Is it right to diagnose mental health problems?

The launch of the most recent diagnostic and statistical manual (DSM-V) 5th Edition) has raised a number of issues regarding the use and terminology of many diagnostic categories within mental health. This has been hotly debated amongst clinicians, people who experience mental health problems and support groups over many years. The main issues seem to center around whether it is meaningful and therefore helpful to diagnose someone with a particular type of mental health term such as schizophrenia, personality disorder, bi-polar disorder, attention deficit disorder, autistic spectrum disorder amongst many others and that it doesn't do enough to break down each of the conditions into the specific causes. There are a lot of people who have a diagnosis of a mental health problem who feel stigmatized by the label and often feel as if it is inappropriate and that it does not describe them, their personalities, strengths or difficulties. Others argue that diagnosis helps clinicians accurately assess and treat conditions and without it we wouldn’t be able to treat conditions, can you imagine some physical health problems not having a diagnosis? Our view is that mental health conditions are brain disorders and therefore have the same status as any other health condition. They are no more or less physical than any other condition and are no more or less psychological and social than any other health problem.

It is hard to do this debate justice here but a very useful starting point is the Division of Clinical Psychology’s Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses available here. This document explores many different views on the usefulness of applying diagnostic labels both for the clinicians who may make them and the people that may receive them. Diagnostic labels in psychiatry are about 10 years behind those in the closest comparable specialty: neurology. One of the main issues is that they are based on a collection of symptoms that say nothing about the causes of the problems, largely because there are multiple causes for each diagnosis. As the diagnosis is not refined based on genetics and the presence of specific neuropathological changes someone with a clinical diagnosis (clinical: based on what the doctors sees directly) of bipolar disorder could have many different biological causes. All medical specialties have gone through the same process, from simple descriptions of symptoms that happen together to an in-depth bio-molecular view of the illness, which, of course, helps when trying to define treatments (and treatment targets) in more robust ways.

The reality is that until there is an alternative, diagnostic criteria serve a purpose and in some cases enable people to access treatment services and be signposted to help at an earlier stage. Diagnostic labels cannot explain everyone’s experience and neither should they; it is equally important to know and understand the issues that are relevant to the person with the problems and to try and help them make sense of their difficulties. For some people this may mean finding a different explanation to a label or a term. Others may have spent a lifetime trying to find a way to describe their experiences and having a diagnosis might provide a framework to understand their problems and help them make sense of what would otherwise be a very puzzling set of circumstances. Maybe diagnostic labels and terms have a role to play in mental health care but they should not be used in isolation; helping people make sense of their unique set of strengths and difficulties, might still be the most appropriate way.  

Dr FreemanComment