We have been saying for the last 30 years that the psychiatric labels used to describe the various aspects of maladaptive behaviour have been for the most part limiting, at times misleading and unhelpful.
Great store has been put by the DSM (The Diagnostic and Statistical Manual of Mental Disorders) as the ultimate reference guide for diagnosing mental health conditions. Currently the 5th edition is the latest ‘bible’ used by most psychiatrists, psychologists and mental health professionals. However, our experience has long demonstrated that the labels that people walk through the door with often get in the way of effective treatment. This is because clients/patients often ‘live down’ to the diagnosis. In other words they begin to embody every aspect of it. They believe the person who’s told them is an expert and therefore must ‘know’ and are not aware that there’s a great deal of clinical judgement that goes into the diagnostic process. This is why the same patient can see 10 psychiatrists and end up with 3 or 4 diagnoses.
This is why we believe, even if someone has a label, it’s not the most important thing they bring into the room. We are interested in the whole person because we know there are numerous factors that have brought them to this point and if we pick up and run with the label we are likely to miss all the other variables that could give us an insight as to the best way forward in terms of their recovery.
We have found that using The Story of Health as a template for working with individuals is a far more effective way to help a client wherever they find themselves on the mental health continuum.
Below is the latest research which goes a long way to supporting the position we’ve been advocating since the 1980s.
Study finds psychiatric diagnosis to be ‘scientifically meaningless’…
Neuroscience News July 8, 2019
Summary: Researchers conclude many psychiatric diagnoses are scientifically worthless as tools for identifying discrete mental health disorders.
Source: University of Liverpool
A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.
The study, led by researchers from the University of Liverpool, involved a detailed analysis of five key chapters of the latest edition of the widely used Diagnostic and Statistical Manual (DSM), on ‘schizophrenia’, ‘bipolar disorder’, ‘depressive disorders’, ‘anxiety disorders’ and ‘trauma-related disorders’.
Diagnostic manuals such as the DSM were created to provide a common diagnostic language for mental health professionals and attempt to provide a definitive list of mental health problems, including their symptoms.
The main findings of the research were:
- Psychiatric diagnoses all use different decision-making rules
- There is a huge amount of overlap in symptoms between diagnoses
- Almost all diagnoses mask the role of trauma and adverse events
- Diagnoses tell us little about the individual patient and what treatment they need
The authors conclude that diagnostic labeling represents ‘a disingenuous categorical system’.
Lead researcher Dr. Kate Allsopp, University of Liverpool, said: “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.” The authors conclude that diagnostic labelling represents ‘a disingenuous categorical system’.
Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”
Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”
About this neuroscience research article
University of Liverpool
Simon Wood – University of Liverpool
The image is in the public domain.
Original Research: Closed access
“Heterogeneity in psychiatric diagnostic classification”. Kate Allsopp, John Read, Rhiannon Corcoran, Peter Kinderman.
Psychiatry Research. doi:10.1016/j.psychres.2019.07.005
Heterogeneity in psychiatric diagnostic classification
The theory and practice of psychiatric diagnosis are central yet contentious. This paper examines the heterogeneous nature of categories within the DSM-5, how this heterogeneity is expressed across diagnostic criteria, and its consequences for clinicians, clients, and the diagnostic model. Selected chapters of the DSM-5 were thematically analysed: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; and trauma- and stressor-related disorders. Themes identified heterogeneity in specific diagnostic criteria, including symptom comparators, duration of difficulties, indicators of severity, and perspective used to assess difficulties.
Wider variations across diagnostic categories examined symptom overlap across categories, and the role of trauma. Pragmatic criteria and difficulties that recur across multiple diagnostic categories offer flexibility for the clinician, but undermine the model of discrete categories of disorder. This nevertheless has implications for the way cause is conceptualised, such as implying that trauma affects only a limited number of diagnoses despite increasing evidence to the contrary. Individual experiences and specific causal pathways within diagnostic categories may also be obscured. A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.