That’s a difficult question to answer. And it depends on who’s asking the question. I thought for many years that mental illness was something someone either had or didn’t have. Which was diagnosed based only upon the “set criteria” of a DSM (Diagnostic Statistical Manuel) disorder. Because as a mental health clinician, this is how we are trained to assess and diagnose. It’s the Holy Grail to the mental health field. And you may be wondering why a person would want a mental health diagnosis in the first place… but it’s fairly simple. It’s because our culture requires it for access to services, such as treatment. Mental Health services can range from school accomodations, medication, therapy, insurance coverage, hospitalization, substance abuse rehabilitation, food assistance, housing, disability benefits, and more.
Many times, that diagnosis ‘box’ is required. And with mental health diagnoses there are pros and cons that are substantial. Potential strengths of a diagnosis is accurate and effective treatment. This type of treatment will hopefully provide the client with support to live a healthy and fulfilling life. On the other hand, a concern is that most mental health diagnoses tend to hold a societial assumtion that will define the person. For example, if a child at age 5 is diagnosed with ADHD by a clinician. Then it is highly likely that the child’s environment will continue to view the child as having symptoms of ADHD. Even if the diagnosis is inaccurate. Which this does occur, but isn’t spoken about much.
For example, let’s use the same example of a 5 year old child who is diagnosed with ADHD. The client is presenting in a mental health clinic with his mom due to being suspended from Kindergarten for biting. The child presents hyperactive, restless, jumping all over the office, rambling about various topics, and has difficulty focusing. So quite legitimately the 5 year old is presenting with symptoms of ADHD and diagnosed with it. The clinician then works with the parent and school to treat the clients symptoms and advocate for appropriate accomodations. But. The clinican and mom are not aware, that the same 5 year old is being sexually abused by the grandparent on weekend visits. So although the presentation is ADHD, the diagnosis is actually PTSD. The same child is extremely anxious, hypervigiliant, irritable, has difficulty focusing, and has difficulty remembering. But to most, the child presents with ADHD. So did the 5 year old fit into the ADHD box? Apparently so. Did the clinican do something “wrong?” Likely not. Can the diagnosis change? Absolutely, it should be a working diagnosis. Is that okay? It should be.
We are human, and not made to fit into boxes. But do the boxes help professionals guide with appropriate treatment? Yes. This is very much needed. Are the boxes perfect? No, because not everyone fits into a box, nor should we. And every diagnosis is not going to look the same, even if the label or diagnosis code does. People simply can not be summed up in a few sentences.
But the good news, that’s perfectly okay. Most clinicians accept that normal is just a setting on one’s dryer. And with this acceptance, we are seeing a change with how people are being diagnosed and treated.
Ramblings of a Clinical Therapist Angie S.Minden, LCSW-BACS