The difference between mental and physical health diagnosis

I’ve been planning to write this post for a while as all the discussion about the new DSM v (for some of the discussion here and here ) has brought it back to my attention. I feel it is an often misunderstood area of mental health and one that has caused some of those suffering a great deal of angst.

 For so many like myself when they got a diagnosis it felt like a watershed moment, a point at which we could and did look to at, as the point at which we started on the road to recovery. And in a way it was true however what I want to talk about is what happens after that because for many people they don’t just get one diagnosis. They can get several and sometimes even at the same time.

Think about how it feels, how difficult it can be when years or even only a few months later you are given another diagnosis, and then maybe another

 but does it really matter?

Of course it depends on the situation but I prefer to think not. You or I have the same symptoms and the same goal- to get them under control- and are working together to find a solution, whether that be medication or therapy or a mixture of both. It’s just a few words, a précis for clinicians to use amongst themselves to have a quick over view of what might be your problems. It doesn’t’ define them or even tell the clinician why you got them either. It’s a just a description.

But what do people expect from the diagnosis?

Well they expect the same as from a diagnosis of a physical illness; a prescribed treatment path with a clear indication of when they have become well and in some cases a timeframe for that recovery. And quite frankly you are not going to get that with mental health.

So why does it matter so much to people?

Well quite apart from the feeling that you can now tackle the problem because you know what it is there is a confidence that it’s not just me anymore, many more people have had this before and they’ve recovered. And for me I think a lot of people gain a lot of strength from this that aids them in their recovery.

So why are mental health diagnosis different from physical ones?

Personally I think there is a big difference between a bacteria or virus causing a problem and the complexities of the brain. Simplistic yes, but my point is about the fact that you can see a physical problem, you have a cause and you can follow it’s progression in a person and in each person regardless of many things the progression and resolution of the problem is the same. Some are more severe some not so but it can be seen/measured in most cases and in mental health you have no such thing.

In short I don’t think we know nearly enough about them to have formed any particular idea of how/ why the symptoms occur or how to reduce them. You can only try things that have been seen to reduce the symptoms for others and see what happens and although these treatments have undergone the scientific testing they are not specific in any way. Which is something that most of us miss in understanding but also in our desires: we want to have an answer that tells us how to get well and we rely on it because to not do opens up that gaping chasm of doubt that we the patient will ever be well and when ill it’s intolerable. We have to feel we are going to get well and we’d like some evidence to that fact to...hence the diagnosis. Proof that others have done it. And please not that just because they can’t say why it happened or even accurately what it is doesn’t mean that they can’t help you to become well.

The whole discussion about diagnosis is intriguing and I recently read a blog posted in April that looked at this issue (found here). It was written by clinical psychologist and makes the point that although the profession has characterized the diagnosis clinicians have recognised the limitations of the criteria and treat symptoms rather than diagnosis.

I have found that most psychiatrists working at the front line are sympathetic. In fact psychiatrists already treat symptoms rather than diagnoses. For example they will consider prescribing an antipsychotic if someone is psychotic regardless of whether the diagnosis is schizophrenia or bipolar disorder. They also recognize that many patients don’t fall neatly into current categories. For example many patients have symptoms of both schizophrenia and bipolar disorder sometimes at the same time and sometimes at different time points.

He goes on to conclude

There is also a justifiable unwillingness to discard the current system until there is strong evidence for a better approach. The inclusion of dimensional measures in DSM5 reflects the acceptance of the psychiatric establishment that change is needed and acknowledges the likely direction of travel. I think that psychiatry’s acknowledgment of its diagnostic shortcomings is a sign of its maturity. Psychiatric disorders are the most complex in medicine and some of the most disabling. We have treatments that help some of the people some of the time and we need to target these to the right people at the right time. By acknowledging the shortcomings of our current diagnostic categories we are recognizing the need to treat patients as individuals and the fact that the outcome of psychiatric disorders is highly variable.

All we can hope as the patient is that the clinicians aren’t hampered by the government’s inability to fund research or treatment because it doesn’t have clear and comprehensive results to judge whether it was a success, where patients aren’t treated to particular courses of action based solely on diagnosis or for that matter moved unnecessarily from services aimed at youths because they may have turned 16 or 18 when it is in their best interests to stay right where they are.