Diagnosis: the identification of the nature of an illness or other problem by examination of the symptoms.
Having been diagnosed with mental illnesses and working with people who have been, I have a lot of mixed feelings about whether diagnoses are actually useful.
For a start, diagnoses always shape the treatment. If someone is diagnosed with depression, they will be referred to counselling and put on an SSRI medication. Of course, a diagnosis makes it easier for the doctor treating the person. This is fine if someone has a physical illness with and known cause which can be cured with a certain medicine. However, this ignores the fact that mental illnesses are a lot more complex. This means that treatments need to be tailored to individuals rather than assuming that certain things will work for certain illnesses. It is not a realistic model to be treating mental illnesses on.
Unfortunately, this insufficient treatment model will continue because doctors do not have the time to look at someone’s history and take each individual as a unique case. Although cases share similarities, humans are complicated and failing to take this into account means that treatments are not necessarily suitable.
Essentially, a diagnosis is just a list of tick boxes. The difficulty with mental illness is that most people will fall onto the spectrum. For example, one of the ‘criteria’ for BPD is “excessive efforts to avoid abandonment.” Now, to tick this box, one has to define what excessive efforts are. This is all subjective to the person diagnosing, it is dependent on their beliefs and values. This is one of the reasons people often get different diagnoses from different professionals. I was told I had depression and generalised anxiety disorder. Then it was depression. Then it was possibly bipolar. Then it was BPD. There is no wonder I have an unstable sense of self when I’m being told I have all these different illnesses! It is difficult to trust mental health professionals when they cannot even seem to agree on what to call your set of symptoms.
Some people find it helpful to be diagnosed. It reassures the person that they are not imagining there to be something wrong or overreacting. It helps them to reach out to others with the same diagnosis and feel less alone. However, this is certainly not the case for everyone. When I was initially diagnosed, I sunk into the illness. I saw it as all I was and all I ever could be, I struggled to have an identity outside of my mental health. A lot of people face this issue. It is like being put in a box and the box is really comfortable and you now have an understanding of how the box works. You do not want to leave the box. You do not want to put the work in to escape the box because you fear there is nothing good outside of it. Of course it is easy to say that everyone is more than their mental illness but when you feel the opposite, it is a very difficult belief to shake off. There are people I work with who have a very hard time separating themselves from their diagnoses. They are stuck in the belief that they will never be well because of being diagnosed with a mental illness.
Giving labels to things can also result in stigma. Outwardly saying that you have been diagnosed with BPD leads to a lot of assumptions about you by the general population and by professionals. This stigma can then effect how you are treated in all parts of your life in a very detrimental way. If someone hears you have Schizophrenia, it is likely they will associate this with violent tendencies. They may start to act differently around you, be more on edge. All this stigma is difficult to deal with and completely unfair. But, it happens all the time. Maybe without labels, there would be less opportunity for this to occur.
The great thing about humans is that everyone is different. Everyone’s minds work in a different way. Diagnosing mental illness requires someone somewhere to set out the norms and anyone who falls outside of that is considered unwell. But, who can really say what the norm is anyway? Over time, if it becomes the case that the majority of people self harmed, would it not then be that those who did not would be considered unwell. If the symptoms are subjective then so are the diagnoses and this is why having so much dialogue around ‘mental illness’ is strange. It is not like medical conditions, people do not all fall onto a spectrum of cancer. You either have it or you do not. But you could tick a few boxes for depression or another mental illness and be diagnosed with it. This just does not sit right with me.
I fully understand why some people like to have a diagnosis. Personally, I think it does more harm than good in terms of mental health. In an ideal world, each case would be taken individually. A professional would sit and talk to someone for a long time, get to know them and work with them on things which the person wanted to change. This model of diagnosis is more personalised rather than medical. It avoids lumping groups of people together and ignoring things about them which could explain certain behaviours. Not having a diagnosis makes treatment a more complex issue but it would be more likely to be effective. I feel like the model for mental health diagnosing needs to be changed in one way or another.
What are your thoughts on this?