Most visits to a medical doctor involve a similar sequence of events; the patient presents their symptoms and the provider goes through a mental checklist and/or administers a series of tests until they eventually deduce the reason for the patient’s ailment – a broken bone, an ear infection, a ruptured appendix, etc. The diagnosis is made and the appropriate treatment follows. Although many conditions are quite complex and may elude codification, a diagnosis – in addition to symptom relief – is usually the ultimate goal. In the world of mental health, however, there is more ambivalence about the utility of a diagnosis.

There are many reasons – some practical, some emotional – why obtaining an official mental health diagnosis is important and even sometimes necessary. First, diagnoses are often used to guide treatment. Research shows that, for example, Exposure and Response Prevention is the most effective treatment for OCD, while Cognitive Behavioral Therapy is extremely effective in treating depression. Furthermore, diagnoses are sometimes needed to access accommodations. For example, a student diagnosed with a learning disability may require an official documented diagnosis in order to receive an IEP. Diagnoses also provide a framework of shared understanding to help mental health professionals communicate with one another about a client’s condition. Additionally, insurance reimbursement sometimes depends on a diagnosis.

Furthermore, receiving a mental health diagnosis is often very helpful toward validating a person’s lived experience and providing a more cohesive understanding of oneself. Without a proper diagnosis, people tend to assign themselves with harmful labels, such as “crazy,” “dramatic,” or “dumb.” A diagnosis may therefore help a person to make meaning of what they have endured, and to see themselves in a less critical, more compassionate light. Similarly, it can
help their loved ones understand them better and identify more adaptive ways of interacting. Diagnosis can also facilitate other forms of social support by helping individuals connect with others with the same diagnosis. Because mental illness is often fraught with feelings of isolation and loneliness, it is often crucial for people to know that they are not alone in their experience.

However, there are multiple reasons why many people are uncomfortable with making or receiving a mental health diagnosis. First, there is widespread critique of our overall diagnostic framework itself; human behavior falls on a spectrum, and thus identifying the line between normal and abnormal can sometimes seem arbitrary. Many diagnoses also share overlapping features, which calls into question the meaning behind their distinction. Also, because of the broad array of symptoms that many diagnoses may entail, two people may receive the same
diagnosis but have very different clinical presentations. It is also important to note that diagnosis is highly culturally-based; what is considered maladaptive or abnormal in our Western culture may be deemed completely normal in another culture, and vice versa.

Another problem with making a mental health diagnosis is the potential for subjectivity. Unlike many medical conditions in which a diagnosis can be definitively made by, for example, examining an X-ray or conducting bloodwork, mental health diagnoses are extremely nuanced. Symptoms are assessed via a clinical interview and a review of one’s history; in some cases, standardized assessments and self-report questionnaires are also utilized. After collecting
sufficient data, the clinician then determines what symptoms are present, how long they have been present, and to what extent are they interfering in the client’s life. All of this information helps determine whether the client meets criteria for a diagnosis. However, the ambiguity that is involved in this process sometimes leads different providers to arrive at different diagnoses. If this is the case, simply describing the symptoms and behaviors that are present without labeling
them may be even more fruitful than making a diagnosis. And while diagnoses are often helpful in guiding treatment, a skilled clinician will be able to understand and treat a client whether or not an official diagnosis has been assigned.

Another reason why someone might dislike receiving a mental health diagnosis is due to the fear of being “labeled” or stigmatized. They worry about the impact that such labels can have on others’ perceptions of them. Some diagnoses can affect one’s school admissions or job prospects, even if the condition is in remission. Finally, our system of diagnosis is grounded in a deficit model, where the focus is on a client’s struggles and shortcomings. This is overly reductive, as human beings are far more than just a collection of symptoms and problems. Hyperfocus on a diagnosis might cause the client or clinician to ignore a client’s many strengths and positive attributes.

If you are the client, which side of the debate do you lean toward?

Ashley Dennin, Psy.D.
Licensed Clinical Psychologist