The decision to diagnose a client remains one of the most controversial issues in the mental health sector.
What is a diagnosis? It is essentially a title summing up a careful, methodical arrangement of symptoms. It can be analogous with a recipe, in that a diagnosis has precise ingredients. The universal code for diagnosing can be found in the DSM-IV-TR (Diagnostic and Statistical Manual: 4th edition revised). The fifth edition will be released sometime in 2013. This book provides a comprehensive overview of all the diagnosis (from anxiety-related disorders to schizophrenia to sleep disturbances to depression) and it is very specific in determining which diagnosis or diagnoses a client may have. It is a universal language understood among all mental health clinicians, from therapists to social workers to psychiatrists to psychologists.
So, why do we diagnose?
Several reasons. A diagnosis gives a name to an issue or several issues. It offers verifiable proof that the client is not “the only one experiencing this,” and gives a sense of strength in numbers. Diagnoses can aid in providing the appropriate course of treatment (mode of therapy, expected results, medication possibilities, etc.). For this reason, diagnoses can be beneficial for both the client and the practitioner. The client begins to understand his or her the problematic or distorted behavior, which, in turn, paints a clearer picture for the therapist in deciding the best, appropriate action. Diagnoses can also make room for more support and networks. Nowadays, there is an abundance of resources and treatment methods available for nearly every type of disorder. Clients may join online forums, participate in group therapy or community outreach programs to build that camaraderie and realize they are “not alone.”
Moreover, diagnoses can help clients receive the materials and tools they need for treatment. Diagnoses are often necessary to receive insurance reimbursement, sliding-scale treatment and medication, and affordable and available assistance.
There are, however, drawbacks in diagnosing. Some clients may find “living with a label” deliberating and painful. Some individuals will “become” that diagnosis, acting in such a way that fits a self-fulfilling prophecy. He or she may believe they are exempt from faulty behavior or simply feel hopeless and untreatable. Reactions such as deflated self-esteem, isolation, and the sense that “everyone else is normal” are common and can be traumatic for both the client and his or her loved ones.
Likewise, while mental health professionals take all the steps and procedures necessary for absolute accuracy, mistakes do happen. Clients may lie, forget, or omit information when being evaluated. Symptoms can be overlooked, exaggerated, or minimized. Consider the evaluations medical doctors must provide when diagnosing a patient. Let’s say that an individual comes in complaining of “nausea, fatigue, irritability, and headaches.” He or she may be experiencing a head cold or fever. Possibly pregnancy. Possibly an autoimmune disease, such as diabetes, fibromyalgia, or multiple sclerosis. Possibly a gestational issue or brain tumor or indication of spreading cancer. Or a combination of several problems. In other words, the possibilities can be endless, and the same overlap can occur when diagnosing mental illness.
If that same individual comes to a therapist complaining of “nausea, fatigue, irritability, and headaches,” further probing and analysis will occur. He or she may be experiencing general anxiety or dysthymia. Possibly a dissociative disorder or sleep disturbance. Possibly an eating or adjustment disorder. There are several different options (all which seem very close and similar), and just like with a physical illness, misdiagnosing poses a variety of serious problems, from legal issues (giving the wrong kind of medication) to ethical issues (serious, psychological distress).
Diagnosing also tends to ignore individual differences, because diagnoses generalize several symptoms and lump them into a concise category. While this provides a black-and-white solution, we all know that human behavior can be surprising, evolving, and differing, depending on the social context, time frame, culture, and individual history. Theories on this often vary. Some believe that people all fall into certain categories of behavior, whereas others believe that we are all absolutely different and, thus, unable to be categorized.
Clients and therapists respond differently to diagnoses, as does the general public. We are so quick to stereotype or label behavior (“she’s so bipolar,” “she looks anorexic”, “he’s a psychopath,” “he’s an alcoholic”), that we often fail to realize how harmful these quick, automatic statements can be for people who are suffering from these disorders. Furthermore, once we do find out people may have a diagnosis, the stereotyping can be even worse (“oh, she has OCD; no wonder she’s so anal about cleaning” or “of course he has ADHD; he can’t sit down for two minutes!”
These perceptions can be deeply-rooted and we often fail to believe the person can improve, change, or even rid themselves of certain mental disorders. We may “expect” them to act in certain ways that are in accordance with their diagnoses, and when they do, they are reinforcing our beliefs, and when they do not, they make us question the validity of their diagnosis (“she can’t have bipolar disorder; I’ve only seen her depressed” or “he can’t have narcissism; he’s just really confident and self-assured.”
In conclusion, as a society, because diagnoses are a mainstream part of therapy and medical treatment, we must be careful with how we interpret, label, and react to them.
A mental disorder does not make a person less of a person.
It also does not mean they are that disorder.
Suffering from something is not synonymous with being something.