The Stories We Tell Ourselves: Diagnosis as a Narrative

How does the story we tell about our mental health shape our reality?

While other teenagers were sneaking into bars with fake IDs, playing sports, or going to parties (and, to be fair, I did some of that, too), my best friend and I had a different obsession: walking the streets of the Upper West Side, diagnosing everyone we knew.

Sometimes, we’d spend hours in diners, drinking coffee and smoking cigarettes. Other times, we’d end up on a brownstone stoop, letting the conversation unfold. More than boys, books, or even our imagined futures, what fascinated us most was psychiatry.

We lived in a zip code defined by therapists, psychoanalysis, and psychopharmacology. No one—not our teachers, our parents, or ourselves—was spared. My best friend was a master diagnostician, an armchair psychiatrist with an enthusiasm that, looking back, was probably its own diagnosis. She was certain she had anxiety (and not-so-secretly feared she had a brain tumor). Another friend was depressive. She sometimes labeled me bipolar, sometimes depressive, though she could never quite decide, “you’re elusive,” she’d say with a sigh. Our categories shifted depending on the day, the mood, or whatever psychology book she had recently pulled from her parents’ shelf.

At the time, I didn’t take these labels too seriously. It was the late 90s, and these terms were as commonplace as the Starbucks popping up on every block. But looking back, I see that even then, we were grasping for language to make sense of the world. Naming something gave it shape. It turned chaos into order. It was a way of making meaning, setting limits, and—whether we realized it or not—testing out self-fulfilling prophecies. Even then, I felt the tension between curiosity and belonging, between the comfort of a shared language and the risk of pathologizing emotions that might otherwise just be called life.

And it planted a question in me: How do the labels we wear—both the ones we choose and the ones placed upon us—shape our reality? Do they confine us or set us free? How do they define the borders of our emotional range and identity? What are the stories we tell ourselves about who we are?

When a Diagnosis Becomes a Core Story

Fast forward twenty years. I was 35 when I was misdiagnosed with an aggressive form of cancer. I was told I would need major surgery and that I would likely face radiation and chemotherapy. Doctors were dubious about my prognosis.

In an instant, a new identity crystallized: I am someone with cancer.

The diagnosis became a defining narrative—one that dictated how I saw myself, how I made decisions, and even how I moved through the world. My identity and my life became tightly contained.

Gratefully, that diagnosis turned out to be wrong, but the residue of the story remained. Some of the changes I made—like quitting drinking—were life-giving. Others were harder to untangle, especially the ways I had let myself shrink inside that narrative and the slow unraveling of all the other unprocessed illness stories I had carried with me.

Diagnosis & Narrative Medicine

This experience made me acutely aware of how diagnosis functions—not just as a medical fact but as a narrative created by culture and deeply woven into our identities. Diagnosis offers a framework that can shape, limit, and define us profoundly. The field of narrative medicine examines precisely this phenomenon: diagnosis is more than a biological truth—it is a story we receive, shaping our self-perception and lived experiences.

This insight is central to the work of Charles Barber, a good friend, author, and health advocate. Charlie explores these ideas deeply through his roles as Writer-in-Residence at Wesleyan University and Lecturer in Psychiatry at the Yale School of Medicine.

In his book Comfortably Numb: How Psychiatry is Medicating a Nation, Charlie investigates the societal shift where psychiatric medications, once prescribed exclusively for severe mental illnesses, have become widely overprescribed, effectively embedding themselves into everyday culture. Conditions previously seen as rare or extreme are now commonplace, and medications once reserved for acute psychiatric crises are now routinely used to manage ordinary life challenges.

This shift isn’t just personal—it’s systemic. Psychiatric medications are so embedded in our culture that they’ve seeped into the environment itself—literally. Studies have found traces of antidepressants in rivers, wastewater plants, and even in the brains of fish. It’s a striking metaphor for how deeply these drugs have permeated our collective consciousness, shaping not just individual lives but the world around us.

In Comfortably Numb, he dives into the widespread reliance on psychiatric medication in the U.S. and what this says about our culture. One statistic really struck me: in 2006 alone, Americans filled 227 million antidepressant prescriptions—two-thirds of the global market. Barber points to aggressive pharma marketing, our culture's craving for quick fixes, and a healthcare system that leans heavily toward medication rather than therapeutic approaches. He raises important questions about why we often medicate normal, everyday struggles instead of exploring non-pharmaceutical methods, like cognitive-behavioral therapy, which could offer deeper, longer-lasting support. Ultimately, he calls for clarity around the line between genuine mental illness and the normal emotional ups and downs of being human.

This exploration is deeply personal and subjective and depends so much on client care and agency. For some, a diagnosis feels like a constraint—a limit on what they believe they can do. For others, it’s the first time they feel truly seen

Esmé Wang writes courageously and beautifully about her lived experience with chronic mental illness. In The Collected Schizophrenias, she weaves together memoir, cultural critique, and thoughtful reflection, bringing readers inside the complexities and stigma of schizophrenia. Wang’s voice is powerful, intimate, and illuminating—her work not only helps us understand mental health more deeply but also invites empathy, compassion, and a broader conversation about resilience, creativity, and identity. She describes how receiving her diagnosis of schizoaffective disorder was not a death sentence but a language—a tool that allowed her to better navigate the world:

“A diagnosis is comforting because it provides a framework—a community, a lineage—and, if luck is afoot, a treatment or cure.”

The stories we tell ourselves and are told about our diagnosis determine whether it’s a map or a trap.

Freedom’s Paradox: Why Boundaries Can Set Us Free

I've been reflecting on this while studying clinical diagnosis in my MSW program. Our culture worships freedom—the power to define and redefine ourselves at will. And yet, I wonder—does absolute freedom truly set us free, or does it sometimes leave us unmoored, untethered, lost in an endless sea of reinvention? Maybe true freedom isn’t the absence of limits, but finding the right structure—the one that holds us, rather than confines us.

We tend to think of freedom as limitless possibility—no constraints, no edges, no boundaries. But real freedom isn’t about avoiding limits; it’s about finding the right ones. A poem isn’t less powerful because it follows a form—it’s made more resonant by the shape it takes. A song isn’t less moving because it has structure—it’s the rhythm that carries us.

I think about this when it comes to diagnosis. At its best, it offers a kind of clarity, a framework for understanding ourselves. But when it hardens into identity—when it becomes the only story—we risk losing sight of everything else we are. The challenge isn’t to reject diagnosis, but to hold it lightly—to use it as a tool, not a definition.

Because the full truth of who we are doesn’t live inside a label. It lives in the contradictions, the messy in-betweens, the places where we refuse to be reduced. It lives in the stories we tell ourselves—and in the courage to rewrite them.

A correct diagnosis can be like reading the perfect poem at the perfect moment—a stabilizing force, a framework that allows someone to move through the world with greater understanding. But when diagnosis becomes identity—when it becomes the only story—we risk confinement rather than clarity, mistaking a single truth for the whole of who we are. It’s like fixating on one line of a poem, missing the full sweep of its meaning, the rise and fall of its human complexity.

Creativity as an Act of Narrative Agency

A common concern for people receiving a diagnosis is how it will impact their creative flow—their drive, their desire. Will medication dull inspiration? Will the label itself become a limit? The answer, of course, depends on the particulars of the situation.

Kay Redfield Jamison’s Touched with Fire explores the long-standing connection between mood disorders—particularly bipolar disorder—and artistic genius. Drawing on historical case studies, scientific research, and her own expertise as a clinical psychologist, she examines how figures like Van Gogh, Sylvia Plath, Lord Byron, and Virginia Woolf exhibited patterns of intense emotional highs and lows that often fueled their creative work. She argues that, while mental illness has been disproportionately represented in creative circles, it is not suffering alone that breeds art—it is the ability to channel emotional intensity into meaningful expression.

Jamison also wrestles with a difficult paradox: many of these artists created in their manic states, but they also suffered deeply, and their illnesses ultimately destroyed some. Her book raises essential questions: Does treatment dull creativity? Is the price of genius instability? How do we balance the need for mental health care with the fear that medication or diagnosis might limit creative potential?

These are important questions, but my own interest lies elsewhere. I’m less focused on the connection between madness and creativity and more on the relationship between creativity and wellness—how writing and artistic expression can be tools for resilience, agency, and self-definition rather than being inextricably tied to suffering. Creativity doesn’t have to come from torment; it can be a path toward wholeness.

A strengths-based approach to mental wellness shifts the focus from pathology to possibility. It asks: What is beyond the diagnosis?

Writing—like all forms of creative expression—allows us to step beyond diagnosis, to see it as one story among many rather than the only one. It expands the narrative, revealing new dimensions of identity and new ways of understanding ourselves.

Before diagnosis, we had feelings. Now, we risk letting a label overshadow the full spectrum of who we are. The real challenge is to hold both truths: to use the diagnosis as a tool for understanding while refusing to let it be the only story we tell ourselves.

Writing Prompt: The Stories We Tell Ourselves

We all have stories we tell about ourselves—stories about who we are, what we’re capable of, and where we belong. Some of these stories lift us up; others hold us back.

Take a moment to reflect: What is a story you’ve been telling yourself lately?

• Where did this story come from?

• Does it still feel true, or is it an old narrative that no longer fits?

• What might happen if you rewrote it?

Now, try writing that story in two different ways:

First, write it as you’ve always told it. Be as honest as possible—what is the version that plays in your head?

Then, rewrite it from a different perspective. What would the story look like if you told it with more possibility, self-compassion, or curiosity?

Stories shape our reality, but we can reshape them, too. What shifts when you tell a new version of your own?

Interested in diving more deeply into these practices? Check out my book, Narrative Healing.

Just a quick reminder: There will be no gathering this Friday. Instead, I hope you'll join us next Friday, March 28th, for our weekly live gathering at noon, where we'll come together to write and share. Looking forward to seeing you then!

With gratitude,
Lisa