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Mental Health Diagnoses & Guessing Needs

A student recently asked how she could possibly guess the needs of her mother who was diagnosed with borderline personality disorder.  As far as she can see her mother just has a compulsion to prove she is right at any cost.  Medical diagnoses can create interference with your ability to connect with another's needs just like any other difference. At their best, mental health diagnoses can create space from blame and clarity about a constellation of behaviors and common treatments.  At their worst, diagnoses detract from the fact that regardless of the level of mental illness, this is still a person attempting to meet his or her needs.

Looking through the lens of mental health diagnosis, you might find yourself categorizing behaviors according to the diagnosis.  While this might meet your need for mental clarity, it doesn't necessarily inspire compassion. If you can listen for another's needs without automatically attaching some sense of obligation to meet them, you will feel your heart open and relax.

However, when you witness behaviors that you would label as extreme, you might need some creative ways to even begin to guess needs.  One way is to ask yourself the question, what if this behavior were in total alignment with what's true, what needs would be met then?  Let's look at a few examples.

  • For the student that has the mom who wants to be right, she might ask herself this, "If my mom really was always right, what needs would be met for her?"

  • For the dad that worries a lot and often hands out unsolicited advice, "What if my dad really did live surrounded by threats, what needs would worry and advice to be cautious meet then?"

  • For the brother who believes he is a prophet and begins preaching to you and the rest of the family, you might ask this, "If my brother really were a prophet, what needs would be met for him?"

These examples point to a willingness to look out from the worldview of the person for whom you are attempting to have empathy.  Often this is a difficult step because you are hurting from the impact of such worldviews and have long wished you could shift that person's way of seeing the world.  Having spent years fighting these views the last thing you want to do is stand in them, even if for a moment.  In the end though, being able hold in your heart the precious needs that a loved one is trying to meet, even if through tragic behaviors, allows you to maintain an open heart of compassion and is a heck of a lot less stressful.

Did you make some guesses for the examples above?  Go ahead and do this on your own now and then I will share my guesses.

Okay, here are my guesses:

  • The mom who has to be right:  safety, acceptance, security, purpose, meaning, competence, belonging

  • The dad who worries:  empathy, support, safety, collaboration, peace

  • The prophet brother:  self-acceptance, purpose, security, wholeness, belonging

An important thing to remember here is that the accuracy of your guesses doesn't matter.  It's the willingness to get curious and make guesses that gives rise to compassion.


Take a moment now to reflect on something someone does or says that could only feel irritated about before.  Frame the person's behavior as though his or her view of the situation were correct.  Make a guess at the needs this person is trying to meet with this behavior.

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6 Responses

  1. Oct 23, 2014

    I love this advice. This points to a wonderful way to be compassionate in the face of extreme behavior. Thank you.

  2. Oct 23, 2014

    Your welcome, glad it resonated :)

  3. Oct 30, 2014

    A big YES welled up in me when I read this piece! I've often found myself quite triggered when I hear people use diagnoses as a reason that connection just isn't possible with a person. What you've articulated here meets needs for understanding for me. And, it occurs to me that this process of connecting with my guess about someone's worldview applies in all situations and not just those involving people with diagnoses. Huge thank you LaShelle!

  4. Oct 30, 2014

    So glad to hear it. Your welcome!

  5. Dec 08, 2014

    I've been struggling with a mother who had an undiagnosed mental illness for years. I often felt confused, afraid, and sad. Recently through my own work with a therapist, I was told that the behaviors of my mothers that are so painful for me are very likely a mental illness. When I heard that, I felt so relieved, and also really sad. I was offered a sort of mental clarity that you wrote about (what good words to describe that!). I also felt sad and disappointed that my mother will never be the mom I want her to be. As I've come to accept that more, I find my new struggle is not knowing how to be in my relationship with her. I so appreciate the wisdom you shared. It adds to some needed clarity. Thank you!

  6. Dec 08, 2014

    Your welcome Kristen. Thank you for taking the time to share this. I am glad to be of support.

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