Do Diagnostic Labels Change Lives?

[David Baxter PhD]

Diagnostic Labels That Change Lives
by Dinah, Shrink Rap
Monday, April 11, 2011

From time to time, our readers comment that they are distressed with a diagnosis a psychiatrist has given. They've met with a doctor, talked for a while (half an hour, an hour, maybe two hours) and based on whatever information the psychiatrist has, a diagnosis is made. Maybe it's right, maybe it's not, and maybe the diagnosis will change over time. Some readers have commented that they object to the idea that psychiatrists must assign a diagnosis to be paid, when in fact there is no diagnosis, and they think that's wrong. The psychiatrist should work for free? Since I don't accept insurance, I'm not obligated to make a diagnosis, but if I don't put one on the statement, the patients won't get reimbursed. Some tell me that they aren't submitting psychiatric claims to an insurance company, others don't have insurance, and many do submit claims. I'm left to wonder why someone with no psychiatric diagnosis would consult a psychiatrist to begin with, especially since some diagnoses (Adjustment Disorder, for example, or Anxiety Not Otherwise Specified) are not particularly stigmatizing.

I understand that people are miserable with mental illnesses-- the symptoms are debilitating and miserable. I also understand that people are angry about being told they have an illness that they don't agree they have-- it's a bit like being judged, or like feeling unheard, or even dismissed. Some docs may not spend the time necessary to make the right diagnosis, sometimes the diagnosis evades us, and sometimes patients don't agree with us as to what we deem 'pathology' or symptoms, versus normal reactions or behaviors.

What has perplexed me, however, is the claim that the label itself is what causes the problem. I've been practicing for a long time, and I'm not aware that anyone has ever had a problem because of a diagnostic label I've stuck on an insurance form. I think that most people who worry that their diagnosis will cause others to judge them negatively, simply don't tell people that a doctor says they have disease X. And many will say that's unfair, that people should be able to openly announce their psychiatric illnesses without worrying about the reaction or judgments of others, the way they do their medical illnesses, but personally, I'm not much for announcing health issues in open ways unless it's necessary. Enlarged prostates, diarrhea, vaginal discharges, coughing up phlegm, the details of where one is injecting one's insulin, are simply not everyone's cup of tea at the dinner table.

Sometimes people behave in distressed or dysfunctional ways and the fact that they have a psychiatric disorder is obvious. This is not because of the title of the label, it's because of the symptoms of the illness and the person's behavior. The psychiatrist's diagnosis gave it a name, but the problem belongs to the patient.

Here's my question for you: if a diagnostic label alone has caused your life to change, tell us your story. I don't mean if it's upset you and caused you personal subjective distress, or if you've worried about having your psychiatric history discovered, but if the label itself has caused you outside difficulties or limited your life, tell us how. Email us at mythreeshrinks at gmail dot com.

 

[forgetmenot]

Depends on the label some labels can be very damaging to the pt some labels like borderline personality well that one will get you barred from any help The programs even state on some prochures this diagnosis will not be allowed into the groups Personally i don't think labels should be given i think the symptoms should be treated as such and no label attached I have seen what labels can do the can help but they also can harm greatly

 

[David Baxter PhD]

It's the behaviors associated with borderline personality disorder that lead to the exclusion of those patients from certain programs or from being treated by certain practitioners, not the diagnosis. And this is as it should be: Treating borderlines requires special skills and experience on the part of the therapist, and borderlines do not react well to certain treatment approaches.

The diagnosis doesn't change anything, except prior awareness of the problems the individual presents to therapy. Suppose an undiagnosed borderline begins a program that isn't appropriate or begins therapy with a practitioner lacking the skills and experience to treat her. Don't you think the mismatch will soon be discovered and identified anyway?

The diagnosis certainly doesn't change the person: She is the same person with the same problems, issues, and symptoms before and after diagnosis.

 

[Dragonfly]

The diagnosis certainly doesn't change the person: She is the same person with the same problems, issues, and symptoms before and after diagnosis.

Indeed. In all branches of allopathic (western) medicine, we walk into the practitioner's office with complaints, symptoms and worries. And we walk out with a diagnosis / illness. But it seems like putting a label on beahvioural issues / symptoms can sometimes lead to additional problems - because, in general, it seems like we can only approximate the specificity of a diagnosis. That is, we can diagnose a fractured bone (usually) by the history, physical exam and objective test (xray). Likewise pneumonia - except lab tests are included as part of the objective tests. But not so with a mental illness - and even less so when the diagnosis pertains to a personality structure that is, by definition, relatively static.

In the US, historically, many, many people have been hurt by receiving a formal diagnosis from the DSM. I am thinking of the group of people (? thousands) who were then denied health or disability insurance under the "pre-existing illness" clauses that many of the insurance companies had. Fortunately, one of the benefits of the recent health insurance reformation is that this is now illegal. Except, disability insurance is considered supplemental and voluntary - so many people are still refused based on previous diagnosis of, say, mood disorders. Or the people that are assigned a significantly higher premium on term or life insurance, simply because they have been given a diagnosis from the DSM. Given this, it surprises me that shrinkwraps is a asking for examples of where someone has been hurt or caused difficulties because of a diagnosis .... I must be missing something. This continues to happen all the time .....

 

[David Baxter PhD]

I am thinking of the group of people (? thousands) who were then denied health or disability insurance under the "pre-existing illness" clauses that many of the insurance companies had. Fortunately, one of the benefits of the recent health insurance reformation is that this is now illegal. Except, disability insurance is considered supplemental and voluntary - so many people are still refused based on previous diagnosis of, say, mood disorders. Or the people that are assigned a significantly higher premium on term or life insurance, simply because they have been given a diagnosis from the DSM.

I had not considerd this. But of course that is not a problem with diagnosis per se but rather with (a) stigma and discrimination associated with mental illness and mental health issues, which is undeniable; and (b) acts by insurance companies that should not only be illegal but should be rigorously prosecuted. I am certainly no fan of insurance companies, who seem perfectly happy to take billions of dollars evbery year in premiums and that search vigorously for any semi-plausible reason to deny claims when they are presented.

 

[Dragonfly]

.... I must be missing something. This continues to happen all the time .....

OK. To clarify - I must be missing something that shrinkwraps is looking for. Because from my perspective, discrimination based on DSM diagnosis continues to happen all the time.

However, the fact that I believe that I must be missing something also continues to happen all the time .... :lol:

 

[Dragonfly]

I had not considerd this. But of course that is not a problem with diagnosis per se but rather with (a) stigma and discrimination associated with mental illness and mental health issues, which is undeniable; and (b) acts by insurance companies that should not only be illegal but should be rigorously prosecuted. I am certainly no fan of insurance companies, who seem perfectly happy to take billions of dollars evbery year in premiums and that search vigorously for any semi-plausible reason to deny claims when they are presented.

ummmmm ..... in a technical sense, I agree. A diagnosis is nothing more or less than a label. A shorthand to understanding a complex construct. Indeed it is what people make of the label - what it historically has implied - the stereotypes that are attached, that cause the problems. However, clearly we have (historically) chosen labels that are potentially inflammatory. I am thinking of labels like: "Histrionic Personality Disorder" or "Passive Aggressive Personality Disorder", or "sexual orientation disturbance" (when we pathologized homosexuality). Pretty hard to believe that these were merely labels .... objective descriptions.

Re: medical insurance companies. Yes. Your point is well made. I guess I see it as an inherent conflict of interest to have medical insurance provided by for-profit companies.

 

[forgetmenot]

The label changes and suddenly more doors are open to this same person that was not before. The perception of that person automatically changes there is not prejudice against them personality disorders are shunned not only by lay people but by medical people The person is the same person no matter what label they give them yet as you said they are treated so differently because of that label. After the borderline diagnoisis was dropped suddenly there was hope there was treatment there was an acceptance that was not there before
the diagnostic label changes one life because from that point the label was applied it seems tey were not a person but an illness not so with other medical illnesses

 

[David Baxter PhD]

The label changes and suddenly more doors are open to this same person that was not before.

Isn't that a good thing? Indeed, there are certain programs which require certain diagnoses as a condition of entrance. Even government disability is facilitated where there is a specific diagnosis such as schizophrenia.

 

[David Baxter PhD]

However, clearly we have (historically) chosen labels that are potentially inflammatory. I am thinking of labels like: "Histrionic Personality Disorder" or "Passive Aggressive Personality Disorder", or "sexual orientation disturbance" (when we pathologized homosexuality). Pretty hard to believe that these were merely labels .... objective descriptions.

I won't argue strongly against this point. It's similar to the description "atypical antipsychotics" given to medications which are often prescribed "off label" for non-psychotic illnesses - the label is quite alarming for someone who recieves a prescription for one of these medications to assist with anxiety, insomnia, or depression.

 

[forgetmenot]

Yes if one can get a label that the doors will open too it is a good thing. i don't understand the label just is a name it is the person that matters i for one will never allow myself to be label never just me though i don't need to have a label to get treatment you treat me as me not as a label i am not making sense im sorry

 

[David Baxter PhD]

It's not a matter of not making sense but I think you are talking about stigma issues linked to a diagnosis, and I don't think that's what the author of the article has in mind.

I agree with one of your points: I don't treat a diagnosis in my practice - I treat the person, the client. But a priori knowledge of a diagnosis helps to save both me and the client time and effort when it's not something I consider to be within my areas of expertise.

 

[Andy]

Can this question even really be answered? With the stigma of mental illness still alive and well how is it possible to know if it's the diagnosis or the people around the person with the diagnosis that are making things difficult or limited?

I think that most people who worry that their diagnosis will cause others to judge them negatively, simply don't tell people that a doctor says they have disease X. And many will say that's unfair, that people should be able to openly announce their psychiatric illnesses without worrying about the reaction or judgments of others, the way they do their medical illnesses, but personally, I'm not much for announcing health issues in open ways unless it's necessary. Enlarged prostates, diarrhea, vaginal discharges, coughing up phlegm, the details of where one is injecting one's insulin, are simply not everyone's cup of tea at the dinner table.

This IS unfair. Personally I would be fine with keeping my mental health to myself but it doesn't work that way. Coughing up phlegm isn't a reason for not being able to work, which in turn has people ask why your not working...there are tonnes of other questions that come along with having to hide a mental illness. I suppose I could just keep saying I am not working because I don't feel like it, or I never leave the house because I just hate all kinds of weather or maybe I could say I don't like being around people because I cough up to much phlegm.
When your sitting at a dinner table your not required to talk about the nasty things coming out of your body. Most people do talk about their day however. Some people do not have the "typical day", so being able to say I am diagnosed with this or that so I'm not working right now (for example) makes it easier so one doesn't have to explain themselves for not having the "typical day" that a lot of people do have.

Hopefully that made sense. I kind of found that paragraph ignorant. Comparing mental illness with those not so appealing health topics. I noticed cancer wasn't used. You would talk about that at a table if you chose to, diabetes was mentioned (the harsh reality of it that is, the gross injection) I think people would talk about that at a table if they chose to.Why? Because they aren't disgusting. lol Ass issues maybe some people would do that but it's hardly the same thing.
The label should be said. Keeping it a secret is just contributing to the stigma of mental illness. Should I be ashamed? I know I have the right to choose or not choose who I tell but his examples were completely ignorant.

 

[forgetmenot]

I know with getting a job sometimes a mental illness label will prevent one from getting that position again stigma but that label changes a lot

 

[Futurepower3000]

Yes, but only if you believe in them?