When I first started this blog I came up with several topics that I wanted to write about over the first few months. As I’ve worked to promote the blog and interacted in various communities on social media I continuously come across what appears to be an obsession many have with the idea of their diagnosis. I am writing Mental Health Diagnosis: What You Need to Know in reaction to seeing more posts than I can count written by people worried about their diagnosis, afraid of being diagnosed, or asking to be diagnosed. I was also asked to write this post in one of the mental health communities that I participate in. In this article, I will explain how professional mental health workers use diagnosis, the benefits, the possible problems that occur when people put too much emphasis on their diagnosis, and the boring reality of how we use diagnosis.
What Exactly Does a Mental Health Diagnosis Mean?
The overwhelming majority of mental health diagnoses are classified and worded as disorders. Some examples include: Major Depressive Disorder, Generalized Anxiety Disorder, Borderline Personality Disorder, etc. What this generally refers to is a collection of symptoms that an individual is experiencing that is causing significant impairment in their ability to function. This could mean that it is causing serious distress in your ability to work, your relationships, your physical health, or other factors in your life. These collections of symptoms organized into different diagnoses are symptoms that most people experience at one time or another in their life: sadness, nervousness, insomnia, lack of appetite, feeling overwhelmed, etc.
All psychiatrists, psychologists, and master’s level therapists are trained in the use of diagnostic manuals. In the United States, we use the Diagnostic and Statistical Manual or DSM. Versions of this manual are update every so often. We are currently on the DSM-5. Every mental health diagnosis imaginable is in this book and for every diagnosis there is a set of diagnostic criteria that one must meet in order to be given the diagnosis. For many diagnoses, it’s required that an individual experience a certain number of the listed symptoms (such as some given as exampes above) and for a certain period of time. In most cases, these symptoms must be causing a significant impairment in the individuals life.
What Mental Health Professionals Really Use Diagnosis For
There are a few things that mental health professionals use diagnosis for. You might be surprised but the first and foremost important part of diagnosis has to do with billing insurance. Whether you know it or not, if you have ever been to a psychiatrist or therapist for anything and successfully used your health insurance to pay for it, you’ve been given a diagnosis (at least in the United States. I am not aware how this works in other). Health insurance companies will not pay for any mental health services without the insured being given a mental health diagnosis first.
This causes a few problems. For one, in most agencies and private practices that take health insurance, you will be given a diagnosis whether you meet the criteria or not, as the alternative is for the therapist to say to you “I know you really want help, but you’re going to have to pay full price out of pocket. Even though you have insurance, you don’t qualify to use it.” We understand this would make it impossible for many people who really need therapy to get it because of the cost.
For this reason, you are usually given your diagnosis at the time of intake. After the first hour of an intake worker or your therapist meets with you to take background information and then talks to you for 20 minutes or so about what you’re going to therapy for, you have been given a diagnosis. This is done because even that first session wouldn’t be paid for by your insurance without them giving you that diagnosis.
If your issues are not so severe to actually warrant a diagnosis such as Major Depressive Disorder, Bipolar I Disorder, etc. responsible clinicians will probably diagnose you with an Adjustment Disorder. Adjustment Disorder in a nutshell is saying that you have experienced either depression, anxiety, or both in relation to recent life stressors that are having an impact on your functioning. It isn’t hard to meet the criteria for this diagnosis and most people probably have experienced symptoms of depression or anxiety during particular times of stress during at least one time in their life.
I have worked for an agency where this is done regularly. Unfortunately, I have also worked for agencies that will throw around what we would consider more serious diagnoses like Bipolar I Disorder, Schizophrenia, Major Depressive Disorder even though they have only talked to the individual for a short time and they may not actually meet the criteria. I’ve actually experienced much more of this kind of careless approach to diagnosis than the former. All kids with behavioral problems get diagnosed with ADHD or ODD. All adults that say they lose their temper and snap get diagnosed with Bipolar I Disorder. On one hand, it’s irritating, on the other, it’s not really that important. I’ll explain what I mean by that a bit later.
5 Things That May Surprise You about Mental Health Diagnosis
1. If you are not completely open and honest during your initial session or sessions, it’s very likely you’ll be given a very inaccurate diagnosis. Most of us (mental health professionals) are really not trying to figure out if you’re lying to us or not.
2. It’s not a far fetched possibility to go to 3 different psychiatrists or therapists and get 3 completely different diagnoses. Every clinician has a different level of training regarding diagnosis, every clinician is skewed by their own personal bias, and every clinician has a substantially different level of how much they care about the accuracy of diagnosis.
3. This may only be my opinion, but from what I’ve seen individuals struggling with mental health issues tend to put a lot more importance on the idea of a diagnosis then the majority of professionals working in the field. I am one of many therapists I have known who make it a point to not even look at the diagnosis or documentation in the chart of any client I work with (if I am not the one responsible for giving the initial diagnosis).
4. While there are a few disorders that we believe are fairly permanent, the majority of mental health diagnoses are not considered to be life-long and it is possible to recover from them.
5. With a few exceptions, psychiatrists and therapists don’t have specialized and individualized treatments for certain diagnoses.
So What’s Actually Good About Mental Health Diagnosis?
There are some benefits to the use of mental health diagnosis. For many, being given an accurate diagnosis can help give them words to describe symptoms and feelings they didn’t know how to express. It can be a starting point to helping the individual educate themselves further about their disorder. As always, knowledge is power. The more you know about what you’re facing, the more ammunition you have to defeat it.
Another thing that I have found helpful for many is the sense of community that many feel when they join support groups for certain diagnoses and get a chance to meet others who suffer from the similar symptoms and issues.
Lastly, I’ve stated that I generally make it a practice to not read about a clients history or diagnosis before working with them. This is true, however, if after working with a client I feel as though they may not be sharing information with me that they may have with someone else, I will look at their records. If a past diagnosis of them was an accurate one, it gives me some idea into symptoms they may be experiencing before they have to tell me. This can help speed the process along in therapy for clients who are slow to warm up and not very talkative.
Psychiatrists and Therapists Treat People, not a Diagnosis.
There are 267 different diagnoses in the DSM-5. There are approximately 7.5 billion people in the world. It would be ludicrous to think that every person with one of the 267 diagnoses are exactly the same or experiences the disorder in the same way. For this reason, many of us don’t pay much attention at all to the diagnosis but focus more on the individual symptoms a person is experiencing, how they are experiencing it, and what impact it is having on their life.
I believe Carl Jung, famous psychiatrist, said it best when he stated
“Every individual is the exception to the rule.”
There is no set medication regimen for any specific disorder. There is no set form of therapy for any specific disorder. Different methods work differently for each individual.
5 Problems Mental Health Diagnosis Can Cause
I felt most compelled to write this post in order to point out problems that focusing too much on diagnosis can cause because I continue to see these problems over and over again while I practiced therapy and while I participate in online communities.
- “Please diagnose me!” I see this over and over and over again online. First of all, no ethical professional that actually has the education and experience to give an accurate diagnosis would ever give someone a diagnosis without being able to take a full history and meet with them in person. What you get when you’re someone asking to be diagnosed is plenty of armchair psychologists telling you what they think it is and it’s most likely the farthest thing from an accurate diagnosis.
- Self Diagnosis: “I’ve never been to a therapist but I’m pretty sure I’m bipolar” Even if you were a licensed psychologist, psychiatrist, or professional counselor, it is never considered good practice to diagnose yourself. One of the most important aspects of seeing a mental health professional is the nearly completely objective view this person has in relation to you. That’s why we don’t provide therapy for friends or family members, because it would cause a bias that would skew our practice.
- Giving Too Much Power to the Label: While it can be helpful for individuals to get some sense of identity regarding their mental illness as it can be beneficial to link up with others who have similar problems for support, it can be extremely easy to go down the slippery slope of overly identifying with their diagnosis. What I mean by this is that our mental health issues and symptoms are only a part of who we are. If we overly identify with them, we may forget that we have many other, equally (if not more) important parts. We can forget that we are an artist, a musician, an avid golfer, or good friend. This will only make problems worse.
- Avoiding Responsibility and Learned Helplessness: “It’s not my fault I flipped out and yelled at you. That was my Bipolar!” “I can’t go on that interview. I have Generalized Anxiety Disorder!” No matter what our symptoms are and what difficulty they create for us as we go through our lives, we remain responsible for the actions we take or the inactions that we decide on. Using the label of a mental health diagnosis to shirk responsibilities and make excuses for behavior that harms others is self-enabling and only create worse problems in the long run. In many cases, an individual engaging in this is not doing so with the intention to manipulate, but actually believes that they are incapable of controlling their actions due to their mental health symptoms. The stronger this belief, the more it will become reality, as outlined in the ideas of learned helplessness.
- Lastly, for individuals given a diagnosis by a professional, self-diagnosis, or believing they have a diagnosis some random armchair psychologist on social media tells them about, this can be very dangerous. If someone fully believes they have a certain diagnosis they may consciously or unconsciously seek out or actually begin experiencing symptoms in order to confirm their beliefs. This is caused in part by the self-fulfilling prophecy which I will write about soon in a future post.
How to Apply This Information
Mental illness is real. It causes everything from constant minor annoyances to major debilitating symptoms for folks all around the world. Mental health and your symptoms should be taken seriously and focused on. Use information regarding diagnosis very carefully.
If it helps you to find a sense of understanding in the symptoms you have been experiencing or helps you find a sense of community, great. Hold on to that.
If you are afraid of getting a certain diagnosis, are more concerned with getting diagnosed than getting treated for your symptoms, or are self-diagnosing…. STOP IT! You’ll be creating problems for yourself that aren’t even there because at the end of the day, the label of a diagnosis itself holds no more power over you than you give it.
If you are experiencing mental health issues and have been concerned about your diagnosis, remember that you are an amazingly complicated person. Your mental health symptoms and diagnosis are just one small part of the complicated weave that makes up you! Don’t ignore your symptoms, but don’t focus so much on your symptoms or diagnosis that you begin to ignore the rest of yourself!
I hope you found this article helpful and informative. If you did, please share with the social media links below! If you have any follow up questions or would like to discuss anything in this post, please comment!
-The Web Shrink
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