Some people who experience long term mental ill health are not accurately diagnosed until quite late in their adult life. We refer to this as Late Stage Diagnosis. This can be due to you not recognising that your struggles are actually unusual, or your medical professionals not recognising the specific condition that you have. The latter of these often leads to a sequence of erroneous and unfortunately, misleading diagnoses that lead to the wrong treatment plan and wrong medication, which can lead to disillusionment with the health system and victim blaming. When you do get that correct diagnosis, you are likely to experience a series of predictable phases, the Phases of Late Stage Diagnosis.

Many of the phases are related to aspects of Grief and Loss, which is our human response to negative change. Due to the specific context of Late Stage Diagnosis, we will explore some major phases unique to Late Stage Diagnosis. As this is not a specific to you page, the information will be somewhat generalised, but will be specific to the common experiences of Late Stage Diagnosis for MH.

Relief and Validation

Initially, after receiving your diagnosis, you will feel “seen”, that your difficult experience has been “understood” and that this fills in the “missing piece”. This will be affirmed as the diagnosis comes with knowledge, medication and therapy that help your manage your life better and things begin to improve.

It is a relief to finally be understood and to know why you are the way you are. You aren’t weak, broken or lazy. You had a condition that would be hard for anyone to manage, that interfered with various aspects of your health and life.

Is it validating to have your struggles, both past and present, be explained by something that is outside of your control, that interfered with how you could handle situations, or explained why so many people’s advice just didn’t work.

A diagnosis, even in adulthood, is a relief and validating.

Denial and Bargaining Phase

It is very common for a doctor to begin the diagnostic process by acknowledging the most obvious symptoms. This leads to the likely diagnoses of Anxiety and or Depression. These seem to fit your experience, after all, you pass the criteria. Unfortunately, we still seem to think of the symptoms like Anxiety as a Diagnosable Disorder, which halts the exploration in to “why do you have this symptom?”

For example, if you are diagnosed with Anxiety, you will likely be prescribed SSRI medication for your continual anxiousness. For those it does significantly help, they don’t need a Late Stage Diagnosis. For everyone else, most SSRI medication will have minimal to no significant benefit, since it isn’t actually treating the underlying problem. What this diagnosis often doesn’t do is specify which anxiety do you feel (general, social, specific phobias and aversions, low social spoons, signs of domestic violence, secondary to a cardiopulmonary condition etc), and why you have this symptom. The understanding of these could lead to a more accurate diagnosis.

You can just substitute the word Depression for Anxiety above and get the same system and problems.

The next common diagnosis you may receive from general doctors, psychiatrists and psychologists is either Borderline Personality Disorder or Bipolar Disorder. These are most likely diagnosed due to an apparent escalation in your mood compared to what Anxiety / Depression would explain, some odd behaviours and suicidal and or self harm symptoms.

Outrage Anger Phase

When it is correct, the more we learn about our diagnosis, the more we realise that there were very clear signs for this throughout our lives, that make it clearly this diagnosis rather than the faulty or partial diagnosis, just thinking that we were living life badly, or that it seems weird for us to be living life on hard mode while everone else seems to be getting an easier ride. We know that this is the right diagnosis because the treatments for it are working and our life is becoming easier, more fun and we can see the improvements (assuming that you have a good therapist and script writer).

The clear signs imply that we should have had our condition noticed earlier in life. For example, in primary school, hiding under tables when it all seemed too hard, dyslexia & dysgraphia and difficulties in making and keeping stable friends should have flagged possible autism. Emotional instability and fragility, frequently tuning out of class & drawing art while still tracking the lesson, and a complete oblivion to deadlines should have flagged likely ADHD. Yet no one said anything, or took seriously what this could mean.

It is easy to be angry that the professionals failed to do their job.

As we learn more about the health system and how broken it is, we can become incredibly outraged. Paediatricians and parents rely on teachers and doctors to flag that a child may be neurodivergent (or whatever the language is at the time), and once flagged, on the testimony of the parents and teachers to diagnose the child. However, teachers are not trained to recognise the signs of neurodivergence, and they are not qualified to offer an opinion, on a background of most school’s policies to not inform the parents of opinions about why a child may have diagnosable reasons to be different. Parents are not taught how to spot signs of neurodivergence in their children on a background of stigma towards diagnosis for difference. Parents who are neurodivergent themselves have a significant leg up on recognising the differences in their kids to neurotypical children, however their education to their own children can lead the kids to not have the life struggles that diagnosis still relies on. The diagnosis stage relies on testimy from parents and teachers – who aren’t education on what any of this means and how to give proper testimony.

I have heard from many teachers “I don’t know how to fill this form in – I’m not qualified to ansewr this”, and “I don’t want the kid to get labelled”. I have heard from many parents “but that’s normal – I do/did that”, or “surely it is just a phase they are going through?”

Additionally, to get a diagnosis through the public system for Autism or ADHD takes around 3 years, which can’t be started until the child is having considerable difficulties due to their neurology. That is 3 years of suffering before the government will asssess the child, and hopefully the assessor has the right qualification and expertise to properly assess the youth. Here in Western Australia, children facing mood and behaviour difficulties are initially referred to CAMHs (Children and Adolescent Mental Health Services), who specialise in psychotic and schizophrenic disorders. Neurodivergent children are either misdiagnosed or dismissed as this service doesn’t know how recognise Autism, ADHD or other neurodivergent conditions beyond Anxiety and Depression. Many of my clients were told “there’s nothing wrong with you”, implying that the child was faking it, or that it isn’t very serious and perhaps they will grow out of it.

If your child needs to get a diagnosis urgently, so that they can gain access to affordable services and specialised medication, then you need to pay a considerable sum of money to get this done privately.

Up until this year (2026), an adult with ADHD needed to see a private ADHD Psychiatrist, a specialist in ADHD, to get scripts for medication. Due to the specialist and private nature of the Psychiatrists, this is expensive. Note the irony here, to be diagnosed the condition needs to be severely life affecting, which often means troubles with family, living and work – aka, you’ll likely be on a government income, that is poor. To get your adult diagnosis, you need to pay thousands of dollars – $3000 for an Autism diagnosis so that you might get access to NDIS funding for services (which you then need to fight every year to keep), $2000 for an ADHD diagnosis so that you can then pay $300 every 3 to 6 months to get a script for medication.

People diagnosed with schizophrenia, a neurological condition that severely impacts your life, get a free diagnosis and very cheap medication supported by any doctor. Autism is twice as common as schizophrenia and there is no real support path that isn’t expensive if you were not diagnosed as a child. ADHD is five times more common as schizophrenia and again there is no support that isn’t expensive.

As of 2026, in Western Australia, the state government has allowed GPs to get trained and certified to diagnosed and prescribe ADHD medications, so hopefully the ADHD costs and medical system availability become better.

As of 2026, NDIS continues to erode the Autism supports, leading to harder fights to keep necessary funding, a “streamlined system” that erodes personalisation of services and needs, and increasing complexity about what it is that is needed to give to the unqualified NDIS staff to make medical decisions.

There is a lot to be angry about.

However, it isn’t the teacher’s fault that they were not educated on how to recognise likely Autism and ADHD or any other neurodivergent indicators, or that the policies restricted the ones who knew from saying anything. It isn’t the doctors fault that they Autism and ADHD were glossed over in their education, or that paediatricians and general psychiatrists also don’t have any quality educationon Autism and ADHD, nor that neurodivergence is a relatively new phrase to describe the neurological nature of what is still called psychiatric conditions. The world is changing for the better in most places, and we can be a part of that change.

Talk to those who you think might need to know about what their struggles mean. Advocate for the system to change.

Sadness & Grief Phase, I feel like I missed out.

Another angle that looking back often leads us to is wondering what our life could have been like if we had been properly understood when we were younger, recognised, diagnosed and then given the right support and medication. We can wonder how different the world would be if we had known “this is why I am like I am” without it victimising us. We aren’t broken, we are just different. Having someone help you fill in forms is no different to someone needing glasses to read the form they are filling in – they are both ability aids. Taking ADHD medication is no different to taking heart or diabetes medication. Why do we stigmatise neurodivergent care and inclusion?

We can look back at all of those times that we missed out, unwittingly sabotaged ourselves, or lost years in drugs trying to self medicate. We can wonder how our life could have been better if we didn’t miss out or muck up.

We often grieve what could have been, and feel very sad about what has been.

This is natural.

I’m sorry, but you can’t speed run the grief and sadness.

You also don’t have to do it alone.

Identity Phase – aka “Who Am I?”

Often we have defended a thing that we do as our personal unqiue quirk. We defend it because we are told that it is weird, different, annoying or strange. We often make up narratives to explain why we have this unique quirk.

Once we get a correct diagnosis, we often find that many people in our diagnostic cohort have this quirk. It isn’t weird, different, annoying or strange – its normal for us. The deeper we dive into the quirk, recognising that it has evolved amongst our group, we can start to recognise the protective function it has. If it wasn’t beneficial in some aspect, it would have likely been bred out of us.

Neurodivergence isn’t new. The word is, but the difference in neurology is ancient. Take ADHD. The a study that investigated groups in various cultures, countries and continents using the same diagnostic criteria and method found that the prevalence of ADHD in all populations tested was about the same. For the same highly herritable condition to be that spread amongst so many populations implies that it was present when there was a common ancestor. Compare that to high altitue tolerance, where people live so high up a mountain that oxygen is at much lower quantities in every breath – we have 3 major places where this is a factor and the natives of those areas evolved 3 different solutions since there was no common ancestor version of “tollerate low oxygen”. Because neurodivergence like Autism and ADHD etc are very, very old in humans, it has had a long time to evolve out the expensive traits that serve no survial benefit – so what is the survival benefit of this annoying trait?

Often, out of defence of ourselves from social pressure to conform, we have defined ourselves on our quirks. When we realise that our quirks are just a part of a neurological condition, we can begin to wonder “what part of me is actually me and not the diagnosis?”

At this point, we have an identity crisis.

• Who am I?
• What is the real me?
• What did I inherit from my parents genes?
• What did I adopt from my parents wants and expectations?
• What did I adopt from society’s expectations?
• What did I mimic from other people?
• What is left that is me?

This is a big topic. Here is the short version.

“You” Are Dynamic

As a living entity, you will grow and change over time. There is no single, unchanging you.

If you believe in a spirit or soul, even that has to change as the physical you experiences things – otherwise what is the point of life and experience? Put another way, if the spirit/soul doesn’t change, it can’t be aware of what the physical you experiences. To observe is to change.

Everything is a Copy Plus

Humans do new things by copying and modifying what others have done. It is very rare for someone to have a radically different idea. When we look back at the greatest novel ideas that changed the world, historians show us how that idea evolved from other ideas around at the time.

It is fine to mimic others for a while and see if this way of being works for you. If it doesn’t add something, you’ll drop it. If it does, you’ll evolve it, changing it to be more about you. At some stage, you’ll adopt a new something to replace it when it doesn’t work well enough.

This is not a bad thing.

Being Human Requires Biology

About 90% of people are right handed. People are quite happy to let you know which hand dominance they have, identifying as a righty or a lefty, without any shame or dilemma about “but that’s just my genetics!” We often identify part of who we are with hair or eye colour, height, build, or any other biological feature.

While most people don’t identify with their blood type, we all have one.

Our brain is a natural part of our body. You won’t live long without one. Our brains are different from each other, which is why we are all different in some way to everyone else. Everything about you as a person who decides things is in your brain. This is true for all humans.

When we discover that our quirk is common in our brain type, we can feel aghast that this previously unique identifier is not that unique. It is the error in thinking it was unique and having to defend it that generally causes the dissonance in identity. Consider that neurotypical people are very similar to each other exactly because their neurology is so typical, and they aren’t having an identity crisis over that neurologically led identity.

There is nothing wrong with continuing to value that quirk and what it says about you, identifying that it is an important part about who you are. In fact, it is natural to do so.

You Are the One Who Decides, Through Your Actions Will We Know You

We don’t actually truly know anyone. We have an estimation of who someone is. The more we associate with them and the more they affect our lives, the more accurate we are likely to become in our model of that person being the “true” version of that person. Except that people are wrong about people so often. We need to accept that our model of others needs to be taken with a pinch of salt, with error margins.

This also means that no one knows you.

If you are proud of the decisions that you make and the actions that you take, then those decisions and actions speak loudly about who you are.

When our choices lead to poor outcomes, do you learn? Do you avoid making the same mistakes? If so, then this speaks strongly about who you are.

We are our choices and our actions.

Masking and Being Genuine to Yourself

Everyone masks.

Consider the most neurotypical person that you know, or imagine one if you don’t know any. Do they behave the same at home as they do at work, or the same in social groups? The odds are that they do not. The difference is behaviour is the mask. We adjust in some way what we do and how we project ourselves based on the circumstances and what is appropriate. To mask is normal.

The neurotypical person doesn’t need to adjust the mask much from one setting to another. Hopefully, they do not think that the stronger masks they put on is truly them, rather they recognise that this is an adjustment they are making to their normal selves for specific reasons.

The trap in Masking is mistaking the mask for ourselves, denying our genuine self and undervaluing the cost of maintaining a mask that is very different from that genuine self.

Masking is a camouflage alteration in how we present and act for the benefit of others. Everyone does it. When we are in a more accepting environment, we don’t need to alter that presentation as much, so it becomes cheaper to do.

We can become caught up in thinking that because we restrict our normal movements or words for a setting, that the things we are restricting are generally wrong or that we are generally broken for wanting to do them. So long as those words and actions don’t typically hurt others, then they are not a problem. The joke I say at the pub is not appropriate for the courtroom – that doesn’t make the joke inherently wrong, or me inherently bad. Eating in the lunchroom is fine, but eating in the middle of surgery is not – that doesn’t make eating food inherently wrong, or me inherently bad for needing or wanting to eat. It is just the wrong place and circumstance.

Being our genuine self is about figuring out what feels natural and costs the least amount of energy. We are the most ourselves when we are on our own.

• Note how that shifts when you are around others.
• Does it need to shift that much?
• Is there a cheaper way to get a similar result?
• Is there a particular person or people that are very expensive?
  • Is that person or group bad for you?

The happier we are in ourselves and the less we need to change for various circumstances, then the more genuine we are being. This will make your social interactions better and help people feel more comfortable with who you are. Those who don’t like this should be examined for why. It is fine for them to have a bit of adjustment time as you become more of that genuine self person, but those who actively oppose your genuine self (so long as it doesn’t harm yourself or others) may be toxic. If you aren’t sure, speak to a good therapist who specialises in neurodivergence.

Sources

Much of this article was based off personal and professional experience.

Some is a re-write and expansion of my previous The Life Cycle of the Psychiatric Diagnosis, Apr 2010.

Additional ideas were inspired by “The AuDHD Guide (Late Diagnosed)”, Bridgette Hamstead, Jan 2026