What is the benefit of a mental health diagnosis? – DW – 26/10/2022

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Imagine: Your partner breaks up with you. You feel sad and exhausted and find it difficult to continue a normal life. Your friends suggest you find someone to talk to.

You have started looking for a psychotherapist. It takes a few months, but eventually you find someone. You have five sessions to start. Things are going well – you’re getting to know each other and you’re enjoying the ability to talk without feeling like you’re overwhelming the other person with sadness.

After the five sessions are complete, your therapist asks you to go to the doctor to fill out forms. You must file a contract with your health insurance fund to finance your treatment. In addition to your doctor’s forms, your therapist should include their own analysis of your condition: A diagnosis.

Your therapist diagnoses you with “major depressive disorder”. And it’s true, you feel sad. You don’t sleep well, you can’t pay attention at work, and you lose interest in your hobbies.

Yet you are conflicted. Part of you is relieved: you love being able to put a name to what you’re feeling, that it’s something millions of people have already felt, and that now that your problem has been identified, you can start trying to solve it.

But another part of you wonders if your bad mood is simply due to circumstances. Sure, you feel depressed, but who wouldn’t in your situation? The diagnosis runs through your mind for the next few weeks.

The boy sits staring at the phone in the dark
The COVID-19 pandemic has caused feelings of anxiety, loneliness and depression in many people around the world, especially young people. Image: Thomas Trutschel/photo library/picture alliance

Pathologizing normal distress

In Germany, the United States, Finland and many EU countries, to receive treatment that can be reimbursed by public health insurance, people must obtain a diagnosis. As the number of people interested in accessing mental health treatment has skyrocketed since the start of the COVID-19 pandemic, many are asking the question: where does the line lie between regular depression in response to some kind of environmental trigger and a depressive disorder? What role does diagnosis play in our understanding of ourselves?

Many psychiatrists and psychologists criticize insurance companies’ need for diagnosis, arguing that it forces them to pathologize normal distress.

Peter Kinderman, professor of clinical psychology at the University of Liverpool, said the result was a kind of “mistranslation of the human experience”.

“What’s happening is our partners are cheating on us,” Kinderman said. “We get depressed. We go get help, and they say, ‘No, you’re wrong. It’s not the case that what you’re going through is the normal, understandable, age-old experience of depression for perfectly understandable reasons. In fact, you are wrong – this is a major depressive disorder, which I will now treat and bill your insurance company. “”

A person is sitting on a bed, looking out the window
Psychologists say the diagnosis can make people feel like there’s something wrong with them, when all they can feel is everyday or normal distress.Image: Westend61/IMAGO

In many countries, therapy patients can only access care if they accept a diagnosis, Kinderman said. But he stressed that just because they’re diagnosed with a disorder doesn’t mean they’re sick, or that they’ll always be sick, or that there’s something wrong with their brain.

“It has nothing to do with your distress or the practice of psychotherapy or the nature of the world,” he said. “These are business decisions made by people wishing to ration services in a particular way.”

Spanish psychiatrist Eduard Vieta, an expert in neurobiology and the treatment of bipolar disorder, agrees with Kinderman that the diagnosis is not always necessary – in cases of mental distress that are not extreme.

When it comes to non-serious conditions, a diagnostic requirement can cause mental health care providers to “medicalize a normal reaction or a situation that doesn’t need a label,” Vieta said.

However, Vieta considers the diagnosis to be “extremely important” when it comes to more severe mental distress.

Diagnosis can allow people to better assess their care

Vieta said that for conditions like bipolar disorder or schizophrenia, diagnosis can work as a kind of quality control. Once people are diagnosed, they can go online to learn about other people with the same condition, or ask another psychiatrist or doctor for a second opinion to see if they’re okay with it. diagnosis and further treatment suggested by their original provider.

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Vieta added that while some psychiatrists don’t tolerate it, he doesn’t see much wrong with patients researching their diagnosis on the internet.

“People have the right and that’s a good thing, unless it becomes something a bit obsessive,” he said. “But otherwise, it’s a good thing that people are informed and try to find answers to the questions that arise when you have some kind of suffering.”

Diagnosis offers a streamlined way to move people with severe psychological distress toward treatment — either through targeted psychotherapy, medication, or both, Vieta said.

Til Wykes, a clinical psychologist at the University of London, agreed that the diagnosis can offer a useful explanation for a person’s distress.

“It allows some people to think carefully about how to adjust their life and think about themselves and how to live with the diagnosis or avoid the worst times of a diagnosis,” Wykes said, who specializes in treating patients who are experiencing episodes of psychosis. , like hearing voices.

But Wykes said people shouldn’t be required to get a diagnosis before allowing them access to ongoing treatment.

Image depicting a person talking to a psychotherapist
If a mental health diagnosis were “free from stigma, it would be essentially good.”Image: Christin Klose/dpa/picture alliance

Stigma can be barriers to therapy

Vieta noted that while practicing diagnostics can be beneficial in theory, that’s not always how it works in practice. Societal stigma around certain diagnoses – such as schizophrenia or a bipolar state – can cause people to reject or avoid treatment.

“Diagnosis is helpful,” Vieta said. “And if there was no stigma, it would be basically good.”

Wykes said the stigma surrounding certain diagnoses has led some mental health care providers in early intervention clinics to change their practices.

“Some [clinicians] never say the word schizophrenia because they think it will scare the person,” Wykes said.

Wykes added that in the UK, where diagnosis is not required for people to access treatment, therapists can support people who may not meet the threshold for diagnosis of schizophrenia or psychosis, but who clearly need help with a range of other issues.

For them, Wykes said, treatment can prevent or delay the onset of true schizophrenia disorder. Or he “could engage them in services so that when trouble begins they will then more easily accept services and help”.

This type of support is not possible in countries where diagnoses are required for access to care, which can lead people to reject it completely for fear of receiving a diagnosis with which they do not feel comfortable. easy.

“People will try to avoid them as much as possible. And then families will try to avoid them as much as possible,” Wykes said. “If you can’t access healthcare without a diagnosis, you’re really stuck. Because if you don’t want a diagnosis and you just want help, you’re not going to approach the services in case they would give you that label.”

Published by: Zulfikar Abbey

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