Psychiatry’s State Of Mind

Joseph Pierre tackles claims of over-diagnosis in his profession:

The diagnostic creep of psychiatry becomes more understandable by conceptualising mental illness, like most things in nature, on a continuum. Many forms of psychiatric disorder, such as schizophrenia or severe dementia, are so severe – that is to say, divergent from normality – that whether they represent illness is rarely debated. Other syndromes, such as generalised anxiety disorder, might more closely resemble what seems, to some, like normal worry. And patients might even complain of isolated symptoms such as insomnia or lack of energy that arise in the absence of any fully formed disorder. In this way, a continuous view of mental illness extends into areas that might actually be normal, but still detract from optimal, day-to-day function. …

The truth is that while psychiatric diagnosis is helpful in understanding what ails a patient and formulating a treatment plan, psychiatrists don’t waste a lot of time fretting over whether a patient can be neatly categorised in DSM, or even whether or not that patient truly has a mental disorder at all. A patient comes in with a complaint of suffering, and the clinician tries to relieve that suffering independent of such exacting distinctions. If anything, such details become most important for insurance billing, where clinicians might err on the side of making a diagnosis to obtain reimbursement for a patient who might not otherwise be able to receive care.

Vaughan Bell praises Pierre’s piece as a “surprisingly good snapshot” of the field, but he has reservations:

Probably the most important thing it underlines is that most psychiatrists are less obsessed with diagnosis than people who are are obsessed about the fact that psychiatrists make diagnoses. Most psychiatrists typically don’t think that ‘every diagnosis is a disease’ and recognise the fuzziness of the boundaries – as indeed, do most medical professionals. …

I would also say that the piece reflects mainstream psychiatric thinking by what it leaves out: a sufficient discussion of the psychiatric deprivation of liberty and autonomy – and its emotional impact on individuals. Considering that this is the thing most likely to be experienced as traumatic, it is still greatly under-emphasised in internal debates and it remains conspicuous by its absence.