I feel that I have been surrounded by conversations about psychiatric diagnosis lately. The recent publication of DSM5 has raised some great concerns on this topic. An article in last month’s Guardian prompted strong reactions from some. And in the context of my own professional practice, I have spent a long time in conversations with colleagues about a complex individual with a raft of possible diagnoses – none of which seem to sit quite comfortably.
I have been aware for some time now that I appear to hold contradictory views on diagnostic labelling. On one hand, I am passionate about accurate differential diagnosis to ensure each person I see gets the most appropriate intervention. On the other hand, I have always advocated that the power is in the description rather than the label. What exactly do this person’s difficulties look like? And how do they impact on his or her daily life? Further, I take real exception to people referring to individuals by their diagnosis as if it defines them – terms like epileptic or schizophrenic get me really annoyed!
I have met several individuals and families over the years who are desperately seeking a diagnosis because they feel that a label will give them an explanation, a future direction and access to services. However, I have also worked with individuals who have been inaccurately diagnosed and this label has had a negative impact on their life, often due to the assumptions that people have made about them based on that diagnosis. And I know a significant number of people who would have their needs best met by a certain service but are denied access because of the presence or absence of a diagnostic label.
I have been wondering if one of the reasons this is such a contentious issue is our attempt to treat the mental and physical aspects of a person in the same manner. Being diagnosed with diabetes, for example, will explain the physical symptoms a person is experiencing, however, is this true for mental health problems? Does a diagnosis of depression explain why you feel the way you do, or does it just label what you already know? Is this the same or different from the impact of getting a physical diagnosis? This is something that I will continue to mull over, possibly for years to come. However, it is my firm belief that what people really value is the feeling that the difficulties they are experiencing are understood by someone; that they are being taken seriously, and I am not convinced we always need to label something to be able to do this.