Category Archives: psychotherapy

Do I need a diagnosis?

Do I need a diagnosis?The latest version of an influential psychiatric diagnostic manual is coming out this year – version 5 of the DSM (Diagnostic and Statistical Manual of Mental Disorders, produced by the American Psychiatric Association).   This event has supercharged a long-standing conflict between those for and against the use of standardised diagnoses for mental health issues.  For a UK-based discussion see this recent article on the BBC website:

http://www.bbc.co.uk/news/health-20986796 

 

Such disagreements among mental health professionals can be very confusing for someone trying to deal with their own issues and wondering where to turn for help.  Here are some pros and cons of getting a diagnosis, written from my personal perspective.

Pros:

  • Access to NHS psychiatric services.  This is important if you believe medication will help you, as part of your route to getting well.  And particularly if you are experiencing ‘out of control’ moments when you may take risks or put yourself /others in danger.
  • Some people feel relieved to have a diagnosis: they stop worrying and start taking action.  This is particularly true for people who prefer to be well-organised and structured.
  • Many sources of support are diagnosis-specific (e.g. voluntary organisations, support groups) so you can find and connect with people who experience similar issues.

Cons:

  • A diagnosis doesn’t always lead to a clear ‘treatment plan’.  When we have a medical diagnosis, e.g. gallstones, it is useful because then we know (or the doctor knows) what treatment is needed.  Mental health issues don’t really fit this medical model.  You can get a diagnosis, but then you still need to choose, from the very many options available, what kind of help to go for.
  • Sometimes a diagnosis can be a sticky label.  Even when someone is feeling well again, a part of them may think the label still applies. It can limit their aspirations and expectations. (Taking this a step further – occasionally people may use a diagnosis as way to get people to look after them, or avoid taking responsibility for themselves.)
  • Diagnosis of mental health issues is not as robust or accurate as most medical diagnoses: you can’t have a blood test for OCD!  It relies very much on the subjective experience and perception of both the patient and the mental health professional.
  • Diagnosis systems such as DSM and ICD do not capture you as a whole  unique person, but as a collection of symptoms and behaviours.  This can rub off on you and the professionals treating you.

The most common route to get a diagnosis is via your GP who may refer you to a psychiatrist.  What if you want to understand your symptoms but don’t want a formal diagnosis?  Psychotherapists with a UKCP-recognised qualification will be familiar with psychiatric diagnosis systems, and understand the range of diagnoses available (this is not a requirement in counselling qualifications).  However most psychotherapists will be very mindful of the potential downsides of psychiatric labelling, and will focus on you as a whole person.

Decades of research have consistently shown that the most important predictor of successful therapy is the quality of the relationship between client and therapist.  Being seen and accepted for who we really are is central to the work of therapy.  A diagnosis can be like a filter between you and the therapist – distorting or limiting what can be explored.  But in some cases it might be like a safety harness as you take your first steps to make sense of yourself.  The one sure thing is that you can talk about it in therapy!

 

Are your mind and body the same thing?

This piece is prompted by Oliver Burkeman’s column in Saturday’s Guardian (28th April 2012) which divides people into ‘dualists’ and  ‘physicalists’.  The underlying philosophical assumption of a ‘dualist’ is that their mind is a separate entity from their body, and ‘physicalists’ believe that:

“everything that happens in the mind must arise from the spongy grey tissues of the brain”.

He reported research findings which indicate that ‘physicalists’ are more likely to take care of their bodies by eating healthily, whereas ‘dualists’ are prone to treat their bodies less respectfully.  Whether we think our body is ourself or just a container for it makes a difference to how we behave.  He goes on to say that if you believe that physicalism is correct, instead of turning to psychotherapy for problems of the mind, physical intervention is the way to go: “FIRST, GO FOR A SWIM”, he recommends.

I am a physicalist – I wonder if there are many people who have studied neuroscience who are not? – and I agree with the swimming part, or walking, cycling….  But I think Oliver Burkeman has missed out an important point.  If the mind and the body are essentially the same thing, connected through the nervous system, then the influencing can go both ways.

Physical activities – exercise, breathing – have an impact on our state of mind.  With almost every client, I enquire about diet and exercise.  But in the opposite direction, our thoughts or mindset can have an impact on our bodily wellbeing.  For example, practising mindfulness can reduce physical symptoms of anxiety such as racing heartrate, sweating, muscle tension.  Years of research under the Positive Psychology banner has demonstrated the link between optimism and general wellbeing.

And making-sense-of, understanding something (a mind-based activity) enables us to make different choices.  Recently I ran some workshops on resilience, which included this information: that the body doesn’t distinguish between the kind of stress it’s under.  Mental stress, being too cold, blood sugar being too ‘spiky’, it’s all the same to our adrenal glands which have to  deal with the stress regardless of the cause.   A week later I received a text from a group I trained, to say they had swapped their sweets and biscuits for nuts and fruit in meetings, and were feeling the benefits.  Knowledge is power to choose how we behave  – one of the ways our mind influences our body.

As usual (although it doesn’t make for pithy newspaper articles) the answer is not ‘either/or’ but both.