Imagine: Your partner breaks up with you. You feel sad and exhausted and struggle to carry on with your normal life. Your friends suggest you find someone to talk to.
You have decided to find a psychotherapist. It takes a few months, but eventually you find someone. You are given five sessions to start. Things are going well: you are learning about yourself and you like the ability to speak without feeling like you are overwhelming your interlocutor with sadness.
Once the five sessions are over, your therapist asks you to go to the doctor to fill out some forms. You must submit a contract with your health insurance company to finance your treatment. Along with your doctor’s forms, your therapist must include their own analysis of your condition: A diagnosis.
Your therapist diagnoses you with “major depressive disorder”. And it’s true: you feel sad. You don’t sleep well, can’t pay attention to work, and you’ve lost interest in your hobbies.
However you are in conflict. Part of you is relieved: You like the fact that you can name what you feel, which is something millions of people have already tried and that now that your problem has been identified, you can start trying to fix it.
But another part of you wonders if your depressed mood is simply due to circumstances. Sure, you feel depressed, but who wouldn’t do it in your situation? The diagnosis remains uncomfortable in your mind over the next few weeks.
Pathologies of normal discomfort
In Germany, the United States, Finland and many EU countries, to receive treatment that can be reimbursed by public health insurance, people must obtain a diagnosis. With the number of people interested in accessing mental health treatment skyrocketing since the start of the COVID-19 pandemic, many are left wondering: where is the line between regular depression in response to some sort of trigger? environmental and a depressive disorder? What role does diagnosis play in our understanding of ourselves?
Many psychiatrists and psychologists criticize insurance companies’ need for a diagnosis, arguing that it forces them to pathologize normal distress.
Peter Kinderman, a professor of clinical psychology at the University of Liverpool, said it results in a kind of “misinterpretation of the human experience”.
“What happens is our partners cheat on us,” Kinderman said. “We get depressed. We go get help and they say, ‘No, you are wrong. It is not true that what you are experiencing is the normal, understandable, age-old experience of depression for perfectly understandable reasons. In fact, you are wrong: this is a severe depressive disorder, which I will now treat and bill your insurance company. ‘”
In many countries, patients in therapy can only access treatment if they accept a diagnosis, Kinderman said. But he pointed out that just because they are diagnosed with a disorder does not mean that they are sick, or that they will always be sick, or that there is something inherently wrong with their brains.
“It has nothing to do with your distress or the practice of psychotherapy or the nature of the world,” she said. “These are business decisions made by people who want to ration services in a particular way.”
Spanish psychiatrist Eduard Vieta, an expert in the neurobiology and treatment of bipolar disorder, agrees with Kinderman that diagnosis is not always necessary in cases of non-extreme mental distress.
When it comes to non-serious conditions, a diagnostic requirement can prompt mental health providers to “medicalise a normal reaction or a situation that doesn’t need a label,” Vieta said.
However, Vieta considers the diagnosis “extremely important” when it comes to more severe mental distress.
Diagnosis can allow people to better evaluate their care
Vieta said that for conditions like bipolar disorder or schizophrenia, the diagnosis can function as a kind of quality control. Once people are diagnosed, they can go to the Internet to read about other people with the same condition or ask another psychiatrist or doctor for a second opinion if they agree with the diagnosis and subsequent treatment suggested by their provider. original.
Vieta added that although some psychiatrists don’t forgive him, he doesn’t see much wrong with patients researching their diagnosis on the Internet.
“People have the right and that’s a good thing, unless it gets a little bit obsessive,” he said. “But otherwise, it is a good thing that people are informed and try to find answers to the questions that arise when you have a certain type of suffering.”
Diagnosis provides a simplified way to bring people in severe psychological distress to treatment, through targeted psychotherapy or medication or both, Vieta said.
Til Wykes, a clinical psychologist at the University of London, agreed that the diagnosis can offer a useful explanation for a person’s distress.
“It allows some people to think carefully about how to adapt their lives and think about themselves and how to live with the diagnosis or prevent the worst parts of a diagnosis,” said Wykes, who specializes in treating patients suffering from episodes of psychosis. , like hearing voices.
But Wykes said people shouldn’t be required to get a diagnosis before allowing them to access ongoing treatment.
The stigmas surrounding the diagnosis can be barriers to therapy
Vieta noted that although the practice of diagnosis can be useful in theory, this is not how it always works in practice. Social stigmas about certain diagnoses, such as schizophrenia or a bipolar condition, can lead people to refuse or avoid treatment.
“The diagnosis is helpful,” Vieta said. “And if it were free of stigma, it would be essentially good.”
Wykes said the stigmas surrounding certain diagnoses have led some mental health care providers in early intervention clinics to change their practices.
“Some [clinicians] never say the word schizophrenia, because they think it will scare the person, ”Wykes said.
Wykes added that in the UK, where diagnosis is not needed to allow people to access treatment, therapists can support people who may not reach the diagnosis threshold for schizophrenia or psychosis, but clearly need help with a diagnosis. series of other problems.
For them, Wykes said, treatment can prevent or delay the onset of a true schizophrenic disorder. Or “it could involve them in services so that when there is an onset of the disorder, they more easily accept services and help.”
This type of support is not possible in countries where diagnoses are required for access to treatment, which can lead to people refusing them altogether for fear of receiving a diagnosis they feel uncomfortable with.
“People will try to avoid them as much as possible. And then families will try to avoid them as much as possible,” Wykes said. “If you can’t access health care without a diagnosis, you’re really stuck. Because if you don’t want a diagnosis and you just want help, you won’t go near the services if they label you.”
Edited by: Zulfikar Abbany