Pros and cons of diagnosis

Pros:

  • People feel understood, “not crazy”, and a sense of being helped by a professional -that can put a label on a cluster of symptoms, experiences, or problems. Being understood reduces anxiety and helps people feel connected and hopeful.
  • In some instances, specific diagnosis can help people identify empirically supported treatments that have a good track record for symptom reduction and decreased pain. For instance, exposure and response prevention treatment works for obsessive-compulsive disorder.
  • If you meet criteria for a diagnosis, it could be argued that your treatment is medically necessary and thus qualifies you for insurance reimbursement.
  • Psychological assessment and testing can help determine adequate treatment for erratic behavior. Assessment may differentiate psychosis, dissociation, brain damage, dementia, impairment from psychoactive substances, and/or cognitive limitations. Getting clarity on a diagnosis may be helpful in making referrals to appropriate providers, getting educational or vocational assistance, and getting appropriate medication.

Cons:

  • There are stigmas attached to having a “psychiatric disorder” when pain and suffering is ordinary and understandable. To the uneducated public, “having” a mental illness, having mental problems, or being known for psychiatric problems can be stigmatized and confused with psychosis and violent behavior. Labels and stigmas can also be a detriment down the road when applying for licenses and certain jobs that require intensive screening.
  • In one of my first classes in graduate school I was taught that diagnosis is not valid (ie, it doesn’t accurately “capture the essence” of that which is trying to be captured) nor is it reliable. In other words, different interviews with different clinicians would not yield the same results. Trends in diagnosis vary in terms of popularity, educational influences, and controversy and biases within the field. Structured interviews such as the SCID (structured clinical interview for DSM disorders) or psychological assessments (such as personality testing or the Beck Depression Inventory) can increase accuracy for diagnostic criteria, but can be time consuming and in some cases quite costly.
  • Labels don’t explain causes. I can’t recall the number of times I hear people (colleagues included) explaining behavior through descriptions of behavior. In the great rhetorical scheme of things, being depressed because you act depressed and acting depressed because you are depressed doesn’t really account for depression- nor does it get you to stop being depressed.
  • Putting a label on something doesn’t necessarily mean that you will be helped, or that any given psychotherapist will know how to treat “what you have.” Psychotherapists should ethically refer when they are not familiar with “what you have”, but bear in mind that clinicians all have their own approaches, own theories, and own biases about “what you have.” (Thankfully, some of them also have niche areas.) Bear in mind that there are a wide variety of factors that go into getting treatment for “what you have” including factors related to research and economy.

If you are curious about diagnostic criteria, you are welcome to visit  http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm.

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