Is a Diagnosis Helpful, or Harmful?
There’s an eternal debate in the scientific and clinical community over whether diagnostic manuals such as the DSM make our lives better or worse, and truthfully, it really depends.
As a Marriage and Family Therapist (MFT) by training, I tend to despise the DSM and am hesitant to touch a diagnosis besides “adjustment disorder” with a ten-foot pole.
Adjustment disorder is a diagnosis for a broad variety of symptoms of distress that someone might be experiencing due to significant changes or stressors in their life—which might be good or bad. It’s sort of a “catch-all” that allows us to put something on paper that validates the distress of the client without yet assigning them a label that might seem more permanent or pervasive.
All of us experience changes and stressors throughout different periods of our lives that might cause us a great deal of distress—so much so that we may not appear like ourselves for some period of time.
For example, moving away from your parents for the first time, having children, losing a loved one, or being diagnosed with a chronic illness. These are all bound to cause a great deal of distress that is entirely reasonable given the context—whereas many other diagnoses have been criticized for leaving context out of the equation entirely, focusing more so on biology, genetics, or personality.
So, if most everything is contextual and situational in part, why do we diagnose at all?
Labels Can Be Premature, Inaccurate, and Stigmatizing
Mental health professionals are often pressured to assign a diagnosis to a client that has come through their door, whether for insurance coverage, school or work accommodations, or other paperwork purposes—and to do so quite rapidly. But many of us aren’t ourselves in a crisis—especially the first few times we meet with a stranger in an unfamiliar place who we may see as an authority figure.
Objectively, it would be absurd for mental health professionals to be absolutely confident in any diagnosis they assign to a person within just a few sessions of meeting with them, regardless of the amount of training they receive.
Can you think of a time when you were absolutely not yourself while meeting someone new? Maybe you had trouble finding the location or parking your car, or you had a headache during the entire interaction. What if you had just lost your job, or you were feeling particularly ticked off about the traffic on your way over? Imagine the audacity of that person applying a permanent label to the way that you presented during that hour or so that they first met you. Ludacris, right?
But humans love to label things. We don’t like uncertainty or ambiguity, which is what drives us to learn, research, write and live. But it’s also what made us create the concept of a diagnostic manual.
Mental health professionals wanted to have a common language with which to communicate with one another. It wasn’t so much about assigning people to categories as it was about communicating as much as possible about a patient or a client with as few words as possible. So, a diagnosis was created that carried with it a cluster of traits, behaviors, or symptoms that tended to appear in persons with that diagnosis. The goal was efficiency.
Unfortunately, whenever you try to simplify something, you run the danger of oversimplifying it. So, some people don’t fit perfectly into one category or another—and this information might get left out.
And as we discussed previously, a diagnosis doesn’t speak to the context of why a person might present with that cluster of traits, behaviors, or symptoms, which is pretty pertinent to how you might actually help that person. The presence of trauma or adverse events, the impacts of socioeconomic status, racial biases, societal pressures, or the lack of resources can fall through the cracks.
A diagnosis might communicate a broad sketch of how someone presents, but what it doesn’t communicate is who someone is as an individual, why they are the way they are, and what might actually be helpful for them.
And in the process of simplifying and categorizing individuals, we increase the chances of prejudice and stigma. People (even mental health professionals) might make all sorts of assumptions about an individual who they have just met because of a diagnosis. It doesn’t really seem fair to know all about someone’s symptoms while knowing nothing else about them upon first meeting them.
And oftentimes, the diagnosis is not accurate. The DSM is still subject to human error just like any other diagnostic tool. In the process of making a diagnosis, an individual has to make subjective judgments about what is “normal” and how far off they feel the individual is from this subjective mark; so, depending on who is doing the assessment, someone might get a very different diagnosis.
The same person might present radically different depending on the day, time, and internal state. Someone might present as more or less distressed than their own personal norm—and since the person doing the assessment likely hasn’t known the person long enough to know what their personal norm or “baseline” is, they have to guess based on a short interaction.
Labels Can Also be a Validating, Useful Tool
But it’s not all about insurance paperwork and mental health professional records. According to NAMI (The National Alliance on Mental Illness), a diagnosis can help someone understand why they are having certain symptoms and validate them in their experience.
NAMI advocates for a diagnosis being nothing more than a tool to help you and your doctor address those symptoms most effectively and help claim any rights for benefits, accommodations, or treatment.
Having a diagnosis might make it easier to weed through all of the books, podcasts, and other treatment options available to you for the ones that are most likely to fit your experience, even if all of it doesn’t apply to you, it’s likely that more of it will than if you waded through everything.
It also makes it easier to find a mental health professional who likely has specialized knowledge and experience working with the types of symptoms you might be experiencing—and who is most likely to be enthusiastic about working with you.
Having a diagnosis for some gives a sense of relief and validation. Knowing that others experience things similar might make a person feel less alone or less guilty for symptoms that they may have trouble controlling. We now understand that there are biological and genetic influences on many DSM diagnoses, however, it’s unclear exactly how much is genetic and how much is environmental—the classic nature vs. nurture argument.
A diagnosis can be a very useful thing to ensure that someone is able to get their needs met whether that’s at work, at home, or at school. Sometimes it’s the thing that makes the difference between having those unmet needs recognized and validated or having them spun as a personal failing of the person.
So, Which Is It?
If you’re wondering what to do with a diagnosis you or a loved one has been given or considering pursuing a diagnosis, consider what it means to you personally. In what ways might you find a diagnosis useful? In what way do you think it might be harmful?
Think of a diagnosis as a working hypothesis or shorthand for what someone might be experiencing at a given time, rather than thinking of it as a permanent trait of someone’s personality.
Oftentimes people get so caught up in what a diagnosis means about them or another or which diagnosis they feel is entirely accurate that they miss the point—that it’s supposed to make things simpler, yet it often does the opposite. It’s supposed to help you see the person as just that, a person, and if it’s doing the opposite, it may not be so useful.
A diagnosis can be a very useful tool or it can be something just as distressing as the symptoms themselves. Ultimately, people are still people, and it’s important to remember that above all else.