Although mental illness is viewed much more openly today than years ago, most people are still uninformed when it comes to how mental illness is assessed, as well as the different treatment options that exist. When I talk to people about mental illness, I am routinely asked questions about how mental illness disorders are defined, as well as the reliability and validity of the diagnostic process. My findings from these interactions suggest that many people believe the diagnostic process is very precise and specific, and that there are many safe drugs available that quickly cure mental illness. While there appears to be much greater acceptance of mental illness today, there is still a lot of ignorance about mental illness, diagnostic procedures, and treatments.
What is ‘mental illness?’
It’s important to note that what separates healthy, abnormal, and psychopathological is quite subjective, and based upon changing diagnostic criteria, cultural influences, diagnostic bias, the times (at one time not long ago homosexuality was considered a mental illness), and even conspiratorial variables (i.e. pharamaceutical drug companies driven exclusively by fiscal profits). Another important understanding is that a mental illness diagnosis implies you either do or do not “have” the mental illness, meaning we don’t qualify in shades of grey. The consequence of this kind of assessment is that individual sufferers often feel as though they have something they will experience for the rest of their lives — almost as though they are doomed. This way of thinking has dramatic, negative consequences — why even try to improve your mental health if you believe you have a disorder that is incurable?
Perhaps a better way of looking at mental health might be to draw a line left to right to serve as a continuum. On one side you might think of a relatively healthy person, devoid of any mental health limitations. On the other side of the continuum is mental illness at its worst, including people who suffer from disorders like schizophrenia leaving them challenged to fit in successfully with normal society. Between these polar opposites fall in varying shades of grey with respect to mental health status — yes, it’s an inexact science, at best.
Diagnosing mental illness
Without getting into the various iterations of the Diagnostic & Statistical Manual (DSM) used to assess mental illness (currently in the 5th edition), I would prefer to offer a few basic facts relating to the diagnostic process. First, and perhaps most importantly, mental health clinicians do not diagnose mental illness with the same precision in which physicians diagnose physical ailments. There are no blood pressure measurements, no EKG, or MRI used for the typical client complaining of mental duress. Instead, the diagnostic process is built upon a client being asked subjective criteria questions from a trained mental health clinician, who then counts the affirmed responses and assesses whether enough check marks have been compiled to meet the diagnostic criteria for the disorder.
As you can see, there are countless problems with this type of assessment. Rather than being able to objectively count things like white blood cells or blood pressure, there is great risk that the client could be feigning symptoms in order to receive a diagnosis and subsequent drugs (as commonly seen with ADD clients seeking Adderall), as well as the clinician having bias toward what he or she thinks is occurring. Mental health assessment is based entirely upon a subjective evaluation process, and is susceptible to human errors and inconsistencies between professionals sharing notes. More succinctly, it’s not a process to be unconditionally trusted.
The observations provided here with respect to mental health are not designed to diminish confidence in the mental health diagnostic process, but to instead prompt critical thinking and encourage healthy dialogue between clients and mental health practitioners. It’s also important to examine treatment options when a mental illness is diagnosed, as there are many options beyond potentially dangerous drugs.