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Have you or a loved one received a psychiatric diagnosis? Or, have you played armchair shrink and applied a diagnostic label to yourself or someone else?
Either way, psychiatric diagnoses, while useful in certain instances, should come with warning labels. The risks in question are psychological and social, not medical. I’ll describe those shortly, but first, some background.
Traditional psychology has long embraced the “medical model,” the one your physician uses to nail down what’s ailing you. This methodology consists of identifying symptoms, gathering historical data and using diagnostic tests to determine one’s ailment. That’s why doctors have us complete those long family medical histories and symptom checklists. The modus operandi is formulaic. Assess, diagnose, treat.
Many mental health providers replicate this model. However, their precision in this regard is limited. A blood test may determine if you have diabetes, for example, but definitive diagnostic markers for mental illness are few and far between. So, grafting the medical model onto the assessment and treatment of mental disorders proves challenging, at best. Which is why mental health types lean hard on symptom identification and developmental history to pinpoint what’s amiss.
Watch for False Positives
Now, psychology has no monopoly on questionable diagnoses. The medical profession produces its share of false positives and miscues, but additional tests, more in-depth examinations and second opinions can often get it right. In the mental health arena, getting it right proves more challenging. A recent study in Psychiatry Research looked at the reliability and usefulness of the primary categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM). They found widespread inconsistencies in diagnostic decision-making, meaning there is no uniform methodology for determining which mental disorder applies.
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Also, regarding those symptom checklists, the study identified extensive overlap across many diagnostic categories. For example, anxiety and depressive disorders share many near-identical symptoms, making it tough to parse out the main culprit. The researchers concluded that psychiatric diagnoses are “scientifically meaningless” and “disingenuous,” and they placed blame squarely on the use of the medical model as a template for mental health care.
This criticism is not new. In the 1960s, psychanalyst R.D. Laing chastised his colleagues to minimize diagnostic labels and, instead, focus on understanding the “lived experience” of the patient. He recognized that each individual’s mental state is unique and that blurring it with diagnostic generalizations creates social stigma (“I’m broken”) and faulty treatment planning. A salient example is “depressive disorder,” one of the more common labels pasted on people these days. Once a mental health provider attaches this diagnosis to a client, they may cease exploring the nature of the individual’s lived experience and begin treating the diagnosis instead of the person. Absent a deeper understanding of what the client is going through, the rapport and felt connection with the therapist, which is critical for emotional healing, may fail to emerge.
Also of concern, diagnoses can become self-fulfilling prophecies. Once told one has attention deficit disorder, for instance, a client may begin interpreting their lived experiences (distracted, hyperactive, hurried, etc.) within this diagnostic label, rather than contemplating the unique nature of what they are going through, what is says about their life and how best to address it.
Granted, when in mental distress, we want to identify what we’re up against. Nobody likes not knowing, so receiving a diagnosis, even when unwelcome, assuages this angst. And, in the realm of serious mental illness, an accurate diagnosis may help guide treatment efforts. However, such accuracy is often lacking, and, even when we get it right, psychiatric labels pose the risk the client will be treated as a diagnosis first and as a person second.
As psychologist Alice Miller stated, “Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual.”
Too often, diagnoses impede the emergence and affirmation of that truth.
For more, visit philipchard.com.
