When Mental Illness Becomes an Identity: 3 Things You Can Do

Ash San Filippo
May 7th, 2019

I sat with Aaron as he answered questions at the rehab intake interview.

He gave all of the details of his opioid addiction, his marijuana use, and his creative blending of chemicals to find new highs. 

He talked about his overdoses and hospital stays. 

Then came the mental health questions. He outlined his history of diagnoses, beginning at age 12 through his current age of 18—Anxiety, clinical depression, OCD, borderline personality disorder, social anxiety, non-suicidal self-injury, and substance use disorder. 

The nurse dutifully noted every detail.

A few minutes later, we were driving away from the facility. He had been rejected for treatment because they couldn’t care for his array of mental health challenges. 

I was mad. He had finally decided to go to treatment and found a facility he could afford. This was going to be the turning point, but he got rejected because his chart was too complicated. 

He was upset too, but less surprised than I was—his litany of issues consumed his life. He always assumed that his diagnoses were going to limit his success. 

As the labels were added throughout adolescence, his identity had been shaped and reshaped. 

One by one, each diagnosis edged out the rest of his sense of self. By age 18, he only knew himself by words on a medical chart. By a complex interplay of symptoms, definitions and prescriptions. 

A Pendulum Swing in Thinking

In the US, we’ve had an arduous relationship with mental health. There has been a history of stigmatizing and marginalizing those who struggle with mental health. We’ve heard loud voices suggesting that mental illness is nonexistent and that going to therapy or taking psychotropic medication amounts to sin.   

Now, I observe, that the pendulum is swinging, especially amongst the younger crowd. For many, mental illness is seen as the norm. Anxiety, depression, and suicidal ideation have become pop-culture hallmarks of the Millennials and Gen Z generations. Memes about depressive episodes and death wishes flood social media timelines. 

Diagnoses are on the Rise

It’s not surprising that young people are talking about their mental wellbeing, as we are seeing an uptick in mental health issues among adolescents. Long-term studies that measure common mental health symptoms show an increase an over of the last 30 years. 

It also seems that the efforts to destigmatize mental illness and increase access to mental health care are starting to pay off. Researchers theorize that part of the uptick we’re seeing in mental illness in young people is due to more of them being willing to seek and receiving treatment.

Additionally, most of the time, insurance will only pay for therapy that is “medically necessary.” That means a therapist needs to supply a diagnosis in order to get vital therapy costs covered by insurance. 

If there is no obvious diagnosis to be given, they will often diagnose with something relatively benign, such as an “Adjustment Disorder.” However, if insurance cuts off payments, they may need to add additional diagnoses in order to continue care. In this way, it’s possible for a person to end up with a long list of diagnoses. It’s not an ideal system but therapists are doing their best to get care to people who need it the most. 

The net result of decreased stigma, increased access to care, and necessary diagnoses for insurance, will be a continued increase in mental health diagnoses in the students we serve. 

Diagnoses Becoming Identities

As adolescents are working on the task of identity formation, mental health diagnoses are easy labels—which come with a neatly packaged list of symptoms—to build an identity around. 

This can be especially true of students who experience strong symptoms of mental illness—such as debilitating anxiety—or if they were already experiencing a weak sense of self prior to their diagnosis. 

So what can we do to help students seek mental wellness while keeping their identity formation on a healthy track?

1. Help Them Process their Diagnosis 

For some, receiving an accurate diagnosis is like taking a breath of fresh air—finally, their experience makes sense and their struggle has been validated. Others may feel confused about their new label, wondering what it means for them. 

Regardless of how a teen is feeling about their diagnosis, we can help them process their new reality. Honest dialogue will help keep shame at bay and prevent the diagnosis from growing into a dark secret that defines them. 

Ask things like: 

  • How do you experience your diagnoses? 
  • In what ways do you feel like your diagnosis is accurate or inaccurate? 
  • What areas of your life are affected most and least by your diagnosis?

2. Literally Name the Mental Illness

One way of helping students keep their identity separate from their diagnosis, is helping them give their illness a name. A human name, like Bob. As soon as you do this, it changes the conversation from focusing on what’s wrong with the student to the reality of an outside force causing harm to the student. 

Ask things like: 

  • Sorry Bob is being such a jerk lately. How can I help?
  • How has Bob been showing up in your life? 
  • What choices have you been making that feed or starve Bob?

Feed Them Truth

Adolescents are like an identity sponge; if they’re dry, they will absorb just about anything. It should be our goal to fill them up with truth about themselves so that there isn’t room to build a harmful identity. 

Some ways to do this: 

  • Go through an Identity in Christ bible study together.
  • Constantly affirm your teen when you see them live out the fruits of the spirit.
  • Have honest conversations about how your student views themselves, helping them see that their mental challenges are only a part of their life. 

Above all, pray for your students and be a steady presence in their chaotic life. We can bless them by being a nonjudgmental adult that brings peace and helps points them to the loving arms of Christ. 

Ash San Filippo

Ash SanFilippo is committed to giving youth workers the tools needed to reach teens who are experiencing hopelessness. That is why he’s at TreeHouse, whose mission is to end hopelessness among teens. Check out TreeHouse at thyouth.org

Disclaimer: The views and opinions expressed in the YS Blog are those of the authors and do not necessarily reflect the opinion or position of YS.