To Diagnose or Not

Within the mental health community and our culture at large, there is a debate around the value of a mental health diagnosis.

A diagnosis occurs when a professional identifies that an individual meets the criteria for a specific mental health disorder. Mental health disorders are defined in the DSM-5 and are primarily determined by the negative symptoms that an individual experiences. For this reason, many individuals find diagnoses to be pathologizing and prefer to not use them.

"To Diagnose or Not" Mixed Media Collage by Jackie Schuld

I also feel that diagnoses can be misleading by making the individual feel something is wrong or broken in them. Many times, the individual is responding in a normal way to overwhelming factors.

For example, a person may meet the diagnostic criteria for depression. However, the symptoms they are experiencing may be due to a confluence of factors, such as living in poverty, a difficult family environment, systemic racism, work struggles, hustle culture, etc.

Diagnoses can also be problematic because the research that contributes to the formation of the disorder is typically based on cis white heteronormative males. For example, autism in women often goes undiagnosed because autism presents differently in women than the symptoms listed in the DSM-5. The symptoms in the DSM-5 are based primarily on research with white boys.

Although there are significant problems with diagnoses, there can be benefits to a diagnosis. In some cases, a diagnosis can lead a mental health practitioner to recommend the most effective form of treatment. For example, dialectical behavioral therapy is the most effective form of therapy for borderline personality disorder. Other forms of treatment can be frustrating or even counter-productive.

Diagnoses can also provide access to helpful medication. For example, someone with schizophrenia may benefit greatly from medication. Similarly, an individual with Attention Deficit Disorder may find they can focus better with medication.

In some instances, diagnoses may be necessary in order to have access to mental health treatment. Insurance companies require a diagnosis prior to covering an individual for mental health care. I find this unfortunate (many people would benefit from mental health services irrespective of a mental health disorder), but it is the reality of the current healthcare system in the US. You can read more about my views on the current insurance system here.

Having a diagnosis on a person’s permanent medical record can also have negative consequences in the future. An individual can experience negative bias against them because they have a history of “mental health problems” (such as when a person is in a court case or battling for child custody).

In my private practice, I navigate the gray area. I examine and note all of the factors that impact a person’s mental wellbeing. I look at the social, environmental, familial, historical, systemic, and medical influences. I also listen to the negative symptoms a client describes AND the growth/positive they would like to experience. I then provide a treatment plan that takes all of these factors into account. I do not need to provide a diagnosis or pathologize a client.

I will provide a diagnosis if it will benefit an individual, such as for insurance reimbursement (I provide super bills) or accommodations at college. I will also let individuals know a diagnosis if I think it will help them personally. For example, it is helpful for an individual to know they are autistic, which I explain in why it matters to know you’re neurodivergent).

As with most mental health topics, there is an opinion I gravitate toward (I typically do not diagnosis), but I also see that there are always expectations for valid reasons.

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I provide art therapy for individuals with overwhelming emotions and thoughts.

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