How Scientific Is Psychiatric Diagnosis?

It’s not the first time that critics have set out after psychiatric diagnoses. While  many psychiatrists and insurance companies are happy to use the categories delineated in the Diagnostic and Statistical Manual  of Mental Health Disorders, critics have noted that classifying a mental illness by the prevalence of certain characteristics does not really tell us what we need to know. Fulfilling the criteria for depression is not the same thing as having an infectious disease. An individual in mourning will manifest most of the criteria for clinical depression... and yet, we would not say that his depressed state correlates perfectly with that of the women who was shunned for having bad table manners.

While certain characteristics will allow a physician to test for an infection, test results, showing the presence of a bacterium or virus, are needed to confirm the diagnosis. Ifa patient breaks his wrist, the evidence is clear and manifest. 

In most cases, when it comes to mental health, no measurable physical trait can function as evidence. If there is such a trait-- as in brain damage-- then the condition is physiological, not mental.

Anyway, researchers from the University of Liverpool have conducted a study of the DSM. They have found the manual lacking. They published their study in the journal Psychiatric Research.

We read John Anderer’s conclusions at Studyfinds-- as of now, link not available.

Andere explains that more and more people are being diagnosed with mental illnesses. In passing we note that this would fly in the face of the conventional wisdom, namely that we as a culture stigmatize mental illness… and that , as a consequence, people tend to hide their emotional problems and do not get help. Apparently, this latter belief is nonsense. People today are more than happy to regale the world with their mental illnesses, being as this makes them open and honest and shameless.

Anderer opens:

More people are being diagnosed with mental illnesses than ever before. Multiple factors can be attributed to this rise; many people blame the popularity of social media and increased screen time, but it is also worth considering that in today’s day and age more people may be willing to admit they are having mental health issues in the first place. Whatever the reason, it is generally believed that a psychiatric diagnosis is the first step to recovery.

All of these diagnoses allow psychiatrists to believe that they are providing medical treatment.  And it allows insurance companies and government agencies to pay for them. And yet, some researchers now reject the DSM classification system. 

That’s why a new study conducted at the University of Liverpool has raised eyebrows by concluding that psychiatric diagnoses are “scientifically meaningless,” and worthless as tools to accurately identify and address mental distress at an individual level.

Worthless, but how can that be? The researchers studied selected chapters in the DSM:

Researchers performed a detailed analysis on five of the most important chapters in the Diagnostic and Statistical Manual of Mental Heath Disorders (DSM). The DSM is considered the definitive guide for mental health professionals, and provides descriptions for all mental health problems and their symptoms. The five chapters analyzed were: bipolar disorder, schizophrenia, depressive disorders, anxiety disorders, and trauma-related disorders.

What did they find:

First, the study’s authors assert that there is a significant amount of overlap in symptoms between disorder diagnoses, despite the fact that each diagnosis utilizes different decision rules. Additionally, these diagnoses completely ignore the role of trauma or other unique adverse events a person may encounter in their life.

Perhaps most concerning of all, researchers say that these diagnoses tell us little to nothing about the individual patient and what type of treatments they will need. The authors ultimately conclude that this  diagnostic labeling approach is “a disingenuous categorical system.”

They are saying that treating an individual requires us to understand his life circumstances, the reality he is living. To classify and categorize his reality under a series of descriptive terms tells us little about how to treat his condition… unless, of course, we believe that we should mostly medicate.

It is fair to note that a patient who comes down with bronchitis is diagnosed on the basis of a laboratory test. And the patient will receive a treatment to cure the illness. The physician does not really need to know the specifics of the patient’s life. If a surgeon is operating on a patient, he cares about the body, not about the individual. The psychiatric system seems to want to mimic the medical approach. 

“Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.” Lead researcher Dr. Kate Allsopp explains in a release. ...

“Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.” Professor John Read comments.

A useful point, even if it has been made before.