I’m going to go out on a limb and say psychology is one of the few areas to self-sabotage itself. Unlike the medical profession, we tend to second guess our own field and our diagnoses more than others. If you go to a doctor and tell them that your previous physician diagnosed you with high blood pressure or a thyroid disorder, your doctor would probably believe them. Even if they didn’t, something like this could be fairly easily examined.
But what happens when you go to your new therapist and you tell them that your previous therapist diagnosed you with Depression, Anxiety, Borderline Personality Disorder, Conduct Disorder, ADHD? It doesn’t quite work the same way. Sometimes the therapist will accept it much the same way a medical doctor will, but other times, there may be an air of skepticism. Why is that? Well the obvious answer is that psychological phenomenons are not as easily measurable. However, there is something else that may be going on too…
The way we define mental disorders is still very categorical. The 5th edition of the Diagnostic and Statistical Manual has improved on this, but much of it still is categorical rather than dimensional. What I mean by categorical vs. dimensional is whether we say someone has Depression or whether someone lies on a continuum of depressive symptoms. Alcohol and Substance Use Disorders are one area that moved to a much more dimensional perspective where individuals are diagnosed with a specifier of either mild, moderate, or severe.
Part of the reason we’ve stuck with the categorical way of defining mental illness for so long is the fact that it’s much easier to tell a clinician, client, or anyone else that they have Depression rather than they endorsed 3 out 10 questions on some Depression scale. It’s a lot more informative to just have that label. However, the problem is that it can be seen as a “catch-all” rather than giving a more fine-grained perspective about what an individual’s complaints truly are.
The reality is that we’re all unique colors on a broad spectrum. Suppose you went to a paint store and were trying to pick a specific color for your bedroom wall. You got some random shade that is between light blue-ish, with a hint of beige, and purple undertones. If you were to look carefully, you would notice that color was made up of 3 numbers, corresponding to the RGB (Red, Green, Blue). Using these primary colors, they add together to make any single color. This is how we’re all wired. We’re all a unique number on a broad spectrum and somewhere along the way, we say that passed a certain number, we have a certain mental illness.
Let me clarify this and say that not all mental illnesses have as broad of a spectrum as others. For some disorders, the line between “normal” and “abnormal” is very fine. However, other disorders, such as Schizophrenia, are a bit more black and white. Even within schizophrenia though there is still heterogeneity and variability in the type of symptoms one has and how severe it actually is.
Don’t get me wrong though, I have great respect for our field and appreciate how far we’ve come. Our field has come as far as it has because we have second guessed and challenged ourselves. This act of challenging is what causes growth. In order to move forward from where you are, you have to see that there is something better on the other side. And with that comes the assumption that what’s on this side isn’t working. This is no easy feat because unlike brain lesions or tumors or something fairly easily visible, we’re talking about behavior, neuronal connections, and things hardwired into us that aren’t as clear. It takes a lot of work to understand how our brain, body, and behaviors interact. And each day we’re getting closer.
Let’s all work together to find a better way of describing one’s mental illness rather than slapping on a label. Just like physical illnesses, mental illnesses can be affected by genetics and environments and each disease has unique influences of both. Let’s work on describing one’s symptoms in the way that is most efficient yet most descriptive.
- The Disease Model of Mental Illness and Addiction
- How do you know when it’s time to make a change?
- Imminent Danger: The Problem with Mental Illness and the Justice System
- Why mental illness is not a one-lane highway
- A follow-up conversation on mental health and the criminal justice system
- Reducing mental health stigma- How different are we all?
Rubin Khoddam, Clinical Psychology PhD student at University of Southern California, founder of Psych Connection.
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