Thursday, 16 February 2012

Would you like a label? Or should we just stick to the symptoms at hand?

Currently there are 297 disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) this book is the bible of guidance for the diagnosis of mental illnesses for those who work in the fields of psychology and psychiatry, the next DSM (due to be published May 2013) is likely to have a higher number of classifiable disorders.

On the surface categorising and labelling of mental illnesses seems like a logical thing to do, after all there are different sub types of the very general term 'mental illness' and just as like other illnesses are labelled e.g. common cold, flu, ear infection, tonsillitis etc. we know what causes such illnesses,how to treat them and sometimes avoid them.

However mental illness is much more complicated when you start exploring the underlying issues of why an individual suffers from such a illness.

We all experience the world in our own way and there are limitless incidents and experiences, which are unique to each individual, that can contribute to the development of mental illness.

So is there a benefit in having a label for a mental illness? Possibly. For starters the label can help you to understand that you are not weak, stupid, immature or just a miserable git, as a matter of fact you are suffering from an illness and you did not realise it until a medical professional says to you that you have been behaving/thinking/feeling this way because of this particular thing.

Okay, we have a diagnosis of an illness, now that we know what it is, how do we treat it and for how long? When can I get back to work/college? When can I get back to 'normal'?
Having the illness diagnosed may offer some answers to the above and some have said it is a relief to finally know what is wrong, no longer do they have to keep asking themselves 'what the hell is wrong with me', you have a answer.

Some of the disorders (like depression) are very common throughout the world and so it might offer some reassurance that you are not in fact alone with what you have to deal with. Also it helps the medical professionals to categorise your illness to simplify the recommended course of treatment.

There is a flip side. Probably one of the biggest issues of being labelled is being defined by the illness;

Person A: Hey how is C doing these days?
Person B: Oh you didn't hear? C is a schizophrenic.

Whether it is schizophrenia, clinical depression, bi-polar disorder, a personality disorder or whatever disorder someone may have, often the individuality of a person gets stripped away and is replaced by the disorder.

This can lead to the person in question being discriminated by employers (in fact recently a friend of mine lost his job after having time off due to depression), friends, family, partners etc. and once a diagnosis is made it will stick with you for the rest of your life regardless of whether you become ill again or not.

Usually having treatment takes a fair amount of time in which you may not be able to do anything and so if you look to get back into employment you may well have to disclose your illness and subsequent treatment to a potential employer to explain why you have had an unemployment gap of x time.

Being given a label of a disorder could induce a sense of hopelessness especially if the illness is severe, there are times I feel my life will never get better because I have depression and sleep terror disorder both of which cannot be cured and will continue to undermine me. Others may feel as I do, that it will never better and its all about containing the illness as best you can but it won't go away.

The label is for life, the illness is for life...your life.

Not to mention that some disorders share a crossover of symptoms, like schizophrenia and bi-polar disorder which share psychosis, depression (an illness with its own category but is a major feature of bi-polar disorder and often affects those who suffer from schizophrenia) cognitive impairments and so on.

The diagnostic criteria gives a general outline of a disorder, however it does not help with subtle differences and variations between people who might be classed as having a certain disorder.

Therefore confusion and misdiagnosis can happen, even worse it is possible in some instances for some to move from one disorder to another (schizophrenia alone has a number of sub types, paranoid, disorganised, catatonic, undifferentiated, residual), thus incorrect treatment can be given, causing more harm than good.

So what is the alternative?

There is a debate going on about the ethics of labelling within the psychology and psychiatry fields and some call for it to be abandoned altogether, after all the one size fits all approach is fraught with difficulty if you consider that you are dealing with people who all have unique experiences and reasons for their illness.

For me when I sought help for my issues I was never diagnosed with a particular disorder, instead my symptoms were the focus for treatment. It is clear I get depressed, anxious and angry a lot of the time, so I was referred to a group psychotherapy sessions and here they explored my past and how that past affects the way I think and behave now.

So here the reasons for my depression, anxiety and anger were looked at, basically they noticed that whenever people tried getting close to me emotionally in the group I become hostile and pushed them away by getting angry, making them afraid to approach and challenge me.

The reason for that is I had been badly treated in the past, enough so that I became depressed as my self-esteem, self-worth was low and often attempts at increasing it was rejected by others and so I pushed people away before they had the chance to reject me.

Once it had been established how I think, feel and behave and why I do so, the therapists seek to address what they believe is unhelpful way of thinking and behaving on my part that can actually be part of a vicious cycle with my depression, for instance when I pushed people away to stop them having the chance to reject me in some way I was also pushing away the chance of something good, like making a friend.
In my case it was easier to focus on what symptoms I displayed and the underlying reasons for their existence and what I could do to help alleviate what issues I faced.

By addressing the symptoms themselves it will help in avoiding to a certain extent at least the stigma that may follow from being labelled with a disorder, some people won't get help due to the fear of stigma and discrimination associated with mental illness.

Also dealing with the symptoms alone means the individual's circumstances are more likely to be taken into consideration as it will not be as necessary to look up the DSM as often for the guidance of a diagnostic criteria.

I hope one day the labelling will be scaled back enough that it is nothing more than a very broad term which does not stick with a person for life.

Thursday 16th February, the journey continues. 

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