Psychiatric diagnosis 'scientifically meaningless'
A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete (either you have it or you don't) mental health disorders.
The main findings of the research were:
- Psychiatric diagnoses all use different decision-making rules
- There is a huge amount of overlap in symptoms between diagnoses
- Almost all diagnoses mask the role of trauma and adverse events
- Diagnoses tell us little about the individual patient and what treatment they need
Lead researcher Dr Kate Allsopp, University of Liverpool, said: "Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences."
Professor John Read, University of East London, said: "Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed."
Source: https://www.sciencedaily.com/r.../07/190708131152.htm
I'd love to hear the perspectives of other clinicians and clinical researchers on these findings!
I am so interested in these findings. As a Family Physician with a strong interest in Psychotherapy, a more holistic approach is inevitable and I have always believed the DSM V to be too restrictive and patients do not feel heard and often prejudiced as the author notes. In Family Medicine we are immersed in "complex causes of human distress" all day and we need to have an approach that acknowledges this better. Very refreshing paper with courage to question our approach.
Thank you for sharing. The article moves our perspective to a level where we can appreciate the causal factors (including trauma) and personal nature of suffering. As a physician, I am so heartened by the potential of articles like this one in changing our culture and catalyzing our evolution. We need to question a model based on "scientifically meaningless" diagnoses and we need to utilize our current state of knowledge, our creativity and our vision in finding ways to prevent (where possible), address and alleviate human distress.
Thank you for posting this.
I really liked what this article had to say and feel that sometimes clinicians rely too much on the diagnoses and totally miss the person being treated. The diagnosis can pose a barrier between the clinician and client.
Many years ago, I learnt about the three clinical values:
Approach the client with an attitude of not knowing (don't read the client's chart beforehand, etc), for only then can you truly bear witness and out of this interaction will emerge the treatment plan. In the Beginner's mind there are infinite possibilities, in the experts, there are few.
Some other perspectives that challenge diagnostic criteria and methods are found in these papers.
“But What About Real Mental Illnesses?” Alternatives to the Disease Model Approach to “Schizophrenia”
https://journals.sagepub.com/d...177/0022167817745621
Understanding Psychosis and Schizophrenia
https://pdfs.semanticscholar.o...e116d7f1631270b9.pdf
Also this statement:
Division of Clinical Psychology Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses: Time for a Paradigm Shift
https://dxrevisionwatch.files....nosis-master-doc.pdf
I am including this particular link to "The Adverse Childhood Experiences (ACE) Study" because of what the page includes (their bold, my highlighting):
" What is epigenetics and how does it relate to ACEs?
Epigenetics is the study of how external factors can alter gene expression of one’s DNA. Researchers are learning that environmental factors —such as the exposure to toxic stress — can influence how genes are expressed and cause changes in the body. Studies are now showing that both adverse experiences and resilience can affect gene expression.vi vii Even more profound is that epigenetic changes can be passed from one generation to another.viii ix x
The gift of resilience
The good news is that people can be extremely resilient in the face of adversity when provided with protective relationships, skills and experiences. Research has shown that resilience – which can be learned - can mitigate the impact of ACEs and produce better health and educational outcomes.xi xii At the heart of resiliency is the need to cultivate healthy social-emotional development in children and families. This includes both intrapersonal skills – self-regulation, self-reflection, creating and nurturing sense of self and confidence – and interpersonal skills – establishing safe, stable and nurturing relationships.xiii xiv xv xvi "
It appears like a setup for yet another reductionist model that ignores the social conditions that give rise to the stress that produce ACE in the first place. The status quo usurps meaningful change, yet again
Excellent! Individuals need individual attention, and we too easily lose site of each person's uniqueness when we categorize and group that person. A distancing from the individual is likely because we often feel safer in focusing on a categorized problem than a person.
Recognizing the value of each human being, caring for that individual, listening to them so we know them as individuals, and asking them the right questions to help us see each person more clearly also helps them to see themselves more clearly. This extends to possible approaches they may not have considered.
At the same time, the individual needs to be ready for those alternative approaches, and this comes right back to where they are in their own unique outlook and perspective. This includes their willingness and readiness to make needed changes so right decisions are made by them as individuals. Great wisdom is needed in all this, requiring solid understanding of what really is right and wrong - not an easy process in our post-modern society with its convenient categorization tendencies using relativity to hide real people from us.
I'd like to add two perspectives to this discussion. Firstly, as a patient, I am tremendously grateful when people actually read my chart. I have had several chronic diseases for 25+ years, and I don't remember all the details of hospitalizations, investigations, medications, etc. That's what a chart is for.
Secondly, I have seen the problems caused by the notion that there is no standard and we are all different. This can often be a barrier to service for people who really do have needs. In this instance I am thinking of my son in the education system. For many years before my son was diagnosed with not one but two "disorders", the assistance he got from year to year was entirely dependent on the individual teacher's training, interest and general awareness. Some teachers said he was just fine. Others were concerned and offered more individualized supports. Turns out that he missed the age window for the most effective interventions for both diagnoses because of this variation. He has not been well served by the lack of a standardized approach.
Every year I beg teachers to read the psychiatric testing and reports from Occupational Therapists, SLPs and others. Often all of the gains my son has made with these professionals are ignored in favour of the teacher's own professional judgement. You win some, you lose more.
As a patient myself, I was not effectively treated for the last 20 years for my mental health issues because my family doctor didn't seem to believe I was really having a problem. The last 6 months of outpatient treatments I have received would have drastically improved the quality of my life and family relationships if they had started 20 years earlier. My actual diagnosis was the key to accessing these services and getting the supports I need from my employer.
I believe there is great value to be gained by learning from the past and having actual standards for diagnoses, even if they are flawed. I welcome the values of "bearing witness" and "loving action/treatment", but I cannot agree with "not knowing". It places too much burden on the patient who may not be well equipped to recall every relevant piece of information (I place my son and I both in that category).
Let's aim for incremental quality improvement in the standards, rather than saying they don't help.
Thank you for providing thought provoking articles. Fascinating results of epigenetic studies - provides very hopeful perspective if we acknowledge the impact of ACE's and provide support to the individual and their families.
Is there a link to their study? This is ridiculously over simplistic and seems to be driven by resentment. There’s absolutely no doubt that psychiatry has its issues especially in relation to pharma and the disease model. the DSM can also be problematic, but the article here lacks a genuine stance and again seems motivated by bias and a desire to condemn rather than trying to create a better and more productive way to help people.
Here is the link to the study: https://www.sciencedirect.com/...ii/S0165178119309114
It is behind a paywall, but the highlights and abstract are viewable.
Yes I read the article thanks! I can probably access it through my school.
Thanks!
I think there is value in having a diagnosis, sometimes for guiding a treatment decision (although may not be ultimately what is followed) and sometimes for reasons related to workplace accommodations, supportive benefits through different programs etc. That said, almost all clinicians I know take a holistic approach when working with clients and consider several factors in their work. It feels wrong to say one or the other is right.
This isn't new information from my understanding. I prefer the breadth of the below lit review showing they both help and hurt.
https://www.thelancet.com/jour...30095-6/supplemental
We work so hard to find a magic bullet for the complexity of human existence. This info has been alive in service user knowledge and research for quite some time. The challenge I see is, at least in the GTA, the majority of support and services require a diagnosis for access, and even then it's really challenging. Taking a diagnosis as a starting point can go a really long way. Taking it as an identity is a concern in my view, and that is what happens. The labels end up overshadowing the depth of a person's life and experience. For everything we have now, we still don't have one solid answer. There will be more and more discoveries in the years to come and it seems the DSM is designed to hold a little too strongly to it's roots, continually painting the walls of a house with a faulty foundation in the hopes it will make it livable, so to speak. Everything has it's place and limited value, but once it becomes "gospel", we're facing issues.