An important Lancet Psychiatry paper has just come out. It is the largest review looking at service user, carer and clinician experiences of mental health diagnosis. For some people, psychiatric diagnosis was helpful, and the problem was that it was not given early enough. For others, a diagnosis was deeply oppressive.
Some diagnoses are more useful than others. Diagnoses such as obsessive-compulsive disorder and depression, for example, are more likely to be experienced positively, validating suffering and giving people a platform from which to speak about distress and access help. Yes, there is stigma, but not the rampant sticky, staining discrimination one gets with diagnoses associated with serious mental illness. With the latter, diagnosis can produce what the philosopher Miranda Fricker has called “testimonial injustice” – an inbuilt prejudice that gives less credibility to the diagnosis.
Even within diagnostic categories, some people find diagnosis more useful than others. As the Lancet paper makes clear, the context in which a diagnosis is given is crucial. If a diagnosis is offered carefully, with time for discussion, clear information and hope, it is more likely to be experienced positively.
It is difficult to make definitive statements about the scientific worth of diagnostic categories. Classifications often bleed into one another and lack the laboratory-type objective tests one generally finds in other branches of medicine. Elsewhere, the difficulties lie with the point at which we start to view experiences that lie on a spectrum as problematic.
nstead, we need to create space for new ways of speaking about distress that foreground the effects of trauma and the socio-political context on the psyche and body, and that recognises that difference becomes disability at the point that society tries to squeeze people into one-size-fits-all boxes. We must place the power to dictate the thrust of speech firmly with the person of most importance – the person in need. This can only occur if we hold a more tentative relationship to the diagnostic system, binning ways of diagnosing that slur the speaking credibility of certain patient populations, and ensuring access to resources such as benefits are dependent on severity of illness rather than acceptance of diagnosis.
From The Guardian.