The Dangers of Diagnosing
Almost fifty years ago, several disturbing flaws were identified with the process of diagnosing mental illnesses. What’s most alarming is that these flaws are still relevant today. It makes one question — do the benefits of diagnosing someone with a mental illness outweigh the risks of labelling them for life?
In the 1970s, a psychologist had himself and seven other mentally fit people admitted to psychiatric hospitals with one made-up symptom that disappeared upon admittance. David Rosenhan wanted to study the validity of psychiatric diagnosis and ended up being confined to a mental hospital for two months. He and some mentally healthy associates made appointments at unsuspecting psychiatric hospitals and presented with auditory hallucinations (this was the fake symptom). They were diagnosed with schizophrenia (although one person was instead diagnosed with manic-depressive psychosis despite having the same symptoms). These people were held in psychiatric wards for, on average, almost a month. They were only released after being forced to admit they were mentally ill and agreeing to take anti-psychotic medication.
These people all presented with the exact same symptom, and yet they were given two different diagnoses. Diagnosing patients is often quite arbitrary and depending on what you’re looking for, many illnesses can fit similar symptoms according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is less like a diagnostic tool and more like a bible, often open to interpretation where a multitude of answers can be applied to the same question. This largely affects the validity and reliability of diagnosing mental illnesses, even for psychologists trained in interpreting symptoms and applying them to the rubric.
On top of the questionable diagnosis, the “patients” in the experiment were labelled “in remission” and their diagnosis marked on their record permanently. Had they not used fake names, their supposed mental illness would have followed them for life. This is super relevant, especially when taking into account the fact that psychologists get diagnoses wrong. Oftentimes, a new doctor will simply look over a previous doctor’s records and assume a patient’s diagnosis is correct. Even if administering new tests, the diagnostician will be biased by previous diagnoses. Medical records are confidential, but many doctors require a patient’s records be transferred to their office. This inadvertently assures a patient’s label will follow them wherever they go.
In a world where mental illness is still largely stigmatized and labels can have ill effects on both wellbeing and treatment, we must be extra careful with the labels we are applying to fellow humans. With such variability in diagnosing patients using the DSM, it becomes important to ask — are these diagnostic tools ultimately helping or hurting us?
