What Does A Mental Health Diagnosis Really Mean?
A psychological or psychiatric diagnosis is complex and a bit of a mystery. When I do psychological testing with children, they often ask where my stethoscope is and wonder if I am going to poke them. They hear that they are going to see a doctor for tests and are confused when I tell them that I am a different kind of doctor. But, I find that it is not just children who are confused; the process for obtaining and meaning of receiving a mental health diagnosis is a new venture for many. The field does not do a great job with transparency when it comes to mental health diagnoses, leading many to rely too heavily on them. I am not discounting the value of giving, receiving, or having a diagnosis, but find it important to be clear about what a diagnosis really does (and does not) mean.
First, a little bit on language: I will be using the term “mental health diagnosis” purposely as the terms psychological and psychiatric diagnosis can be confusing when there is not a difference between the two. The difference is that a psychiatrist is a medical doctor who focuses on biological and neurochemical mechanisms and prescribes medication whereas a psychologist has a doctorate in philosophy or psychology and is trained on giving psychological tests and utilizes different treatment approaches that focus on behavioral, emotional, social, and spiritual elements beyond (or in addition to) medication. I also do not like to refer to diagnoses as “mental disorders” as it gives a false impression that they are somehow separate from mental health when they are just part of overall health and wellness.
A mental health diagnosis is different than a physical health diagnosis. There are no straightforward blood tests or x-rays that can diagnose a mental health difficulty. There is also no single psychological test that can provide a diagnosis. Given that the brain is so complex, there are not clear neurochemical or biological markers for the different diagnoses. Therefore, the mental health diagnostic process is more complex and involves considering biological, psychological, social, and spiritual elements. A mental health diagnosis is based on observable behaviors and/or performance on multiple psychological and neuropsychological tests. This process attempts to externalize subjective, abstract, internal experiences and make them concrete and therefore provides a limited view that may miss or misinterpret things at times.
A mental health diagnosis is a classification. Without giving too much of a history lesson (which can be found here), it is helpful to first understand how mental health diagnoses were created and used. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the main system used by most clinicians in the United States to classify mental disorders. The DSM was first developed after World War II by the U.S. Army (and modified by the Veterans Administration) to better identify the outpatient presentations of servicemen and veterans. Since then, there are have five revisions and the DSM-5 now contains almost 300 diagnoses. The intention behind the first DSM was simply to classify and it has since attempted to be of more clinical use by providing a common language to help with communication, billing, research, and treatment. However, the DSM is designed to be used as only one of many tools to guide diagnosis and treatment.
A mental health diagnosis is not clear-cut. It is misleading to have so many different diagnostic categories because it gives the impression that each mental health diagnosis is a separate, objective reality. However, there can be overlap between individuals diagnosed with different disorders and differences among people diagnosed with the same disorder. For example, there are 18 different criteria listed in the DSM for the inattentive and hyperactive symptoms that make up ADHD and only six are needed for a diagnosis. Additionally, all of the symptoms found in ADHD can also be found in other diagnoses. Therefore, an ADHD diagnosis can “look” many different ways and may even be better explained by an entirely different diagnosis instead.
A mental health diagnosis has profound social influences. Mental health diagnoses are typically thought of as aspects of individual personalities and brains. However, what is considered “abnormal” and diagnosable is a result of cultural and societal norms, values, and expectations. Although the diagnostic manual suggests that behaviors considered “at odds with social norms” are not considered disorders unless these actions are the result of some dysfunction, it is important to consider if the dysfunction is a result of not “fitting” with what is considered to be the norm instead of something within the person.
Not all difficulties or behaviors require a diagnosis. Classifying and labeling mental health difficulties gives the sense of some sort of factual reality that does not exist for the reasons outlined above. The diagnostic process attempts to draw a hard line that divides us into normal and abnormal when in reality, we are all warriors sharing common struggles. Mental health is not an absence of mental difficulties and not all difficulties are considered disorders. For example, some level of anxiety is actually good for us as it increases productivity and performance.
What can we do with this information to support our own mental health?
Just like physical health, mental health is not a passive process, it is dynamic and lifelong. A diagnosis itself is not the answer to mental health; it is a “tool” to facilitate change and connection.
Because the DSM diagnostic criteria serve as a guide only, proper diagnosis and treatment are heavily based on professional judgment. Therefore, it is important to find the appropriate clinician. You should interview potential providers to find the best one for you. Ask questions about their background and approach and choose one whose style and experience best matches with your personality and goals.
Be actively involved in your psychological and/ or psychiatric treatment. Ask what your diagnosis is, how it relates to you, and understand the different treatment options and possible outcomes. It is okay to ask questions and make sure they are answered in a way that you understand. Try not to be scared off by psycho-babble (psychological jargon) and ask for things to be explained in plain language.
Focus more on your symptoms, needs, and strengths rather than the diagnosis itself.
Know that you can get a second opinion, change providers, or ask for additional information if you do not feel as though treatment is helping or going the way you would like.