Mental health diagnoses: what are they (and aren’t they) good for?

Diagnoses can be tricky. 

They can be useful; they can be complicated; they can be helpful or unhelpful. 

Mental health diagnoses are a tool; and like any tool, they can be productively used or destructively misused. 

One of the important things to understand about a diagnosis is that it’s not a “thing” that exists independently of anyone’s behavior or neuropsychology. 

You can’t see, feel, hold, or physically measure an “eating disorder” or “PTSD.” 

These are all descriptions of patterns of feeling and behavior. No less, but no more. 

Many people get in trouble when they over-assign importance to a diagnosis, or when they begin to think of a diagnosis as a “thing” unto itself. (There’s actually even a name for this problem— it’s called “reification,” after the Latin word for “thing.”)

It’s true that a diagnosis can be helpful in understanding what’s going on with someone. It can even leave some people feeling relieved that their pain has a name, and that it’s more than just someone choosing to act destructively or think negatively or feel terrible. 

But it’s also true that if we get it in our heads that simply naming our pain will always lead to a straightforward path to a cure, we’re going to be in for frustration and heartache. 

When you’re facing the issue of a mental health diagnosis, keep in mind that the labels and numbers we mental health professionals assign to your symptoms serve various functions. 

Sometimes they serve a “place holder” function while we gather more information. 

Sometimes they open up opportunities to work with different kinds of professionals (there is a subset of specialists, for example, whose services are unavailable unless people are diagnosed with specific conditions). 

Sometimes a diagnosis is necessary to procure payment for the kind of professional services necessary, even if the specifics of that diagnosis aren’t particularly well-established. 

Don’t get married to a diagnosis. 

Don’t fall into the trap of thinking that a mental health diagnosis necessarily means what is “wrong” with you has been determined with the specificity of a CAT scan or a blood test. 

And always, always, always remember that a diagnosis can, at best, DESCRIBE what’s going on with you…but it often can’t EXPLAIN what’s going on with you. 

So, if there are all these caveats, what good is a mental health diagnosis at all? 

There is a subset of conditions for which accurate diagnoses are absolute lifesavers, when it comes to choosing treatment modalities. Post traumatic and dissociative conditions are like this. Very often PTSD and dissociative disorders get diagnosed as mood, anxiety, or psychotic disorders, and treatment functionally grinds to a halt because it is not accounting for the core symptomatology that trauma presents. 

Another good example of this is certain eating disorders. There are known patterns to how people with anorexia and bulimia tend to think, and labeling these conditions accurately can give the provider a clue on how to treat them psychotherapeutically. 

Most mental health diagnoses, however, are not like this. 

Major depressive disorder, for example, is a condition that is frequently diagnosed (accurately enough, according to its diagnostic criteria), but which doesn’t, on its surface, give a provider much to work with in terms of the thought patterns and life events that are contributing to it. 

Most disorders that are diagnosed with a caveat of “not otherwise specified” (NOS) are also examples of this. The “NOS” designation is usually employed as a sort of “place holder” diagnosis when someone’s difficulty is clearly related to a type of diagnosis— is clearly a mood problem, or clearly has elements of an eating problem, or clearly has aspects of a dissociative problem— but the specific diagnostic criteria necessary to nail down a firm diagnosis are not present. As a rule “NOS” diagnoses don’t contain an awful lot of useful information for a treating therapist— or a suffering patient. 

Something else we need to remember about mental health diagnoses is that, most often, they essentially offer “snapshots” of someone’s symptoms and functioning at the time of assessment. While this can be useful, it is also necessary for therapists (and patients, and family members) to think about this “snapshot” in the context of everything we know about this person— including their past behavior, their past diagnoses, and their past treatment (both successful and less than successful treatment). 

All of which is to say: treat mental health diagnoses as the provisional tools that they are. 

They do contain information, and that information is often useful. 

But they are not tools that are designed to be used in the absence of other information; they are not tools that should be considered infallible or unchangeable; and they are limited by the imperfect procedures and perceptions of the human beings who assign them. 

Remember what I always say about any tool: you need hammers to build houses. It’s hard to build a house WITHOUT hammers. 

But hammers can also crush your thumb if you’re not paying attention.