Diagnosis difficulties

Dr Aspasia E. Paltoglou writes.

I agree with Kate Johnstone that D for Diagnosis was a fascinating program (‘Culture’, September). I wonder whether we are a little too harsh towards the poor-old DSM monster though, teasing it about how much weight it has put on recently! Still, I agree that DSM is highly flawed, and that it is a product of its time. Lest we forget that homosexuality and female hysterical neurosis were included in the DSM until fairly recently.

Descartes has also a lot to answer for. His mind-body divide has permeated medical research and practice. Ed Bullmore discussed the fascinating idea that inflammation in the body can inflame the brain and lead to depression, suggesting that the blood-brain barrier is not as impermeable as previously thought; an example that the mind-body divide is not always a helpful construct.

Nevertheless, for better or worse, we tend to treat body and mind separately. Mental health professionals are presently the most qualified people to make a mental health diagnosis (although GPs can also diagnose, presumably after having been trained). That said, diagnosing mental health conditions is fraught with difficulties, and even mental health professionals can change their mind and disagree over labels, as Episode 2 demonstrated.

Things can get even more puzzling when other health professionals cross the barrier of their specialization to diagnose mental health disorders. I was about to be discharged from hospital after having hysterectomy/oophorectomy to treat womb pre-cancer, stage 4 endometriosis and adenomyosis. The body was weak but the mind was cheerful and grateful, until it saw the words ‘anxiety disorder unspecified’ in the discharge letter. I was later told that the whole medical team concluded I had an anxiety disorder, without specifying on what grounds. Even later I found out that the label was there because I had reported ‘mild anxiety’ when asked at the pre-operation appointment how anxious I was, which suggests a confusion between the notions of state anxiety and anxiety disorder.

I wonder whether the already fragile mental health labels are undermined even further when used this way. I appreciate that the label was given with the best intentions, but I wonder how helpful it was in the end. Am I splitting hairs? Is this another storm in a teacup? What’s in a label when specialization barriers are suddenly crossed, when a label is given on the hoof and when not asked for?

Nevertheless, I have utmost respect for all health professionals for battling to save our crumbling bodies and minds, while having to cross virtually impermeable time and resource barriers. They are bound to make mistakes; they are only human. Meanwhile, the search continues, and there are some very interesting findings already – listen to Episode 3! We might still have a long way to go, but, as Manchester Pride would say, look how far we’ve come.

Finally, does it really take you just 60 seconds to perform a diagnosis? (See Episode 2.)

Dr Aspasia E. Paltoglou
Lecturer in Psychology
Manchester Metropolitan University

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