Why Learning From Our Emotions Requires Resisting Talk of Diagnoses

The popularization of mental disorders on social media is in full swing. In pithy language and relatable snapshots of personal experience, commercial and user-generated messages discuss or display “symptoms” of disorder that foster personal appropriation—“self-diagnosis”—of diagnostic categories. Anxiety disorders, ADHD, and dissociative identity are among the favorites. Appropriation promises a new understanding of experience and self, the possibility of a community, and an opening of a pathway to medication or accommodations of various kinds.

For reasons like these, identification with a diagnostic label can be comforting. In interviews for my book Chemically Imbalanced, people spoke of how their diagnosis conferred social recognition on their struggles, eased a sense of isolation or differentness, or gave them hope for resolution. Most believed that clinical categories implied a physiological cause of their distressing thoughts and feelings, yet not a malfunction so serious as to be a mental illness. They were just a little different.

One interviewee, Brittany, for instance, found “depression” and “anxiety disorder” helpful ways to think about her “sadness” and “fears.” Because she couldn’t explain her feelings or why they were arising, she concluded that they had no reasons; they were about nothing. The medical categories, however, provided a kind of external validation of her inner suffering. Armed with an interpretation—a “chemical imbalance in the brain”—she now had a plan of action: to pursue getting prescribed medication. The medical names, she said, also made it easier to explain to her friends why she might at times need forbearance.

Brittany’s need to medicalize her emotions is not only widely shared but deeply ironic. We fancy ourselves as living in an age in which we are in touch with our feelings, no longer subject to the repressions and silences of past generations. These days, all emotions are good, we are told, and we are free (especially thanks to social media) to speak the unspeakable and share our secret craziness. Now, we’re open, vulnerable, and unashamed. Toward the feelings of others, we are accepting and empathetic.

Or so we imagine. Yet the move toward medicalizing emotions with diagnostic categories takes us in the opposite direction—not toward emotional openness or empathy or understanding, but toward closing off and shutting down. Diagnostic labels end the conversation.

Emotions and Self-Knowledge

To see how this turn leads to a brick wall, we need to consider the crucial relationship between our feelings and self-knowledge. The very idea of being open and listening to our emotions presupposes that they have something valuable to say to us and about us. They do, but how does this work?

A short answer goes something like this: Emotions arise in our everyday experience of the world. They are a special form of awareness, an affective way of “seeing” and evaluating situations as being of a certain kind or having a certain character. To feel shame, for instance, according to the philosopher Charles Taylor, is to be aware of a situation as shameful, as one that “shows me up to be base, or to have some unavowable and degrading property, or to be dishonorable.” Shame is the emotional response to our experience of a situation as shameful.¹

To have this response, however, the norm at stake in the situation must matter to us in some important way. Otherwise, the emotion wouldn’t move us in the first place. For instance, it is a common tradition at my university for graduating students to streak naked down a part of the central campus known as “the Lawn.” If students regard streaking as just good fun or even a kind of duty, then, despite their nakedness before strangers, they probably won’t feel ashamed. They might feel pride instead (though still be reticent to tell Mom and Dad). The things that matter to us are the things we get emotional about.

When we feel shame, then, we are expressing a judgment about a situation that (1) defines the basis for our feeling (the situation is shameful) and (2) indicates that it has a special significance for what we care about (such as our dignity and good name).

Not all emotions are like this. Shame is one of the “social emotions,” like remorse, admiration, envy, outrage, indignation, and guilt. These emotions emerge in our relations with others and with the norms and ideals we perceive in society—what, for instance, in the case of shame, is base or degrading or dishonorable. This is different from emotions that arise in other contexts, such as in interaction with the natural environment, where emotional responses may be more visceral (disgust, awe). Social emotions involve norms that are important to us and that concern our social status and self-worth.² For that reason, they are especially relevant to struggles with our thoughts and feelings.

Precisely because these emotions involve an evaluation of our circumstances, we can be mistaken about them. Our feelings, to give just one example, can be at odds with our understanding of a situation. A college student, Ivy, for instance, told me that she feels guilty all the time because she is not accomplishing more. When I asked what else she might be doing, she couldn’t provide an answer. In fact, she has an overflowing plate of activities and is already remarkably stretched. Ivy herself doesn’t think there is any warrant for her guilt feelings, yet she feels them, nonetheless.

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That we can be mistaken about our emotions is why further reflection is often necessary. Efforts to understand our emotions and the evaluation of a situation they presuppose (e.g., guilt implies a wrong), Taylor says, “admit of—and very often we feel that they call for—further articulation.” We may reject previous interpretations as inadequate or distortions in our effort to reach a more accurate understanding. The new formulation, in turn, can and often does lead to changes in how we feel.

On reflection, for example, Ivy may decide that it is not guilt but some other emotion she is feeling. Or she might come to see that some actual wrong, of which she previously had but a vague intimation, is provoking the guilt. Or perhaps she comes to see that she has been resisting awareness of some features of her situation because the emotions are threatening and hard to acknowledge. There are many possibilities; our emotional life is complex.

Whatever the case, having an accurate name for and understanding of our emotions is important because it helps us to better understand ourselves, account for how we feel, and see the appropriate actions we might need to take. It also helps us bring into greater focus the relevant social norms and their influence. Ivy’s feelings of guilt, if that’s what they are, raise the question of what in her situation creates a sense of wrongdoing, a question that could initiate an interrogation of the expectations of high performance and social success that she is living under. A dialogue with the norms can also change the way we feel.

Displacing Our Emotion Language

All this brings us to the flat, homogenous language of symptoms and disorders. Recasting emotional distress in this language effectively displaces our normal way of talking about our feelings and the situations that give rise to them. In my interviews, people who adopted clinical terms to characterize their emotional responses relied on those terms almost exclusively. Virtually every reference Brittany made to her negative feelings, for example, was in such terms as being “depressed” or “anxious.”

But it is our rich, everyday emotion vocabulary—jealousy, envy, betrayal, disappointment, embarrassment, boredom, loneliness, sorrow, resentment, unworthiness, and so many other feelings, including, of course, the positive ones—that brings into focus our inner life and the meaning of our emotions for us. This is the language that allows us to characterize how and what we feel. These are the terms that allow insight into the relation of our feelings to our desires, our purposes, our commitments, and our real-world circumstances.

Without a rich word-hoard for our emotions, the possibility of further reflection or reassessment is greatly reduced. Symptoms and disorders are things you have, not experiences you explore. In clinical language, our emotional experience cannot speak to us. In these terms, our emotions no longer express our response to our situation. What is unique to us disappears.

Simplifying and homogenizing experience is not an unintended consequence of clinical terms; it is their very purpose. Which is why they also hinder empathy. Without our emotional language, we cannot know what others are feeling because that is the only language in which they can communicate it. If all we have are clinical categories, we are left with abstractions. Care, however, is a response to persons.

While we can understand the appeal of clinical terms, in the absence of psychopathology, they have to be resisted. They are a dead end. Our emotions have valuable things to tell us about ourselves, about our very humanity. But only if we let them.