Does a psychiatric diagnosis mean anything?

I have a new psychiatrist and a new tentative diagnosis. Or rather, a new additional diagnosis. So at the moment I have been diagnosed at some time by somebody with: severe depression, bipolar disorder, obsessive-compulsiveness disorder, obsessive thinking, anxiety disorder, social anxiety disorder, panic disorder, dissociative disorder, autistic spectrum disorder, narcissistic personality disorder, borderline personality disorder, and now adult attention deficit disorder. I have might forgotten one or two. Although I am certain I have depression and a batch of severe anxiety disorders, parts of all these diagnoses seem right, but none of them alone fits perfectly. I don’t think I’m special in feeling confused, even frustrated, about the problems in getting a clear diagnosis.

When you have a problem with your gallbladder or spleen, the diagnosis and treatment are comparatively obvious. Your just look at the spleen and you can usually see what’s wrong with it, and if that doesn’t work (I’m no spleen specialist) you run a few simple tests, like a blood test, and look at those results. But looking at the brain won’t help for mental illness. You can see a brain tumour easily enough, but you can’t see depression or anxiety. (I admit that this claim isn’t quite true, as there are some correlations between some structural changes to the brain and some mental illnesses some of the time, but the correlations are complex and not perfect predictors – yet – so I think my statement is essentially true.)

And then there is the pathologising of the extremes of normal behaviour. It is perfectly normal to grieve when a loved one dies, or to be upset when something important goes wrong. When does grief edge over into depression? It isn’t easy to say. When is a child abnormally hyperactive and not just rather boisterous? When is a person manic and bipolar rather than just lively and extraverted?

So at the moment mental illness is different from physical illness. Things might change in the future, with more sophisticated imaging and the means of visualising neural circuits and neurotransmitter system in real-time action. But even then we are left with the fact that the brain is a hugely complicated organ and the relation between what it does and its structure is also extremely complicated, and mental illness results from the interaction of developmental, situational, and genetic structures to the whole brain. Although we obviously have many working hypotheses, we don’t have any good complete models of mental illnesses and how exactly they arise, and how changes to the brain and its neurochemistry changes behaviour. I think this difficulty in seeing what is wrong contributes to the stigma of mental illness: with a physical illness, you can see, and therefore point to, your problem – look at my swollen spleen! – but people with mental illness look the same on the outside and on the inside.

Simple diagnoses make life easier for clinicians. You have a label, and then you also have a range of possible treatments: the label will determine that treatment. If you are diagnosed with depression and are given anti-depressants, and you respond to anti-depressants, then you must have had depression. Everything else, like poor concentration, tiredness, anger, lack of empathy, and inability to sit still, or whatever, must have been caused by the depression. But why should disorders of a very complex organ that we barely understand map nicely on to simple linguistic categories devised by clinicians in order to enable them to classify and treat people? I doubt if they do.

I don’t see that for mental illness we are in any better situation than physicians at the time of the Black Death who thought that the plague was caused by a miasma rising from the ground. But at least they could see the buboes. Just look at the mess the idea that depression is caused by a lack of serotonin is in.

In practice there is no point going in to see your doctor, psychologist, or psychiatrist, saying that their diagnosis is rubbish and unscientific. They have busy, difficult lives and can’t know everything. Do though make sure that every symptom that troubles you is taken seriously, and that you receive appropriate treatment for these symptoms. And if after a while things don’t get better you need more or a different sort of help. If your mood improves a lot but your concentration doesn’t, then you shouldn’t feel bad about trying to find out why. Good luck.

Author: trevorharley

I am Professor of Cognitive Psychology at the University of Dundee, Scotland. I am the author of several books, including the best selling texts "The psychology of language" (now in its fourth edition) and "Talking the talk: Language, psychology and science". I am currently also writing books on the science of consciousness and on the philosophy of science as applied to psychology (the latter with Richard Wilton), with both due to be published in 2017. Several other books are in the pipeline. My research interests are varied and I have published widely in some of the leading peer-reviewed psychology journals. My interests include language production, how we represent meaning, computer models of the mind, sleep and dreams, consciousness, mental illness, personality and motivation, the effects of brain damage on behaviour, and how the weather influences behaviour. I believe passionately that scientists, particularly those paid from the public purse, have a duty to explain what they do to that public. I also believe that we can reach a wide audience by the use of social media and new ways of explaining what we do. In my spare time I use stand-up comedy to talk about my research; a few years ago I appeared at the Edinburgh Fringe. One of the strangest things about being a comic is that I am often severely depressed (as well as anxious and obsessive). I have been on many types of medication, with varying degrees of success. When depressed I am always struck by how pointless everything seems: nothing seems worthwhile, and those things that I usually enjoy (playing the piano - even if not very well, looking at the natural world, reading, watching movies) no longer entice. My interest in things is a very accurate barometer of how well I am. I have realised that some mental illnesses, particularly severe mood disorders, are in part a loss of purpose and meaning in life. Becoming well involves recovering this purpose. I am also very keen to help remove the stigma that still surrounds mental illness. All of my life I have been puzzled by the question of what is the best way to spend my time. This blog is my search for answer to that question. In it I talk about my life, psychology, mental illness, purpose, living a better life, time management, existential despair, death (making me a death blogger I suppose), being creative, writing, and trying to write when depressed. I try and blog once a week or so; long silences usually mean I'm too depressed to write. For more information about me, see the home page of my website at www.trevorharley.com. I welcome comments on my blog, or if you prefer you can email me at trevor.harley@mac.com. You can follow me on Twitter at @trevharley.

3 thoughts on “Does a psychiatric diagnosis mean anything?”

  1. You mention that you have a received a new tentative diagnosis, but did not share your new ‘label’ …………. also, I am wondering if you own this or any of your previous labels, or if it is more for the benefit of medics and clinicians.
    Fab photo 🙂

    Liked by 1 person

    1. Thank you. It’s San Francisco.

      Currently I think I count officially as unipolar depression with anxiety.

      As for my own diagnosis … we have a problem when it comes to labelling mental illness because the categories of the APA DSM (The Diagnostic and Statistical Manual of Mental Disorders, currently DSM–5, of the American Psychiatric Association) provide a linear, at best two-dimensional (e.g. unipolar v. bipolar depression with or without anxiety) space with which we can label disorders. Furthermore we are currently further constrained to use words to provide that label. The diagnosis is currently at the behavioural level, but the underlying disorder is what has gone wrong in the brain, and is at the biological level. The brain is complex and the mapping between brain and behaviour a many-to-many mapping: so different problems at the brain level can give rise to a behaviour we give just one label. So “anxiety” could arise because of different “brain problems”, for want of a better phrase. And similarly an impairment to one brain structure could give rise to several behavioural problems.

      The “brain problem” is currently a snapshot of genes + effects of early environment + current situation, all of which interact and might make different contributions to our current situation. It’s all very different from a cold, say, where we know that a simple virus causes much the same symptoms in anyone that’s infected.

      Which is all a roundabout way of saying that I can give verbal labels to my symptoms (which are indeed aspects of severe depression, bipolar disorder, obsessive-compulsiveness disorder, obsessive thinking, anxiety disorder, social anxiety disorder, panic disorder, dissociative disorder, autistic spectrum disorder, narcissistic personality disorder, borderline personality disorder, and adult attention deficit disorder, as given above). But these are just behavioural labels. The definition of a medical diagnosis is “the process of determining which disease or condition explains a person’s symptoms and signs” (from Wikipedia, which is as good a definition as any). But we don’t know which disease explains all these symptoms – we don’t know at the moment for sure which disease explains something fairly simple, such as a compulsive disorder. We don’t know what the diseases underlying mental illness are.

      We do know something about the cause of the disease (genes + effects of early environment + current situation, plus perhaps in some cases traumatic or viral damage) but our current knowledge of how those factors lead to behavioural changes via the medium of changes to brain structure and neurotransmitter levels and whatever is patchy at best.

      The disease model of mental illness is currently very vague. Note that I’m not claiming that it’s wrong – in the future we might well be able to provide that detailed mapping, but that until recently we’ve lacked the tools to be able to explore that mapping.

      Like

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