The monstrous inflation of diagnosis

'D for Diagnosis' on BBC Radio 4, reviewed by Kate Johnstone.

This short series is aimed at a general audience interested in diagnosis in mental health. In the first episode, presenter and Society member Claudia Hammond explores the history of the classification for diagnoses relating to the mind. It should come as no surprise to psychologists that diagnosis is inseparable from the social context. Many examples are explored, some more overtly political than others. Defining the expression of female desire, or homosexuality, as mental illnesses fits with historical prejudice against women and gay men. Drapetomania and sluggish schizophrenia are more specific to time and place, and easier to dismiss. Yet the point is, without the benefit of hindsight, how do we know we’re not making the same prejudicial judgments today?

In the second programme, Claudia considers both the utility, and accuracy, of a mental health diagnosis. The voices of those who have received a diagnosis (sometimes several different ones) feature strongly in this episode. Diagnosis can bring relief, and the key to treatment: it can also bring judgement, discrimination, isolation. No discussion on this topic would be complete without talking about the DSM, and its monstrous inflation – from around 100 diagnoses in DSM1 to almost 300 in the current DSM5. This is identified as being an artefact of  the power of the pharmaceutical industry in the USA, and the need for all (paid for) treatments to be justified by a diagnosis. It is also argued that historically, the DSM was driven by psychiatrists seeking to bolster their status in relation to other, more scientifically robust specialism: a facet of ‘medical imperialism’. Lucy Johnstone (no relation) articulates an alternative approach, which does not involve giving a diagnosis (‘what’s wrong?’) but rather seeks to understand and help the person with ‘what’s happened’ in their lives.

The third programme looks to the future, and the possibility of more personalised, individualistic treatments - which we know is the direction of travel in medicine generally. Claudia visits the Cognition and Brain Sciences Unit at the University of Cambridge, who are researching a transdiagnostic approach. This focuses on what help the person themselves feels would be of benefit, and effectively disregards their diagnosis. She also talks to Ed Bullmore about ‘inflamed depression’, and to the team at King’s College about work to dissolve diagnostic boundaries between neurodevelopment conditions.    

I would have preferred less time on the history, and more on challenging some of the power structures which can inhibit change. But overall, it is an interesting listen, and a useful reminder to psychologists to reflect on the cultural and social forces which shape mental illness.

- Reviewed by Kate Johnstone, Associate Editor for Culture.

Listen now on the BBC iPlayer.

All of Claudia Hammond's radio and podcast offerings are collected on her new website

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