Beware the dangers in psychiatric diagnosis

Beware the dangers in psychiatric diagnosis



Making a psychiatric diagnosis can be a tricky business. In some ways, it’s like making a medical diagnosis. Both medical doctors and psychiatrists are looking for relative change - that is, changes within an individual over time - and both match the symptoms they find with the category label that includes the largest number of key symptoms.


When making a medical diagnosis, however, doctors have objective measures at their disposal. For example, laboratory tests can detect the presence and concentration levels of a virus or a bacterium, and a CAT scan can reveal a broken bone or the presence of a tumour.

Psychiatrists, on the other hand, can only observe behaviour and then either guess at intention, or ask the patient to explain what they’re thinking and how they’re feeling. When a patient cannot or will not offer any explanation, the psychiatric must rely entirely on guesswork. Relatives, friends or carers can sometimes offer helpful information, but there’s still an enormous amount of speculation involved.


To make matters even more complicated, the accepted norms of the particular culture must be taken into account when making a psychiatric diagnosis. For example, in some cultures, if a person claims to be hearing voices they may be regarded as someone with spiritual capabilities, whereas in our culture, if someone claims to be hearing voices we would suspect that they have a serious mental disorder. This is not the case in medicine, where the presence of a bacterium or a tumour has the same implications, regardless.


Yet another danger in psychiatric diagnosis is that many conditions are believed to be permanent, so once an individual receives a diagnosis, it can be difficult for them ever to be regarded as 'well’ again. For example, most people believe that a person who has had a schizophrenic episode (perhaps they claimed to hear voices or they reported delusions) will inevitably have further relapses. The truth is that about 25 per cent of people who have a schizophrenic episode recover and never have another one.


But perhaps the gravest danger with a psychiatric diagnosis is that, once it is given - whether or not it’s accurate - it can become a self-fulfilling prophecy. In other words, once someone is given a particular diagnosis, family, friends and colleagues are then likely to notice only the behaviours that 'fit’ that profile, and ignore everything else. This can make it extremely difficult for an individual to recover and return to a normal social life.


It’s always important to seek professional help if you experience distressing psychological symptoms. But symptoms can be treated effectively without first attempting to categorise them – which is hard to do on first meeting anyway – so think carefully before you insist on an initial diagnosis. Make sure you’re aware of the pitfalls. Mistakes can be made, and once you’ve recovered, it may be difficult to divest yourself of the expectations that others may have about the condition.



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The Telegraph, Monday 3 August 2015



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