Skip to 0 minutes and 5 seconds We’re here to talk about the functions of psychiatric diagnosis so if each of you could tell me what you think are the functions of diagnosis, and what are some of the benefits, and also what are some of the downsides of diagnosis? So, could we do it better? and, could we even do without it? So Claire would you like to start us off? In brief, a diagnosis give you a way of communicating something to somebody else fairly easily and succinctly. It describes what somebody’s problems are, what’s going to help them and what the prognosis would be or the outcome would be.
Skip to 0 minutes and 48 seconds So if I wanted to tell a colleague about somebody I had seen, a client, and try and explain what their problems were I could do it in hopefully one word. Now obviously the downside of that is to use one word to describe some of these problems
Skip to 1 minute and 7 seconds is clearly going to be very different from describing another person’s problems and they may have the same one-word label attached to them, but really have a whole host of different problems so I think the downside is that it can be too narrow. so it really depends on what you’re using it for. And I think also sometimes people want a diagnosis and it can be very comforting and reassuring and sometimes they really don’t want it, and that partly depends on the person and it possibly partly depends on what diagnostic label you’re giving him as well.
Skip to 1 minute and 45 seconds So I think it we’ve got to be really sensitive to the individual situations to decide whether or not you’re going to use that with an individual. But generally the background, you’re going to have to use it for all sorts of administrative purposes anyway Okay, thankyou. So Peter… So I didn’t really disagree with any of that. I guess that some of my concerns were about as Claire says losing some of the context in the use of diagnostic labels to describe people’s problems.
Skip to 2 minutes and 19 seconds I think also, the idea of the language coming not from a social or even a psychological perspective but from the medical perspective of, I suppose implying that person has an illness or has a disorder or that there’s something wrong with them. I think that has some worrying elements to it. I think also that when we label people as having an illness which is essentially what diagnoses, even psychiatric diagnoses do, I think theres a tendency both to think that there’s something wrong with them and also fear towards medical interventions. So I think for me, all of that description of what psychiatric diagnoses, the benefits that they bring, I agree with.
Skip to 3 minutes and 5 seconds I just think that we could possibly use language that describes people’s problems in slightly more neutral terms, rather than language which gives the implication that they’ve got a problem, they’ve got an illness, and that there might be a medical solution to those problems. It’s about emphasis rather than complete disagreement. Okay. Keith, how about you? As I was going through this long process of psychiatrists and psycologists There was a certain time when I wanted a label, I wanted to know what was happening to me that was if I’m honest I was tired, I just wanted… and I’ve got an inquiring mind. Why shouldn’t I know what’s happening to me? What is this all about? So it would have helped.
Skip to 3 minutes and 51 seconds I know it doesn’t work for everybody, some people don’t want diagnoses but it could have helped at a certain time. But now I don’t have a diagnosis But of course it was a long process of sorting me out, sorting my mind out. So fine. But I do understand it helps people. Particularly, I was thinking about how it helps if it comes to benefits Because that’s a great worry that you’re gonna lose your benefits. Particularly if your GP doesn’t understand. So there might be certain things that you miss out on by not having a diagnosis such as benefits and some people might suffer because… Probably a better relationship with my GP, I’m not sure, if it would have been the case.
Skip to 4 minutes and 39 seconds If you had had a diagnosis? Yes. But… I’m not sure. And were there things that were beneficial to you even though you didn’t have a diagnosis? Just meeting people that understood what was happeneing to me because I felt that at one stage I was very much on my own. I thought my GP would be the person that would, that I could trust. But it wasn’t the case, And my uncle was the first person that understood. He supported me through all this, and yeah it’s finding those people that really do understand. When I was attending a day center the volunteer, she came along and she’d studied psychology and she pointed me in the right directions.
Skip to 5 minutes and 30 seconds I may not be sat here now if it hadnt been for her coming along. Lets just think of some of the benefits that you could get through diagnosis like understanding and explaining things and being able communicate to others. You’d managed to get through some other ways without having a diagnosis, without using that? Yes, one of the things that I notice, I think, about mental health care is I think that the issue of diagnosis dominates and yet there are so many sort of workarounds that people have like the clustering system where unlike formulation where the diagnoses don’t actually do the job.
Skip to 6 minutes and 10 seconds So there’s a frustration in my mind in that that the idea of diagnosis being a key part of the medical and therefore the psychiatric approach and yet it doesn’t do the job it doesn’t actually tell you why people’s problems have developed. It doesn’t really tell you a great deal about what would help. And when we use things like clustering, it doesn’t really help health services. And so theres a frustration in my mind that diagnoses is this really important thing, and yet it doesn’t do the job that its supposed to do.
Skip to 6 minutes and 38 seconds It’s too narrow and even though if you look at diagnostic classifications, they’re huge, you know the the ICD 10 and the DSM are really big books, and though that they’ve got lots of headings, subheadings, and subbheadings underneath that. So you’ve got huge range to pick from and yet still, yeah, it doesn’t communicate enough information to use usefully. I do understand about the therapeutic relationship that for me was about trust and could I tell you what I’ve never told anybody before when I talked about my perfectionism, when I talked about my OCD, and I talked about the paranoia that was affecting my life. Once I talked about it I mean then we started to deal with it.
Skip to 7 minutes and 25 seconds I think that the reference to the therapeutic relationship is really important so in some of the reading that I’ve done of psychiatrists who were critical of the traditionalist medical approach, They emphasize things like trust and relationship and using the relationship between psychiatrists and the patient, or the psycologists and the client as the as the vehicle to help change.
Skip to 7 minutes and 50 seconds And yet you then read material where people are talking about the importance of the tradition of Psychiatry as a branch of Medicine and the reliance on accurate diagnosis and the dangers of misdiagnosis it’s again for me there’s a tension between things like trust and the therapeutic relationship being vitally important from one perspective and then getting the diagnosis accurate and the perils of misdiagnosis coming from the other perspective So I find a conflict. I avoided my psychiatrist because I said to my GP “why should I?” because my uncle advised me to pay becuase I needed help straight away.
Skip to 8 minutes and 28 seconds Why should I pay a man I can’t relate to and the reason for that was that the last time I’d seen him, the way he spoke to me, I’ve termed it as tough love. Well I could only remember about having an inferiority complex but I couldn’t remember the other things. I don’t need, that I don’t want to be spoken to like that so I avoided him and went into the private sector No doubt, if I’d been seeing him then I would have been paying him, but i paid somebody else. But I’m sure he’s a good man, its just I didnt like his style. It didn’t click for you? It didn’t. No, no, that’s a barrier to me.
Skip to 9 minutes and 5 seconds I was interested to hear you say that you you were desperate for a diagnosis or a label right at the beginning, but at the end you didn’t seem like you wanted to because picking up on the other thing that you said around a relationship, I think if you’re working with somebody, the key to having a successful therapeutic relationship with somebody is being able to relate to each other and understand each other and develop a trust and so if I was going to use a diagnostic label with somebody, I would want to find out first whether or not I thought they would find it useful or whether they would be alienated by it.
Skip to 9 minutes and 46 seconds And yet you said at the beginning that you were desperate for one. So if I found out that and you know, I was your doctor I would probably given you what I thought was a diagnosis at that time. And yet you’ve gone on with time, to manage without it and you seem to have really valued coping without it. I consider myself to be lucky but I’ve just met the right people at the right time. I think that’s it there’s an idea of letting people know that you understand the experiences that they’re having,
Skip to 10 minutes and 22 seconds the problems they’re having which I guess can be done without saying: “Oh by the way, there’s an illness label attached to this”. So when people are really struggling, and they’re having lots of intrusive thoughts and they’re compelled to do some behaviors to keep the anxiety in check and they’re feeling very paranoid I think when you for me if you reflect that back to people you can demonstrate your understanding, without saying “and here’s the diagnostic label that I’d attach to it.” So I guess I’m arguing for a middle ground, but labeling things appropiately, conveying your understanding without attaching an illness or disorder label to it.
Skip to 10 minutes and 59 seconds Possibly, I think you can develop a relationship by showing that I’ve listened to what you said, I’ve understood it, and I can reflect that back so you have been confident that I’ve understood it and that might do in place of a diagnostic label. But I think some people also feel a sense of relief if they’re given a diagnostic label, about legitimizing their problems.
Skip to 11 minutes and 24 seconds And I guess you do have to go back to your family and they say: “What did the doctor tell you?” Well we had a long conversation. It’s interesting isn’t it because obviously at the beginning you’re really keen and clinicians are kind of saying to you at that time why would you want one we’re not going to give you one. But then once you, if you had been given one at that time, because someone felt like that would be useful for you, that was what you’re asking for, then they’re difficult to take away once they’ve been given though.
Skip to 11 minutes and 50 seconds So as it turned out you pleased that you didn’t come out the other side with a diagnosis and you found other ways of understanding your difficulties but what if you have been given one? I think that, I mean, I think it’s just simply true that psychiatric labels are very sticky, if you were given a label of schizophrenia at the age 16 I think it’s going to be very difficult that to be shaken off. A lot of people, not a lot of people, some people, want to actually change their medical records to remove psychiatric labels.
Skip to 12 minutes and 21 seconds So I think that doesn’t necessarily mean that they’re incorrect but I think it is a real concern especially for young people when they receive a psychiatric illness label it can be quite problematic for them. Okay, so thank you very much for sharing your views with us, It’s been really interesting to hear all these different perspectives. Thankyou. Thanks.
The functions of psychiatric diagnosis - a panel discussion
This video is a panel discussion about psychiatric diagnosis between Clare, a psychiatrist, Peter, a clinical psychologist, and Keith, an expert by experience who has survived the mental health system. They discuss the functions of diagnosis, the positives and the problems with it, and whether there are alternative ways of thinking about mental distress.
We’d like you to watch the video (it’s not too long!), and in the next steps, we’ll take you through the issue raised.
© University of Liverpool