Diagnosis: What's in a Name

Why I take a person-centered, nonpathological approach to therapy.

I am not opposed to obtaining a diagnosis. I know that many people find a diagnosis to be both affirming and validating. And allow me to say up front that as a person who suffers from a chronic pain condition, I fully understand the benefit of having a term to explain my medical experience. If a diagnostic label supports you in your journey to health, then you should get a diagnosis. However, it is my sincere belief that a diagnosis should never be a requirement to access healthcare.

My issue with mental health diagnosis being the gateway to treatment is that 1) it creates additional barriers to treatment and 2) it promotes the medical model of mental health over the behavioral model.

1) In the US at least, it seems we reserve these barriers primarily for mental health care. For many, obtaining a diagnosis can serve as an unnecessary hurdle to life-affirming services. Prior to reimbursing for many forms of mental health care, most insurance companies require a DSM diagnosis. While this might not seem like such a hurdle at first blush, this can often take weeks and months of waitlists, testing, and undue stress, all of which may or may not be covered by insurance, to receive a diagnosis that the individual may or may not have even wanted in the first place.

A diagnosis is merely a snapshot of a set of behaviors presented by an individual at the particular time and place of diagnosis. If a person demonstrates grief for the loss of a loved one over an extended period, they might be seen by a psychiatrist or appropriately qualified MD and be diagnosed with complicated grief. Whether the diagnosis is a good or bad experience that accurately reflects the context of their behavior within their environment would be for the individual themselves to say, but I think anyone could agree that the diagnosis itself should not determine eligibility for mental health services. Additionally, a diagnosis remains in an individual’s medical history in perpetuity. So, if it were a bad experience, a diagnosis the individual disagreed with, for example, it would be difficult to have those records removed and it may follow the individual throughout their life. I believe the individual should determine if they want a label to describe their behavior, and access to healthcare should not be contingent on that decision.

Meanwhile, anyone with the financial resources to afford self-pay services can simply call a therapist, and schedule a session. They don't have to be put on a waitlist for never-ending testing. They don't have to pay additional fees for psychiatrists and MDs. They get to skip all these unnecessary steps if they choose.*

2) The medical model presents numerous issues surrounding diagnosis. The first is that the medical model regards diagnosis as a problem to be "fixed." Many individuals with diagnoses take issue with this approach. For many, the behaviors that warranted their diagnosis and those that make up their beautiful gestalt are one and the same. So to "fix" the diagnosis is to erase an important piece of an individual's identity. The medical model (vs the behavioral model) of mental health can inadvertently encourage clinicians to treat diagnosis as pathology, rather than look at the whole person in front of them. Instead of encouraging collaboration with the clients to determine what is challenging for the client and create workable solutions for their particular circumstances, a medical model of care can assume a great deal of homogeneity and effective treatment outcomes among individuals. A medical model assumes the problem lies within the client. In the medical model, a clinician looks at the client and says and says, "you act this way because of your ATTENTION DEFICIT/HYPERACTIVITY DISORDER, OPPOSITIONAL DEFIANCE DISORDER, AUTISM DISORDER, GENERAL ANXIETY DISORDER," etc. On the other hand, the behavioral model of mental health assumes the problem lies within the environment. In a behavioral model, a clinician looks at a client and says, " based on what we've seen and talked about, it seems like you have a learned history of X and perhaps your specific biological makeup has reinforced these certain behaviors, let's make a plan to find more workable solutions that meet your goals." A behavioral model doesn’t absolve the individual of all responsibility for changing their behavior, but more importantly, it does not regard individuals as biologically “disordered.” A behavioral model would simply regard these types of behaviors as the individual engaging in behavior incongruent with their current environment. Sometimes it is the responsibility of the individual to amend their behavior to fit the environment and sometimes it is the members of the environment who must amend their behavior to fit the individual. Either way, outside of the medical model, change is possible and autonomy can be nurtured.

*Side note, this is why I keep my fees low and offer a sliding scale.