4 ms·

Why is more diagnosis better diagnosis? I hear this constantly, literally every time people point out we might be calling people mentally ill now that we would

Why is more diagnosis better diagnosis? I hear this constantly, literally every time people point out we might be calling people mentally ill now that we wouldn't have called mentally ill 20 years ago people go "wow we must be diagnosing people better". To me better diagnosis would be reflected in things like the suicide rate dropping, drug abuse falling, general health metrics improving, and so on, not in simply increasing the amount of people we give labels and medicalise. I am so incredibly unconvinced that labelling a bunch of people as mentally ill is "better" because the more we're diagnosed people as mentally ill, the more things like suicide have increased. Now obviously that can be due to an underlying increase in mental illness driving suicide, the thing is the diagnosis itself and the resulting differential treatment of society and your self-perception of yourself can be the cause of that mental illness. Making the diagnosis a self-fulfilling prophecy. So far the increase in diagnosis over time has completely failed to actually improve peoples mental health. I am constantly perplexed at why nobody is worried about this. It seems how we diagnose people is totally unconnected from any empirical data on if a culture more willing to diagnose people is making people healthier on a population-wide level. To me it seems like most evidence points to the population-wide trend getting worse and the increase in diagnosis being a failure making people sicker, and I can't help but also notice many of those who advocate that the increase in diagnosis is a great thing have a conflict of interest and financially benefit from more people being labelled ill.

mrj 4y ago
True, of course labeling is only the first step before treatment. Maybe the root cause of the rise is then we are telling kids they're depressed and we have relatively ineffective treatments for it. Labelling wouldn't be a problem if we could actually help everybody with the diagnosis, but they're too often stuck with a "ehh. maybe this pill" approach.
LarryMullins 4y ago
> It seems how we diagnose people is totally unconnected from any empirical data on if a culture more willing to diagnose people is making people healthier on a population-wide level. Speaking of an absence of empirical data: People are being told by doctors that their brain has a "chemical imbalance" which medication can fix, despite those doctors not performing any chemical tests on the patient's brain at all. Supposed "chemical imbalances" for which the science of chemistry can produce no empirical data. My brother lost years of his life in a drug-induced haze before he questioned the wisdom of doctors, got off the psyche drugs, and saw a massive improvement in his outlook on life all around. Turns out he had real problems to address and the drugs were only helping him to ignore those problems instead of actually confronting them. He never needed drugs, he needed a mature mentor.
- faeriechangling 4y ago
  Generally I think mental illness will remain in the dark ages so long as there is a divide between neurologists and psychiatrists, and so long as the ICD and DSM are the gold standard of diagnosis. Mental illness is mostly defined based on others perception of you, and is rarely defined based on any sort of psychological testing. There are a few which can be objectively tested for like Alzheimers but they're in the minority.
ok123456 4y ago
It's not. There are Physician Incentive Plans that incentivize doctors to prescribe SSRIs for anyone complaining about generalized anxiety or depression.
- SV_BubbleTime 4y ago
  I've seen it. I've watched in my lifetime an industry and doctors push SSRI and "mental health medicines" to target children for lifetime use. This is the real crisis, and I don't think we've peaked yet.
solarmist 4y ago
The best description I've heard of why more diagnosis is better is that as a society we're moving up Maslow's Hierarchy of Needs from level 2 "Safety Needs" to level 3 "Love and Belonging". For the first time in history there is psychological space to care about mental health and social issues en mass. So, of course, there's going to be an explosion of diagnosis.
- remarkEon 4y ago
  That doesn’t strike me as a good thing. Maintenance of “safety needs” is part and parcel of finding love and belonging in the first place. If we’re offloading that all together, then yeah I can see how more and more get depressed and suicidal. They don’t have anything to live for when you get down to it.
  - solarmist 4y ago
    That's not what moving up means; they're cumulative from the bottom up. You can't move up to the next level until all lower levels are consistently met. Moving up means those needs are being met satisfactorily and can be maintained without prolonged attention. And if a lower level stops being met, your level will fall to that level until it is met again. I.e., if you're hungry and don't know when your next meal is, then who the hell cares if you're anxious, angry, or happy? You have more pressing concerns.
    - remarkEon 4y ago
      Right, I'm aware of Maslow's work, I just think it's wrong on a number of different dimensions, or at least incomplete.
      - solarmist 4y ago
        Sure, I agree, at best it is a gross simplification. But it’s useful and, in my opinion, captures the most basic relationship which is that some needs have higher priority than others and will drive those other needs to the recesses. What about that do you disagree with?
jabroni_salad 4y ago
Having a diagnosis also gives you a set of tools to actively deal with your issues. Personally I have trouble with avoidant personality disorder, and I really wish I had gotten diagnosed earlier. Maybe school and my early career would not have been such a dumpster fire if I understood how to properly deal with myself back then.
- faeriechangling 4y ago
  So I think there's lots of examples of diagnosis's helping individuals, my specific concern is why it is if all this diagnosis is apparently just helping everybody, why is the general population getting more mentally sick over time? I can think of only two reasons - 1: That the mental health system is actively harmful at the population level. or 2: That the mental health system is impotent to address mental health issues (more keen on this idea honestly, but I can't even rule out 1) The latter case means that the mental health system could be helping, but at the very least, the mental health system is a distraction from the bigger issue of mental health. I believe declines in mental health are driven by things like increasing inequality, scarcity, competitiveness, loneliness, and so on which we can't nessecarily solve by telling people you are disordered with such and such so live in such and such a way and you can maybe be better adapted to a society which has their collective mental health in freefall which I dunno is something but it's pretty depressing. P.S. I specifically resent the label of "disorder" in general and think that label is part of the problem, because no matter how you spin it, somebody saying you are "disordered" is an insult, and as we call more and more of the population disordered I think the adjective will become untenable to keep using. I'm more keen on the concept of neurotypes, because neurotypes CAN be negative, and CAN require accommodation, and CAN require treatment, but none of those things are NECESSARILY true becuase "neurotype" isn't loaded in the same way "disorder" is. If you discover your "neurotype" you can try tools and techniques that helped others with that same neurotype. Whereas the word "disorder" sort of has an intrinsically negative connotation, and I don't think it's medically necessary for psychiatrists to regularly insult their patients. The mental health system is so condescending and some of the shitty things they do don't really get examined or critically looked at that much. Like why don't we ask, is telling millions of people they are "disordered" likely to improve their mental health and confidence and self-esteem? Probably not and it's totally viable to avoid doing this.
P_I_Staker 4y ago
The industry itself could be to blame. It's not fun to have your provider insult your appearance and try to push you to make devastating career choices, while cutting you off from effective treatments. While non-gender conforming people need special protections, it's deeply sad that the industry wasn't able to recognize this itself... they just keep doing it with other people. As always with these issues, no one stopped to think at a high level about labeling people's personality as a disorder that must be fixed. They just said, "we have to stop doing this to trans people"... "we'll make an exception for them"

mrj 4y ago

True, of course labeling is only the first step before treatment. Maybe the root cause of the rise is then we are telling kids they're depressed and we have relatively ineffective treatments for it. Labelling wouldn't be a problem if we could actually help everybody with the diagnosis, but they're too often stuck with a "ehh. maybe this pill" approach.

LarryMullins 4y ago

> It seems how we diagnose people is totally unconnected from any empirical data on if a culture more willing to diagnose people is making people healthier on a population-wide level. Speaking of an absence of empirical data: People are being told by doctors that their brain has a "chemical imbalance" which medication can fix, despite those doctors not performing any chemical tests on the patient's brain at all. Supposed "chemical imbalances" for which the science of chemistry can produce no empirical data. My brother lost years of his life in a drug-induced haze before he questioned the wisdom of doctors, got off the psyche drugs, and saw a massive improvement in his outlook on life all around. Turns out he had real problems to address and the drugs were only helping him to ignore those problems instead of actually confronting them. He never needed drugs, he needed a mature mentor.

faeriechangling 4y ago
Generally I think mental illness will remain in the dark ages so long as there is a divide between neurologists and psychiatrists, and so long as the ICD and DSM are the gold standard of diagnosis. Mental illness is mostly defined based on others perception of you, and is rarely defined based on any sort of psychological testing. There are a few which can be objectively tested for like Alzheimers but they're in the minority.

ok123456 4y ago

It's not. There are Physician Incentive Plans that incentivize doctors to prescribe SSRIs for anyone complaining about generalized anxiety or depression.

SV_BubbleTime 4y ago
I've seen it. I've watched in my lifetime an industry and doctors push SSRI and "mental health medicines" to target children for lifetime use. This is the real crisis, and I don't think we've peaked yet.

solarmist 4y ago

The best description I've heard of why more diagnosis is better is that as a society we're moving up Maslow's Hierarchy of Needs from level 2 "Safety Needs" to level 3 "Love and Belonging". For the first time in history there is psychological space to care about mental health and social issues en mass. So, of course, there's going to be an explosion of diagnosis.

remarkEon 4y ago
That doesn’t strike me as a good thing. Maintenance of “safety needs” is part and parcel of finding love and belonging in the first place. If we’re offloading that all together, then yeah I can see how more and more get depressed and suicidal. They don’t have anything to live for when you get down to it.
- solarmist 4y ago
  That's not what moving up means; they're cumulative from the bottom up. You can't move up to the next level until all lower levels are consistently met. Moving up means those needs are being met satisfactorily and can be maintained without prolonged attention. And if a lower level stops being met, your level will fall to that level until it is met again. I.e., if you're hungry and don't know when your next meal is, then who the hell cares if you're anxious, angry, or happy? You have more pressing concerns.
  - remarkEon 4y ago
    Right, I'm aware of Maslow's work, I just think it's wrong on a number of different dimensions, or at least incomplete.
    - solarmist 4y ago
      Sure, I agree, at best it is a gross simplification. But it’s useful and, in my opinion, captures the most basic relationship which is that some needs have higher priority than others and will drive those other needs to the recesses. What about that do you disagree with?

jabroni_salad 4y ago

Having a diagnosis also gives you a set of tools to actively deal with your issues. Personally I have trouble with avoidant personality disorder, and I really wish I had gotten diagnosed earlier. Maybe school and my early career would not have been such a dumpster fire if I understood how to properly deal with myself back then.

faeriechangling 4y ago
So I think there's lots of examples of diagnosis's helping individuals, my specific concern is why it is if all this diagnosis is apparently just helping everybody, why is the general population getting more mentally sick over time? I can think of only two reasons - 1: That the mental health system is actively harmful at the population level. or 2: That the mental health system is impotent to address mental health issues (more keen on this idea honestly, but I can't even rule out 1) The latter case means that the mental health system could be helping, but at the very least, the mental health system is a distraction from the bigger issue of mental health. I believe declines in mental health are driven by things like increasing inequality, scarcity, competitiveness, loneliness, and so on which we can't nessecarily solve by telling people you are disordered with such and such so live in such and such a way and you can maybe be better adapted to a society which has their collective mental health in freefall which I dunno is something but it's pretty depressing. P.S. I specifically resent the label of "disorder" in general and think that label is part of the problem, because no matter how you spin it, somebody saying you are "disordered" is an insult, and as we call more and more of the population disordered I think the adjective will become untenable to keep using. I'm more keen on the concept of neurotypes, because neurotypes CAN be negative, and CAN require accommodation, and CAN require treatment, but none of those things are NECESSARILY true becuase "neurotype" isn't loaded in the same way "disorder" is. If you discover your "neurotype" you can try tools and techniques that helped others with that same neurotype. Whereas the word "disorder" sort of has an intrinsically negative connotation, and I don't think it's medically necessary for psychiatrists to regularly insult their patients. The mental health system is so condescending and some of the shitty things they do don't really get examined or critically looked at that much. Like why don't we ask, is telling millions of people they are "disordered" likely to improve their mental health and confidence and self-esteem? Probably not and it's totally viable to avoid doing this.

P_I_Staker 4y ago

The industry itself could be to blame. It's not fun to have your provider insult your appearance and try to push you to make devastating career choices, while cutting you off from effective treatments. While non-gender conforming people need special protections, it's deeply sad that the industry wasn't able to recognize this itself... they just keep doing it with other people. As always with these issues, no one stopped to think at a high level about labeling people's personality as a disorder that must be fixed. They just said, "we have to stop doing this to trans people"... "we'll make an exception for them"