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Diagnosis, Diagnosis and Diagnosis: Learning to Unlearn the Labels

Updated: Oct 9, 2022

In the 1970s, To align psychiatry with the rest of medicine, it began to adapt to a classification system, separating people with diagnosis and those with mental illness and without mental illness into sub-buckets. But what if some of these diagnoses are nothing but labels that carry stigma and a bottle of pills with hopes of "curing" people of something that is totally normal and human? What if we're living in a world that is hyper-inflated of mental health diagnosis?



Diagnosis for a mental illness is based exclusively on patient-reported symptoms and clinician-observed signs. There are no laboratory tests or biomarkers, except those used to exclude a medical cause such as adrenal disease for depression, or a brain autoimmune syndrome for psychosis. While biological psychiatrists have spent five decades searching for a lab test to rule in a psychiatric illness, as opposed to ruling out a medical cause, there is no clinically useful diagnostic test. Neither is there any genetic, biological, chemical or other physical tests of any kind that can determine the presence or absence of any mental disorders.


Diagnosis in mental health is largely based on the Diagnostic and Statistical Manual of Mental Disorders's 5th edition (DSM-5) or the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), a medical classification list by the WHO. Governmental bodies and the insurance industry use the DSM or ICD-10 as a common standard for medical insurance and billing purposes, and this is part of what makes use of the DSM or ICD-10 so widespread, even in the mental health industry.


But what's the problem with the DSM? Everything.


The DSM is a copyrighted product of the American Psychiatric Association (APA). Through its most recent three editions, the DSM and has so far generated over $100 million in direct profits for the APA, ranking it among the most financially lucrative books of any kind published in America since the 1950s.

There are, however, many additional, indirect profits that are closely linked to the DSM. The DSM-5 was written by different task forces made up of mental health clinicians, academics and researchers chosen by the American Psychiatric Association, where each small task force was responsible for a particular diagnostic section or category. Nearly 70% of the DSM-5 task force members reported having financial ties to pharmaceutical companies, and at least 56% of those who posted disclosure statements admitted having industry ties such as holding stock in pharmaceutical companies or serving on the boards of pharmaceutical companies.


The DSM is almost like a bible in the mental health industry, and it’s been used by clinicians worldwide and its misuse is leading to an inflation in diagnosis by healthcare providers. More diagnosis entails many other detrimental problems, including misprespcribing people with medication that they do not need and can have severe side effect profiles.


Although now many people are trying to stand up against this inflation of diagnosis in mental health, including the chair of the DSM-4 itself, Allen Francis. He is an American psychiatrist and is currently a Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine.


“I despair the diagnostic inflation that results from a too loose diagnostic system, aggressive drug company marketing, careless assessment, and insurance company pressure to rush to judgement. Diagnoses should be written in pencil, and under-diagnosis is almost always safer and more accurate than over-diagnosis” - Allen Francis, Duke University

Another study, published in Psychiatry Research, by The University of Liverpool has concluded that psychiatric diagnoses are scientifically worthless as tools to identify or discrete mental health disorders, stating that diagnoses tell us little about the individual patient and what treatment they need and that there is a huge amount of overlap in symptoms between diagnoses. For many of us, this can be difficult to accept or believe because we have heard otherwise so frequently of diagnosis in medicine.

Another astonishing study in the US, has stated that according to the old DSM almost 83% of kids meet a mental health diagnosis by age 21, What is this if not an over-medicalisation of normal stresses, worries and disappointments of everyday life? More to blame here is the pharmaceutical industry which is pressurising clinicians to diagnose more. See extra diagnosis means extra medication, and that in return means extra revenue for them. And that quite explains the 16 billion dollars anti-psychotic industry and the 11 billion dollar anti-depressants industry.


Being diagnosed with a mental illness can often lead to unnecessary stigmatisation of patients. Even clinicians who treat this population can be guilty of having the same stigmatisation, potentially impacting the treatment of patient. At least that's the conclusion from researchers at the University of Bath in Britain, who found that diagnosing patients with labels such as schizophrenia or personality disorder could lead the less effective treatments being used by clinicians. Although stigma is another conversation, let's get back to diagnosis.


There have been multiple instances where patients have been overwhelmed by different diagnosis, and each label comes with a different cocktail of medication. This is why it's important for a good mental health professional and diagnostician to take their time to diagnose after understanding the patient well enough, and not jump into throwing names of disorders.


To summarise, mental healthcare especially psychiatric care is currently very diagnostic-centric while it should be more person-centric. Diagnosises are only useful when done correctly by a mental health professional and as a common language among clinicians. We can often get overwhelmed by a diagnosis and henceforth it's important for us, to learn to unlearn those labels.


References:



Psychiatric diagnosis 'scientifically meaningless' by the University of Liverpool. July 8, 2019 https://www.sciencedaily.com/releases/2019/07/190708131152.html


Conversations in Critical Psychiatry: Allen Frances, MD. Psychiatric Times, Psychiatric Times Vol 36, Issue 10, Volume 36, Issue 10. https://www.psychiatrictimes.com/view/conversations-critical-psychiatry-allen-frances-md


Diagnostic Inflation: Its Extent, Causes, Consequences, And Possible Cures by Allen Frances MD. http://www.ecad.net/images/Killarney/A_Frances_slides.pdf















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