I am inclined to agree with therapist Daniel Mackler, who wrote, “The diagnostic categories we presently use are so often arbitrary, misleading, stigmatizing, or just downright wrong (and at times all of these) that they end up doing far more harm than good” (2011, Abandon Diagnosis and the DSM section, para. 2). Because our society would have to change much more drastically than can be expected in the near future, however, I think Mackler’s call for an abandonment of diagnosis is premature. Diagnosis plays a small, valid role in psychotherapy, but it must be “applied properly and its limitations... understood” (Frances, 2010, Afterword, para. 1).
Diagnosis can lead to discrimination by society, the justice system, the insurance industry, and even the mental health system. (If you don’t believe the latter, ask anyone with borderline personality disorder.)
Mackler argues that there are three groups who benefit from DSM diagnosis: (1) the pharmaceutical industry, (2) psychiatry, and (3) some consumers. As Frances points out, “biological psychiatry has failed to produce quick, convincing explanations for any of the mental disorders” (2010, The Epistemological Game section, para. 4), yet most people believe that behind each and every disorder is a meticulous biological explanation that will direct them to a quick pharmaceutical solution. Far too much weight is placed on diagnosis and the related drug treatment. Diagnosis can also provide some relief for consumers, but in my experience this relief often seems more like resignation. Mackler articulates a similar experience:
...the saddest group to benefit from diagnosis is a not insignificant subset of consumers themselves: those who are so broken, both by the traumas of their childhood and the traumas they’ve suffered at the hands of psychiatry, that they have lost hope. Diagnosis gives them an excuse not to have to struggle anymore. It tells them that their brains are hopelessly broken and that they can never recover. And far too many find a tragic comfort in that.
Diagnosis does not need to be associated with the myth that recovery is impossible, however. It can serve a limited, positive role that allows therapists and researchers to share a common language, points in a very general direction to treatment options, and allows people to obtain needed disability benefits and treatment. Yet far more important than the label we fix to each person is their individual story. If we can remember this, make sure our clients understand it, and most of all listen carefully, we may be able to use diagnosis for good rather than evil.
Mackler, D. (2011). Ten ways to revamp the mental health system. Retrieved from http://www.iraresoul.com/RevampMH.html
Frances, A. (2010). DSM in philosophyland: Curiouser and curiouser. Bulletin of the Association for the Advancement of Philosophy & Psychiatry , 17(10).