The Pros and Cons of a Psychiatric Diagnosis

Medical Reviewer

There are strengths and limitations to a psychiatric diagnosis and the diagnostic process generally. In this Sharepost I weigh up the pros and cons and come to unsettling conclusions.

Over time we have learned that, left untreated, some mental health conditions improve whilst others worsen to a point where they can become a danger to the person or others. Fortunately certain patterns of behavior and symptoms tell us something about the likely course of an illness as to whether it is likely to worsen or improve if left untreated. These clusters of symptoms and behaviors become the yardstick against which a diagnosis may be reached and treatment provided. The treatment may or may not work.

Unlike many physical disorders there is a much higher degree of uncertainty attached to a psychiatric diagnosis. The systems of classification that have been developed aim to reduce this uncertainty but personal interpretations still figure large. If and when a diagnosis is reached we immediately stumble into the problem of labeling.

A lack of precision in the definitions of psychological conditions is a cause of uncertainty and the ramifications are almost all negative. First, the labels (the diagnosis) applied to people whether a phobia, a form of depression, or a type of personality suggests they are different. A human yes, but to those unfamiliar with the condition they may be viewed as not quite normal, perhaps unstable and unreliable, making them feel wary or uneasy? The label itself becomes self-fulfilling and can bias the way clinicians and the public see the person. Ordinary aches and pains, grumbles or personal setbacks, may seen as symptoms of the disease. Even the patient can fall into the trap of behaving in ways they think are expected of them.

A diagnosis is not an explanation and by itself may say nothing about the causes, the mechanism behind the condition, or even the treatment. One person with depression may be entirely different to another, for example, yet the diagnosis has a danger of clumping everyone as a depressive and the treatment offered may be equally uniform or limited in scope.

A diagnosis can give a false impression of certainty, yet the Diagnostic and Statistical Manual (DSM) that guides diagnosis is far from a scientific document, despite its many supporters. With a few notable exceptions no physical cause has been found for psychological disorders and no biological tests are available to support a diagnosis. In real terms a diagnosis is little more than a reflection of the psychiatrist's opinion of what you have told them. Go to a different psychiatrist and you may well get a different diagnosis.

When a patient visits their doctor they are looking to someone to make sense of the intense and frightening emotions they are experiencing. They will present their distress in a variety of ways, often exaggerated, and often due to the need to convey a desire for help. Yet so many patients who follow this process are so unsatisfied with the results. The most depressing consequence is that we could disappear behind the diagnosis, settle for mediocre and ineffective treatments and as a result our individuality is lost.