Let’s talk about diagnosis’. On 20th January I was sat in my car, shivering after scraping my window with an old CD case (sorry Ministry of Sound 2014) and listening to Radio 1. Sound clips of grateful members of the public thanking Love Island star, Chris Hughes, for his appearance on hit TV show ‘This Morning’ came from my speakers. Chris had went on national TV to demonstrate what its like to have a testicular cancer screening with Dr. Chris (a medic who regularly appears on the show). This prompted people to attend their GP with any concerns and allowed many people to get the diagnosis they dreaded to hear, but catch it quickly to overcome this disease (bravo Mr. Hughes! Click here to watch!). The results from this segment of the programme were phenomenal, which got me thinking about how we diagnose other conditions, diseases and illnesses. If you’re reading this you either know me or are interested in the same things I am- and so won’t be surprised to know I’m going to focus this post around mental health. When we raise awareness for mental health we usually use words like “help” and “support” rather than encouraging people to simply attend their GP practice in hope to be explicitly diagnosed. Unfortunately, we aren’t able to attend the doctors surgery, do a quick test or examination and leave with a prognosis- but would it be easier if we could?
As a lot of you may know, it isn’t quick and easy to get a diagnosis for a mental illness. It doesn’t stem from just one interview and it is usually formed by the opinion of several professionals you’ve had contact with rather than one doctor. You may be asked about past and present experiences, your usual behaviours, duration of particular emotions and the impact they have on your life. Professionals will be taking notes on your body language, the way you speak and the terminology you are using. They might ask you to complete assessment tools and they may even trial treatment they believe will be beneficial before giving a formal diagnosis. This sounds terrifying- right? Unfortunately mental health and psychology isn’t yet an exact science and so all of this is in your best interests to try and help you as quickly as possible. If they waited for “proof” they could be waiting forever. This is why some mental health professionals have conflicting opinions. In an attempt to ensure every professional was working from the same evidence and research- the official guidance books called the DSM (Diagnostic and Statistical Manual) and the ICD (International Classification of Diseases) were created.
Currently UK professionals have the DSM-5 (created by the American Psychiatric Association) and ICD-11 (developed by the World Health Organization) to refer to in regards to mental health diagnosis’. Historically both manuals have been very different from each other, but now share the majority of the same content. They both provide evidence-based criteria for diagnosis’ and it is very much at individual discretion which literature professionals refer to in practice. Personally, I prefer the DSM-5 as it is in a lot more depth and discusses the progression of disorders.
The topic of whether we should or shouldn’t diagnose mental illness has proven to be rather controversial. I recently read an article where a professor referred to psychiatry as a pseudo-science. As offensive and frustrating as that is, this isn’t too far from what some of my university colleagues implied through passing narrow-minded comments like “Mental Health Nurses aren’t real nurses” whilst discussing Cardiology as I made my way to a CBT lecture several years ago. As a Mental Health professional we have limited evidence in the brain department, but referring to such a fascinating form of science, which has the ability to change peoples lives, as “pseudo” suggests to me that some people think it as less important. It’s easy to see why I don’t agree with this statement, however it may surprise some of you to know that I don’t agree with formal diagnosis’ either.
Of course, there are lots of reasons why mental health diagnosis’ can be helpful. Firstly, they provide professionals with guidance on how to diagnose and ensure an evidence-based approach is provided. One issue with this is that despite referring to the manual, doctors don’t always ask the same questions. Some professionals have ideas and opinions lodged in their mind and so already their judgement is biased- they’re only human after all. For example, one doctor may diagnose a depressive episode and provide anti-depressant medication where others may delve deeper in to the grief someone continues to experience after a loved ones death 5 years ago and refer to bereavement counselling. Similarly, although I completely agree that diagnosis’ provide a good reference point for a evidence-based clinical decisions, every person is different and we cannot expect the same treatment to have the same outcome. I believe that professionals should focus on the current problem and how to prevent it from happening again rather than being reassured that what they’re seeing are expected characteristics for those with that diagnosis. Now that we have a good understanding of what works and what doesn’t, I believe care plans should be tailored to treating the individual symptoms that someone is presenting with currently rather than what instantly comes to our minds when we are told the diagnosis someone has been given. If you were told that someone has Schizophrenia and presented to services for support, you’d probably assume this was in regards to hallucinations. It’s innocent to think this as it’s what, unfortunately, we most commonly associate with that diagnosis- but that is only one part of someones identity. Their care shouldn’t only surround this diagnosis because at times it will not be relevant. This is also a reason why physical health conditions are often overlooked for those who have a chronic mental illness- but that’s another story.
Another reason for my lack of enthusiasm for working only from diagnosis’ is that people can be misdiagnosed- and despite the benefits the diagnosis could have achieved, that person has probably already felt the wrath of our ignorant, stigmatising society. It’s hard to get rid of the ‘label’ that’s thrust upon us when we are diagnosed. Quite often people say that they can understand the way they feel when they have the opportunity to research the diagnosis they’ve been given- but wouldn’t it make them even more confused if further down the line they were told, “Oh, by the way, It wasn’t a depressive episode you were experiencing. We’re going to change that diagnosis to something we call Bipolar Disorder.”.
What I’ve also come to realise is that every time these manuals are revised more and more diagnosis’ are added to the already endless list. Although the media has raised awareness of some mental health problems, it has almost sensationalised it. It now appears that some people want a diagnosis to explain what are simply normal human emotions. It seems nowadays some people can’t believe they are simply shy but expect to be diagnosed with some kind of ‘social phobia’. Mothers no longer say “I wish I had that much energy” but instead jump to an ADHD conclusion. I could go on…
I took another look at the DSM-5 earlier and could identify several diagnosis’ I got, or could have got, from the GP if I attended at certain parts of my life. Just one example I can share with you is this- I definitely fit the criteria for diagnosis 303.00 on the 29th September 2018. My birthday and the day my friends and I met the criteria for Alcohol Intoxication. Let’s have a look…
A) Recent ingestion of alcohol.
B) Clinically significant maladaptive behavioural or psychological changes (e.g. inappropriate sexual or aggressive behaviour, mood lability, impaired judgement, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion.
C) One (or more) of the following signs, developing during, or shortly after, alcohol use:
(1) Slurred speech
(3) Unsteady gait
(5) Impairment in attention or memory
(6) Stupor or coma
D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.(DSM-5)
Imagine the statistics if everyone stumbling out of Walkabout on a Saturday night were assessed? This is a silly example but it proves the bias that comes with these subjective manuals.
Ultimately, the best care in my opinion stems from listening to people and developing personalised treatment pathways to suit individuals. Categorising symptoms in diagnosis’ form is a helpful way to pin point a potentially effective place to start, however we shouldn’t be frightened to try new things and follow the symptoms rather than the diagnosis. I also believe that professionals should have a more robust account of what has and hasn’t worked for people in the past. After all, we are all different and what works for me might not work for you. Here’s what other people think about their diagnosis…
“It helped me to understand what was going on. I’m not ‘crazy’, I have Emotionally Unstable Personality Disorder.”
“It made me feel less alone. Other people have been depressed and came out of the other side. I joined a support group online to talk to people who had gone through the same thing.”
“It made me feel like a doctor had confirmed what was ‘wrong’ with me.”
“It is getting better, but there is lots of stigma around having a mental illness and sometimes I’m embarrassed to tell people because I’m scared how they will react.”
“They can be offensive sometimes. Even when I’m not “paranoid” I still have the label of being a ‘Paranoid Schizophrenic’.”(Anonymous)
So there we have it, there is no right answer to the question- should we diagnose mental health? Just like there is no right answer in the treatment or care for those struggling with their mental health. Mental illness can be unpredictable and it doesn’t discriminate. It could sneak up on any of us. The unknown can make it extremely difficult for not only professionals trying to help and the patient experiencing it, but for their families and friends too. The brain is a fascinating organ and there is still so much to learn. And to finish off, let me just add, that Mental Health Nurses most definitely are “real” nurses.
So, what’s your opinion? Should we diagnose in the field of Mental Health?
Until next time,
Love, Kayleigh Rose x