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"I'm not sick, you're sick!"

This is what my brother barked at me, eyes glowing with contempt, when I confronted him about his behavior. After a psychotic episode in his twenties, he had been diagnosed Bipolar with Delusions of Grandeur, but rejected the diagnosis. His outward behavior ranged from catatonic to aggressive, and always anti-social. He was also a hypochondriac, until, conveniently, he saw a self-proclaimed exorcist who healed him of all his diseases. He then believed he was a prophet, and was performing his own exorcisms and faith healings on anyone willing to let him.

"He's not sick, you're sick!"

This is what my mother shouted at me, indignant that I would suggest my brother could use some psychological help, and maybe meds. She had a long history of enabling an abusive, alcoholic, narcissist, one of the many sick men she kept in her life to take care of. My brother now lived with her, rent and responsibility free. A psychologist I was working with at the time thought she had Shared Psychotic Disorder, a rare condition where the secondary person is a codependent who believes the delusions of the primary person, usually a Schizophrenic. A psychologist I am working with now believes she has Borderline Personality Disorder. However, there is no way to make a formal diagnosis.

*Silence*

This is the non-response of my father, the abusive, alcoholic, narcissist. After I stopped trying to keep up the one-way relationship, he never tried to contact me. Well, except that one time he attended a faith healing with my brother and then decided he should write me a letter letting me know I'm now obligated to forgive him. Because Jesus.

These are the people in my family.  They don't like it when I use psychological terms to label their behavior. After all, I'm not a psychologist. I'm just the recipient of their abuse.

I used to be more interested in learning the names for the disorders. Having a name meant having vocabulary to explain my family's bizarre and disturbing behaviors. It helped explain why and how they seem to be incapable of love and understanding. Not surprisingly, I've always been fascinated with psychology and the DSM. Understanding mental illnesses and how they work helps give language to complicated situations. It meant I wasn't alone with these experiences. Enough people saw it to give it a name. It is common for those with cluster B personality disorders to twist things around and make other people feel crazy, and trying to reason with my family is a one way ticket to crazytown. Even though I no longer need the label to know there is something wrong with the behavior.

That said, a diagnosis can only go so far. A diagnosis doesn't solve the problem, it only names it. In the case of my family, it's unlikely they will ever get a formal diagnosis, because from their point of view, there is no reason for them to see a psychiatrist. I once sat in counseling with my mother. As soon as the counselor started asking questions that poked holes in her line of thinking, she immediately became defensive and didn't want to go back. The same counselor (and others) advised me to go no contact with her, which turned out to be invaluable advice.

I try to be careful when describing the behavior and say it "looks like" mental illness and/or a personality disorder rather than give a definitive. Personality disorders are not considered treatable, so it seems to me there is little to gain from a formal diagnosis other than understanding. As a survivor, it is more important for me to recognize the patterns of behavior and create good boundaries. I may not be sick in the same ways, but it is required for my own mental, emotional and physical health.