“Psycho”, “schizo”, “paranoid”, “maniac”….. in no other area of medicine are diagnostic labels twisted into terms of abuse and rejection of a person. Perhaps this is because mental disorders affecting other people are often difficult to understand and may cause fear – that is until a person themselves, a family member or friend develops a similar disorder. As the number of people diagnosed with a mental disorder has been steadily increasing globally for several decades, having more understanding and less fear has become crucial for us all.
How we think, feel, experience the World, and behave in society is the core of who we are. To have that “diagnosed” as abnormal, and so a mental (or psychiatric) disorder, can have a huge impact on a person’s life. Acceptance of a diagnosis by the individual, important people in their life, and the community in which they live can lead to appropriate treatment and greatly increased quality of life. For some people, a diagnosis gives validation of their experiences, a sense of identification with a wider group of people with similar experiences, and of being understood. Social media and the connections made possible through the internet have helped this. However, it can also result in prejudice, discrimination, mistreatment, and rejection.
In contrast to other areas of medicine, most psychiatric disorders have no clear underlying biological abnormality which can be measured, and on which a reliable diagnosis based. Judging what is normal or abnormal is a key task of the psychiatrist using their understanding of the population norm as their benchmark. However, the landmarks of what medical science and wider society deems to be the limits of “normal” in the population gradually shift over time, and different societies have different expectations of how a member should think and behave. This results in a constant evolution of what is considered normal or not. Added to this, there are new diagnoses arising all the time as science advances and academic opinions change; some old ones disappear or change in some way.
There has been important progress over the last thirty years in developing standard definitions and guides when making psychiatric diagnoses, though these leave a lot of room for judgement by the psychiatrist and are heavily influenced by what is regarded as normal or not in Western society.
Even with standard guides, the psychiatrist’s judgement on whether someone’s thoughts, feelings or behaviour are abnormal in some way will influence whether a diagnosis is made or not, and what that diagnosis is.
For a psychiatrist working in a clinical situation the central focus is providing the best care for the patient. A careful assessment should lead to a reliable and valid diagnosis (or diagnoses) that is incorporated into a formulation which explains why this person has developed this health problem at this point in their life. This is the starting point for a discussion on treatment options.
Diagnosis in psychiatry can have a huge impact on a person’s life. It is a complex business and must be done with great care. If you want to read more about the complexities and processes of diagnosis, then
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