Do Psychiatric Diagnoses Matter? The Quest for Mental Health Answers
A new study suggests labeling mental illness is not as beneficial as we assume. Does that mean psychology is a sham? Or perhaps, is the answer more intricate than we previously thought?
The Quest for Answers
I have mental illness.
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My social media presence is not only dedicated to fitness, but mental health as well. I try to be very transparent and vulnerable to show people who may suffer that they are not alone and that struggle is normal. Or, at least I think it’s normal. I mean, I’m surviving - thriving, even.
Although my health goals are sometimes held back by my mental illness, I consider myself to be an example of the millions who are living with anxiety, depression, bipolar disorders, and hosts of other issues that society deems “abnormal.”
Recently, I have been wondering what my actual diagnosis is. To be honest, I have been a little obsessed. When I was a teenager, they told me I had panic disorder and depression. When I was in my twenties, it was anxiety disorder.
hose labels were applied a long time ago, so when other symptoms presented themselves, I chalked it up to anxiety and depression. When I made decisions, I was careful to include anxiety and depression. My life continued on but anxiety and depression were always an integral part of who I was.
Or so I thought.
It’s been twenty years since I was assessed officially by a psychologist. I wanted to get re-diagnosed because I feel there is more going on than simple anxiety and depression. But is a diagnosis necessary if my level of functionality hasn’t changed? I am who I have always been. Do I need a doctor to label that?
Maybe not.
In fact, it seems labels and diagnoses are “scientifically meaningless,” according to researchers from the University of Liverpool and the University of East London.
The Study
The study, published in Psychiatry Research, had researchers from the United Kingdom delve into the latest edition of the DSM. The DSM, aka the Diagnostic and Statistical Manual of Mental Disorders, is basically the bible of psychology. It is the book doctors reference to diagnose patients and provide treatment paths and medication.
What the researchers did, was analyze five chapters of the book and examine the “heterogeneous nature of the categories.” This means they took a close look at all the symptoms lists to see where each disorder had common ground and where each diverged.
Lead researcher Dr. Kate Allsop and her colleagues took a fine-tooth comb over the chapters that covered schizophrenia and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, and trauma and stressor-related disorders.
Many of these disorders had a high level of overlap, but they were all being examined subjectively. Some criteria were incredibly flexible, as well, depending on which disorder they were attributed to. According to the book, you could give two people the exact same diagnosis even if they had no common symptoms, whatsoever. You could give two people different diagnoses if they have all the same symptoms except for one.
Also, the detail applied to each disorder varied wildly. For instance, there are 24,000 possible symptom combinations for panic disorder but only one for social phobia. Granted, social phobia is more specific than panic disorder, but one combination of symptoms versus 24,000? Really? They discovered little uniformity and many inconsistencies between each of the chapters.
Does that mean we know more about some disorders and markedly less about others? Does it mean some disorders are very rigid, while others are completely flexible? Or could it mean there is often overlap or a few contributing diagnoses at work simultaneously?
More troubling, the authors noted, was the lack of regard for trauma. Stressors and traumatic events are only given a small chapter and when they do come up, the DSM focuses on the symptom as a “disordered” response to such stress.
When you get down to brass tacks, stress and trauma accounts for a large portion of mental illness symptoms, yet it is not a focus of the book.
With such little explanation, how do we know these symptoms are a “disordered” response to stress rather than a common response to stress? What is the so-called “normal” response to trauma, anyhow?
The Conclusion
According to this study, psychiatric diagnoses all use different decision-making rules, there is a huge amount of overlap in symptoms between diagnoses, and almost all diagnoses mask the role of trauma and adverse events, which are often the root of the issue.
More importantly than that, diagnoses tell us little about the individual patient and what treatment they need. The DSM is supposed to be the key to figuring out a person’s mental illness so they can be treated, right? Or at the very least, it is consulted to explain and predict a patient’s behavior.
However, if the information is discretionary and each patient is unique, it doesn’t help much, except to make the reader feel like he or she is knowledgeable or in control. The patient is more likely to feel distressed, because they are now saddled with the label “disordered,” even if their symptoms are a common and natural response to trauma and stressors.
Besides, most people with mental illness don’t simply suffer from one thing. Oftentimes there are multiple issues – read: diagnoses – going on at the same time. Many people with social phobia also have anxiety disorder.
Some people with eating disorders actually suffer from emetophobia (a fear of vomiting.) Obsessive-compulsive disorder can coincide with schizophrenia, psychosis and anxiety disorders. Each case needs specialized treatment.
Dr. Allsop said, “Although diagnostic labels create the illusion of an explanation, they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”
Better Mental Health Care
Unfortunately, we treat mental health as simply a disorder in the mind, a bug in the system, a diagnosis to be handled with a specific protocol. This can actually obfuscate things and keep underlying issues from being treated.
Stress is one of the primary factors of poor mental health. You can have poor mental health without any inherent malfunction in your chemistry. This is seen often in people going through hard times, who experience symptoms of anxiety or depression or rage and impulse control.
Stress does change your chemistry. It raises cortisol levels, increases blood pressure, and creates sleep disruptions. These changes, in turn, create a slew of symptoms like sadness, emptiness, fatigue, headaches, nausea, digestive problems, tension, worry, and the inability to think clearly or make positive decisions.
If a psychiatrist diagnoses you with “anxiety” and prescribes an anti-anxiety medication, does that solve the problem? Or does it just make you feel a little calmer? People who do not suffer from inherent anxiety need to isolate the stressors and solve the problems that have set off this chain of events, as well as alleviate symptoms.
The patient may now think they have “anxiety” instead of a common reaction to a stressor. They may believe they have a disorder or an illness they do not have. They may let this label identify them, make them feel wrong, when in fact, it is the environment that is wrong.
What if another patient fits the bill for an inherent anxiety problem, but the psychiatrist doesn’t bother finding the trauma that created it? Even people with inherent chemical imbalances need to find the root and work on that, as well as take the pills, or not much progress will be made.
We cannot treat a diagnosis like a simple physical ailment. Mental health demands a tailored approach. There are too many variables. While a diagnosis is a great place to start, because it can give you clarity and direction, too often, people become defined by their diagnosis. They put parameters on themselves, their treatment plans, and their entire lives because they believe they are specifically disordered.
And, if the study is correct in their assessment that a diagnosis is “scientifically meaningless,” we should not place so much emphasis on it. The emphasis should be on cognitive behavioral therapy, coping skills, and life management, which, sadly, is a skill none of us are born with.
We must also work to end the stigma of mental illness. Being afraid of a diagnosis and not wanting to be told you are “crazy” or “damaged” keeps people from seeking help. They do not want to appear weak, or as if they can’t handle stress.
The truth is, human beings don’t handle certain stressors well, no matter who we are and how strong we can be. Mental illness is not a declaration of character.
We also need to treat mental health as equal to physical health, as stress response is where most disease begins. Stress affects the body and the mind. The mind and body are in a continuous feedback loop. You cannot have great physical health if you are in poor mental health, because they go hand in hand.
The maintenance and prevention portion of your mental health should be covered by insurance, just as the maintenance and prevention portion of your physical health is. It must be affordable and treated as an important part of your regular health screenings.
Am I Going to Get Diagnosed?
So, after reading this study, I realize that therapy is a better route for me than psychiatry. I think I had been wanting a diagnosis to explain my head instead of exploring my head to find out what is wrong. One takes a lot more work than the other.
I know I do have a glitch. You can see it snake through my mother’s side of the family. But the ways it presents are always different. I had a great uncle commit suicide, a great-grandfather catatonic from shock therapy, aunts and uncles with symptoms of mania and anxiety, relatives with strange OCD behaviors, and a fair amount of alcohol abuse, drug abuse, and suicide attempts. It’s there, it’s the same glitch, but wildly different expressions due to different environments and stimuli.
Would we all have the same diagnosis? Probably not. When I crash, it is a response to stress and that is what needs to be addressed. I don’t need to try to put a label on it, I need to understand it. Because sometimes it is anxiety, sometimes it’s hypomania. Sometimes it is clinical depression and sometimes it is white hot rage. There. My diagnosis.
It is a great jump off point to know what you are experiencing. Because I can call each experience by name, I do have a level of understanding as to what is happening in my brain. I’m no longer a helpless person, being tossed around by my thoughts and emotions.
Plus, people with more severe mental illness do need a diagnosis. There is significance to labeling and explaining the problem. But what next?
That is what this study is trying to say. Mental illness is very complex and layered. A diagnosis is an important place to start, but it’s the tip of the iceberg when it comes to treatment and care.
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