Beyond the Diagnosis: The Human Behind the Label

Recovery is possible!

Recovery is possible!

Recovery is possible!

Recovery is possible!

Recovery Dialogues Sober Stories.

Welcome to Recovery Dialogues Sober Stories. I'm Antonio Matta, your host, and I'm so glad you've joined us for today's powerful conversation. Before we begin, a heartfelt thanks to our sponsor City Voices, a nonprofit dedicated to supporting individuals with mental health challenges. Their mission is simple but profound. Let's make people with mental health challenges smile again. Visit www.cityvoicesonline.org to explore events, articles, or find ways to volunteer and make a difference. Now, let's dive in. Who are we beneath the surface? Names, roles, and labels—these constructs shape how we navigate the world, but they don't define the entirety of who we are. For some, a diagnosis becomes a label that sticks, not just to medical records but to the very fabric of their identity. It influences how they see themselves, how others perceive them, and the course of their lives. In this episode, we explore the intersection of identity and mental health or addiction labels. While a diagnosis can bring understanding, it often confines the view of a complex, multidimensional individual to an oversimplified narrative. But identity isn't static. It's fluid, shaped by the stories we tell and those told about us. For people navigating mental illness or addiction, reclaiming their identity means moving beyond reductive labels like "addict" or "unmotivated" and embracing their full humanity, one defined by resilience, growth, and potential. Research underscores the profound impact of labels. They can create a phenomenon called identity spread, where a single label dominates, leading to internalized stigma and diminished self-worth. Yet, recovery is often a process of transformation, one where individuals redefine themselves beyond the confines of diagnosis, rediscover their strengths, and reclaim agency over their narratives. This process is vital. Studies show that internalized stigma reduces self-esteem and trust in care, but recovery-focused approaches emphasizing identity reconstruction can be transformative. Across the globe, from From Thailand to Ethiopia, the message is clear: reclaiming identity fosters hope, agency, and belonging. This journey, however, requires community. It calls for clinicians who see beyond diagnoses, peers who share their struggles, and a society that honors the humanity in every individual, no matter their label. So today, we ask: What does it mean to see beyond a diagnosis? How can we shift From focusing on symptoms to understanding the human story behind them, and how can we, as a community, dismantle the stigma that ties identity to labels? Stay with us as we unpack stories of resilience, examine the role of language, and explore how recovery, both deeply personal and profoundly collective, unlocks the potential for all of us to define who we truly are. The weight of labels can be overwhelming, but the voices reclaiming claiming identity beyond them are truly transformative. Today, we're joined by two incredible lived experience experts whose stories shine a light on resilience and empowerment. First, Charisse Rupert, the Executive Director of Wings Across Alabama, has dedicated her life to championing recovery. With 6 years of long-term recovery from crack cocaine addiction, Charisse leads Alabama's largest peer-run mental health nonprofit. Her mantra, "Recovery is possible. I am proof," speaks volumes to her journey of triumph and transformation. Beyond her advocacy, she's a proud mother of 5 and grandmother to 2, inspiring hope at every turn. Next, Dmitry Gudkovitch brings a powerful perspective as a voice hearer for over 15 years. Through his work with Hearing Voices Network USA, Dmitry advocates for understanding and support within his community while balancing a thriving career in marketing and family life. Demetri, let's start with you. Can you describe the moment you were first given a diagnosis and how it shaped your sense of self?

My label was given to me first in 2009 when I was 21 years old. I was just hearing voices and struggling with the new experience. They didn't know what label to give me in the beginning. They thought about psychosis anosus, bipolar, Schizoaffective, schizophrenia. It gave me a sense that they didn't know what was going on. It was just some dartboard exercise of these group of people remind us of each other in some way, so let's throw on a label so we can move on to medication. It felt very imprecise, and probably because of that, I never truly identified with my label, which eventually came to be schizophrenia. I think they changed it a few times over the years based on the whole experience. I think I rejected the label because so much of it was imprecise in how I obtained mine, and the stigma of what I expect from the schizophrenia label doesn't match my own experience. Right now, I'm doing fairly well. For that reason, I've come to overall reject the label I was given.

Sharice, your recovery journey is truly inspiring.

How have societal perceptions of mental health labels affected your relationships, both personal and Both societal perceptions and labeling have really forced me to appreciate the fact that now I'm a part of this wider peer community. Prior to being a part of the peer community that I'm a part of, it really was difficult. Again, I'd never heard anyone share boldly their recovery story or what they'd gone through or what they'd overcome. So once I did get a grasp on, okay, these are the issues I'm dealing with, now I'm seeking help for those issues, and now I'm ready to get back into the workforce or interacting with friends, going to church and things like that, I was forced to, I felt, compartmentalize myself. So I can really be myself when I'm around other peers, but in other circumstances, I need to keep that hidden and not share that. So it really put me again to where I felt like I was the only one. In a room full of people where no one knows that I have mental health challenges, I wouldn't share that because it was just one other thing adding to the list that made me feel like I was all alone.

Dmitry, many people wrestle with feeling confined by a diagnosis. Have you ever felt defined by your label? How did you navigate those emotions?

Rather than feeling confined by my label, I felt an overall rejection of the idea of labels. They really didn't know what to stick me with, and I think in the end they just picked one based on some criteria. I felt an overall rejection of the medical model and overall rejection of turning to the medical model for help because of labels and how I felt that they were attributed to me. If you go to any other doctor, you expect them to be very precise in talking to you about what is going on and the processes and mechanisms involved. And that just isn't there with psychiatry when it comes to hearing voices. Created a lot of doubt and searches for alternative solutions, alternative forms of recovery for me.

Self-stigma is when individuals internalize the negative stereotypes and judgments society places on them due to their mental health condition, addiction, or another aspect of their identity. For example, someone labeled as mentally ill or an addict might start believing they are weak, broken or incapable, even if those perceptions are inaccurate or unfair. This internalization can lead to feelings of worthlessness, shame, and self-doubt. It often causes people to isolate themselves, avoid seeking help, or disengage from opportunities for growth or recovery. Studies show that self-stigma can negatively affect self-esteem, increase the risk of treatment non-adherence, and perpetuate cycles of poor health and relapse. Cherise, self-stigma stigma can be such a heavy burden. What role did self-stigma play in your recovery journey and how did you overcome it?

Most individuals are aware of the stigma and the self-stigma that individuals encounter early on in their recovery journey. One thing I have noticed, even within a very supportive peer community, there still is that self-stigma. And one area where I've noticed it and have begun work to try to combat that and have more discussions surrounding that is when it comes to self-care, especially for individuals employed as certified peer specialists in supervisory roles. A lot of times, we feel that we have to be 100% of the time, which isn't feasible. So with that, even in this role where I am now, I'm the executive director of the largest mental health peer-run organization in the state of Alabama, I'm having to be intentional. I choose to be intentional about self-care and modeling recovery. That's what I do to try to do my part when it relates to self-stigma and community support. There's a lot of support out there within the peer community, but again, when it comes to self-stigma, a lot of times we don't talk about that. We don't talk about the fact that if we have a peer or another peer specialist within the community who's doing well, everything's fine, but as soon as they want to take a day off or they may share with someone, "Hey, I'm not feeling that great today." Then the phone calls start, then the rumors start, and it shouldn't be that way. Being a very active part of the peer community, I'm doing my part to change that narrative that it's okay to not be okay, it's okay to seek help even after you have achieved a lot of the goals that you set for yourself. As a peer specialist, Or just as an individual overcoming these challenges, that's the biggest piece for me. Not so much before an individual is in recovery, but once they are in recovery, realizing that doesn't mean that every day is going to be sunshine and rainbows. Just because it's not, that doesn't take away from who you are and your identity or your accomplishments.

Dmitri, community and connection are vital in recovery. In what ways have peer support or community groups helped you reclaim your identity beyond the label?

So I found a lot of benefit from Hearing Voices Network support groups. The idea was just to combine all of my worlds into one, to be able to talk about my inner world amongst physical world people and to really live in one place fully. So that's been a powerful experience. I went on to lead that organization in New York City and become a board member of the national just because I wanted to further that same mechanism of support for others. But I would say going through everything out loud with peers who can understand you is a, a very therapeutic experience. I recommend it for others who may be facing challenges with their labels.

Sharice, finding balance is essential. How did you go about acknowledging your diagnosis while ensuring it didn't define your entire identity?

Overcoming fear. For me, I had to overcome the fear of what anyone would think about me or say about me and really stand firmly on what I know to be true about myself. I do very important work. But that doesn't take away from other parts of who I am. For example, I love Hello Kitty. Even in the midst of me doing this work, you may see Hello Kitty on my Zoom background, or if you go in my office, you'll see Hello Kitty. So taking away the fear that accompanies trying to navigate between balancing your diagnosis and who you truly are But really, the biggest thing for me is standing firm on who I know I am and allowing that to flow through regardless to what diagnosis I may have, regardless to what addictions I may have overcome. It encourages other people as well to be bold and share who I am and what I stand for empathetically and openly with others really makes a world of difference. That's what I have found that has helped me through this process, to no longer be afraid but to share. Once I do that, people are able to see. It may not be the first time they meet me, but once they're able to see me and hear me, then everything else dissipates and they get a clear understanding that, yes, this individual has mental health challenges, they were addicted to crack cocaine, their life was unstable, but now they're living a different life. And so by showing them that, allowing them to really see me and hear me, it makes a world of difference.

Demetri, healthcare systems can sometimes feel impersonal. Were there moments when you felt healthcare providers focused too much on your diagnosis rather than seeing you as a person? How did that affect you?

So every time I get a new healthcare provider, there's a dance around the diagnosis and my expectations of their expectations on initial conversation of getting to know each other. I've found healthcare professionals that have been much more open to interacting with my full identity, but it still is unpleasant that my diagnosis is something to carry with me in perpetuity and there's no way to appeal it or undo it. It is something I'm uncomfortable with and having to frequently interact in the healthcare setting where first and foremost, I feel like my defining criteria is the diagnosis. Is very emotionally unpleasant and a negative experience I wish was different for my community.

Charisse, for those listening who may be struggling, what advice would you give about carrying the weight of mental health labels and societal stigma?

Become a part of your local peer community. It has been a game changer for me in my life and my recovery. If you're not familiar with a peer community in your area, Wings Across Alabama is here. We welcome anyone throughout the nation to become a part of our peer community. It makes a world of difference having that support, having individuals that you can contact and call on or reach out to who will be there for you, who understand because they've navigated this journey that you may be starting. Connect with other individuals who have been through similar experiences. It changes everything. Demetri, reframing our stories can be empowering.

How have you redefined your identity to include your lived experiences in a way that empowers you?

So we all have our unique hurdles in life, the challenges that make our triumphs more triumphant. My lived experience is that background of every success, whatever I accomplish. I know that I've climbed higher than those who started with less difficulty. We're all struggling in some way, but I try to give myself some slack and some credit for my victories because of my difficulties.

Finally, Charisse, reflecting on your incredible journey, what would you tell your past self about navigating life beyond a diagnosis?

I would tell myself, "It's gonna be okay. You're gonna make it. Not only will you make it, but you're going to shine and use your experiences to impact and affect change in the lives of others. It does get better. Recovery is possible, and you're going to be proof one day.

Now we turn to our clinical experts whose perspectives bridge personal resilience with professional insight. First, Dr. Mani St. Victor, a physician turned coach, combines his psychiatric training and love for game design to create transformative tools for mental well-being. His work focuses on helping high achievers rediscover fulfillment and authenticity beyond societal expectations. Next, Dr. Addy Jaffe, a mental health and addiction expert, challenges outdated recovery models through research, writing, and coaching. With bestsellers like The Abstinence Myth, Dr. Jaffe's work empowers individuals to rewrite their recovery journeys. Finally, Mel McCracken, a passionate advocate for inclusivity and transformation, specializes in addiction therapy, particularly within the LGBTQ+ community. Mel's dedication to breaking stigma through education and activism resonates globally. Let's delve deeper into their insights. Dr. Mani, from your professional personal perspective, how do mental health labels influence a patient's self-identity and self-worth?

I found that most people, but especially people who have a sense of self-doubt or who possibly have a set of, I'll just say, things going on in the background that they lack certainty about, putting a label on their behavior, telling them you are this, it provides an additional sense of safety and security, at the same time giving them something to fall into. Because if you look at most models, of mind where mind is a predictive engine looking for certainty. So unfortunately, if you relieve the patient's uncertainty, which is part of what's driving their anxiety, by telling them, by putting a certain label on them, they fall right into it. Once they fall into it, you have situations like stereotype threat where in certain contexts they're going to act within constraints of that identity. A lot of the science tells you that once someone has claimed something, not only will they surround themselves with the same as themselves, they'll also seek to get the other aspects. If they have a few of the symptoms and the label's put on them, going forward, they're likely to gravitate towards picking up other traits that they might not have had before. That's in addition to the associated stigma. The sense of marginalization, the absorption of any negativity that is placed on the label. For example, if you hear someone saying something negative about depressed people and you've identified with that label, you're essentially taking on these wounds from the cultural narrative that might not necessarily be self-relevant, let alone damaging to you.

Over the years, like many in our community, I've been handed several comorbid diagnoses. At first, it was almost a relief, this sense of validation, like, ah, so there's a name for what I've been going through. But names only go so far. They're a starting point, not a destination. I found myself leaning on these labels sometimes as a reason not to push forward, other times as a way to make sense of the chaos. In hindsight, it wasn't the diagnosis itself, but the meaning I attached to it and the way I allowed it to shape my identity that carried the most weight. That brings us to an important question. Dr. Jaffe, your work often challenges the status quo in recovery. What are the potential risks and benefits of using diagnostic labels in treatment?

Yeah, I think you nailed it with your experience. A lot of people say that they like the label initially because it gives them an explanation, but once they sit with the label for a while, it becomes incredibly limiting. One of the reasons that I share my story pretty publicly is I was very much identified as a meth addict when I first started. If I went to AA meetings, then it would be an alcoholic, even though I didn't drink alcohol. I had to break through those labels, and a lot of people think that lacks humility. I had a lot of humility. I actually didn't want to be limited in my potential. And again, this is not a blanket statement. Not everybody who gets labeled therefore becomes very limited in their thinking about what is possible for them. But a lot of people do. I was one of those people. And there's a lot of self-doubt, a lot of negative self-talk in terms of what is possible for you because you get locked in this box. You can do the same thing with people with ADHD, right? I have ADHD and my whole life I thought that meant I couldn't get organized. What I realized later in life is actually what it really means is I need very ritualistic ways to get organized. Give me the right tools for my own brain and I function well. Labels are really nice shortcuts, but they can be these sort of golden handcuffs or cages for many of us.

Mel, your advocacy is rooted in empowerment. How can clinicians balance the need for diagnosis with fostering a patient's sense of individuality?

I love this question. I think that a diagnosis and diagnostic criteria give us a roadmap to start to work on some of the behaviors, right? And once someone puts down compulsive gambling, once someone puts down substances they've been using to self-medicate, I really start to see who they are. That kind of uncovers their identity, right? Because it's so masked and shrouded with behaviors or characteristics of mental health issues, even substance use issues that a person cannot be seen. So it's like the mud on the windshield, right? All of the characteristics and all of the symptoms of mental health are mud on the windshield. And once we get the wipers going, we can actually start to see very clearly who a person is. And that's the thing I want to cultivate. I want to help someone manage their symptoms of their mental health issues, but I really want to cultivate and expand who they are as a person outside of this diagnosis. Dr.

Mani, stigma is an ever-present hurdle. In your experience, How does internalized stigma manifest in patients and what strategies have you found effective in addressing it?

Internalized stigma often show up— well, they exist as limiting beliefs. These beliefs in turn manifest as mental blocks. These mental blocks can manifest as self-fulfilling prophecies, which hold themselves in place through self-sabotage. Basically, it limits what the person can see, as ways of being, as opportunities. And as I mentioned before, stereotype threat, where in certain contexts, if you tell someone that their reference group— if you say to someone, we're doing a standardized test in our culture, you'll find that African Americans, because you point out that this test measures intelligence, they'll score lower than if you didn't put that frame around it. I think they found similar findings with girls and math. If you labeled the context as a test of your math aptitude, they didn't find that effect with Asian girls, which further demonstrates the power of the Oprah identification. So what tools do you use to overcome that? One of the most powerful things is using, you know, hair of the dog that bit you, so to speak. If you find someone falling into these disempowered roles, one of the ways I help my clients is using the drama triangle: victim, villain, or hero. If you find yourself doing behaviors that are, are triggering self-sabotage so that you can validate this identity where you feel stuck, if you feel like you gotta do things to continue to remain the victim at the expense of your power, or if you find yourself putting others' needs in front of yours so that you can be what you feel is you, If you find yourself bludging someone or judging them, et cetera, then if you're willing to be aware that you're doing that, it goes from being ego, your over-identified narrative, to being an automatic thought. Once it becomes an automatic thought, you can separate yourself from it without feeling as if you're attacking a part of yourself. Subject-object theory is the, uh, the concept that once you can externalize, you can let go of that part without feeling like you're giving a part— away a part of yourself. Once you've let go of that part, you allow yourself to be able to see from the outside the opportunities of different ways of being. A lot of mental issues where you wouldn't necessarily say someone is mentally ill, but would be aware that they are having some less than optimal functioning in some situations, often that comes down to a matter of rigidity, a lack of cognitive flexibility. So a person might find themselves fixated in a maladaptive pattern of, of behaving. Most personality disorders come with the label of a fixed way of behaving. And that rigidity, once you recognize a pattern, having this automatic, mindless reaction, whether or not it's to your advantage, without having the ability or without that script allowing you the space to actually reflect, that rigidity is what behavior-wise manifests as the stuckness. What manifests as automatically going into fight-flight, what manifests as being stuck in self-fulfilling prophecies through this over-identification, through the belief that there's nothing else that's possible for you. So when you look at one of those cases where the answer is in the question, when you look at the fact that a person is stuck in a story, how do you help them out of that story? You reach within the story and introduce things that allow for more choice. You identify similar situations that they can realize that they are capable of fitting into through a set of microchanges. It's important to empower people to make changes through their own realizations. That means it changed their model as opposed to feeling imposed on them. It becomes something they realize was their own idea. That allows sense of autonomy identification. And elaborating their own model of the world. There's the importance of reframing, shift in perspective. There's an importance of surrounding a person with people who are willing and able to reflect their views. You don't want them casting pearls before swine and having— being surrounded by people who need them to be a certain way, because then those people will undo benefits because their identity— the other people, the other players in the game, so to speak— their identity counts on the person, our client, our identified patient, dancing with them from that role. An example of this would go back to what I mentioned earlier, which was the drama triangle. When you have someone who drops into a victim position, the other person essentially finds themselves having a choice of only 3 positions instead of the opportunity to be authentic. Someone drops into a victim position, you find yourself in a situation where the other person feels like, okay, do I decide to be a rescuer and help this person? Yeah, basically enabling. Or do I bludgeon this person into doing what they need to do? Neither of those actually work because you've been pulled into the person's game. If you chose to be the villain, the persecutor, then at some point you two are inviting a third person into the dance so that they can rescue the person that they perceive to be getting beaten up by you. So these dynamics, making people aware of these dynamics empowers them to step outside and do something different again, without feeling like they're being self-inconsistent. I like what Eckhart Tolle says about it. He's like, ego can't exist with awareness. Once one develops awareness, ego becomes habitual mind. Once you say, oh, look at this thing that I'm doing it shifts from being a way of being to a doing, and you can stop doing a doing. You can stop doing something without feeling as if you stopped being yourself. And once you become aware of something as being an ego-driven narrative, an ego-driven behavior, you can, with the right amount of self-regulation or taking a pause in the moment, come up with something else to do and replace that habit with something new, something more adaptive. Dr.

Jaffe, language plays such a powerful role in shaping perceptions. How do you see it reinforcing or dismantling stigma in clinical settings?

I think here we really have to toe the line and be human, right? We don't want to be so automatic and robotic that we completely take out their human experience of having these individualized struggles. But at the same time, we want to make sure that we use language that they are aligned with. Part of that could be including them in the conversation in terms of what labels, what manners of speaking are they comfortable with, and playing with that with them. That can also serve the additional role of letting them feel like they're a part of the equation instead of the old model of medicine and therapy where it was the expert sitting in the chair and being this benevolent overlord. I think by including people in the conversation, we can make sure that we're using language that applies to that particular individual in the appropriate therapeutic way.

Mel, a strengths-based approach can be transformative. Can you discuss how this framework might help patients move beyond their mental health or addiction labels?

I'm so glad you asked this question because a lot of people who seek clinical services or need support have already faced the hardest part, right? They've already faced the adversity. They've already met the challenges. They've already survived them. So I'm huge into positive psychology and really into deepening into people's resilience, right? And how they overcame their struggles. They already have resources for that. So aside from treating the symptoms or the behaviors of a mental health diagnosis, I wanna lean into a person's already gathered resilience, right? What they already know, what they're already good at, what they find strength in. And really hit home with that because that's what's going to really help them and be a continued resource is identifying their own resilience and knowing that they can face challenges and survive and thrive on the other side of those.

Dr. Mani, societal and cultural factors often influence recovery. How do you think these external pressures affect the way patients perceive and respond to their diagnoses?

I think of most mental illness labels as a result of cultural expectations. These are categories that we've taken certain traits, devalued them or judged them. We decided that if they show up in someone, that in order to decrease them happening, we're going to put the person away or medicate the person or just shame them into not doing it anymore. That cultural narrative will result in, and this is models from internal family systems, it'll result in a person, certain aspects of themselves being suppressed and exiled. And at some point, the shame, the invalidation, the judgment results in this, this negative feeling associated with these aspects that could have been strengths or ways of being that would've felt authentic and good to express to others. So you have someone who is underperforming because of the things they're doing, aren't necessarily the things that nurture them. By virtue of underperforming, they have a lower sense of self-worth. And this is not always, I'm speaking generalities. So there's a possibility, I say it that way, there's a possibility of having a decrease in self-worth. A person will find themselves in a situation where they'll put others' needs before theirs and lead to them not getting their needs met. So often, well, there's a possibility. I won't say often, cuz I don't have any numbers right now to back me up right at hand. But if you get enough people who look a certain way not having their opinions heard, then the things that identity group would need so as to be adapted, those things don't get heard. And by not getting heard, you're creating a culture at a larger scale, a culture that is toxic or non-nourishing or depriving, marginalizing, et cetera, to that person. All based on a narrative that has embedded within it a set of values, a set of constraints, a set of expectations, and ultimately limits on how a person can be arbitrary in any given context. Because the same behaviors in a different context could have been valued, worth a lot more. The quickest example that comes to mind is if you look as we're moving towards a culture where people get shamed for body shaming. With that comes a broader range of ways to be that someone may take— may allow themselves, I'll say, to perceive a person as being beautiful, being attractive, or in a neutral to positive way. There was a time, and there still are people who will look at someone who's a healthy weight and feel negative things about them in a knee-jerk way. Based off the identity group. There's situations where we don't think for ourselves. We behave in a way based off of what we perceive. I know it's virtue signaling. You do the things that you think that a cool guy does if you want to be cool. If you want to be popular, you act like the archetypal popular kid. If you look at— if you look at— this was a funny study, how the people who ended up trying to go counterculture ended up going counterculture in the same way where you end up having a stereotype of a hipster. So people end up rebelling in the same way. If a culture has a story that it tells and embedded in that story is negative valuation, then that context is not conducive to a person losing the shame that is keeping them in the need of self-medication, in the need of staying marginalized, in the need of having less opportunities, and as such, having the pain of being devalued that they may be treating or self-medicating.

Dr. Jaffe, depersonalization in healthcare can be deeply isolating. What steps can systems take to reduce this and bring humanity back into care?

I think that's the job of a good clinician. A good clinician can make somebody feel understood and humanized, but at the same time, keep that professionalism involved. Sometimes we err too far on the side of professionalism and objectivity. Whatever objectivity seems to mean to any specific individual clinician. And I think that dehumanizes people and, and they feel it. There's a George Carlin skit that I love about PTSD. We try to move as far away from the real somatically and emotionally laden language of suffering for individuals. And we think that by doing that, we do them a service. But sometimes there's a blowback, which is those individuals may feel like they're not being understood, they're being analyzed. There's a time for that, but I think all of us are humans who want to have human interactions with others. The way we do that is by really training good bedside manners and clinical practices, right? An individual coming into struggle is not this object. They're another person and you have to treat them as such.

Dr. Mani, could you share an example from your practice where a patient successfully reconstructed their narrative identity as part of their recovery journey.

One of my favorite examples of that is I had a client a few years ago who was miserable at her job. She was actually a care provider feeling like an outsider at her hospital. She perceived herself as being really probably boring, on ridiculed by the patients. There was— she was out in the community where she was marginalized based off of her race. And so she was sort of dis— disconnected from and saw the patients as ungrateful and unable to connect with her. She also felt overwhelmed at work. She isolated herself and was in a situation where she was not getting along with the nurses. They were swapping negative feedback on paper. So this, this was basically a spiraling dynamic where she saw herself as this persecuted, stuck victim and everyone was the enemy. After we did some work, I was impressed in the way she was able to pivot into a position of not only listening to patients and being receptive to stepping into a role of a member of the community, more engaged, more curious, and pretty rapidly became an advocate of patient-doctor communication. I was impressed because at one point I was looking through some physician news and I saw her on stage presenting her own data, actually, of how the changes she made were based on her change— shift in narrative, the changes she made and how they affected not just how she interacted with the patients, but really who she was, how she interacted with her nurses, how the nurses perceived her evaluations, her climb within the hospital architecture to the point where she became a thought leader, where she became motivated. She had an increase in income because she felt deserving of it because she was having less resistance getting stuff done on time, showing up early, early, going to after-work events in the community. All these things came from a shift in the story she was telling herself.

We've touched on the weight of labels and the challenge of stigma, but let's take a moment to explore something powerful: the idea of a positive self-concept. At its core, it's about how we see ourselves, not through the lens of a diagnosis, but as multifaceted, resilient individuals. A positive self-concept isn't just an abstract idea for someone in recovery. It's a foundation for hope, a way to push back against the limiting narratives we're told and sometimes tell ourselves. Let's close with a collaborative perspective. Mel, how can clinicians support patients in weaving their diagnosis into a richer, more affirming understanding of themselves?

I think this is one of the most important aspects of really helping people break free from the limitations that a diagnosis diagnosis might have, right? Diagnosis is meant to help you lean into more freedom, not limitation. And as humans in this world, I think we all want a sense of meaning. We all want a sense of purpose. We all want a community to belong in. When people have struggled with mental health issues and they've overcome those, sharing your story of resilience with others, or maybe picking up the phone for a friend that also struggles with depression and being able to pass along a message of hope is probably one of the most esteemable things that you can do and one of the best ways to create a positive framework around struggling with and recovering from mental health issues.

Dr. Jaffe, what are your thoughts?

Yeah, the way to do this is to follow through on everything we talked about today, right? Diagnoses are very crude estimations and that should be communicated to a patient instead of just slapping a label on their forehead and saying, this is what you have. Here's what you should take for it. The next piece is really having human conversations. Right? We've really moved from that in the fee-for-service world where people have 15-minute meetings with their psychiatrists, as if there's a way to humanize somebody in 15 minutes every 3 months. We've— we have to take the time. We have to understand. There's a thing I, I, uh, use in the book, which is oftentimes by the time somebody comes to see me, if I just looked at their behavior in this moment, it may seem irrational. It may seem like it makes no sense. It may seem even crazy to use a non-clinical term, but if I sit with them them sometimes for hours, and I get their stories of what happened, how did it start, what happened along the way, what are some of the critical events that occurred since childhood. Inevitably, once I really understand that story, I have a very clear understanding of how we got to now. And now I have a very clear understanding of the person in front of me. So that to me is the path to helping people, right? If we don't understand how they got here and we don't understand all the struggles they had to endure to develop these protective mechanisms or these maladaptive patterns of behavior, then I'm not well equipped. I'm trying to treat a label, not an individual. In my book Unhooked, I have a whole system that allows people to do this individually, even if they don't have a practitioner who's that involved. I urge all practitioners to use my system of their own. There's narrative therapy, right? Sit through the stories of the people you help. Ask questions that are not just about the current struggles, focus on the path and, and help them connect dots. Because oftentimes when you're in it, it's hard. It's a forest trees analogy. It's hard when you're in the middle of the forest to see anything but individual trees and leaves and bark. But as you pull back, and if you're a good professional practitioner, you can help them identify themes that they can then use, given evidence-based practices and tools that work, to help get them out of it. And then it's part of our job to give them this hope, this idea of, look, if you engage in these tools and resources, here are some potential futures that may be out there for you.

And finally, Dr. Mani, how does this process unlock fuller identity and possibility?

I believe it comes down to authenticity and rapport. Self-concept is a story you tell yourself. Your self-concept ends up projected to your environment. And ends up being nurtured or poisoned by a nurturing or toxic environment. In order for individuals to hear each other, they must feel as if they're not in a zero-sum game environment, allotment of status, peace, respect, money, safety. If they don't feel like the environment is toxic, scary, and scarcity-competitive based, then there's an opportunity to be authentic. There's an opportunity to be not in fight-flight or feeling constantly judged. And that creates the space to be curious and actually get to know each other. To me, an environment where we could get to know each other allows us to be seen in each other's eyes beyond an objectifying transactional reflection. A person could tell that you just see them as a nurse or food service, and they're fully identified and valued through the lens of that role, which is a scary place to be because then that leads to you conflating, combining your worth with your job, your income, your performance, which is objectifying and utilizing a person to no end. Culture of collaboration to me is a culture of curiosity, a culture of authenticity, flexibility, empathy, up and down the chain, giving each person the space to be safe, expressive, and curious, feels, I guess, psychological safety, allowing other people to be a little bit variable without needing to hop on them and judge them. That, to me, that's the healing space. That community, ultimately invested in each other, is the key to having a collaborative, nurturing environment where we don't drain each other.

Thank you to all our incredible guests, Sharice Rupert, Dmitry Gutkovich, Dr. Manny St. Victor, Dr. Adi Jaffe, and Mel McCracken for sharing their insights and stories today. Your voices are changing the conversation around recovery and mental health. To our listeners, if you found this episode valuable, please like, share, download, and subscribe. It helps us reach more more people navigating their own recovery journeys. But if the show is to stay alive, we desperately need your help. Support our GoFundMe campaign, whether with $1, $5, or $50, every bit counts. The link is in the episode description. A special thanks again to City Voices for sponsoring this episode. Their sponsorship is limited, so if you or an organization you know would like to support mental health awareness and addiction recovery through sponsorship, reach out via the contact details in the description. Together, we can continue creating these vital conversations. Remember, recovery is about becoming the fullest version of yourself—empowered, deliberate, and fulfilled. Until next time, take care of your mind, your story, and your potential.

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