Diagnostic Evolution

By Teresa Pitt Green

Many survivors experience a diagnosis of mental illness as another reason to feel shame – and hopeless.

People feed that misery. Often they treat a person like their diagnosis – not as a person with a diagnosis. Even people with a mental illness can, without noticing it, start limiting their dreams because they internal a diagnosis as a constraint.

There’s growing scientific evidence to prove why this needs to stop.

Most clinicians will explain how a diagnosis is not exact. But the shock of being diagnosed with a mental health illness can make it very difficult to hear or believe that truth. Ideally, over time, in therapy we discover how much more of ourselves there is, beyond abuse and beyond diagnosis. Ideally. It doesn’t always happen that way.

But the point remains true. Just take a look at the difficulty involved in pharmacology used in protocols for depression. At best, using medication is a process that is trial and error. Only some people find success. Others get to a point of “best possible” or “good enough.” This is something that helps a person see that, beyond the medicine, there are other dimensions for healing. It is something, too, that has scientists rethinking diagnoses altogether.

Lately there is a growing discomfort among scientists about using diagnostic categories (e.g., depression, anxiety disorder, borderline, schizophrenia) at all in clinical care.

In May 20, 2020, Nature magazine published a science roundup by Michael Marshall entitled, The Hidden Links Between Mental Disorders: Psychiatrists have a dizzying array of diagnoses and not enough treatments. Hunting for the hidden biology underlying mental disorders could help. The title says it all.

Scientists are cognizant how how people tend to have a mix of symptoms and seldom fit neatly into any one traditional diagnosis. They have been developing “ever-finer sub-types” developing within diagnostic classes, but still cannot account for how patients’ symptoms often fall in very different diagnostic categories, such as ADHD and autism, or depression and anxiety.

Simply put, science finds that human mental health and human mental illness defy diagnoses, which fail to be neat or clear cut at all. Most recently, many clinicians are no longer inclined to assigning an overall diagnosis during treatment at all.

Some psychiatrists are pushing further. They are arguing to eliminate diagnostic categories entirely “in favor of a dimensional’ approach.”

The dimensional approach to mental illness shakes the very foundation of mental health care.

T. Pitt green

The dimensional approach will be familiar to most readers. Personality analysis and testing rely on a dimensional approach to human personality. From Myers-Briggs Type Indicator to Eysenck Personality Questionnaire to Rorschach Test and many others, personality tests abound and coexist because each looks at some dimensions of a fully dimensional person. None purports to be able to represent a person completely.

With mental health, a diagnosis “by the book” is not dimensional. It follows the model of a traditional medicine, which traditionally identified an illness and assigned to that illness one or more ways to treat it to cure it or mitigate it. So, too, with mental health diagnoses. Mental health care insurers are hardwired to rely on these diagnoses to cover costs. Unending the current diagnostic framework would be challenging.

Yet, physical medicine is no longer traditional. It is advancing to the point where it is not uncommon for one illness or set of symptoms to be treated as systemic — as dimensional. So why wouldn’t mental health care evolve along the same lines, too?

Marshall’s article is a great piece on how therapy still has much to learn in how to serve the mystery of each full and rich self.

It is also a strong argument for why, even though therapy is important for recovering from abuse, it also should not be mistaken for a panacea when it comes to our human struggles or our human potential.

Mental health care, with responsible diagnostic approaches, helps us each understand behavior, foster mental wellness, and help promote mental wellness. But it’s the responsibility of every patient to be sure that its work and its premises do not limit your hope for healing. That lies well beyond a uni-dimensional diagnosis of a full previous human person.

Dear Reader:

The points in this article are not a rejection of therapy.

If you’re in therapy and doubt your therapist’s methods take heed: It’s not a good idea to interrupt your surgeon in the middle of surgery to ask about current state of new research in the model for diagnosis that got you on the table in the first place. It’s the same with therapy.

When therapy hits white rapids (and it will, if it is any good) and the ride gets very rocky (as it must, to shake the foundations of the wrong lessons we learned from abusers), that’s exactly when each of us needs to stick with a skilled person (a qualified therapist) at the helm of the ship in the rough seas … to get dry land. Ask your questions, make your challenges on either bank of that river, but not in the middle.

Even in the middle point of the river, however, there’s no reason to think that your diagnosis is sufficient for all that you have suffered and for all that you were born to become. It was years into therapy before I realized that I will remain a mystery to myself all my life. My faith deepened at that point. I had to admit, as if I had discovered anew, that of course I am a mystery. I was created in the likeness of God, whom science has not been able to pigeonhole with label or name successfully in millennia.

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