Since the beginnings of psychology as a science in charge of the study of human mind and behavior, numerous investigations have been carried out to determine the origins, consequences and perpetuating factors of the vast majority of psychological disorders.
But… Does this initiative to name psychological phenomena have any drawbacks?
Researching Mental Disorders
The American Psychiatric Association (APA) and the World Health Organization (WHO) are two of the organizations that have invested the most time and effort in trying to understand in greater depth and provide clarification about how mental disorders work , what the symptoms associated with each of them are, how to detect them (how many symptoms must be present in order to establish an accurate diagnosis and for how long), etc. This information is set out in their corresponding diagnostic manuals: the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Classification of Diseases (ICD-10).
Since the 1990s, the APA and other institutions such as the National Institute for Health and Care Excellence (NICE) have also been in charge of checking which treatments are the most effective for each type of disorder, trying to establish empirical validations of different ways of carrying out a therapeutic process.
Specifically, division 12 of the APA, created in 1993 a working group on the promotion and dissemination of psychological treatments based on the conclusions of its research, leading to the development of treatment guidelines with a theoretical-practical basis adapted to the characteristics of each disorder.
On the other hand, the action of NICE includes the provision of information, education and guidance, the promotion of prevention and the proposal of ways of proceeding in primary care and specialized services.
Different perspectives from which to investigate
The main difference that we can find between one organism and another is how APA focuses on research into “classic” or “pure” disorders, while NICE addresses problems that do not necessarily comply with a clinical diagnosis, but rather implements strategies to improve mental health in general (pregnancies, adherence to treatment, suspected child abuse, well-being in old age, etc.).
In the case of APA, “purism” is a factor that often limits clinical performance because it is rare for a disorder to appear in its purest and most easily recognizable form, but often meets criteria for other disorders (comorbidity) or has variations of greater complexity.
Therefore, in psychology today we have a wide margin of research not only on the different typologies of disorders that we can find, but on what are the most appropriate ways to approach them (to date).
Is the psychological diagnosis useful?
Usually, the procedure when some kind of psychological treatment is to be performed is to start with an evaluation phase . In this phase, the interview known as the clinic provides us with a great deal of information about the situation of the patient in question.
Depending on the therapy stream from which each psychologist works, the interviews may have a more open or more structured format, but they will always have the objective of knowing in the greatest depth the functioning and environment of the person in front of them .
The assessment phase may allow us to establish a diagnosis if a disorder exists, since some of the difficulties that occur in consultation (known as Z codes) are not included in diagnostic manuals because they are considered critical situations/changes in the life cycle rather than mental disorders (cases of separation, marital dissatisfaction, difficulties in managing children’s behavior, grief, etc.).
In the event that a disorder exists, in the evaluation phase (in which, in addition to interviews, standardized questionnaires can be used) we will have been able to clarify the symptoms, the course and evolution of the patient’s condition , as well as give a name to the experience he is living.
This diagnosis, based on what has already been mentioned, allows us in a very useful way to know with what difficulty we are relating to and to establish the most adequate treatment mode for each person, so that we address the problem in the most effective and efficient way possible.
Should we always offer a diagnosis?
As health professionals we must take into account that each person is completely different from any other , and that what we would transmit to one patient may be harmful to another.
The diagnosis helps professionals to understand and clarify the situation before us, as well as to lay out and plan our way of acting to solve it.
However, we must be very careful when establishing diagnoses, as there are several dangers:
The label can indirectly become a definition of the person
In other words, we no longer talk about “X has schizophrenia”, but we can incur “X is schizophrenic”.
Diagnosis can lead to victimization of the patient
Whether prudent or not, establishing a diagnosis can lead to the person being absorbed by their label : “I can’t do X because I’m agoraphobic”.
A poorly detailed diagnosis can lead to a state of confusion in the patient
If not enough information is provided and the patient does not understand what is really happening to him/her, it is very likely that he/she will “fill in” the information gaps with data that he/she can extract from less reliable sources than a health professional, generating negative and unrealistic expectations about his/her mental state .
Diagnostic labeling can generate feelings of guilt
“I’ve done something to deserve this.”
Bearing this in mind, it goes without saying that it is extremely complicated for psychologists not to establish a mental diagnosis of the situation we are presented with, since diagnostic labels make it easier for us to understand the information in our mental schemes .
But, despite this, if the patient doesn’t directly request a diagnosis for some reason, he or she probably doesn’t need to know the name of the experience he or she is going through, and simply seeks to resolve it.
On the other hand, if we find a great insistence on “labeling” what is happening, it is important to first clarify whether the request has a solid basis in the person or may be influenced and pushed by other means with which it is related (social links, internet data, etc.).