A dog chasing its tail

Does giving medical names to distress always help us to understand it? In my opinion, diagnosis is a superficially attractive, but ultimately an inappropriate and unhelpful response. Psychiatric diagnoses convey the idea that people's emotional difficulties can be understood in the same way as bodily diseases. One consequence of this idea is that we fail to look for meaning in people's 'disordered' responses and experiences. It also implies that people need 'expert' help and that their own skills and resources are not enough. Worse still, diagnoses are used as pseudo-explanations for troubling behaviours, for example 'this person is hearing voices because they have schizophrenia'. Many people, perhaps even most people, who hear voices don't find them distressing. But for others they are distressing, and these are the people who might seek help from mental health services and receive a diagnosis. Within the disease-model approach, the voices ('hallucinations') are seen as symptoms of 'schizophrenia' - there is a 'mental illness' called 'schizophrenia', and hallucinations are a common 'symptom' of that illness. But, at the same time, the hallucinations are caused by the schizophrenia - 'why is that person hallucinating?', 'because she has schizophrenia', 'how do we know she has schizophrenia?', 'because she's experiencing hallucinations'. It's a circular argument; the dog is chasing its own tail.

Diagnosis in mental health is a flawed and inappropriate technique. Apart from its circularity, the diagnostic approach fails to appreciate the broader context of a person's experience. Diagnoses take no account of whether a person has had significant losses, has been victimised or abused (whether recently or as a child), or has experienced any other environmental stresses. There are two exceptions, namely diagnoses that do include such information, one explicitly and one implicitly. The diagnosis of 'post traumatic stress disorder' or PTSD is distinctive in that, in order to receive this diagnosis, the person must have experienced a very stressful (traumatic, potentially life-changing) event. There is also a diagnosis of 'adjustment disorder', which can be cynically interpreted as the 'something bad has happened and you've been upset by it ... disorder'. These two diagnoses, however, demonstrate the inadequacy of the diagnostic process in this respect. The reference to external, causal factors in both 'PTSD' and 'adjustment disorder' merely highlights how external factors are omitted from all other diagnoses. And this is important. These simple things are profoundly influential. The fact that 'PTSD' is identified as a 'disorder' that represents a response to traumatic external events seems to reinforce the idea that 'depression' or 'personality disorders' are, by contrast, not in any way related to such traumas. This, in turn, means that a person's social and interpersonal difficulties are often ignored in the hope that the right medication regimen will achieve the desired return to normal functioning.

In my experience, the system of psychiatric diagnosis is demeaning and dehumanising. People in distress are not simply a set of symptoms to be assessed and classified. At the point when people most need - and deserve - to be shown empathy and understanding, when they need their individual circumstances to be recognised and taken into account, they are instead merely given a label and allocated to a category within a flawed and out-dated system.

The 'disease-model' approach and its principal tool of diagnosis tend to minimise and ignore issues such as poverty, deprivation, social isolation and childhood abuse. All these experiences lead to distress, and our natural and understandably human responses are then (mis)diagnosed as mental disorders. Giving someone in distress a diagnosis of an 'illness' is essentially futile; merely giving something a name doesn't make it easier for the person to deal with or offer any hope of a solution. We need to lose the labels and start thinking about mental health issues in a different way, with less emphasis on what is 'wrong' with people and more on how and why they feel or act the way they do.

Ultimately, I believe there is no place for medical diagnosis in mental health care. It is at best unhelpful and at worst harmful. At the very least it is an inappropriate and blunt tool to deal with complex psychological events. This is a challenging assumption and one I recognise goes against many decades of accepted wisdom, at least in psychiatric circles (many people in the real world seem to understand these issues rather better). It may sound revolutionary, but I believe that both the history of mental healthcare and scientific research have already proved diagnosis to be problematic and dangerous.

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