When we feel ill, the first thing that many of us want to know is “what do I have?”
In the ideal medical experience, the observable biological effects of an ailment (aka symptoms) will provide sufficient evidence for an initial diagnosis and the beginning of treatment.
But sometimes this path to recovery is not an option, such as when the symptoms don’t consistently match with an observable biological source. This is quite often the case when the symptoms are predominately psychological in nature. My experiences illustrate some of the difficulties with mental health diagnoses.
In the early 2000s, I was diagnosed with major depressive disorder. Looking back I can say that it was a misdiagnosis as I was presenting a range of mood disturbances, but I was very guarded when receiving counseling. This is a common barrier to treatment that faces any professional who is trying to make a diagnosis based on psychological symptoms. The diagnosis was accurate based on the information I provided.
It was almost 10 years before I was re-diagnosed with bipolar type II disorder. The accompanying change in treatment led to a large improvement in my symptoms, and virtually eliminated the dreaded mixed episode from my phases.
I visited several professionals between diagnoses, as I did not receive relief from my then current treatment (it was likely harmful in retrospect). I received no referrals to a psychiatrist, and my treatment was altered only once in that time span.
Whenever I discuss these experiences I’m often asked if I hold any anger towards the professionals I encountered. At a time I did hold a mild resentment, but as I came to understand the systems through which diagnoses are made, I realized that many of those professionals were acting according to the guidelines and information that were available to them.
Sure, there are those in the field that plain out make mistakes, but I believe incompetence to be a rare problem in comparison to the systems that guide diagnosis.
There are barriers I previously mentioned such as hesitance of the patient to divulge true and/or complete information, and the lack of an observable and directly treatable biological source. There are also other barriers to a correct diagnosis, not the least of which is the enigmatic diagnostic manuals known as DSMs.
The DSM manuals are the source for most diagnostic guidelines in psychological practice and research in North America. They are updated and revised occasionally, and the professionals behind its publication do their best to make it helpful and accurate.
Unfortunately, one session of navigation through any DSM version could be enough to dizzy most, if not all professionals. The chaotic, daunting nature of the manual is an appropriate metaphor for the nature of mental illness. It also lends comparison to the inexplicably competing variety of treatment approaches to psychological problems (all the “isms”) and the difficulties professionals face when trying to make a diagnosis.
All that I ask is that you consider these and other complications that arise when trying to make a psychological diagnosis. Mental disorders appear to be a different beast than most other medical conditions, and we can’t expect them to be diagnosed and treated as such. But that’s a blog for another day…
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Last reviewed: 25 Aug 2011