It’s so frustrating when one of your doctors says you have Schizoaffective Disorder (or Social Anxiety Disorder), while another says it’s Bipolar Disorder (or Generalized Anxiety Disorder). And then you switch providers and they think it’s Schizophrenia (or OCD). What’s the freakin’ deal? They have an incredible amount of education and experience. Why can’t they get it right? Here’s why.
In medicine, diagnosis tells us what in nature is causing a person’s symptoms. So when a person is diagnosed with tuberculosis, that means a specific bacterium (mycobacterium tuberculosis) has infected you. Proper diagnosis then tells us what treatment will fix the problem. For tuberculosis, we know what specific antibiotic to prescribe to get rid of that particular bacteria. Diagnosis à Treatment à Cure.
“Whereas in medicine, the diagnostic labels reflect a specific disease cause and process, the same is not true yet in mental health.”
The assumption is it works the same in mental health. If your doctor only knew the “right” diagnosis, then they could give you the “right” treatment, and your symptoms would go away. Right? The problem is, we know far more about what causes physical health problems than we do about what causes mental health problems. Whereas in medicine, the diagnostic labels reflect a specific disease cause and process, the same is not true yet in mental health. In mental health, a group of people literally sat down and decided what labels to put with which symptoms. To make an analogy, it’d be like saying, “If a person is sneezing, it’s a cold.” But then what if it’s seasonal allergies or the flu? There could be lots of reasons a person might have that symptom, which is why diagnosis in medicine isn’t based on symptoms, it’s based on causes.
At the moment, we’re forced to make mental health diagnoses based on symptoms because we don’t know enough about what’s causing the symptoms. Let’s take a trip down memory lane to the history of medicine for a minute. A few hundred years before Christ, Hippocrates (as in…the Hippocratic Oath) had a theory that most medical problems were due to an imbalance between blood, yellow bile, black bile, and phlegm (I’m simplifying here, but that’s the gist). You can imagine what kind of misdiagnosis could come from that! But that’s essentially where we’re at with mental health. When we make a diagnosis of depression, for example, we might as well be saying “What you’ve got, sir, is an excess of yellow bile.” Uh…. ?
Because so many mental health conditions have the same symptoms (just like a cold, the flu, and seasonal allergies have many of the same symptoms), it can be extraordinarily difficult to make the proper diagnosis. The problem is not just that different diagnoses have similar symptoms but also that two people with the same diagnosis can have very different symptoms! It’s maddening.
So it’s true that diagnosis is frequently incorrect in mental health (like it was for Hippocrates back in the day). However, whereas medicine uses diagnosis to prescribe the correct treatment, the good news is that in mental health that’s not the case. There are a couple of important exceptions, but in most cases, we don’t need to know if you have Schizoaffective Disorder or Bipolar Disorder or Schizophrenia to get the best treatment we currently have available…we just need to know what symptoms or problems you’re dealing with. The diagnoses are similar enough that we would use essentially the same treatments. In mental health treatment, we’re focused on goals rather than diagnoses. So if your goal is to reduce anxiety or increase socialization or enhance rational thinking, we can prescribe treatments based on those goals.
It is everyone’s hope that one day we will have the advanced sophistication we have currently in understanding physical health pathogens and disease processes, but for now, as long as your providers understand your treatment goals and recognize the barriers to achieving those goals, they should be able to deliver you the best available treatment for reaching those goals. Focus on goals, not diagnosis, to master your mental health.
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Hayden C. Finch, PhD, is a practicing psychologist in Des Moines, Iowa, focused on helping you master your mental health.
