“Generalized Anxiety Disorder.” “Major Depressive Disorder.” “Attention Deficit Disorder.” Psychiatrists are trained to assess the “symptoms” of their patients and then assign labels using the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (currently the DSM-5). While the DSM gives clinicians a common language to communicate with, the boxes created by these labels can unfortunately cause more harm to patients than good. I often tell my clients to take a diagnosis with a grain of salt. Here are six reasons why:
1. A diagnosis can pathologize what is normal
In his book, Saving Normal, the former director of the DSM-IV describes how every new edition of the DSM has grown exponentially in what it labels as “mental illness.” It casts a wider and wider net, continually claiming more territory from what used to be (and predominantly still should be) considered variations of normal human behavior and experience. (For example, what a healthy person would experience as grief is now called “bereavement disorder.”) Since there is not, in fact, any biological test to determine what should be considered a mental disorder or illness, the expansion of what falls under that umbrella is driven solely by industry and pharmaceutical opinions. The effect of this change has been to increase the demand for drugs to treat these “diseases,” but beyond that, it has simply made people believe they are sick, when they are not.
2. A diagnosis can be a self-fulfilling prophecy
When I was a nurse on an adolescent psychiatric unit, I had a 10-year-old tell me he had depression because his parents did. When I told him there is no firm evidence that depression is genetic, he looked at me with a relieved smile and said, “Really!? Oh, that’s great! … I feel good now!” The messaging he had received was that depression was a part of him; he expected it to be there and didn’t think it could change. I could visibly see the weight lifted from his young shoulders as he realized he was not fated to be depressed for the rest of his life. As humans, we are deeply influenced by our beliefs about ourselves. If someone believes their emotional struggles are a permanent, genetic condition, they will attribute every negative emotion to their diagnosis and will not expect to be able to conquer it.
3. A diagnosis can hide the real solution
Only looking at a diagnosis and its associated symptoms is much like trying to push over a tree without acknowledging its roots. The psychiatric “symptoms” that make up depression, anxiety, or any emotional distress are the visible manifestations of the issues, but the source of the problem lies much deeper. If you have an infection, it can be dangerous to only treat the fever without addressing the infection itself. Emotional distress is the same way. The emotions almost always come from harmful beliefs that in turn have come from experiences where negative messages about oneself (such as “I’m worthless” or “I’m alone”) have been internalized. This is the domain of psychotherapy, not biology. The real solution is to find and address these false beliefs, but this will only happen if we aren’t distracted by attempting to diagnose an illness and cover up the symptoms with a medicine.
4. A diagnosis disconnects our emotions from our present experiences and choices
Attributing negative emotions or “symptoms” to the disease itself implies that those emotions are controlled by the disease and not by us. This creates a disconnect between our emotions and the present circumstances that are causing them to arise. If we attribute the emotions to the disease that we don’t believe we can change, we will not recognize the power we have to make changes to our circumstances or refine our choices to create a healthier life.
5. A diagnosis can become a scapegoat
Far above any intervention to help people emotionally, none comes close to the power of humans taking responsibility to change. Overcoming our struggles is a key feature of what it means to be human. If we apply a diagnosis that implies a permanent illness, then we trade that innate strength for a feeling of powerlessness (which, ironically, is a key feature of depression.) If we believe we are a victim of our biology, then we will not believe that change is within our control and won’t make the effort to heal. It’s true that it can be difficult to confront painful memories and emotions, but the first step on the journey is to believe that deep, lasting healing is possible. Then we have the strength to start down the path.
6. A diagnosis over-simplifies the complex and beautiful
Lastly, the tendency to over-diagnose can obscure our understanding of how amazing and complex humanity is. People are simply not the same. We have a vast array of personalities, perceptions, desires, experiences, and processing, and it’s a mistake to pathologize many of those variations. Each human being has to be more than a label and checklist of symptoms. The oversimplification of psychiatry ignores the beautiful complexity of humanity.
Psychiatry has been steadily changing to be modeled after general medicine and health practices, but a human mind cannot be approached like mere gray matter. There’s a problem when the industry continues to diagnose normal human variations and experiences, and attempt to medicate trauma rather than heal it. If you or someone you know has been given a hasty mental health diagnosis, please feel free to call me! I would love to talk through your diagnosis with you and help you navigate a path to lasting healing.