If we don't diagnose, what's the alternative?

We need a wholesale revision of the way we think about psychological distress. We should recognise that distress is an unfortunate but nevertheless normal, not abnormal, part of human life. People experience many difficult circumstances in their lives, and often become distressed as a result. This needs to be reflected in the way we identify, describe and respond to that distress. We also need to acknowledge the overwhelming evidence that severe distress or unusual experiences (which now attract the misleading label of 'psychiatric symptoms') lie at one end of continua with less unusual and distressing mental states. That means there is no easy 'cut-off' between 'normal' experience and 'mental health problems'.

Some people obviously feel that diagnostic labels are helpful. They say that is important for them to learn that their problems have a name. But in reality, this sense that a diagnosis is helpful or reassuring cannot come from any greater understanding of the problems, any better knowledge of their causes or aetiology, appropriate treatment or prognosis - because diagnoses simply can't offer that information. Instead, the sense of helpfulness seems to result from the person knowing that they have been listened to (and heard), that their problems have been recognised (in both senses of the word), understood, validated, that these problems can be explained (and are themselves explicable rather than simply 'mad') and that some help can be offered. In the flawed world of present-day services, however, people often find that they are reassured by (or at least accept) a diagnosis, feel some immediate reassurance, but then find any real help is illusory. The diagnoses convey very limited useful information, will not explain things, will not guide treatment and will not help predict the future. Instead, a clear description of a person's real problems would be much more useful. A description of an individual's actual problems would provide more information and be of greater communicative value than any diagnostic label.

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