Mental health professionals have debated the importance of diagnosing mental ("neurotic") distress since the days of Freud. While these labels can be helpful ways for clinicians to communicate symptoms in shorthand to other clinicians, they can hardly capture the complexity of the individuals who face these labels in the mirror every day.
Diagnoses can be restrictive and arbitrary.
Although diagnoses can sometimes serve as guideposts for how to best help our clients, they can also be restrictive and arbitrary. For example, the way that mental health disorders are diagnosed is usually based on whether someone experiences X amount of particular symptoms, and that number is usually random.
To be diagnosed with Major Depressive Disorder (MDD), for instance, someone must exhibit five or more symptoms from a particular list for at least two weeks. Technically, MDD is not diagnosed if someone has 5+ symptoms for 12 days (it's less than 2 weeks!), or only 4 symptoms (less than 5!) for 2 months.
You are not a list of symptoms
Furthermore, thinking about diagnosis tends to focus our attention on a “problem” that needs to be fixed. What we sometimes forget is that we are not equations to be solved. Humans are not perfect. We all have obstacles in our lives and we all have things we would like to change about ourselves. Focusing too much on what might be “wrong with us,” rather than considering our strengths and the resources we have to overcome our challenges, may be creating more obstacles in our daily lives than we recognize.
Instead, we might benefit from shifting our attention to the ways we can use our positive traits to improve our lives. For example, Joe’s Bipolar Disorder does not have to stop him from using his sense of humor, compassion, and sensitivity to help his grieving friends feel better. Betty’s Social Anxiety does not have to affect her ability to get a promotion at work, as long as she continues to show her perseverance, responsibility, and commitment to high-quality performance in the office.
Progress is subjective
So, if diagnosis is inherently flawed, why do we keep diagnosing? Other than to help clinicians interface more easily with other clinicians, we sometimes use diagnosis to reflect progress. This is because some diagnoses are modified or described by the frequency or severity of "symptoms" that reflect a particular disorder (e.g., mild, moderate, severe). The number of symptoms someone has can be used by some professionals as a measure of an individual's progress in treatment, as a sign that we are doing the "right" thing (or not). As most clinicians will recognize, however, progress and change are not quite so linear and clear-cut.
Because improvements in mental health are so specific to each individual, a better way to judge the effectiveness of a therapy treatment (rather than diagnosis or number of symptoms) may be to consider the relationship a client has with their therapist.
Do you trust this person?
Can they help you experience unsafe emotions in a safe way?
Are you uncovering parts of yourself that you never knew existed?
Although subjective, answers to these questions tend to be clearer signs of therapeutic progress than diagnosis or symptom count.
Diagnosis can also provide hope
I should note, however, that some individuals really like having a diagnosis. It can be liberating to see that you are not the only one going through what it is that you are experiencing, and it can be empowering to have a label that can be overcome. Some people think that if we know what the problem is, we can treat it. In the case of mental health disorders that benefit from pharmaceutical treatment, this is absolutely true.
For other individuals struggling with experiences that can be harder to capture with a one-size-fits-all label, focusing too much on diagnosis (e.g., what’s wrong with me?) and not enough on your particular experience (e.g., how can I live a happier life?), may not help you as much as you think it might.
about the author
My passion is helping people connect with their most authentic selves. Through this blog, I hope to offer resources to demystify psychotherapy and encourage you to think about your mental wellness.
In my integrative psychotherapy practice in Echo Park, my mission is to support you in finding your best self and living an examined life.