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Classification of Mental Health Concerns: A Boon or Bane?

Diagnosis of mental health disorders has been the spotlight since the emergence of the classification systems, namely; Diagnostic and Statistical Manual of Mental Health Disorders and The International Classification of Diseases. Over a period of time in history of mental health, the need for a classification and diagnostic system of mental health disorders became clear for easier structure and nomenclature. As time went by , the classification systems became questionable, owing especially to the multiple revisions it went through from time to time. The continuous and efficient research being done now in the field allows for more inclusivity, ethnicity and culture to be included, thus leading to more structure and less nomenclature. At the moment, the field of psychiatry and mental health follow the DSM-5 TR and the ICD-11.

So is diagnosing or classifying mental health disorders beneficial or not?

Diagnosis plays a crucial role in how we communicate with patients and make decisions about their care. When faced with various possible interventions for a patient's symptoms, diagnosis guides us in making logical decisions. For example, if an adult presents with symptoms like lethargy, weight loss, reduced activity, and loss of interest in life, we must differentiate between potential causes like a normal response to life's challenges and diseases like cancer, heart failure, or a severe depressive episode with suicidal risk. Diagnosis is essential for determining the most appropriate interventions and forms the foundation of evidence-based practice.

The significance of diagnosis for patients is becoming increasingly important. A diagnosis offers reassurance that their situation is not unique or unexplainable, and it provides access to a body of knowledge and experience that can offer help. It also helps clients to feel less confused and know that there is a name to put to all of the emotions they have been experiencing. It can also reduce inappropriate feelings of blame, such as parents blaming themselves for a child diagnosed with autism.

Additionally, diagnosis helps reduce stigma by acknowledging the presence of an illness, breaking myths that the condition is a result of character weaknesses. It assists individuals in understanding their differences and challenges, addressing feelings of shame, loneliness, and low self-esteem that may arise.

Diagnosis also facilitates communication between the public and professionals regarding support and service needs, including therapies and educational support and other healthcare needs.

On the other hand:

Psychiatric diagnosis has its imperfections. Unlike many medical disciplines that rely on precise measurements related to organ function and pathology, psychiatry relies on clinical observations and descriptive data to categorise clinical syndromes. This discrepancy stems from our limited understanding of the intricate workings of the brain, especially its higher functions, in comparison to other, less complex organs.

It's essential to recognize that classification systems prioritise diagnostic homogeneity to facilitate research on treatment and prognosis, which can lead to the exclusion of patients who don't precisely meet diagnostic criteria. Consequently, this approach often results in the need for multiple 'comorbid' diagnoses, such as when a patient with a depressive disorder is also diagnosed with various anxiety disorders.

Sometimes, it's also possible that diagnoses can be extremely broad. And, it's also important to understand that the same diagnosis can vary in terms of different experiences and needs of the concerned person. People with the same diagnosis can have very different experiences and needs, and thus it will not capture the individuality of the person.

Many people with mental health issues can have more than one condition, called comorbidity. When mental health professionals diagnose separately, there is a tendency to make things complicated. Often, it might be comprehensive enough to reflect the full picture of what’s going on.

So what can be done better?

We spoke to some professionals and students from the field to understand their opinion on the diagnostic and classification system and here is what we got.

1) How can a better diagnosis of mental health disorders be done?

"When we speak about better and correct diagnoses, it is also crucial to understand the purpose of diagnoses. Owing to the complex nature of mental health disorders, they overlap so much and also with the ever changing understanding of disorders through several revisions, it’s hard to exactly say how best to diagnose mental health disorders. I think what we should do is follow the current system but modify the purpose of diagnosis. By that I mean one purpose of diagnosis is to think of what exact treatment to give.. so we should make the treatment such that any error in diagnosis can be corrected. An emphasis on treatment and interventions can lead to better symptom management, and if it does not work, we can move on to trying a different form of treatment for a similar disorder. This is why I really like the process of giving provisional diagnosis and differential diagnosis. It does its job of providing the correct diagnosis at the end. Ofcourse standardised tests also aid in making the informed decision. In its purest form, this should be done as a separate process for the client by a professional like say, a diagnostic specialist as doing this with your therapist can be painstaking. The client is put under stress anyway with the tedious process but doing diagnosis separately makes me think of it in parallel with allopathic treatment.. they also have diagnostic centres for that very purpose."

Another different viewpoint that arose was that "diagnosis is not just entirely up to the mental health professional but also the patient. Since mental health is a little frowned upon the patient might not be able to face the fact that they are mentally facing difficulty and so diagnosis also takes a long time and turns complicated."

"Coordination between various mental health professionals is important as per my personal experience. In a government setting especially, where the whole team works together, there should be no discrepancy. While psychiatrists tend to focus more on diagnoses, psychologists tend to focus more on rehabilitation. There should be a right balance between the two and a combination of factors that contribute to the diagnosis and intervention. Gathering different perspectives from the whole team leads to a sharper and more well rounded understanding of the person as a whole."

2) How can we make changes for the right diagnosis? Or rather, make the process of diagnosing easier?

“Adopting a multidisciplinary approach can also help with the diagnosis. Collaborative assessment can provide for a more holistic view of the person's mental health. Further Mental health professionals should be culturally competent and sensitive to the diverse backgrounds and experiences of their clients. Cultural factors can influence symptom expression and diagnosis. In third world countries where it is largely looked down upon, communication of the same can be difficult."

"I also believe that assessments can be used, with more emphasis on repetitive use. This way one can capture changes in symptoms, functioning and progress and we can also work on getting the right diagnosis.”

“I don’t think there should be a change in the right diagnosis per say but it should certainly be complemented with better management and well-being and more awareness on how the treatment could pan out and how much of an effort the patient needs to put in to make themselves better.”

Thus by implementing some of these measures, mental health professionals can work towards more accurate and personalised diagnoses, while also providing the quality care necessary and other beneficial outcomes for individuals with mental health conditions.

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