We hear terms like “Depression” and “Bipolar Disorder” mentioned in common conversations and talk shows, but I have found that many times people are not clear about what these diagnoses really are and what these terms mean. Whether we personally struggle with symptoms or support others with these issues, education is important. The more you know the better equipped you are to recognize symptoms, find appropriate resources and support, and take an active role in the treatment plan.
Why Use Diagnoses?
In many ways, diagnoses are helpful. Just like an exam where a doctor takes a list of symptoms to determine the type of medical condition, a clinician also takes in information to determine the larger picture and how best to intervene. There are many factors to consider, such as medical conditions, cognitive abilities, substance use, family dynamics, just to name a few. Without assessments, the information is more difficult to organize, communication between members of a treatment team is labored, and important pieces of the puzzle might be overlooked. The end result is less effective interventions and a longer time spent surviving rather than thriving.
There are additional benefits to providing diagnoses. For one, some people feel less ostracized. They learn that they are not alone- there are so many people out there dealing with the same issues that it warrants a place in a clinical book! The struggle also adds legitimacy for the outside world. Unlike many medical diagnoses, where the problems are visible (think of a cast for a broken arm), issues involving the mental health are less tangible and therefore easier to minimize or ignore. But these issues are real. (People die from cancer; people also die from depression.) They can have such an impact on your health and overall functioning that the clinical world not only acknowledges it, but has developed a special vocabulary. And when it we know it exists, we can take action.
The following are links to diagnostic criteria:
http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm This dscribes the diagnostic criteria for disorders straight from the DSM-IV manual.
http://mysite.verizon.net/res7oqx1/ This site provides more user friendly descriptions of diagnoses. The content is similar to the clinical
version, but without so much psychological jargon.
Are There Drawbacks?
Yes. The arguments for diagnoses are very reasonable; however, realize that they also are surrounded in some controversy. I have found, along with many of my colleagues, that there are factors that warrant caution. First, there is still a great deal of prejudice against people with mental “disorders.” Although we no longer treat people with “major mental illness” as unclean, I have had many clients share unfortunate stories about responses to their troubles. Examples have included labeling the diagnosis as the result of a moral transgression, telling the person s/he is crazy, framing their symptoms as excuses to get out of something, and treating the person with kid gloves. Several clients have been denied life insurance because of there was documentation of suicidal ideation, even when it occurred over a decade ago. Clinicians can also fall into this trap. When we use the medical mindset, we tend to see experience through the lens of pathology. In other words, when we frame a person’s experience as an illness, we treat the person as sick. Many choose to quietly suffer than risk potential being devalued and alienated.
There is also the fact that individuals begin to define their lives through the filter of “mental illness”. Emotional reactions, relationship dynamics, and other aspects of living are minimized as just another symptom. In so doing, needs and self awareness decreases. Stagnation ensues because there is no willingness to consider what can be done about a situation. For example, if I believe I
am only capable of getting a ‘D’ on a test, there is much less of a chance that I am going to study and assert myself to do better. It seems like a fruitless endeavor. Similarly, if I believe that I am destined to be depressed, it will be very tempting to cease taking steps to make life better. Thus begins the insidious effects of a self-fulfilling prophecy.
Unfortunately, with the way our system is currently set up, when insurance companies are involved, clinicians can be caught in a bind. In the world of insurance, there is no help with expenses unless a diagnosis has been provided. Yet, according to Pipal (1995), almost half of adults seeking outpatient services have no diagnosable condition. As she states, “we stretch a diagnosis to prove “medical necessity,” and then we turn right around and try to convince our clients that they are not sick!” (1995, p. 326)
Remember, determining a proper diagnosis helps clinicians make sense of complex symptoms and facilitates identifying the most effective ways to provide help. It can help clients understand that they have real issues that deserve recognition and attention, while also serving as a reminder that they are not alone in their struggles. At the same time, diagnoses are not without risk. To prevent a sense
of doom, or to ostracize, the diagnosis should be used only as a tool- not a label.