters. At the same time, I think something else matters too.

Agency.

The sense that, despite our vulnerabilities, despite our diagnoses, despite our histories, we are still participants in our own lives.

Modern psychiatry increasingly recognises that mental health emerges through interactions between biology, psychology, and environment. Even our genes do not operate in isolation. Epigenetics suggests that life experiences and environments can influence how genetic vulnerabilities are expressed.

Vulnerability is not always destiny.

Perhaps this is why exercise and healthy relationships can help. Why meaning can help. Why community and belonging can help. Why self-understanding can help.

Cross-cultural Psychiatry

As someone who has lived and trained within two different cultural worlds, I increasingly wonder whether psychiatric diagnoses are not merely medical concepts, but also concepts that are understood through cultural lenses.

The suffering people describe is real and universal. Anxiety, grief, loneliness, fear, despair, hope, and recovery are part of the shared human experience. Yet the meaning we attach to these experiences, the stories we tell about them, and even the language we use to describe them may differ from one society to another.

Perhaps one of the challenges for modern psychiatry is learning to hold both truths at the same time: the universality of human suffering and the diversity of human interpretations.

Psychiatric diagnoses are undoubtedly useful. They help clinicians communicate, guide treatment, facilitate research, and help people access support.

Yet, I increasingly wonder whether they are best understood as descriptions of particular patterns of suffering, rather than complete explanations of the human mind.

Mental health care works best, in my view, when it balances compassion for suffering with belief in the human capacity for growth, adaptation, and change.

The longer I work in psychiatry, the more I realise that the second most important question is, “What diagnosis does this person have?”

My first most important question is :

Who is the person experiencing it?