In the field of mental health, the practice of categorising individuals into diagnoses has long been standard. While diagnoses can provide a framework for understanding and treating mental health conditions, they also present limitations and potential drawbacks.
Categorising people into diagnoses risks oversimplifying the diverse tapestry of human experiences. Mental health conditions are complex and multifaceted, often defying rigid classification. Reducing individuals to a single diagnosis may overlook the unique nuances and intricacies of their personal journeys (Agteren & Iasiello, 2020). Within each diagnostic category, there exists a wide spectrum of experiences, symptoms, and variations. No two individuals with the same diagnosis will have identical experiences or respond to treatments in the same way. Categorisation may overlook this diversity, potentially leading to misunderstandings or inadequate treatment approaches .
Comorbidity and Dual Diagnoses: Many individuals face multiple mental health challenges simultaneously, resulting in comorbidity or dual diagnoses. This complexity can make it difficult to neatly fit individuals into a single diagnostic label. Focusing solely on one diagnosis may neglect the interconnected nature of mental health and hinder comprehensive treatment strategies. One example is the frequent co-morbidity of anxiety disorders and depression. Clinicians often disagree on whether there is an overlap of symptoms, or for example symptoms of depression such as low mood would fit within a diagnosis of obsessive-compulsive disorder. This further invalidates the concept of a diagnosis, asking the question of whether there is any point using a set of criteria when we could investigate the strengths and weaknesses of an individual and devising treatment methods to support them through their struggles accordingly.
Stigma and Self-Identity: The process of assigning diagnoses can carry unintended consequences, including stigma and issues with self-identity. Labels may inadvertently reinforce societal stereotypes and discrimination, exacerbating the existing stigma surrounding mental health. Nowadays there is far less obvious discrimination – people with mental health and other conditions are not called names and directly excluded from groups and activities, however there are situations such as in school, when individuals are set lower expectations and given less challenge if they have a label. This is detrimental to the individuals’ outcomes and additionally, individuals may internalise their diagnosis, potentially shaping their self-perception and limiting their sense of agency. For example, although not a mental health condition, whilst many people diagnosed with dyslexia find this empowering and choose to keep fighting through their struggles, there are others who feel discouraged and surrender to feelings of helplessness (Gibbs & Elliott, 2020).
Diagnoses heavily rely on clinical judgement and subjective interpretations of symptoms. While diagnostic criteria provide guidelines, there is room for variation in interpretation. This subjectivity raises concerns about diagnostic reliability and consistency, potentially impacting treatment decisions and outcomes. Of course, more complex formulations require more time in training that includes supervision and guidance from experienced clinical practitioners, however this is more likely to improve the overall treatment for people who are struggling.
A further issue is the inadequate consideration of context. Categorisation into diagnoses may not adequately consider the influence of environmental, social, and cultural factors on an individual's mental health. Contextual factors such as trauma, socioeconomic conditions, and cultural norms can significantly impact mental well-being but may be overshadowed by a focus on diagnoses alone. Supporting evidence for this could be that studies have found that individuals from poorer background are much more likely to be prescribed antipsychotic medication than those from more well-off backgrounds (Bonnot et al., 2017). There could be a range of reasons why this is, such as less wealthy people not being able to afford more costly services such as talk therapies, however what is clear is that there is a relationship between context and the use of diagnoses to prescribe medication.
Neglecting Strengths and Resilience: A diagnosis-centred approach often emphasises deficits and challenges, overshadowing individuals' strengths, resilience, and capacity for growth. By focusing solely on pathology, the narrative around mental health can become imbalanced, neglecting the importance of empowerment, self-care, and cultivating positive psychological well-being. Any individual that neglects their own development and needs and is neglected by others is likely to suffer from mental health problems. However, whilst there are some individuals with mental health conditions who cannot recover without serious intervention, a focus on living a life full of self-care and optimism can help many overcome their struggles.
Moreover, mental health is dynamic and evolving, rather than static. The changes we have seen over time in the classifications of mental health conditions have varied tremendously. Categorising people into fixed diagnoses may not adequately account for this fluidity. The diagnostic framework may fail to capture changes in symptoms, shifting experiences, and the potential for personal growth and recovery.
While categorising people into diagnoses has been a longstanding practice in mental health care, it is crucial to recognise its limitations and explore alternative approaches. Embracing the complexity of human experiences, considering individual strengths, and valuing context can foster a more inclusive and holistic mental health system. Ideally, in the future individuals will be seen and supported beyond their diagnoses, empowering them to define their own narratives of well-being and resilience.
References
Agteren, J., & Iasiello, M. (2020). Advancing our understanding of mental wellbeing and mental health: The call to embrace complexity over simplification. Australian Psychologist, 55(4), 307-316.
Bonnot, O., Dufresne, M., Herrera, P., Michaud, E., Pivette, J., Chaslerie, A., ... & Vigneau, C. (2017). Influence of socioeconomic status on antipsychotic prescriptions among youth in France. BMC psychiatry, 17, 1-8.
Gibbs, S. J., & Elliott, J. G. (2020). The dyslexia debate: life without the label. Oxford Review of Education, 46(4), 487–500. https://doi.org/10.1080/03054985.2020.1747419
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