Existing mental health diagnosis systems are flawed and can lead to ineffective labelling and treatment.
Al didn’t begin talking until he was three years old, and went on to demonstrate limited social skills as an adult. Leo often took years to finish important projects, while others waited on him. Maya dealt with trauma and suffered with anxious thoughts.
Today these individuals may have been diagnosed with a multitude of mental disorders. They may have even been considered too disabled to work or thrive in life. Despite their struggles, Albert Einstein, Leonard DaVinci and Maya Angelou all managed to live full lives and leave permanent marks on the world.
This brings up an important question. What makes a particular struggle turn into a mental illness? When does someone’s struggle need “intervention,” and when may it simply be part of a person’s self? Are disorders limited to an individual’s mental world, or are they influenced by physical health, stressors, and external situations?
Today’s mental health industry revolves around the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This bible of mental health guides the entire mental health system—from diagnosis to the selection of psychiatric medications.
The problem is that this system is flawed. It’s not only uncommon, but typical, for people to be given contradictory diagnoses. One professional may diagnose an anxiety disorder, while another may label the problem as a personality issue, or nothing at all.
Even when diagnoses are more consistent, the type of treatment for the same issue can vary just as much. One therapist may advise the person with anxiety to avoid triggering situations, while another encourages her to face fears head on.
Looking at Functioning
While someone may meet the technical diagnosis of a disorder, according to a limited test or assessment, they may, in some instances, still be functioning in the world just fine. For example, many people who test on the autism spectrum, or who have attention deficit hyperactivity disorder (ADHD) symptoms, may not be interested in treatment.
Often people who are diagnosed with anxiety problems or depression believe they must carry those labels for life. Mental health professionals sometimes encourage this, carrying over a diagnosis from previous providers without considering changes in the patient. Meanwhile, the patient may have felt better for years, but still feel obligated to continue getting treatment.
Often, physical conditions that impact mental health are missed as well. Hormonal disorders, vitamin deficiencies and sedentary lifestyles could all lead to a mood or anxiety disorder diagnosis. Clinicians should technically rule these physical issues out first, but the diagnostic process rarely involves such a full assessment.
Here’s a look at some physical issues that can impact mental health, but aren’t always considered:
- Vitamin D is shown to relate to depression, bipolar depression, and schizophrenia
- Exercise is known to decrease the impact of mental health disorders
- Certain diets are shown to either increase or decrease the likelihood of mental health diagnoses like major depression
- Hormonal changes, such as those that occur with childbirth, menopause, or andropause are connected to some mood issues
- Chronic stress and trauma can lead to increased risk for depression and anxiety, as well as physical health issues throughout life
Environmental and situational factors influence mental health as well. The same person may thrive in some conditions, and have significant struggles in others.
For example, if someone has recently lost a job and is having trouble meeting basic needs, this could lead to depression. This could also affect diet, stress levels, and motivation, which can in turn affect many areas of mental health.
Or, a person who recently lost a loved one may be in a normal grief process. Under current guidelines, they may technically meet criteria for a mood disorder. In fact, many therapists use this type of diagnosis so that insurance will kick in to cover treatment. This further demonstrates the flaws in the overall system.
Many people began to struggle after the beginning of the Covid-19 pandemic. Increased fears about illness and loved ones, along with isolation and the interruption of available social support, added up. Relationship and family tensions increased for many, and daily routines were interrupted.
These individuals may well meet diagnostic criteria for depression or anxiety. However, many people had no major mental health issues before this change in the environment. This demonstrates the importance of looking beyond just symptoms.
Typical screens used by those who diagnose mental health illness don’t account for such issues. While broader assessments may take this into consideration, most of these questionnaires, used for years or decades, do not.
This narrowing down to a key “problem” distracts from an overall perspective of a person’s mental wellbeing. A clinician may be missing important information that would determine what a person needs to feel better. Or, someone who feels fine may be told they need treatment. And in some cases, that could make them feel worse.
That’s why some researchers are advocating for a more comprehensive assessment process. An evaluation that looks at a variety of areas could provide a better idea of the needs of a particular patient or individual.
For example, the Mental Health Quotient (MHQ), assesses these key areas:
- Core Cognition
- Complex Cognition
- Social Self
- Mood and Outlook
- Drive & Motivation
- Mind Body Connection
By opening up the assessment process to cover these key areas of wellbeing, clinicians and individuals can get a better sense of strengths and risk. This can guide an individual to consider changes, such as increasing exercise, sleep or adjusting diet. And, clinicians and managers can use this information to provide new interventions or programs to meet needs.
While the traditional diagnostic method has served a purpose, it is no longer in line with science’s current understanding of mental health. The human mind doesn’t operate in a bubble, independent of the physical self, nor of the environment. A more comprehensive look at people’s daily lives and experiences can provide a better idea of what they need, or what they don’t.