Diagnosis is the thing I am going to complain about today. It’s a contentious topic in psychology that most psychologists have to cover at some point in their degree. There are famous anti-psychiatrists, such as Thomas Szasz and R D Laing. They will tell you that all diagnosis is probably a bad thing. Szasz going as far as to suggest that all behaviour is normal and ADHD doesn’t exist. Laing says that what we call mad is actually a perfectly reasonable response to a mad world. Whatever your take on this, it is worth bearing a few things in mind.

The first thing to consider is that most of the systems of diagnosis used are actually reliant on an archaic system of statistics, many of the formulae used in which, were actually designed for agricultural study and not people. These have been around for just long enough for most of the people  using them to have little or no idea how they were conceived and the ones that do, have been so convinced by their efficacy that they don’t bother to question it. The problem with this is, firstly they are based on research that is usually challenged within minutes of hitting a peer review system and due to epistemological differences there is never any certainty anyway. This then due to its numerical or statistical nature, requires arbitrary lines to be drawn around conditions. So, someone who hits a score of 58 on a depression scale does not get a diagnosis of depression whereas someone who gets a 60 does. They would get the same diagnosis as someone who scored 68 despite being considerably more depressed and closer to the person who does not apparently have this condition at all.

This is pretty much the case for most conditions in the diagnostic statistics manual, which is written by the American Psychiatric Association and used by clinicians in the UK, The USA and several other places. What is not explained to the person who has obviously been suffering enough to go and get checked out the first place, never mind the tribulations you have to go through to actually get to see a psychiatrist in the ridiculously underfunded NATIONAL Health Service, is the detail behind this. There are several scales within each test and they are usually constructed through testable measures but rarely actually just measure one thing. The depression tests will conform to some personality scale and it should really. If it just measured if you were sad, then that is not really depression. The arbitrary lines drawn around the diagnostic description of depression has been developed in studying people who exhibit disabling traits that might roughly be described as depression in common language or have been exhibited by a ‘significant’ number of people with the condition, depression.

Another thing to consider is that the research that results in this, while mostly well intentioned by the professional funding it, is largely funded by a pharmaceutical company. In America many post graduate students of psychopharmacology are actually funded by pharmaceutical companies. They often govern which articles get published and will quash research that does not result in a handy pill that they have already developed, yet strangely fits the exact bill of the studies that make it through peer review. Mental health has become big business and the significant number of studies getting out there on it, have a vested interest largely supported by capitalist greed, though what isn’t right?

A study that was brought to my attention last year which left me in that strange emotional place between crying and laughing, suggested that self administered online cognitive behavioural therapy would be made available within the NHS and it would ‘cut costs’. This is just about the stupidest idea anyone has ever had. It doesn’t work. There is evidence to suggest that it doesn’t work and yet because it is cheaper and is shown to work at about the same rate of recovery as people would evidence if you left the alone in the room for an hour, it is being implemented.

So, what is the point of this little rant? Well, to start a discussion really. I am going to continue ranting about this from various angles over the next few days and see where it takes me but really, I think i just wanted to get writing again and start asking some questions of the system we are compliant with due to lack of information. There are several areas that are worthy of discussion. There are some philosophical ones that are worthy of considering, where basically, most of the research done is from a philosophical perspective which all the coolest folk pretty much ignore. There is some history that would challenge this behaviour as a continuation of the savage institutions we used to have all over the world. So, it should be interesting.

 

 

 

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