How a Diagnosis Can Hurt

I’ll put my bias on the table right up front: I think paying too much attention to psychiatric diagnoses can be harmful. For many reasons, I don’t like them for adults – and I like them even less for children.

There definitely is a case to be made for obtaining a diagnosis.  A diagnosis is useful if it offers direction in terms of how to help. It’s important if it allows you or your child to access services, like special education, that will help you be successful.  A diagnosis is useful if it helps you to gain insight, and to be accepting of and patient with yourself as you work to overcome the problems you’re having.  PTSD (post-traumatic stress disorder) is an example of a diagnosis that can help in this way, because it allows the person to connect the overwhelming flashbacks, numbness, and anger to her history rather than concluding that she herself is somehow inadequate.

And, of course, in the insurance world, a diagnosis is usually required for reimbursement, so, from a financial, but not necessarily a treatment perspective, you may need one.

But there are some very serious negative effects of seeing yourself or your child in terms of a diagnosis.

Diagnoses such as ADD (attention deficit disorder), BPD (borderline personality disorder) or bipolar disorder (which is suddenly being diagnosed all over the place) – become labels.  The diagnosis becomes the lens through which you see yourself.  When you’re distracted, you may find yourself thinking,  “Of course I can’t focus!  I have ADD.”  The diagnosis has become a belief about your self that prevents you from trying to figure out why else you might be having difficulty concentrating.  At worst, it becomes a pigeon hole that limits your view of what you can hope to accomplish in your life.  It causes a change in your definition of self; that is, it crystallizes as part of your self image.

That’s rough on adults ; it can be devastating for kids.  A child diagnosed “oppositional defiant” begins to see himself that way : “I am oppositional.”  This simply reinforces the child’s view of himself as troublesome.  How much more useful to help the child say, “I am so angry at being told what to do,” or “It’s so hard for me to do what adults tell me to do!”  Statements like that lead to self discovery – and self discovery creates the capacity for change, for seeing oneself in a new way.

Just as a diagnosis can change one’s view of self, it can also change the way others perceive the person.  Based on a label, conclusions are often drawn about a person’s capacity to achieve; her potential for healing and growth; whether she should be taken seriously.

The impact on self image is not the only negative side effect of a diagnosis.  For the rest, you need a little information about psychiatric diagnoses.

A diagnosis is a name given to a constellation of characteristics that causes impairment in daily life.  It’s not like looking at bacteria under a microscope ; these “symptoms” are much more complex and difficult to define than, say, streptococcus on a slide.  So, committees of mental health professionals meet and hash out which symptoms seem to occur together and should be given a name.  This information goes into a catalogue of diagnoses called the Diagnostic and Statistical Manual of Mental Disorders (the “DSM IV”).

The DSM has been written and revised five times since 1952, with additional intermediate revisions.  What that means is that the way the symptoms were clustered and named in 1952 has been changed – again and again – and the clusters renamed.  The very same symptoms!  The latest version, the DSM V, is in the works right now, and there are major new controversies about how to describe and cluster symptoms under diagnostic labels.  Some of these debates will have a devastating impact on the lives of people who are diagnosed with the labels that come out of these closed-door discussions.  Everything from their sense of self and the way significant people in their lives view them — to their access to health care will be affected.

And in a few years, it will all be rewritten again.  But the impact will already have been made.

In next week’s post, I’ll talk specifically about the diagnosis of depression.  Is it a symptom ? Or a disease ?  Does a label help ? or hurt ?

Also coming —  some great information came out recently about what makes for effective therapy.  You can learn about it in next week’s Invincible Voice on “Therapy that Works”.

The thought to take with you today is this. You’re a lot more than a diagnosis. No label can represent the essence of a person, and some labels actively distort it.  So don’t pay much attention to those labels.  Instead, go about deeply learning who you are and what makes you tick.