What’s Up With Diagnoses?
Once Diagnosed, Not Always Diagnosed
When a mental health professional assigns a diagnosis, it’s important to remember that this does not mean you now “have” this illness forever. Some people find it helpful to think of it as a “snapshot” of one point in time, knowing that months or years later, things may have changed and that diagnosis may no longer be accurate. For instance, generalized anxiety disorder, like all diagnoses, has very specific criteria that a client’s experience must meet in order to be given the diagnosis. But one year later, your life stressors may have changed, you may have begun treatment or psychiatric care that helps, or the distress may have resolved on its own. You might no longer meet the criteria for generalized anxiety at that time.
There are some mental health diagnoses that are more likely to continue over the lifespan than others, such as some bipolar disorders or schizophrenia. Nevertheless, each time you are assessed by a therapist or other mental health professional, those old diagnoses are considered a part of your mental health history, but they may not reflect your present situation. There is also a chance of misdiagnosis. Therefore, there isn’t a need to “collect” diagnoses from each treatment experience you have.
Limitations are Important
There are a lot of valid criticisms of the use of diagnoses, even by the very clinicians who study and use them. There are more than I can summarize here, but I’ll stick to the ones that are most relevant to Canopy’s clientele.
First, diagnoses can have very real limitations in terms of their applicability to BIPOC (black, indigenous, people of color) clients. For instance, when experts and researchers were studying a particular disorder and what treatment helps, were BIPOC folks properly represented in the sample? A problem is defined by the person who is looking at it. So, if the primary lens through which researchers, or an entire field, look at mental health is a white cultural perspective, they are definitely missing important things.
Many critics also point out how diagnoses have been and still are being used to pathologize valid human responses to stress, oppression, violence, and subjugation. This distracts from real, serious societal problems that need to be addressed, such as poverty, educational quality disparities, homelessness, and racism. Therefore, a diagnostic label need not be seen as a label that determines objective truth about someone’s mental health situation.
Many critics also point out how diagnoses have been and still are being used to pathologize valid human responses to stress, oppression, violence, and subjugation. This distracts from real, serious societal problems that need to be addressed, such as poverty, educational quality disparities, homelessness, and racism. Therefore, a diagnostic label need not be seen as a label that determines objective truth about someone’s mental health situation.
Purpose Gives Context
You’re probably thinking, well if diagnoses aren’t permanent, and if they have limitations, why do you even use them? There are a few reasons.
The concept of “evidence basis” is often mentioned in the mental health field, and that just means that there has been research done that shows that a specific type of therapy or technique works to improve a problem. So, in order to research what helps a problem, we need to have some coherent, unifying definitions of the mental health problem. Diagnoses are our version of the problem definition to be used during research. To be clear, there are many problems with how “evidence basis” is determined in our field, but that’s a topic for another day. Nevertheless, the field requires therapists to use evidence-based techniques and treatments to address someone’s mental health concerns.
In addition, insurance companies require a diagnosis for mental health professionals to be able to bill insurance for their work. Again, there are many issues and concerns with requiring the presence of a diagnosable problem before a client’s work with a therapist can be covered (anyone ever heard of prevention?).
In summary, the system as it is requires the use of diagnoses. It’s not perfect, but it’s what we have presently. However, there are some awesome folks out there doing great advocacy work around this issue. We’ll see how changes play out over time, but meanwhile, feel free to view diagnoses cautiously, through the context of their purpose and limitations.